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Administrative Services Only Agreement between CMB & Cigna Health & Life Insurance Company " CHLIC" 2023-, 32 (029 23-2/59-a/ 9 Administrative Services Only Agreement By and Between City of Miami Beach "Employer" And Cigna Health and Life Insurance Company "CHLIC" Effective Date: October 1, 2023 EXCEPT AS PROVIDED BY APPLICABLE LAW, "I'I IIS AGREEMENT AND ITS TERMS ARE PROPRIETARY AND CANNOT'13E DISCLOSED WI 'I IOUI"I IIL PERMISSION ON EACI I OF'T'ITE PARTIES Table of Contents Definitions 3 Section 1. Tenn and Termination of Agreement 4 Section 2.Clrim Adm inistmatbn and Additional Sery ices 5 Section 3.Fundingand Payment of Chins 6 Section 4.Charges 7 Section 5.Enrolhnent and Detemm inat ion of Eligibility 7 Section 6.Audit Rights. 8 Section 7.Plan Benefit Liability;Indemnification 10 Section 8.Modification of Plan and Charges I 1 Section 9.Modification of Agreement I 1 Section 10.Choice of law 1 I Section 11.Infoimation in CHLIC Processing Systems 11 Section 12.Resolution of Disputes. 12 Section 13.Third Patty Beneficiaries. 12 Section 14.No Waivers • 12 Section 15.Headings 12 Section 16.Soverability 13 Section 17.Force Majeure 13 Section 18.Assignment and Subcontracting, I3 Section 19.Notices 13 Section 20.Identifying In format ion,Internet Usage and Trademark 13 Section 21. Confidentiality 14 Section 22.Independent Contractors 14 Section 23.Reservation of Intellectual Property Rights 14 Section 24 CHLIC's Compliance with Florida Public Records Law I5 Section 25 Inspector GeneralAudit Rights... -16 Section 26 E-verify ...18 Section 27.Insurance Requirements 19 Section 28.Entire Agreement 20 Section 29.Request for Proposal .20 SIGNATURES. 21 Schedule of Financia I Charges. 22 Exhibit A-Plan Booklet 52 Exhibit B_.Services 53 Exhibit C-Audit Agreement(Sample) 61 Exh ib it C l-Clinical Audit Agreement(Sample) 64 Exhibit D-Privacy Addendum 69 Exhibit E-Cond itiona l Cb in/Su brogation Recovery Sery ices 75 Appendbt A-Pharmacy Benefit Management Services 77 Appendix B-Cigna Home Eelivery Pharmacy Specialty Drug List 96 Appendix C-SaveOnSP Program 98 Administrative Services Only Agreement for City of Miami Beach THIS AGREEMENT, effective October 1, 2023 (the "Effective Date") is by and between City of Miami Beach("Employer")and Cigna Health and Life Insurance Company("CHLIC"). RECITALS: WHEREAS, Employer, as Plan sponsor, has adopted the benefit described in Exhibit A, as may be amended, ("Plan") for certain of its employees/members and their eligible dependents(collectively " Members");and WHEREAS,Employer has requested that CHLIC provide certain administration services in connection with the Plan (for its own internal purposes, CHLIC identifies Employer's account by the following number(s)3340006). NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, it is hereby agreed as follows: Definitions Agreement means this entire document including the Schedule of Financial Charges and all Exhibits and Addenda, as attached hereto,as well as any subsequent amendments. Applicable Law means the state,federal and/or international law and/or regulation that apply to a Party or the Plan. Bank Account means a benefit plan account with a bank designated by CHLIC; established and maintained by Employer in its or a nominee's name. ERISA means the Employee Retirement Income Security Act of 1974, as amended and related regulations. CHLIC acknowledges that Employer's Plan may not be subject to ERISA. Extra-Contractual Benefits means payments which Employer has instructed CHLIC to make for health care services and/or products that CHLIC has determined arc not covered under the Plan. Member means a person eligible for and enrolled in the Plan as an employee or dependent. Participant/Participating Members means Member(s)who is(are)participating in a specific program and/or product available to Members under the Plan. Participating Providers means providers of health care services and/or products, who/which contract directly or indirectly with CHUG to provide services and/or products to Members. Party/Parties means Employer and CHLIC,each a"Party"and collectively,the"Parties". Plan Benefits means amounts payable under the terms of the Plan for expenses incurred by Members for services/items covered under the Plan. Plan Year means the twelve(12) month period, beginning on the Effective Date and,thereafter, each subsequent twelve(12)month period. O6/28/2023 3 Administrative Services Only Agreement for City of Miami Beach Run-Out Claims means claims for Plan Benefits relating to health care services and products that are incurred but not processed prior to termination of this Agreement;termination of a Plan benefit option or termination of Member eligibility, as applicable. Subscriber means the Member whose employment or participation is the basis for eligibility under the Plan. Section 1. Term and Termination of Agreement This Agreement is effective on the Effective Date and shall remain in effect until the earliest of any of the following dates: i. The date which is at least one hundred and twenty(120)days from the date that either Employer or CHLIC provides written notice to the other of termination of this Agreement; ii. The effective date of any Applicable Law or governmental action which prohibits performance of the activities required by this Agreement; iii. The date upon which Employer fails to fund the Bank Account as required by this Agreement provided CHLIC notifies Employer in writing of its election to terminate and Employer does not fund the Bank Account as soon as possible but no longer than within thirty(30)days of receipt of such written notice; iv. The date upon which Employer fails to pay CHLIC any charges identified in this Agreement when due,provided CHLIC notifies Employer in writing of its election to terminate and Employer does not make such payments as soon as possible but no longer than within thirty(30)days of receipt of such notice;or v. Any other date mutually agreed upon by Employer and CHLIC. vi. Notwithstanding the foregoing, all provisions in this Agreement reasonably related to CHLIC's administration of the Plan's Pharmacy Benefit (as such term is defined in Appendix A) (the "Pharmacy Benefit Provisions"), shall continue in effect for no less than thirty six (36) months commencing on the Effective Date,except that, if any of the following dates occurs,the Pharmacy Benefit Provisions set forth in the Schedule of Financial Charges and Appendix A will cease being in effect as of such date: a. The effective date of any Applicable Law or governmental action which prohibits performance of the activities in connection with the Pharmacy Benefit required by this Agreement; b. The date upon which Employer fails to fund the Bank Account as required by this Agreement for claims under the Pharmacy Benefit provided CHLIC notifies Employer in writing of its election to terminate the Pharmacy Benefit Provisions and Employer does not fund the Bank Account as soon as possible but no longer than within thirty(30)days of receipt of such written notice; c. The date upon which Employer fails to pay CHLIC any charges in connection with the Pharmacy Benefit identified in this Agreement when due,provided CHLIC notifies Employer in writing of its election to terminate the Pharmacy Benefit Provisions and Employer does not make such payments as soon as possible but no longer than within thirty(30)days of receipt of such notice; or d. The date that is sixty (60) days after written notice by either Employer or CIILIC ("non- defaulting party") of the material breach by the other (the "defaulting party") of a material 06/28/2023 4 Administrative Services Only Agreement for City of Miami Beach obligation of the defaulting party related to the Pharmacy Benefit(other than failure to fund the Bank Account or failure to pay any charges when due pursuant to Sections l.vi.b and l.vi.c above) that is not cured to the reasonable satisfaction of the non-defaulting party within a reasonable time following the initial notice of breach. During such thirty six(36)month period(or shorter period,as applicable under(a),(b),(c)or(d)above), CHLIC will continue to be the exclusive provider of Pharmacy Benefit administration services for the Plan's Pharmacy Benefit. Section 2. Claim Administration and Additional Services a. While this Agreement is in effect,CHLIC shall,consistent with,the claim administration policies and procedures then applicable to its own health care insurance business(i)receive and review claims for Plan Benefits;(ii)determine the Plan Benefits,if any,payable for such claims;(iii)disburse payments of Plan Benefits to claimants;and(iv) provide in the manner and within the time limits required by Applicable Law, notification to claimants of(a) the coverage determination or(b)any anticipated delay in making a coverage determination beyond the time required by Applicable Law. b. Following(i)termination of this Agreement,except pursuant to Section 1.iii and 1.iv;(ii)termination of a Plan benefit option or(iii)termination of eligible Members, if any required fees have been paid in full,CHLIC shall process Run-Out Claims for the applicable Run-Out Period(Refer to Schedule of Financial Charges for applicable fees and Run-Out Period).At the termination of any applicable Run- Out Period, CHLIC shall cease processing Run-Out Claims and, subject to the requirements of Section 21.a,make all relevant records in its possession relating to such claims, other than CIILIC's proprietary information,available to Employer or Employer's designee in electronic format. CHLIC is not required to provide proprietary information to Employer or any other party. c. Employer hereby delegates to CHLIC the authority, responsibility and discretion to determine coverage under the Plan based on the eligibility and enrollment information provided to CHI.IC by Employer.Employer also hereby delegates to CHLIC the authority,responsibility and discretion to(i) make factual determinations and to interpret the provisions of the Plan to make coverage determinations on claims for Plan Benefits,(ii)conduct a full and fair review of each claim which has been denied (as defined by ERISA), (iii) conduct level one of internal appeals of"Urgent Care Claims," "Concurrent,""Pre-service," and "Post-service"claims(as those terms arc defined under ERISA)and notify the Member or the Member's authorized representative of its decision. Employer will ensure that all summary plan description materials provided to Members reflect the delegation of discretionary authority outlined above. If the Plan provides a level two internal appeal,Employer shall conduct and retain full responsibility and discretionary authority for such appeals including notification to the Member and/or the Member's authorized representative of its decision. Employer will ensure that the summary plan description materials provided to Members properly outline the internal appeal process and Employer's responsibility for level two internal appeals. d. In addition to the basic claim administrative duties described above,CI ILIC shall also perform the Plan-related administrative duties agreed upon by the Parties and specified in Exhibit B. Unless otherwise agreed to in writing by CHLIC, all services identified in this Agreement shall be provided by CHLIC to Members covered by this Agreement on an exclusive basis with respect to that portion of the Plan administered by CHLIC pursuant to this Agreement. c. As part of the Plan Benefits provided under this Agreement,CHLIC and Employer agree that CHLIC will provide the Pharmacy Benefit(as defined in Appendix A)services described in the Schedule of 06/28/2023 5 Administrative Services Only Agreement for City of Miami Beach Financial Charges and Appendix A as attached hereto,if any(the"Pharmacy Benefit Provisions"). In the event of any conflict between the terms set forth in the Pharmacy Benefit Provisions and any other terms set forth in this Agreement, including Exhibits hereto, the Pharmacy Benefit Provisions shall control solely with respect to the Pharmacy Benefit services. Section 3. Funding and Payment of Claims a. Employer shall establish a Bank Account,and maintain in the Bank Account an amount sufficient at all times to fond payments from it for the following(collectively"Bank Account Payments"):(i) Plan Benefits;(ii)those charges and fees identified in the applicable Schedule of Financial Charges as payable through the Bank Account and(iii)any sales tax,or similar benefit-or Plan-related charge, surcharge or assessment however denominated, which may be imposed by any governmental authority.Bank Account Payments may include without limitation:(a)fixed per person payments and pay-for-performance payments to Participating Providers;(b)amounts owed to CHLIC which are not billed to Employer in accordance with Section 4 of this Agreement;and(c)amounts paid to CHLIC's affiliates and/or subcontractors for, among other things, network access or in-and out-of-network health care services/products provided to Members. CHLIC may credit the Bank Account with payments due Employer under a stop loss policy issued by CHLIC or an affiliate. b. CHLIC,as agent for the Employer,shall make Bank Account Payments from the Bank Account, in the amount CHLIC reasonably determines to be proper under the Plan and/or under this Agreement. c. In the event that sufficient funds are not available in the Bank Account to pay all Bank Account Payments when due, CHLIC shall cease to process and issue payment for claims for Plan Benefits including Run-Out Claims and CHLIC may notify claimants and Members regarding such insufficient funding. d. CIILIC will promptly adjust any underpayment of Plan Benefits or pay-for-performance payments by drawing additional funds due the claimant from the Bank Account. In the event CHLIC determines that it has overpaid a claim for Plan Benefits or paid Plan Benefits to the wrong party,it shall take all reasonable steps consistent with the policies and procedures applicable to its own health care insurance business to recover the overpayments of Plan Benefits. CHLIC shall also take all reasonable steps consistent with the policies and procedures applicable to its own health care insurance business to collect pay-for-performance payments due to Employer or to recover pay-for- performance overpayments (collectively "Pay-for-Performance Recoveries"). CHLIC shall not be required to initiate court, mediation, arbitration or other administrative proceedings to recover any overpayment of Plan Benefits or to collect or recover Pay-for-Performance Recovery.However,when it elects to do so, CHLIC is expressly authorized by Employer to take all actions on behalf of the Employer and/or the Plan to pursue overpayment recovery of Plan Benefits or to collect or recover Pay-for-Performance Recovery including, but not limited to, retaining counsel, settling and compromising claims or Pay-for-Performance Recoveries,in which case CHLIC shall he responsible for the attorney fees,court costs or arbitration fees incurred by CHLIC in the specific overpayment recovery action of Plan Benefits (not applicable to subrogation or conditional claim payment recoveries) or to collect or recover Pay-for-Performance Recovery, but not any indirect,associated third party costs absent consent of COLIC. CHLIC shall be responsible for reimbursing any unrecovered payments of Plan Benefits or Pay-for-Performance Recoveries resulting from CHILC's (1) failure to perform its duties under the Plan or this Agreement with the degree of skill and judgment possessed by other third party administrators experienced in furnishing claims administration services to plans of similar size and characteristics as the Plan and/or (2) gross negligence or intentional wrongdoing. 06/28/2023 6 Administrative Services Only Agreement for City of Miami Beach e. Employer shall promptly reimburse CHLIC for any Bank Account Payments paid by CHLIC with its own funds on behalf of the Employer or the Plan and no such payment by CHLIC shall be construed as an assumption of any of Employer's liability for such Bank Account Payments. f. Following termination of this Agreement, Employer shall remain liable for payment of all Plan Benefits and other due Bank Account Payments and for all reimbursements due Members under the Plan. The obligations set forth in this Section 3 shall survive termination of this Agreement. Section 4. Charges a. Charges.CI ILIC shall provide to Employer a monthly statement of all charges Employer is obligated to pay, in full, under this Agreement that are not paid as Bank Account Payments. Payment of all billed charges shall be due on the first day of the month, as indicated on the monthly statement. Employer shall remit payment of charges billed by the sixtieth (601h) day of receipt of a proper invoice may be subject to late charges as provided for by Florida Statutes Section 218"FLORIDA PROMPT PAYMENT ACT." b. Changes- Additions and Terminations. if a Subscriber's effective date is on or before the fifteenth (15th)day of the month,full charges applicable to that Subscriber shall be due for that Subscriber for that month.If coverage does not start or ceases on or before the fifteenth(15th)day of the month for a Subscriber, no charges shall be due for that Subscriber for that month. c. Retroactive Changes and Terminations. Employer shall remain responsible for payment of all applicable charges and Bank Account Payments incurred or charged through the date CHLIC processed Employer's notice of a retroactive change or termination of a Member. However, if the change or termination would result in a reduction in charges, CHLIC shall credit to Employer the reduction in charges charged for the shorter of(a)the sixty(60)day period preceding the date CHLIC processes the notice,or(b)the period from the date of the change or termination to the date CHLIC processes the notice. The obligations set forth in this Section 4 shall survive termination of this Agreement. Section S. Enrollment and Determination of Eligibility a. Eligibility Determinations and Information. Employer is responsible for administering Plan enrollment. In determining any person's right to benefits under the Plan, CHLIC shall rely upon enrollment and eligibility information provided by the Employer and CHLIC shall have no liability for administering the Plan in reliance upon enrollment and eligibility information provided by Employer. Such eligibility information shall identify the effective date of eligibility and the termination date of eligibility and shall be provided promptly to CHLIC on at least a monthly basis (unless otherwise agreed to in writing by CHLIC)using a method and with such other information as mutually agreed upon by Employer and reasonably may be required by CHLIC for the proper administration of the Plan. b. Release of Liability.Notwithstanding any inconsistent provision of this Agreement to the contrary, if Employer fails to provide CHLIC with accurate enrollment and eligibility information,benefit design requirements, or other agreed-upon information in a mutually agreed upon timeframe and format, CHLIC shall have no liability under this Agreement for any act or omission by CHLIC, or its employees, affiliates, subcontractors, agents or representatives,caused by such failure. 06/28/2023 7 Administrative Services Only Agreement for City of Miami Beach c. Reconciliation of Eligibility Information and Default Terminations. CHLIC will periodically share potential discrepancies in eligibility information with Employer.Employer will review and reconcile any discrepancies within thirty (30) days of receipt and provide CHLIC corrected eligibility information. If Employer fails to timely do so,CHI.EC may terminate coverage for any Member not listed as eligible in Employer's submitted eligibility information. Section 6. Audit Rights a. Employer may audit CHL1C's administration of Plan Benefits in accordance with the following requirements: i. Except for clinical audits, Employer shall provide to CHLIC a scope of audit letter and the fully executed Audit Agreement,a sample of which is attached hereto as Exhibit C, together with a forty-five(45)day advance written request for audit.For a clinical audit,Employer shall provide to CHLIC a ninety(90)day advance written request to audit,together with a scope of audit letter, which scope shall be mutually agreed upon between the parties. CHLIC will provide the Auditor and Employer, if Employer is participating in the audit, with a draft Clinical Audit Agreement,sample of which is attached hereto as Exhibit CI, within a week of receiving the request to audit and scope of audit letter. ii. Employer may designate with CHL1C's consent (which consent shall not to be unreasonably withheld)an independent,third-party auditor to conduct the audit(the"Auditor"). iii. Employer and CHLIC will agree upon the date for the audit during regular business hours in a virtual/remote audit environment or at CHLIC's office(s), as business needs require. iv. Except as otherwise agreed to by the parties in writing prior to the commencement of the audit, the audit shall be conducted in accordance with the terms of CHLICs Audit Agreement attached hereto as Exhibit C and/or Exhibit Cl,as applicable,which would hereby be agreed to by Employer and which shall be signed by the Auditor prior to the start of the audit. v. If the audit identifies any errors requiring adjustments, such adjustments will be made in accordance with this Agreement and based upon the actual claims and fees reviewed and not upon statistical projections or extrapolations. vi. Employer shall be responsible for its Auditor's costs. vii. If Employer has five thousand(5,000)or more employees who are Members, Employer may conduct one such audit every Plan Year (but not within six (6) months of a prior audit); otherwise, Employer may conduct one such audit every two(2) Plan Years (but not within eighteen(18)months of a prior audit). viii. In no event shall any audit involve Plan benefit payments or administration prior to the most recent two (2) plan years, (unless otherwise noted) or involve Plan benefit payment or administration that has been previously audited. ix. New audits shall not be initiated until all parties have agreed that the prior audit is closed. 06/28/2023 8 Administrative Services Only Agreement for City of Miami Beach In the event Employer requests to alter the scope of the audit, CHLIC will endeavor to reasonably accommodate the Employer's request,which may be subject to additional charges to be mutually agreed upon by the Employer and CHLIC prior to the start of the audit. Employer may (as determined by CHLIC based upon the resources required by the audit requested)be responsible for CHLICs reasonable costs with respect to the audit,except that while this Agreement is in effect there shall be no additional cost to Employer for an audit of the following: • Claims: Payment documents relating to a random, statistically valid sample of two-hundred twenty- five(225)claims paid. 0 Requests to review provider contracts will be subject to CHLIC's current criteria and contrary terms in Participating Provider Agreements. • Appeals: Documents,including payment documents as appropriate, relating to a random sample of up to thirty-five(35)appeals. • Customer Service: Documentation and review of call recordings relating to a random sample of up to thirty-five(35)Member calls. o CHLIC maintains call recordings for up to twelve(12)months, and any customer service audit is limited to the availability of the call recordings. • Accumulator/Combined Deductible: Audits are allowed based on mutually agreed-upon scope of up to thirty(30)cases. • Benefit Implementation: Audits arc allowed based on mutually agreed-upon scope and timing. CHLIC will support the benefit implementation audits for review of benefit set up related to claim processing. • Clinical Cases/Calls: The standard annual allowable number of cases/calls for audit and standard number of days allowed to conduct the audit is as follows,based on number of Employer Subscribers during the time period covered by the audit: Number of Subscribers #Cases #Calls #Days* 5,000& under 10 3 1 >5,000&<25,000 15 4 1 >25,000&<75,000 20 5 1.5 >75,000 25 6 2 All cases and calls related to case selection will be prepared and presented in compliance with all Applicable Laws,Privacy Addendum in Exhibit D, including but not limited to the IIIPAA Privacy and Security Rules and 42 C.F.R. Part 2. Cases selected will have been managed during the rolling twelve (12)month period prior to the date of the written request to conduct an audit and not previously audited for the current audit scope. • Medical Cost Containment Program Fees(MCCP): MCCP audits are limited to confirmation of fees paid by the Employer related to the programs in place. The audits will not include review of 06/28/2023 9 Administrative Services Only Agreement for City of Miami Beach documentation that is not applicable to claim administration. In addition, Auditor agrees that it will not outreach to Participating Providers or Members for claim or medical record information. MCCP fee audits are based on the following criteria; o Random samples based on the following: ■ Twenty-five(25)claims in which fees were paid for the Non-Participating Provider Cost Containment Programs which include Network Savings Program;Supplemental Network and Medical Bill Review(Pre-payment Cost Containment for Non-contracted claims) • One-hundred (100) claims related to Other Cost Containment Programs which include Medical Bill Review(Bill Audit;DRG Validation Audits and Recovery; Medical Implant Device Audits);COB Vendor Recoveries;Secondary Vendor Recovery Program;Provide Credit Balance Program; High Cost Specialty Pharmaceutical Audits; Eligibility Overpayment Recovery Vendor Services; Class Action Recoveries and Subrogation/Conditional Claim Payment. h.Pharmacy Audits.The rights and obligations regarding pharmacy audits are set forth in Appendix A. Section 7. Plan Benefit Liability; Indemnification a. Employer Liability for Plan Benefits. Employer is responsible for all Plan Benefits including any Plan Benefits paid as a result of any legal action.CHLIC shall reasonably cooperate with Employer in its defense of any action or proceeding involving a claim for Plan Benefits. If Employer directs CHLIC in writing to pay Extra-Contractual Benefits,Employer is responsible for funding the payment and such payments shall not be considered in determining reimbursements or payments under stop loss insurance provided by CHLIC or CHLIC affiliate or in determining any CI ILIC or CHLIC affiliate risk-sharing or performance guarantee reimbursements. Employer shall reimburse CHLIC for any liability or expenses(including reasonable attorneys' tees) CHLIC may incur in defense of its making such payments. b. Employer Liability for Plan-Related Expenses. Unless Employer qualifies for a tax exemption, Employer shall reimburse CHLIC for any amounts CHLIC may be required to pay(i) for any sales tax or similar benefit-or Plan-related charge,surcharge or assessment,or(ii)under any unclaimed or abandoned property, or escheat law, with respect to Plan Benefits and any penalties and/or interest thereon. c. In performing its obligations under this Agreement, CHLIC shall use reasonable diligence and that degree of skill and judgment possessed by one experienced in furnishing claim administration services to plans of similar size and characteristics as the Plan.This includes making a good faith effort to correct any mistake or clerical error which may occur due to actions or inaction by CI ILIC, undertaken in good faith once the error or mistake is discovered. d. CI-ILIC shall be liable to and indemnify the Employer for any loss, cost or expense(including court costs and reasonable attorney's fees)for which Employer may become liable in consequence of(l) any acts or omissions of CHLIC or its employees,agents,or representatives,which constitute a failure,on the part of CHLIC,to perform its claim administration and other services in accordance with the standard set forth in section 7(c)above;(2)CHLIC's failure to perform the claim administration and other services pursuant to the Plan or this Agreement; or(3) fraud, embezzlement,willful misconduct or intentional disregard on the part of the provisions of the Plan or CHLIC or its employees,agents, or representatives. 06/28/2023 10 Administrative Services Only Agreement for City of Miami Beach CHLIC shall not be liable to the Employer for actions taken in good faith and performed in accordance with the provisions of the Plan or this Agreement. The obligations set forth in this Section 7 shall survive termination of this Agreement. Section 8. Modification of Plan and Charges a. Except as may be otherwise provided in the Schedule of Financial Charges,and no earlier than sixty (60) months after the Effective Date, CHLIC shall have the right to revise the charges identified in this Agreement (i) by giving Employer at least sixty (60) days' prior written notice, (ii) upon any modification or amendment of the benefits under the Plan, (iii) upon any variation of ten percent (15%) or more in the number of Members used by CHLIC to calculate its charges under this Agreement, and/or (iv) upon any change in law or regulation that materially impacts CHLIC's liabilities and/or responsibilities under this Agreement. b. Employer shall provide CHLIC written notice of any modification or amendment to the Plan sufficiently in advance of any such change as to allow CHLIC to implement the modification or amendment.Employer and CHLIC shall agree upon the manner and timing of the implementation of such modification or amendment subject to CHLIC's system and operational capabilities. c. Employer is solely responsible for communicating any Plan modification or amendment to Members or individuals considering enrolling in the Plan. Section 9. Modification of Agreement This Agreement constitutes the entire contract between the Parties regarding the subject matter herein. Except, as otherwise provided herein, the provisions of this Agreement shall control in the event of a conflict with the terms of any other agreements. No modification or amendment hereto shall be valid unless in writing and signed by an authorized person of each of the Parties,except that modification of charges pursuant to Section 8 above may be made by written notice to Employer by CHLIC. Section 10. Choice of Law a. This Agreement shall be interpreted and construed in accordance with the laws of the State of Florida Any and all claims,controversies,and causes of action arising out of or relating to this Agreement, whether sounding in contract,tort, or statute, shall be governed by the laws of the State of Florida, including its statutes of limitations, without regard to any conflict-of-laws or other rule that would result in the application of the law of a different jurisdiction. Both CHLIC and Employer consent to Miami-Dade County, Florida, as the sole venue for resolving any state court, federal court, or arbitration proceedings arising from or relating to the performance or interpretation of this Agreement. h. 'ihe Parties shall perform their obligations under this Agreement in conformance with all Applicable Laws and regulatory requirements. Section 11. Information in CHLLC Processing Systems CHLIC may retain and use all Plan-related claim/payment information recorded/integrated into CHLIC's business records (including claim processing systems) in the ordinary course of business. Such information will be available to Employer pursuant to Section 21. CHLIC will retain such Plan-related claim/payment information in accordance with its record retention policy and Applicable Law. 06/28/2023 II Administrative Services Only Agreement for City of Miami Beach Section 12.Resolution of Disputes It is understood and agreed that,prior to initiating any state court, federal court or arbitration proceeding in Miami-Dade County, Florida, the Parties shall first attempt to resolve any dispute arising from or relating to the performance or interpretation of this Agreement using the following dispute resolution procedures: a. Any Controversy shall first be referred to an executive level employee of each Party who shall meet and confer with his/her counterpart to attempt to resolve the dispute ("Executive Review") as follows:The disputing Party shall initiate Executive Review by giving the other Party written notice of the Controversy and shall specifically request Executive Review of said Controversy in such notice. Within twenty(20) calendar days of any Party's written request for Executive Review, the receiving Party shall submit a written response.Both the notice and response sha I include a statement of each Party's position and a summary of the evidence and arguments supporting its position. Within thirty(30)calendar days of any Party's request for Executive Review,an executive level employee of each Party shall be designated by the Party to meet and confer with his/her counterpart to attempt to resolve the dispute. Each representative shall have full authority to resolve the dispute. b. In the event that a Controversy has not been resolved within thirty-five(35) calendar days of the request for Executive Review under Section 12.a, above, either Party may initiate mediation by providing written notice to the other Party, which shall be conducted in Miumi-Dade County, in accordance with the American Arbitration Association commercial mediation rules("Mediation"), and using American Arbitration Association mediators. Each Party shall assume its own costs and attorneys' fees, and the compensation and expenses of the mediator and any administrative fees or costs associated with the mediation proceeding shall be borne equally by the Parties. The Parties shall not,however, be required to mediate the Controversy. The obligations set forth in this Section 12 shall survive termination of this Agreement. Section 13.Third Party Beneficiaries This Agreement is for the exclusive benefit of Employer and CHLIC. it shall not be construed to create any legal relationship between CHLIC and any other party. Section 14. No Waivers No waiver by any party of a breach or default of any provision of this Agreement,failure by any party,on one or more occasions, to enforce any of the provisions of this Agreement, or failure by any party to exercise any right or privilege hereunder shall be construed as a waiver of any subsequent breach or default of a similar nature,or as a waiver of such rights or privileges hereunder, unless and solely to the extent waived by the party against whom the waiver is sought in writing and signed. Section 15. Headings Article,section, or paragraph headings contained in this Agreement are for reference purposes only and shall not affect the meaning or interpretation of this Agreement. 06/28/2023 12 Administrative Services Only Agreement for City of Miami Beach Section 16. Severability if any provision or any part of a provision of this Agreement is held invalid or unenforceable by a court of competent jurisdiction, such invalidity or unenforceability shall not invalidate or render unenforceable any other portion of this Agreement. Section 17. Force Majeure CHLIC shall not be liable for any failure to meet any of its obligations under this Agreement where such failure to perform is due to any contingency beyond the reasonable control of CIILIC or its affiliates or subcontractors,its employees, officers,or directors. Such contingencies include, but are not limited to, acts of God, fires, wars, accidents, labor disputes or shortages, and governmental actions, laws, ordinances, rules or regulations. Section 18. Assignment and Subcontracting No Party may assign any right,interest,or obligation hereunder without the express written consent of the other Party; provided, however that CHLIC may assign any right, interest,or responsibility under this Agreement to their affiliates and/or subcontract specific obligations under this Agreement provided that CHLIC shall not be relieved of its obligations under this Agreement when doing so. Section 19. Notices Except as otherwise provided,all notices or other communications hereunder shall be in writing and shall be deemed to have been duly made when (a) delivered in person, (b)delivered to an agent, such as an overnight or similar delivery service, (c) delivered electronically,or(d)deposited in the United States mail, postage prepaid, and addressed as follows: To CHLIC: Cigna Health and Life Insurance Company 900 Cottage Grove Road Bloomfield,CT 06152 Attention:Jeremy Rainha, Risk& Underwriting Senior Director • To Employer: City of Miami Beach 1700 Convention Center Dr., Fourth Floor Miami Beach, FL 33139 Attention: Sonia Walthour Risk Management/Benefits Division Director The address to which notices or communications may be given by any Party may be changed by written notice given by one Party to the other pursuant to this Section. Section 20. Identifying Information, Internet Usage and Trademark Each Party reserves all right,title,and interest in and to its respective trademarks, service marks, trade names,trade dress,logos,and other proprietary trade designations,whether presently existing or hereafter authored, developed, established, or acquired (collectively, "Marks"). Except as necessary in the performance of their duties under this Agreement or as separately agreed to in writing,no Party shall use 06/28/2023 13 Administrative Services Only Agreement for City of Miami Beach the other Party's Marks in advertising or promotional materials or otherwise. All use of a Party's Marks shall remain subject to such Party's reasonable quality control and brand usage guidelines. Additionally, no Party shall establish a link to the other's World Wide Web site, without the owner's prior written consent.All goodwill arising from use of a Party's Marks shall inure exclusively to such Party's benefit. The obligations set forth in this Section 20 shall survive termination of this Agreement. Section 21. Confidentiality a. Subject to the requirements of Applicable Law, the terms of this Agreement and the Privacy Addendum in Exhibit I), a signed Business Associate Agreement between Employer and its designee(s), and a signed Confidentiality Agreement between CHLIC and applicable designee(s), CHLIC shall release copies of confidential claims and Plan Benefit payment information in CHLIC's claims system ("Confidential Information") and may release copies of proprietary information relating to the Plan in CHLIC's claims system("Proprietary Information")to the Employer and/or its designee(s).Employer will keep Confidential Information and Proprietary Information confidential and will use Confidential Information and Proprietary Information solely for the purpose of administering the Plan or as otherwise required by law. Employer is solely responsible for any unauthorized use or disclosure of Confidential Information and/or Proprietary Information provided by CHLIC pursuant to this Section 21 whether by Employer or its designee and the consequences thereof. b. CHLIC and any of its affiliates or subsidiaries which have any Protected Health Information in their possession will maintain the confidentiality of such Protected Health Information in accordance with the Privacy Addendum in Exhibit D and any applicable state privacy laws, including, without limitation, 201 CMR 17.00: Maachusetts Standards for the Protection of Personal Information of Residents of the Commonwealth. c. Upon termination of this Agreement and subject to the provisions of Section 21.a above,CHLIC shall make information available to a third party such as a "successor administrator" as requested by Employer,to the extent administratively feasible, if the Parties agree upon the charge to be paid by Employer. The obligations set forth in this Section 21, shall survive termination of this Agreement. Section 22. Independent Contractors The Parties'relationship with respect to each other is that of independent contractors and nothing in this Agreement is intended, and nothing shall be construed to, create an employer/employee, partnership, principal-agent, or joint venture relationship, or to exercise control or direction over the manner or method by which CHLIC performs services hereunder. No Party shall make any statement or take any action that might cause a third party to believe such Party has the authority to transact any business, enter into any agreement,or in any way bind or make any commitment on behalf of the other Party, unless set forth in this Agreement or expressly authorized in writing by a duly authorized officer of the other Party. For the avoidance of doubt,CHLIC is authorized to perform certain services on behalf of Employer under this Agreement and this provision is not intended to in any way diminish that authorization. Section 23. Reservation of Intellectual Property Rights Each Party reserves all right, title, and interest in and to its respective copyrights, patents, trade secrets, trademarks, and other intellectual property, whether presently existing or hereafter authored, invented, 06/28/2023 14 Administrative Services Only Agreement for City of Miami Beach developed,or acquired. Without limiting the foregoing,as between the Parties,CHLIC shalt solely and exclusively own the systems, methodologies, and technology used to provide the services, all modifications, enhancements, and improvements thereto,and all associated intellectual property rights. No rights or licenses are granted to Employer other than the limited right to receive and use the services under and in accordance with this Agreement. CHLIC shall own and be free to use and incorporate without payment or other consideration to Employer any ideas, suggestions, recommendations,or other feedback provided to CHLIC in connection with its provision of the services. Nothing in this Agreement is intended or shall be construed to create any joint authorship,joint inventorship,or similar relationship or endeavor between the Parties. The obligations set forth in this Section 23 shall survive termination of this Agreement. Section 24.CHL1C'S Compliance with Florida Public Records Law a. CHLIC shall comply with Florida Public Records law under Chapter 119, Florida Statutes,as may be amended from time to time. b. The term"public records"shall have the meaning set forth in Section 119.011(12),which means all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software,or other material, regardless of the physical form,characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of Employer. c. Pursuant to Section 119.0701 of the Florida Statutes, if CHLIC meets the definition of "Contractor"as defined in Section 119.0701(1)(a), CHLIC shall: i. Keep and maintain public records required by Employer to perform the service; ii. Upon request from Employer's custodian of public records, provide Employer with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law; iii. Ensure that public records that arc 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 Agreement if CHL 1C does not transfer the records to Employer; iv. Upon completion of the Agreement,transfer,at no cost to Employer,all public records in possession of CHLIC or keep and maintain public records required by Employer to perform the service.If CI transfers all public records to Employer upon completion of the Agreement,CHLIC shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If CHLIC keeps and maintains public records upon completion of the Agreement, CHLIC shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to Employer, upon request from Employer's custodian of public records, in a format that is compatible with the information technology systems of Employer. (D) REQUEST FOR RECORDS;NONCOMPLIANCE. i. A request to inspect or copy public records relating to Employer's contract for services must be made directly to Employer. If Employer does not possess the requested records, Employer shall immediately notify CHLIC of the request, and CHLIC;must provide the records to Employer or allow the records to be inspected or copied within a reasonable 06/28/2023 15 Administrative Services Only Agreement for City of Miami Beach time. ii. CHLIC's failure to comply with Employer's request for records shall constitute a breach of this Agreement, and Employer, at its sole discretion, may:(1)unilaterally terminate the Agreement;(2)avail itself of the remedies set forth under the Agreement;and/or(3) avail itself of any available remedies at law or in equity. iii. If CHLIC fails to provide the public records to Employer within a reasonable time may be subject to penalties under s. 119.10. (E) CIVIL ACTION. i. if a civil action is filed against CHLIC to compel production of public records relating to Employer's contract for services, the court shall assess and award against CHLIC the reasonable costs of enforcement, including reasonable attorneys' fees, if: a. The court determines that CHLIC unlawfully refused to comply with the public records request within a reasonable time;and b. At least 8 business days before filing the action,the plaintiff provided written notice of the public records request, including a statement that CHLIC has not complied with the request,to Employer and to CHLIC. ii. A notice complies with subparagraph(1)(b)if it is sent to Employer's custodian of public records and to CHLIC at CHLIC's address listed on its contract with Employer or to CHLIC's registered agent.Such notices must be sent by common carrier delivery service or by registered,Global Express Guaranteed,or certified mail, with postage or shipping paid by the sender and with evidence of delivery,which may be in an electronic format. iii. If CHLIC complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. (F) IF CHLIC HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CHLIC'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: CITY OF MIAMI BEACH ATTENTION: RAFAEL E. GRANADO,CITY CLERK 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139 E-MAIL: RAFAELGRANADO(a�MIAMIBEACHFL.GOV PHONE: 305-673-7411 Section 25. Inspector General Audit Rights a. Pursuant to Section 2-256 of the Code of Employer of Miami Beach, Employer has established the Office of the Inspector General which may, on a random basis, perform reviews, audits, inspections and investigations on all Employer contracts, throughout the duration of said contracts. This random audit is separate and distinct from any other audit performed by or on behalf of Employer. 06/28/2023 16 Administrative Services Only Agreement for City of Miami Beach b. The Office of the Inspector General is authorized to investigate Employer affairs and empowered to review past, present and proposed Employer programs, accounts, records, contracts and transactions. In addition, the Inspector General has the power to subpoena witnesses, administer oaths, require the production of witnesses and monitor Employer projects and programs. Monitoring of an existing Employer project or program may include a report concerning whether the project is on time, within budget and in conformance with the contract documents and applicable law. "Ihe Inspector General shall have the power to audit, investigate, monitor, oversee, inspect and review operations, activities, performance and procurement process including but not limited to project design,bid specifications,(bid/proposal)submittals,activities of CHLIC, its officers, agents and employees, lobbyists, Employer staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. Pursuant to Section 2-378 of the City Code,Employer is allocating a percentage of its overall annual contract expenditures to fund the activities and operations of the Office of Inspector General. c. Upon ten (10) days written notice to CHLIC, CHLIC shall make all requested records and documents available to the inspector General for inspection and copying. The Inspector General is empowered to retain the services of independent private sector auditors to audit, investigate, monitor,oversee,inspect and review operations activities,performance and procurement process including but not limited to project design,bid specifications,(bid/proposal)submittals,activities of CHLIC its officers, agents and employees, lobbyists, Employer staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. d. The Inspector General shall have the right to inspect and copy all documents and records in CIILIC's possession,custody or control which in the Inspector General's sole judgment, pertain to performance of the contract,including,but not limited to original estimate files, change order estimate files,worksheets,proposals and agreements from and with successful subcontractors and suppliers, all project-related correspondence, memoranda, instructions, financial documents, construction documents, (bid/proposal) and contract documents, back-change documents, all documents and records which involve cash, trade or volume discounts, insurance proceeds, rebates, or dividends received, payroll and personnel records and supporting documentation for the aforesaid documents and records. e. CIILIC shall make available at its office at all reasonable times the records, materials, and other evidence regarding the acquisition (bid preparation) and performance of this Agreement, for examination,audit,or reproduction,until three(3)years after final payment under this Agreement or for any longer period required by statute or by other clauses of this Agreement. In addition: (1) If this Agreement is completely or partially terminated, CHLIC shall make available records relating to the work terminated until three (3) years after any resulting final termination settlement;and 06/28/2023 17 Administrative Services Only Agreement for City of Miami Beach (2) CHLIC shall make available records relating to appeals or to litigation or the settlement of claims arising under or relating to this Agreement until such appeals, litigation, or claims are finally resolved. f. The provisions in this section shall apply to CHLIC, its officers, agents, employees, subcontractors and suppliers. CHLIC shall incorporate the provisions in this section in all subcontracts and all other agreements executed by CHLIC in connection with the performance of this Agreement. R. Nothing in this section shall impair any independent right of Employer to conduct audits or investigative activities. The provisions of this section are neither intended nor shall they be construed to impose any liability on Employer by CHLIC or third parties. Section 26. E-verify a. To the extent applicable to the services offered herein, CHLIC shall comply with Section 448.095, Florida Statutes, "Employment Eligibility" ("E-Verify Statute"), as may be amended from time to time. Pursuant to the E-Verify Statute,commencing on January 1,2021,CHLIC shall register with and use the E-Verify system to verify the work authorization status of all newly hired employees during the Term of the Agreement. Additionally,CHLIC shall expressly require any subconsultant performing work or providing services pursuant to the Agreement to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subconsultant during the contract Term, If CHLIC enters into a contract with an approved subconsultant, the subconsultant must provide CHLIC with an affidavit stating that the subconsultant does not employ, contract with, or subcontract with an unauthorized alien. CHLIC shall maintain a copy of such affidavit for the duration of the Agreement or such other extended period as may be required under this Agreement. b. TERMINATION RIGHTS. i. If Employer has a good faith belief that CHLIC has knowingly violated Section 448.09(1), Florida Statutes, Employer shall terminate this Agreement with CHLIC for cause, and Employer shall thereafter have or owe no further obligation or liability to CHLIC. ii. If Employer has a good faith belief that a subconsultant has knowingly violated the foregoing Subsection 10.9(A), but CHLIC otherwise complied with such subsection, Employer will promptly notify CHLIC and order CI ILIC to immediately terminate the Agreement with the subconsultant. CHLIC's failure to terminate a subconsultant shall be an event of default under this Agreement, entitling Employer to terminate CHLIC's contract for cause. iii. A contract terminated under the foregoing Subsection(B)(1)or(B)(2)is not in breach of contract and may not be considered as such. iv. Employer or CHLIC or a subconsultant may file an action with the Circuit or County Court to challenge a termination under the foregoing Subsection(BX 1)or(B)(2)no later than 20 calendar days after the date on which the contract was terminated. v. If Employer terminates the Agreement with CIILIC under the foregoing Subsection (B)(l),CHLIC may not be awarded a public contract for at least 1 year after the date of termination of this Agreement. vi. CHLIC is liable for any additional costs incurred by Employer as a result of the 06/28/2023 18 Administrative Services Only Agreement for City of Miami Beach termination of this Agreement under this Section 26. Section 27. Insurance Requirements CHLIC shall maintain the below required insurance in effect prior to awarding the contract and for the duration of the contract. The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage may be treated as a material breach of the contract, which could result in withholding of payments or termination of the contract. a. Worker's Compensation Insurance for all employees of the CHLIC as required by Florida Statute 440, and Employer Liability Insurance for bodily injury or disease. Should CHLIC be exempt from this Statute,CHLIC and each employee shall hold the City harmless from any injury incurred during performance of the Contract. If exempt,CHLIC shall also submit(i)a written statement detailing the number of employees and that they are not required to carry Workers' Compensation insurance and do not anticipate hiring any additional employees during the term of this contract or(ii)a copy of a Certificate of Exemption. b. Commercial General Liability Insurance on an occurrence basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than$1,000,000 per occurrence,and $2,000,000 general aggregate. c.Automobile Liability Insurance covering any automobile,if CHLIC has no owned automobiles, then coverage for hired and non-owned automobiles,with limit no less than$1,000,000 combined per accident for bodily injury and property damage. d. Professional Liability(Errors&Omissions)insurance appropriate to CHLIC,with Iimit no let than$1,000,000. Additional Insured-Employer must be included by endorsement as an additional insured with respect to all liability policies(except Professional Liability and Workers' Compensation)arising out of work or operations performed on behalf of the CHLIC including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned,leased,hired or borrowed in the form of an endorsement to the CHLIC's insurance. Notice of Cancellation - Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach c/o EXIGIS insurance Compliance Services. Waiver of Subrogation—CHLIC agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. However, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. Acceptability of Insurers-- Insurance must be placed with insurers with a current A.M. Best rating of A:VIi or higher.if not rated, exceptions may be made for members of the Florida Insurance Funds(i.e. FWCIGA,FAJUA).Carriers may also he considered if they are licensed and authorized to do insurance business in the State of Florida. Verification of Coverage—CHLIC shall furnish the Employer with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the Employer before work 06/28/2023 19 Administrative Services Only Agreement for City of Miami Beach commences. However, failure to obtain the required documents prior to the work beginning shall not waive the CHLIC's obligation to provide them.Employer reserves the right to require complete, certified copies of all required insurance policies,including endorsements,required by these specifications, at any time. CERTIFICATE HOLDER MUST READ: City of Miami Beach do Exigis Insurance Compliant Services P.O. Box 947 Murrieta, CA 92564 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent, EXIGIS,at: Certificates-miamibeach@riskworks.com Special Risks or Circumstances - Employer reserves the right to modify these requirements, including limits,based on the nature of the risk,prior experience,insurer,coverage,or other special circumstances. Compliance with the foregoing requirements shall not relieve CHLIC of his liability and obligation under this section or under any other section of this agreement. Section 28. Entire Agreement As of the Effective Date,this Agreement constitutes the entire agreement between the Parties regarding the subject matter herein and supersedes all previous and contemporaneous agreements, understandings, inducements or conditions expressed or implied, oral or written, between the Parties, except as herein contained. Further,this Agreement shall not be modified by any shrink-wrap,click-wrap, browse-wrap, click-through, web-site based, online or use agreements("Click-Wrap") that purport to be accepted or deemed accepted by download or online acknowledgment and to the extent of any conflict between this Agreement and the Click-Wrap,this Agreement shall control. Each Party acknowledges that in entering into this Agreement, it is not relying on any statement, representation, or warranty, other than those expressly set forth herein. Except as otherwise provided herein the provisions of this Agreement shall control in the event of a conflict with the terms of any other agreement regarding the subject matter herein. Section 29. Request for Proposal The Provisions of RFP 2023-259-WG Health, Pharmacy (Rx), and Medicare Advantage Plans and all attachments,amendments,and addendums thereto,attached as Exhibit_, are hereby incorporated into this Agreement. To the extent the provisions of the RFP and all Amendments thereto conflict with any other terms of the Agreement, Schedules, Exhibits, Addendums, Amendments or like documents, the terms of the Agreement,Schedules,Exhibits,Addendums,Amendments,or the like documents, control. For the avoidance of doubt,the following order of precedent shall prevail: this Agreement(including its Schedules, Exhibits, Addendums, Amendments, or the like documents); the RFP; and the CHLIC proposal. 06/28/2023 20 Administrative Services Only Agreement for City of Miami Beach SIGNATURES IN WITNESS WHEREOF, the Parties have caused this Agreement, to be executed in duplicate and signed by their respective officers duly authorized to do so as of the dates given below. Employer executes as the authorized representative of the Plan with respect to the Privacy Addendum to this Dated at 14laMIP1a•)1,�L _ City of Miami Beach • Dated: i 4 oak' By: 9-I; ATtI Name: Its CA MatnotOstr Duly Authorized Dated at Hartford,Connecticut CIGNA HEALTH AND LIFE INSURANCE COMPANY Dated:June 28,2023 ATTEST: ONCI+r By: 47)1 Name: Aimee E. Burnham By. Its Contractual Agreement Unit Manager Name: Rafael E.Granado Duly Authorised Title: City Clerk Date: JAN092024 1 `•.INCORF.O W0.1 s APPROVED AS TO FORM&LANGUAGE &FOR EXECUTION . •9 -lollies— 06(Zi6•1 3 ,k City Attorney Dale 06/28/2023 2I Administrative Services Only Agreement for City of Miami Beach Schedule of Financial Charges Certain fees and charges identified in this Schedule of Financial Charges will be billed to Employer monthly in accordance with CHLIC's then standard billing practices. However, CHLIC is authorized to pay all fees and charges from the Bank Account unless otherwise specified in this Agreement. MEDICAL ADMINISTRATION CHARGES (Including Benefit Advisor Fees payments agreed to by Employer) Product Description Charge Medical Open Access Plus In-Network(OAPIN) $26.50/employee/month with Care Management Preferred Medical Open Access Plus(OAP) $26.50/employee/month with Care Management Preferred(All Plans) Medical Benefit Advisor Fees For OAPIN and OAP Products: $9.36/employee/month M);DICAL NETWORK ACCESS FEE,i1'1 iLIZATIOY M_4NAGEMENT FEE AND OPTIONAL PROGRAM FEE Product Description Charge Medical OAPIN $17.25/employee/month Access Fee Included in Medical Administration Charge Medical OAP S17.25/employee/month Access Fee(All Plans) , Included in Medical Administration Charge MULTI-YEAR CHARGE/FEE,GUARANTEES.:= The maximum increase for the Medical Administration Charge(s) and Network Access Fee(s) for the 2024 Plan Year will be 0.0%over the 2023 Plan Year charges/fees. The maximum increase for the Medical Administration Charge(s) and Network Access Fee(s) for the 2025 Plan Year will be 0.0%over the 2024 Plan Year charges/fees. 06/28/2023 22 Administrative Services Only Agreement for City of Miami Beach The maximum increase for the Medical Administration Charge(s) and Network Access Fee(s) for the 2026 Plan Year will be 0.0%over the 2025 Plan Year charges/fees. The maximum increase for the Medical Administration Charge(s) and Network Access Fee(s) for the 2027 Plan Year will be 0.0% over the 2026 Plan Year charges/fees. The maximum increase for the Medical Administration Charges(s) and Network Access Fee(s) for the 2028 Plan Year will be 0.0%over the 2027 Plan Year charges/fees. The above fee guarantees are not applicable to Pharmacy Administration Fee. The above charges/fees are guaranteed for the time periods identified above, provided, however,that CHLIC may revise the above charges/fees pursuant to Section 8.a.ii, 8.a.iii and/or 8.a.iv of this Agreement. t AMOUNTS OWED TO CHLIC CHLIC may pay amounts with its own funds on behalf of Employer or the Plan for charges which Employer or the Plan is obligated to pay under the Agreement including Plan Benefits, Bank Account Payments (including fixed per person payments and pay-for-performance payments to Participating Providers),governmental taxes or assessments and those amounts paid by CHLIC shall be the Employer's financial responsibility. CHLIC is authorized to recover all such amounts from the Bank Account. CIGNA PHARMACY BENEFIT MANAGEMENT SERVICES CHARGES AND RELATED PROVISIONS PHARMACY ADMINISTRATION FEE Cigna Pharmacy Product Administration Fee: $5.53 per script. FINANCIAL GUARANTEES FOR DRUGS COVERED UNDER THE PLAN'S PHARMACY BENEFIT Covered Drugs Dispensed by Cigna Home Delivery Pharmacy:CHLIC will guarantee the following charges for Covered Drugs dispensed by Cigna Home Delivery Pharmacy, subject to the provisions in the section titled"PBM Pricing—Additional Provisions": Brand Drug Claims: For all Cigna Home Delivery Pharmacy Brand Drug Claims,the Employer's guaranteed annual average discount will be AWP minus 25.50%. Generic Drug Claims: For all Cigna Home Delivery Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be.: AWP minus 87.25% for Plan Year 2023; AWP minus 87.50%for plan year 2024;AWP minus 87.75%for plan year 2025;AWP minus 88.00% for plan year 2026 and AWP minus 88.25% for plan year 2027. 06/28/2023 23 Administrative Services Only Agreement for City of Miami Beach Dispensing Fees for Drug Claims: For all Cigna Home Delivery Pharmacy Brand Drug Claims and Generic Drug Claims the Employer's guaranteed annual average Dispensing Fee will be$0.00. Covered Drugs Dispensed by Retail Pharmacies in 30-day* supplies: CHLIC will guarantee the following charges for Covered Drugs dispensed by Retail Pharmacies in 30-day supplies, subject to the provisions in the section titled"PBM Pricing—Additional Provisions": "A 30-day supply means any Covered Drug dispensed by a Retail Pharmacy in an amount less than an 83-day supply. Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 20.00%. Generic Drug Claims: For all Retail Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be:AWP minus 83.50%for Plan Year 2023;AWP minus 83.75%for Plan Year 2024:AWP minus 84.00%for Plan Year 2025;AWP minus 84.25%for Plan Year 2026 and AWP minus 84.50%for Plan Year 2027. Dispensing Fees for Both Brand Drug Claims and Generic Drug Claims: For all Retail Pharmacy Brand Drug Claims and Generic Drug Claims, the Employer's guaranteed annual average Dispensing Fee will be$0.50. Covered Drugs Dispensed by Retail Pharmacies in 90-day** supplies: CHLIC will guarantee the following charges for Covered Drugs dispensed by Retail Pharmacies in 90-day supplies. subject to the provisions in the section titled"PBM Pricing-Additional Provisions": **A 90-day supply means any Covered Drug dispensed by a Retail Pharmacy in an amount equal to or greater than an 83-day supply. Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 25.25%. Generic Drug Claims:For all Retail Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be:AWP minus 85.25%for Plan Year 2023; AWP minus 85.50% for Plan Year 2024; AWP minus 85.75% for Plan Year 2025 : AWP minus 86.00%for Plan Year 2026 and AWP minus 86.25% for Plan Year 2027. Dispensing Fees for Both Brand Drug Claims and Generic Drug Claims: For all Retail Pharmacy Brand Drug Claims and Generic Drug Claims, the Employer's guaranteed annual average Dispensing Fee will be$0.00. 06/28/2023 24 Administrative Services Only Agreement for City of Miami Beach AGGREGATE:SPECIALTY ORVG DISCt)O1 E . . CHLIC shall guarantee an aggregate annual average discount of A WP minus 21.00%for covered Specialty Drug prescriptions dispensed by Retail Pharmacies and Cigna Home Delivery Pharmacy. CHLIC's performance will be measured based on analysis of Plan-specific utilization for the contract year. AGGREGATE LIMITED DISTRIBUTION DRUG AND EXCLUSIVE DISTRIBUTION DRUG DISCOUNT GUARANTEE Limited Distribution Drug and Exclusive Distribution Drug Claims: For all covered Limited Distribution Drugs and Exclusive Distribution Drugs that are dispensed to Members by a Cigna Specialty Drug Pharmacy,the Employer's guaranteed annual average aggregate discount will be AWP minus 17.00%. RECONCILIATION OF PHARMACY BENEFIT MANAGEMENT FINANCIAL GUARANTEES Pricing Guarantee Calculation. The following calculation will be performed on an aggregated basis for all paid Claims for Covered Drugs processed during the applicable contract year in order to reconcile against the average annual ingredient cost discount guarantees set forth above: 1 —[(the total ingredient cost charged to the Employer prior to application of the Plan's Member cost-share requirements)/ (the total AWP) for all Covered Drugs] For the purposes of the pricing guarantee calculation, and notwithstanding anything herein to the contrary,the total ingredient cost shall also include the ingredient cost for a Covered Drug for which a Member pays 100%in the form of cost-share. The application of brand and generic pricing may be subject to certain "dispensed as written" ("DAW") protocols and Employer defined plan design and coverage policies for adjudication and Member Copayment purposes. For example, DAW 5 (House Generic) claims will be considered a Generic Drug claim for pricing purposes. Pricing Guarantee Exclusions.The following Claims or products shall be excluded from the calculation of any pricing guarantee set forth in this Agreement: - Specialty Drugs, unless otherwise noted in this Schedule of Financial Charges. - Workers' Compensation Claims. -Claims for Supplies. -Non-standard facility Claims(Indian Tribal, Veterans Administration, or Dep. of Defense facilities). - Limited Distribution Drugs and Exclusive Distribution Drugs except with respect to the Aggregate Limited Distribution Drug and Exclusive Distribution Drug Guarantee above) - Subrogation Claims. -Repackaged products. - Products filled through Pharmacies not participating in the network accessed by Employer under this Agreement (including a contracted 06/28/2023 25 Administrative Services Only Agreement for City of Miami Beach pharmacy that does not participate in a sub-network or preferred network tier). -Over-the-counter(OTC) products, with the exception of diabetic supplies and insulin. - Secondary Payer Claims. - Direct Member Reimbursement Claims. - Compound Drugs. - Claim reversals. -Outlier Claims. -Products identified as prescriptions covered under the federal 340B drug pricing program. -Claims paid at the Retail Pharmacy's U&C Charge. -Claims where pharmacy reimbursement is determined or mandated by Applicable Law, not based on CHLIC's contracted rates with the Retail Pharmacy(applicable to Retail dispensing fee guarantees only). For the avoidance of doubt and clarity, any type of Paid Claim not excluded in this Agreement shall be considered included in the Financial Guarantees stated above. RECONCILIATION AND OFFSETS REGARDING FINANCIAL GUARANTEES CHLIC will report on the guaranteed amounts within one-hundred eighty(180)days following the end of each contract year. Upon reconciliation, CIILIC's performance with respect to each ingredient cost discount or Dispensing Fee offered under this Agreement will be individually measured and reconciled. CHLIC's performance with respect to ingredient cost discount or Dispensing Fee shall not be reconciled in the aggregate. PBM PRICING—ADDITIONAL PROVISIONS • For a specific Claim for a Covered Drug dispensed by a Retail Pharmacy or Cigna Home Delivery Pharmacy, and after application of any Plan cost-share requirements, CHLIC shall charge the Employer the lowest of the following amounts: (1) The Prescription Drug Charge;or (2) The pharmacy's submitted U&C Charge, if any. • For a specific Claim for a Covered Drug dispensed by a Retail Pharmacy or Cigna Home Delivery Pharmacy, CHLIC shall charge the Member in accordance with the terms of the Pharmacy Benefit. For example, for a Covered Drug subject to a fixed dollar copayment requirement, CHLIC shall charge the Member the lowest of the following amounts: (1) The fixed dollar copayment for the Covered Drug, if any; (2) The Prescription Drug Charge;and 06/28/2023 26 Administrative Services Only Agreement for City of Miami Beach (3) The pharmacy's submitted U&C Charge, if any. • CHLIC may apply,if available and based on price favorability to the Member,a discount card market price for certain non-specialty drug generic products(unless Employer opts out of program enrollment). • Unless specifically noted herein,the discounts to Employer for Covered Drugs set forth in this Agreement are not guaranteed to result in an average aggregate discount off the aggregate AWP of all such Covered Drugs. • Home Delivery Pharmacy Dispensing Fees and Dispensing Fee Guarantees are inclusive of shipping and handling. If carrier rates(i.e., U.S. mail and/or applicable commercial courier services) increase during the term of this Agreement, the Home Delivery Pharmacy Dispensing Fee and Home Delivery Pharmacy Dispensing Fee Guarantee will be increased to reflect such increase(s). • Any pricing guarantees,including any ingredient cost discount or Dispensing Fee guarantee. set forth in this Agreement shall be rendered null and void in the event Employer terminates CHLIC's administration of the Pharmacy Benefit prior to completion of the then-current Plan Year.CHLIC's fees,Rebates(if any),discounts or guarantees(if any) are, among other conditions communicated in this Agreement or otherwise in writing to Employer,contingent on,and assume,adoption by Employer of a specific Formulary.Retail Pharmacy network, and Plan design features(e.g. cost-share structure, utilization'cost management programs). • HIV/transplant medications that appear on the Specialty Drug List are included in the specialty drug pricing and specialty drug Rebates based on the dispensing channel, as applicable. • DAW penalties and/or mandatory generic penalty amounts will not be included in the discount guarantee calculations or reconciliations; however, such Claims will be included in the discount guarantee calculations and reconciliations and valued at the Total Ingredient Cost. • The MAC list used for Home Delivery Pharmacies will include at least the same identical drugs on the MAC list used for Retail Pharmacies or more. • There is no minimum, charge to either a Member or Employer for any claims dispensed by a Home Delivery Pharmacy. • Notwithstanding anything to the contrary,CHLIC will charge Employer for retail pharmacy claims on a Pass-Through Pricing basis. For purposes of this Agreement,the term'`Pass-Through Pricing"means the actual ingredient cost and dispensing fee amount paid by CHLIC for the prescription drug claim when the claim is adjudicated by a Participating Pharmacy, as set forth in the specific Participating Pharmacy remittances related to Employer's claims. 06/28/2023 27 Administrative Services Only Agreement for City of Miami Beach • Notwithstanding any other provision of this Agreement, CHLIC may, effective upon written notice to Employer, adjust any or all of the fees,Rebates(if any),discounts or guarantees(if any)in this Agreement to the extent reasonably necessary to preserve the economic value of this Agreement to CHLIC as it existed immediately prior to any of the following events or changes:(a)there are any significant changes in the composition of the CHLIC pharmacy network utilized by Employer hereunder or in such pharmacy network's contract compensation rates,or the structure of the pharmacy stores/chains/vendors that are contracted with CHLIC,including but not limited to disruption in the retail pharmacy delivery model, or bankruptcy of a chain pharmacy; or there is a change in or to the pharmacy network reflected in the pharmacy pricing summary;or(b)there is a change in government laws or regulations which has a significant impact on pharmacy claim costs;or(c)any material manufacturer-rebate contracts with,or for the benefit of,CHLIC are terminated or modified in whole or in part; or(d)there is any legal action or law that materially affects, or could materially affect the manner in which CHLIC's rebate program is administered or an existing law is interpreted so as to materially affect or potentially have a material effect, on CHLIC's administration of the Plan;(e)a major change in market conditions affecting the pharmaceutical or pharmacy benefit management market,a drug shortage in the market,an issue involving the safety of the drug supply,an unexpected introduction of a new drug(e.g.authorized generic),or similar market event occurs;(t)the Pharmacy Benefit enrollment decreases by equal to or greater than ten(10)% from the enrollment on which CHLIC's financial offer is based;or(g) Employer fails to disclose a material feature of the Plan or the Plan's Pharmacy Benefit or there is a change to the Plan's Pharmacy Benefit including but not limited to the Formulary,benefit designs,OTC plans,clinical or trend programs or otherwise that has the effect of lowering the amount of Rebates earned hereunder or materially impacting any guarantee. DRUG MANUFACTURER-PAYMENT SHARING Subject to the caveats below,CHLIC will remit to Employer the following portion of Rebates and Manufacturer Administrative Fees that CHLIC collects with respect to utilization of Covered Drugs under the Plan's Pharmacy Benefit: For All Products: The greater of: 100.00% of Rebates and Manufacturer Administrative Fees on such utilization dispensed in the full calendar year immediately preceding CHLIC's remittance,or the sum of:$253.15 for the Plan Year 2023; $274.11 for the Plan Year 2024;$288.05 for the Plan Years 2025 through 2027 multiplied by the number of Retail Pharmacy Brand Drug Claims(excluding Specialty Brand Drug Claims) dispensed in 30-day* supplies plus$595.50 for the Plan Year 2023;$627.03 for the Plan Year 2024; $664.68 for the Plan Year 2025 through 2027, multiplied by the number of Retail Pharmacy Brand Drug Claims(excluding Specialty Brand Drug Claims)dispensed in 90-day** supplies plus$732.95 for the Plan Year 2023; $799.14 for the Plan Year 2024; $842.82 for the Plan Years 2025 through 2027 multiplied by the number of Cigna Home Delivery Pharmacy Brand Drug Claims(excluding Specialty Brand Drug Claims)plus$418.73 for the Plan Year 2023;$594.87 for the Plan Year 2024;$626.87 for the Plan Years 2025 through 2027, multiplied by the number of Retail Pharmacy Specialty Brand Drug Claims plus$2,029.06 for Plan Year 2023 ; $2,608.98 for Plan Year 2024; $3,034.61 for Plan Years 2025 through 2027 multiplied by the number of Cigna Home 06/28/2023 28 Administrative Services Only Agreement for City of Miami Beach Delivery Pharmacy Specialty Brand Drug Claims processed in such full calendar year. Caveats: (1) CHLIC or its agents contract with drug manufacturers on CHLIC's own behalf,and not as agent of the Employer or the Plan. Rebates are paid based on the contractual terms set forth in this Agreement. (2) Should Employer terminate this Agreement before completion of the then-current Plan Year, no Rebates shall be due and owing with respect to that Plan Year, and any Rebate minimum or fixed dollar guarantees shall be null and void, as the payment of Rebates is conditioned on CHLIC exclusively administering the Pharmacy Benefits for the entire Plan Year. (3) For percentage-based sharing arrangements, Rebate payout amounts may differ slightly from the stated percentage when payout occurs before manufacturers' final reconciliations and payments are made to CHLIC. For purposes of clarity, CHLIC shall reconcile its performance with respect to any Rebate payment guarantees,including,without limitation,any minimum or fixed dollar guarantees, in the agrgregate. Moreover,any amount directly or indirectly provided by a manufacturer or other third party that is allocated to reduce and/or wholly or partially satisfy a Member's cost-sharing obligation for a Covered Drug shall not be considered a"Rebate"for the purposes of Rebate payments to Employer but may be included when reconciling CHLIC's performance against any Rebate minimum guarantee set forth in this Agreement. (4) For percentage-based sharing arrangements, the percentage share payment of Rebates shall not include the payment of any Rebates received,if any, for Run-Out Claims,340b Claims, Medical Specialty Claims, Direct Member Reimbursement Claims, Reversed Claims, and Compound Claims. (5) The Rebate payment commitments, including any minimum or fixed dollar guarantees, if any, set forth in this Schedule of Financial Charges arc, among any other conditions communicated in this Agreement or otherwise in writing to Employer, contingent on the availability of Rebates to CHLIC and Employer's Pharmacy Benefit applying a 30-day supply limit for Specialty Drugs. and standard days' supply limits. (6) Rebate Guarantees are paid on a per Brand Claim Basis regardless of days supply. Timing of Rebate Pay-Out:Remittance will be provided within ninety(90)days after the close of each applicable calendar quarter for the portion of such calendar quarter that coincides with the Plan Year. 06/28/2023 29 Administrative Services Only Agreement for City of Miami Beach REBATE PAYMENT EXCLUSIONS The Rebate Guarantee payment obligations set forth in this Schedule of Financial Charges shall exclude the following types of claims and/or products: Claims paid pursuant to a Dispense as Written(DAW) 5 code. Direct Member Reimbursement Claims. Vaccines. Compound Drugs. Claim reversals. Products identified as prescriptions covered under the federal 340B drug pricing program. Employer shall be solely responsible for ensuring that any pharmacy affiliated with or operated by Employer or its affiliate,such as an in-house pharmacy, systematically identifies 340B prescriptions on Claim transactions administered by CHLIC. If such pharmacy fails to systematically identify 340B prescriptions on Claim transactions submitted to CHLIC,then CHLIC may withhold all Rebates,or modify any minimum or fixed dollar Rebate guarantee, otherwise attributable to utilization at such pharmacy. Run-Out Claims. Rebate guarantee reconciliation calculations will not include member-submitted coupon copay assistance. For the avoidance of doubt and clarity, any type of Paid Claim not excluded in this Agreement shall be considered included in the Rebate Guarantees stated above GENERIC DISPENSING RATE Retail The number of covered Retail Equivalent Generic Drug Claims(including single-source Included at No generics notwithstanding any other provision herein) divided by the total number of all Additional Cost covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed to Members under the Plan's Pharmacy Benefit by CHLIC's contracted Retail Pharmacies during the applicable annual period, expressed as a percentage,will equal or exceed 90.20% ("Target Retail GDR")during the applicable annual period. Supplies, such as diabetic testing supplies, dispense as written claims, over the counter products, vaccines, compounds, and Specialty Drug Claims, are not considered Retail Equivalent Generic Drug Claims or Retail Equivalent Brand Drug Claims and will be excluded from the calculation. If the actually achieved GDR with respect to covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed by CHLIC's contracted Retail Pharmacies falls below the applicable Target Retail GDR, CHLIC will pay Employer a dollar-for-dollar adjustment for each percentage point by which the actually achieved GDR falls below the applicable Target Retail GDR,up to an aggregate maximum_ 06/28/2023 30 Administrative Services Only Agreement for City of Miami Beach payment of$260,000.00.A shortfall in achieving the Target Retail GDR will be offset by an overage in achieving the Target Mail GDR (assuming this Agreement includes a separate Target Mail GDR), before any penalty is determined with respect to the Target Retail GDR shortfall. "Retail Equivalent Claims" shall mean a method for counting claims, where claims with days'supply equal to or less than thirty-three(33) are counted as one claim and claims with days'supply equal to or greater than thirty-four(34)are counted as the number of days' supply divided by thirty(30). Mail The number of covered Retail Equivalent Generic Drug Claims (including single-source Included at No generics notwithstanding any other provision herein) divided by the total number of all Additional Cost covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed to Members under the Plan's Pharmacy Benefit by CHLIC's Mail Service Pharmacy during the applicable annual period, expressed as a percentage, will equal or exceed 86.30%("Target Mail GDR")during the applicable annual period. Supplies, such as diabetic testing supplies, dispense as written claims, over the counter products,vaccines, compounds,and Specialty Drug Claims, are not considered Retail Equivalent Generic Drug Claims or Retail Equivalent Brand Drug Claims and will be excluded from the calculation.If the actually achieved GDR with respect to covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed by CHLIC's Mail Service Pharmacy falls below the applicable Target Mail GDR, CHLIC will pay Employer a dollar- for-dollar adjustment for each percentage point by which the actually achieved GDR falls below the applicable Target Mail GDR, up to an aggregate maximum payment of $15,000.00. A shortfall in achieving the Target Mail GDR will be offset by an overage in achieving the Target Retail GDR(assuming this Agreement includes a separate Target Retail GDR), before any penalty is determined with respect to the Target Mail GDR shortfall. "Retail Equivalent Claims" shall mean a method for counting claims, where claims with days'supply equal to or less than thirty-three(33)are counted as one claim and claims with days' supply equal to or greater than thirty-four (34) are counted as the number of days' supply divided by thirty(30). PHARMACY VACCINE PROGRAM Notwithstanding anything to the contrary in this Agreement or otherwise, the following terms and conditions shall apply to the administration of vaccines by CHLIC under the Cigna Pharmacy Program. Vaccine Claims will adjudicate at the lower of the U&C Charge or the amounts shown in the Vaccine Pricing Schedule below. For Vaccine Claims, the U&C Charge shall be the retail price charged by an in-network participating retail pharmacy for the particular vaccine, including 06/28/2023 31 Administrative Services Only Agreement for City of Miami Beach administration and dispensing fees,in a cash transaction on the date the vaccine is dispensed as reported to CHLIC by the in-network participating pharmacy. "Vaccine Claim"means a claim for a Covered Drug which is a vaccine. Notwithstanding anything to the contrary in this Agreement or otherwise,all Vaccine Claims shall be excluded from the calculation,measurement, and payment of any and all financial guarantees, including but not limited to rebate guarantees, ingredient cost guarantees, and dispensing fee guarantees set forth in this Agreement. CHLIC reserves the right to revise and modify the Vaccine Pricing Schedule below, including but not limited to revising or adding an additional Pharmacy Vaccine Administration Fee or Vaccine Program Fee, based on changing market dynamics,the entrant of new vaccines, or changes in law or interpretation of law. Vaccine Pricing Schedule *To the extent,if any,Employer's Schedule of Financial Charges includes a Pharmacy Administrative Fee charged on a per prescription basis,then such fee shall apply for Vaccine Claims. Retail Pharmacy Retail Pharmacy Member Submitted LNFLUENZA ALL OTHER VACCLNES Vaccine Claims Pharmacy Vaccine Pass-Through Pass-Through Submitted amount Administration Fee (Capped at S I5 per in-network (capped at S20 per in-network Vaccine Claim) Vaccine Claim) Ingredient Cost Retail Pharmacy Ingredient Cost as Retail Pharmacy Ingredient Cost as set forth in Submitted amount set forth in this Agreement this Agreement Dispensing Fee Retail Pharmacy Dispensing Fee as Retail Pharmacy Dispensing Fee as set forth in Submitted amount set forth in this Agreement this Agreement Vaccine Program Fee $2.50 per vaccine claim N/A PHARMACY MANAGEMENT FUND("PMF") CHLIC will provide Employer up to $30,000.00,to reimburse Employer the actual, fair market value of expense items and services related to transitioning, implementing and administering the pharmacy benefit initially and throughout the term of the Agreement. The foregoing reimbursement is subject to submission of adequate documentation to support reimbursement within one hundred-eighty(180)days of incurring 06/28/2023 32 Administrative Services Only Agreement for City of Miami Beach the applicable expense. All reimbursement under the PMF is subject to CHLIC's standard PMF business practices for all clients Employer represents and warrants that: (i) it will only request reimbursement under the PMF for its actual expenses incurred in transitioning, implementing, and administering the pharmacy benefit managed by CHLIC hereunder, and/or the additional clinical or other similar program provided by CHLIC throughout the Plan Year; (ii) that the applicable service, item, or program was actually performed or provided;(iii)the amount of the reimbursement is equal to or less than the reasonable fair market value of the actual expenses incurred by Employer;(iv) it will notify and disclose the amount and the terms of any PMF reimbursements to Members and other third parties to the extent required by applicable laws and regulations.In addition,if the Employer and the Plan are subject to ERISA, Employer represents and warrants that it will only request reimbursement under the P'vIF for items or services for which Employer, in the absence of the PMF,would be allowed reimbursement from the Plan(i.e., not"settlor functions"). Employer shall comply with all applicable federal and state requirements, including, but not limited to, all applicable federal and state reporting requirements with respect to any expense,item or service reimbursed under this section. CHLIC reserves the right to periodically audit the books and records of Employer on-site, during normal business hours and after giving reasonable advance notice, for the purposes of verifying Employer's compliance with the PMF requirements set forth in this Agreement. CHLIC intends to amortize the PMF over the Plan Year for pharmacy services on a straight-line basis. In the event of a termination of this Agreement for any reason other than CHLIC's uncured material breach prior to the expiration of the initial term,Employer will reimburse CHLIC an amount equal to any paid but unamortized portion of the PMF. Reimbursement to CHLIC by Employer pursuant to this Section will not be in lieu of any other rights or remedies CHLIC may have in connection with the termination of this Agreement,including monetary or other damages. PMF reimbursements shall not be paid prior to the Effective Date of this Agreement and are not payable until this Agreement is executed. Employer will have no right to interest on, or the time value of, any PMF, and unused funds shall be retained by CHLIC. CIGNA HOME<DELIVERY PHARMACY DISCLOSURE Product Charge Cigna Home Specialty drugs dispensed by Cigna Home Delivery Pharmacy and administered under the The drug's charge under Delivery Pharmacy Plan's medical benefit. a national specialty drug (a CHLIC affiliated discount schedule that company(ies)) "Cigna Home Delivery Pharmacy"means a duly licensed pharmacy operated by CHL1C or generates a 19.00% its affiliates,where prescriptions are filled and delivered via the mail service. Cigna Home annual average aggregate Delivery Pharmacy may maintain product purchase discount arrangements and/or fee-for- discount off AWP across service arrangements with pharmaceutical manufacturers and wholesale distributors. Cigna specialty drug claims Home Delivery Pharmacy contract for these arrangements on its own account in support of dispensed at Cigna Home its pharmacy operations. These arrangements relate to services provided outside of this Delivery Pharmacy to 06/28/2023 33 Administrative Services Only Agreement for City of Miami Beach Agreement and other pharmacy benefit management arrangements and may be entered into CHLIC's self-funded and without regard to whether a specific drug is on one of the formularies that CHLIC offers to insured group-client entities like Employer that sponsor group health plans. Discounts and fee-for-service book of business. payments received by Cigna Home Delivery Pharmacy are not part of the administrative fees or other charges paid to CHLIC in connection with CHLIC's services hereunder. This provision shall survive termination or expiration of the Agreement. FEES FOR EROCESSIN(RUN-OUT CLAIMS OAPIN Run-Out Period of twelve(12) months The sum of the last two (2) months of billed fees and OAP CHLIC shall not be required to process Run-Out Claims until it has received full payment of applicable to the the required fees. terminated(i) Agreement, (ii)Plan benefit option or(Hi) Member eligibility. CHLIC MEDICAL COST CONTALNMENT FEES CHLIC administers the programs listed below to contain costs with respect to charges for health care service/supplies that are covered by the Plan (the"Cost Containment Programs"). In administering these Cost Containment Programs, CHLIC may contract with vendors to perform various tasks related to the Cost Containment Programs.These Cost Containment Programs include services that are performed on claims that are subject to the federal No Surprises Act and are not otherwise subject to state law("NSA Services"). CHLIC's charge for administering a Cost Containment Program is the applicable percentage indicated in the table below of the: 1) "gross savings"(i.e., the difference between the charge the provider made and the allowable amount resulting from the Cost-Containment Program); 2) "net savings"(i.e., the gross savings less the applicable vendor charge);or 3) "gross recovery" (i.e.,the amount recovered as a result of the Cost-Containment Program). CHLIC will make a per claim charge to the Bank Account that includes both CHLIC's applicable Cost Containment Program charge, as shown in the Sections A through C of the table below, and the applicable vendor charge. CHLIC will pay the vendor its charge. For charges for covered services received from a non-Participating Provider(including NSA Services and emergency/urgent care services that are covered at the in-network benefit level),CHLIC may apply discounts available under agreements with third parties or through negotiation of the non-Participating Provider's charges whether on a claim-by-claim basis or in advance of services being rendered("Discounts"). The programs for 06/28/2023 34 Administrative Services Only Agreement for City of Miami Beach obtaining the Discounts are identified in Section A and Section B of the table below. CHLIC's per claim charge for administering the programs listed in Section A and Section B of the table below plus any per claim vendor charges associated with those programs shall not exceed S30,000.00 per claim. Vendor charges for the programs listed in Section A and Section B of the table generally range from 5-11%of gross savings. Specific rates charged by vendors for the programs in Section A and Section B of the table are available upon request, subject to execution of a mutually agreed upon non-disclosure agreement to protect the proprietary vendor information from unauthorized use/disclosure. The administration of charges for covered services from non-Participating Providers described above and in Section A and Section B of the table below is consistent with the claim administration practices with respect to CHLIC's own health care insurance business, unless state law requires otherwise. A. Cost Containment for Services/Supplies that are not NSA Services For services/supplies that are not NSA Services,applying the Discounts may result in higher payments than if the maximum reimbursable charge is applied. Whereas application of the maximum reimbursable charge may result in the patient being balance billed for the entire unreimbursed amount, applying the Discounts may avoid balance billing and substantially reduce the patient's out-of-pocket cost. If no Discount is available or negotiated, reimbursement will be based upon: (i) If charges are not subject to CHLIC's benefit enhancement policy—the plan's maximum reimbursable charge(in which case the patient may be balance billed by the non-Participating Provider if the provider's charge exceeds the plan's maximum reimbursable charge); or (ii) If charges are subject to CHLIC's benefit enhancement policy—depending upon the Employer's election: a the amount of the non-Participating Provider's billed charge not exceeding the greater of a CHLIC determined percentage of the Medicare allowable amount(the 80th percentile of the reasonable and customary charge if there is no Medicare allowable charge)or the amount required by state or federal law(in some instances,the patient may be balance billed by the non-Participating Provider if the provider's charge exceeds such amount), or b. the provider's billed charge. Non-Participating Provider Cost Containment Programs for Services/Supplies that are not NSA Services 1. Network Savings Program 29% of net savings 2. Supplemental Network 29% of net savings 3. Medical Bill Review—(Pre-payment Cost Containment for Non-contracted claims): 06/28/2023 35 Administrative Services Only Agreement for City of Miami Beach Inpatient Hospital Bill Review 29%of net savings • Professional Fee Negotiation • Line Item Analysis Re-pricing Lesser of 5% of hospital bill or the gross savings achieved Outpatient Hospital Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings Physician/Professional Bill Review 29%of net savings • Professional Fee Negotiation • Line Item Analysis Re-pricing 29%of net savings 4. For employers that are subject to state laws providing protections from surprise bills: 29%of net savings Payment based on amounts other than Network Savings Program, Supplemental Network,and Medical Bill Review. These payments include amounts determined through negotiation or independent dispute resolution under state law. (The charges indicated in the column to the right include the fees charged by government departments or agencies for administering the independent dispute resolution process and the fees charged by entities conducting independent dispute resolution.) B. Cost Containment for NSA Services For NSA Services, CHLIC will issue initial payments at amounts determined by CHLIC or its vendors("Initial Allowed Amount"). The Initial Allowed Amount may be based on Discounts and may be higher than, equal to, or lower than the qualifying payment amount, as calculated by CHLIC(-QPA"). Patient cost-share will be based on the lower of the QPA,the non-Participating Provider's billed charges,the amount determined by CHLIC to be required by state law(if applicable),or the Initial Allowed Amount Patient cost-share will not increase as a result of negotiations or independent dispute resolution determinations under the No Surprises Act. If additional payment above the Initial Allowed Amount is owed as a result of negotiations or independent dispute resolution under the No Surprises Act,CHLIC, as agent for the Employer, shall make Bank Account Payments from the Bank Account in the amount of such additional payment. 06/28/2023 36 Administrative Services Only Agreement for City of Miami Beach Non-Participating Provider Cost Containment Programs for NSA Services 1. Network Savings Program 29%of net savings 2. Supplemental Network 29%of net savings 3. Medical Bill Review—(Pre-payment Cost Containment for Non-contracted claims): Inpatient Hospital Bill Review 29% of net savings • Professional Fee Negotiation • Line Item Analysis Re-pricing Lesser of 5% of hospital bill or the gross savings achieved Outpatient Hospital Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings Physician/Professional Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings 4. Payment based on amounts other than Network Savings Program, Supplemental Network,and 29%of net savings Medical Bill Review. These payments include amounts determined through negotiation or independent dispute resolution under the No Surprises Act. (The charges indicated in the column to the right include the fees charged by government departments or agencies for administering the independent dispute resolution process and the fees charged by entities conducting independent dispute resolution.) C. Other Cost Containment Programs I. Clinical Complex Claim Review — (Pre- or Post-payment Cost Containment for Non- contracted and Contracted claims): 06/28/2023 37 Administrative Services Only Agreement for City of Miami Beach • Bill Audit 29%of the gross savings/gross recovery achieved plus hospital fees or expenses passed through Diagnosis Related Grouping(DRG) Validation/Audits and Recovery.An overpayment audit 29% of gross and recovery program in which CHLIC or its vendors review paid claim data to identify savings/gross recovery overpayments based on inaccurate DRG coding. plus any fees or expenses passed through by the hospital or regulatory agency 29°A, of the gross • Medical Implant Device Audits savings/gross recovery 2. COB Vendor Recoveries [Exclusive of pharmacy programs where claims are adjudicated at 29% of the gross time prescription is received.] recovery 3. Secondary Vendor Recovery Program 29% of the gross recovery 4. Provider Credit Balance Recovery Program 29°A°of the gross recovery 5. High Cost Specialty Pharmaceutical Audits (this service is only provided with respect to 29°A° of the gross Medical coverage) recovery 6. Eligibility Overpayment Recovery Vendor Services. Identification and recovery of funds in 29%of the gross situations where the overpayment is due to the late receipt of Member termination recovery information. (This service is only provided with respect to Medical coverage). 7. Class Action Recoveries 35% of the gross recovery 8. Subrogation/Conditional Claim Payment. Identification,investigation and recovery of claim 5% of the gross payments involving other party liability or where another entity is responsible for payment recovery plus (including by way of example but not by limitation automobile insurance, homeowner litigation costs if insurance, commercial property insurance, worker's compensation). (This service is only counsel is retained provided with respect to Medical coverage.) and an appearance is filed on behalf of 06/28/2023 38 Administrative Services Only Agreement for City of Miami Beach CHLIC or Employer in any litigation, or a lawsuit is filed on their behalf; 29%of the gross recovery if no counsel is retained and in all other instances, including cases where state law requires that employee benefit plans be named as party defendants or involuntary plaintiffs. u ... .song . .r.... V;�'`;,_,l ,.. _.;":.} .r :a1, CHLIC administers the following programs to contain costs with respect to charges for health care service/supplies that are covered by the Plan. In administering these programs, CHLIC contracts with vendors to perform program related services. CHLIC's charge for administering these programs is the percentage(indicated below) of the "recovery" (i.e. the amount recovered) or percentage of"program savings", as applicable. 1. Pharmacy Vendor Recoveries. CHL1C performs periodic audits of contracted pharmacies in 30.00%of recovery order to determine the accuracy of payments to the pharmacy(ies). CHLIC's recovery vendor collects and remits to CHLIC all overpayments to pharmacy(ies), and CHLIC remits to the Bank Account the balance collected from the recovery vendor, less the recovery fee set forth herein. 2. Class Action Recoveries. CI-ILIC identifies, monitors and may (but is not required to) 35.00%of recovery participate, on behalf of Employer, in class action lawsuits or similar legal proceedings against pharmaceutical manufacturers,including,without limitation,lawsuits alleging legal or equitable claims like fraud, anti-trust violations, or unfair trade practices by a manufacturer. As part of this authority, CHLIC may participate in a settlement, exclude Employer from a settlement and/or otherwise represent Employer's interests outside the settlement. CHLIC collects and retains as a recovery fee set forth herein of any recovery(net of attorneys'fees) attributable to Employer's Plan. 06/28/2023 39 Administrative Services Only Agreement for City of Miami Beach 3. SaveOnSP Program. A Member cost share program available when the Employer makes plan 25.00% of program design changes to certain, designated covered prescription drugs as non-essential health savings plus any benefits and establishes Member cost share at amounts that allow for receipt of manufacturer- applicable tertiary supported patient copay assistance. The program fee shall be charged to the Bank Account cost share and measured and calculated based on the program's standard savings methodology. Payment of program fees shall be invoiced on a monthly, incurred basis. Additional terms and conditions of the SaveOnSP program are set forth in the attached SaveOnSP Appendix C. W}Vvx+s. Advanced Cellular The Advanced Cellular Therapy Program (ACT) is an enhanced network benefit solution Therapy Program designed to manage the high cost of advanced cellular therapies(e.g. CAR T-cell therapy). This program delivers predictability, clinically appropriate care and maximizes affordability by leveraging a specially selected provider network, with benefit language that includes a travel benefit and a dedicated care management team to support Participating Members receiving these therapies. For all in-network medical claims covered under the ACT Program at an existing ACT participating provider, Employer shall pay CHLIC(who in turn will pay the rendering ACT participating provider) a Guaranteed Price for the covered advanced cellular therapy. The Guaranteed Price shall equal the Average Wholesale Price(AWP) of the covered advanced cellular therapy minus 10%and will be charged to the Bank Account. -Guaranteed Price for the covered advanced cellular therapy(ACT) AWP minus 10% Employer understands and agrees that the amount paid by CHLIC for the therapy may or may not be equal to the Guaranteed Price charged to Employer and CHLIC will absorb or retain any difference. There are related costs for Participating Members receiving these therapies that will be paid as covered services according to the Plan. CARE MANAtOE11:100/CO$:T CONTAT NT1R] RAlYI.EttO tai . , Y CHLIC arranges for third parties to provide care management services to: Specific vendor fees and care management (i) contain the cost of specified health care services/items overall with respect to all plans program services are 06/28/2023 40 Administrative Services Only Agreement for City of Miami Beach insured and/or administered by CHLIC, and/or available upon (ii) improve adherence to evidence based guidelines designed to promote patient safety and request. efficient patient care. Charges for these services will be processed through the Bank Account. Medical Management(inclusive of Medical Necessity Review)of Chiropractic services. National Average is S0.16 PMPM; rates vary by market and are available upon request. In addition to such third parties,CHLIC has arranged for an affiliate, eviCore, to provide the following care management/cost-containment programs: Pre-certification of coverage of radiation therapy services. S912.00 per episode of care(EOC) Pre-certification of coverage of diagnostic cardiology services. (If Employer has elected Basic S0.19 PMPM Standard Medical Management(see Administration Charges section above) this program and charge is not applicable to that membership). Pre-certification of coverage of medical oncology services. S1,050.00 per episode of care(EOC) Pre-certification of coverage of musculoskeletal therapy services. (If Employer has elected S0.40 PMPM Basic Standard Medical Management (see Administration Charges section above) this program and charge is not applicable to that membership). Services related to the coverage of high tech radiology which may include pre-certification. Fee reimbursement method and rates may In certain instances,the Plan will pay eviCore a fee on a per member/per month basis for vary by market and pre-certification, arranging care, and other services that eviCore may render. Such are available upon reimbursement will be in addition to the amount that the Plan pays to reimburse the request. provider through which eviCore arranged for the provision of the service or supply,which will be based on eviCore's contracted rate with that provider. In such instances, Plan Benefits and member cost-share will be determined based on the rate that eviCore 06/28/2023 41 Administrative Services Only Agreement for City of Miami Beach contracted to pay the provider for the provision of the service or supply. (If Employer has elected Basic Standard Medical Management (see Administration Charges section above)this program and a charge is not applicable to that membership). eviCore may also charge for services related to the provision of high tech radiology as described below in"Other Vendors and Health Care Services Providers." Pre-certification of coverage of gastroenterology services. (If Employer has elected Basic S0.09 PMPM Standard Medical Management(see Administration Charges section above) this program and charge is not applicable to that membership). Pre-certification of coverage for appropriate setting of care/service for high tech radiology No more than S0.20 services (If Employer has elected Basic Standard Medical Management(see Administration PMPM. Billing Charges section above) this program and charge is not applicable to that membership). method may vary by market and is available upon request. Pre-certification of coverage for appropriate setting of care/service for certain medical 30.00% of shared oncology drugs(redirection may be to Accredo, a CHLIC affiliate). savings(where savings is derived from the difference between drug dose cost at higher cost provider initially requested and drug dose cost at lower cost provider). Fee shall not exceed S5,000.00 per dose for a maximum of three doses resulting in a maximum total of S15,000.00. Note: 06/28/2023 42 Administrative Services Only Agreement for City of Miami Beach CHLIC may retain a portion of the shared savings fee before reimbursing eviCore. Pre-certification of coverage of sleep management services. (If Employer has elected Basic S0.11 PMPM Standard Medical Management(see Administration Charges section above) this program and charge is not applicable to that membership). Network management and care coordination of coverage of home health, durable medical S0.31 PMPM equipment and home infusion services. CHLIC may revise charges/fees by giving Employer at least sixty (60)days' prior written ii �y�n�oatti�ce. ,}'� w rv• ti .p 'Z \3�".C\. R'K .`tip , , �` 4c �$.`Srq ''"��`"``'t ;.,.:�.a<:�<��..i��a',��a �'��, ..::.,. , .. =,. R=T ;t . Ip:�"UI�.S:�TIi�.�'I<IV�+..R�FV.�W-T+Ls'L+S' .,..`w..��..�a�' s�^�c`1��,.<r When a Member elects an External Review(as that term is defined in the Patient Protection S500-S1,500 Per and Affordable Care Act(PPACA))of a benefit determination by an independent third party, Review the cost of a specific third party review is dependent on the nature and complexity of the issue on appeal. Third party review charges will be commensurate with the level of expertise necessary and the time required to complete the review. 4s. .t�Fl �'' _-.�t T.5*:�a ,3 i a;ga " `,�Cti v`-tip -te.- t ,zit'^`. 't v `Y v` \l.' ".-Y �•.4-.a`.`:'.. > _�i"",a>� _,,._.. .44 .+e�..,+aG-a,'z'.. ,`1\vim-x.`,'.�. _�- ' { a._. ?Gi,.a. >.,,: �+�,( .��. ��,..' CHLIC contracts directly or indirectly with other managed care entities and third party All Medical Products network vendors for access to their provider networks and discounts. These third parties charge a network access fee,which is included in CHLIC's monthly charges, as a result of the application of their discounts. Additional details regarding specific charges will be provided upon request. • "t, - ;.x`�iHc�' ..."x $ bsS4tQ'.. _.._ ..v.4s•-"v� �h; ...84'v a c. i`i. •`. ..• .WiRS0`.r.— %. °.R39�k:�• e �,>>�+..w�li• e :a''':'..,. °,. .•,3�..i'ti, The fixed per person per period and/or fee-for-service charges that CHLIC has directly or All Products indirectly negotiated with Participating Providers for in-network health care services and/or supplies will be charged to the Bank Account and will be used in calculating any applicable Member cost-sharing. In addition, performance-based payments to Participating Providers will be charged to the Bank Account. Such payments will be at the payment rates then in effect, which may be amended from time to time. 06/28/2023 43 Administrative Services Only Agreement for City of Miami Beach For certain types of specialty care, including, but not limited to, home health care,durable medical equipment,sleep management, high tech radiology, chiropractic care, acupuncture, physical medicine(such as physical and occupational therapy), speech therapy,orthotics and prosthetics,implants,and hearing,in certain markets CHLIC may contract with various third parties and/or affiliated companies, including eviCore, ("Specialty Vendors") to arrange for the provision of care through their own networks of health care providers on a fee-for-service basis. In addition to arranging for care through their own networks of providers,these Specialty Vendors may also provide additional services, including utilization management services and case management services designed to(i)improve adherence to coverage guidelines;and(ii)contain overall healthcare costs to the Plan. Specialty Vendors are included within the definition of"Participating Provider"set forth in this Agreement and in any benefit booklet covering the Plan. When care is arranged through a Specialty Vendor's network of providers, the form of reimbursement to the Specialty Vendor will be through one of the following methods: • Fee-For-Service Payment: In certain instances, the Plan will pay the Specialty Vendor rather than the treating provider on a fee-for-service basis as a claim for Plan Benefits. The Specialty Vendors' fee-for-service charges may be higher than the amounts that the Specialty Vendor contracts to pay the provider for the provision of any particular service or supply,and some portion of the Specialty Vendor's charges may be attributable to the services that the Specialty Vendor provides in addition to those services or supplies provided by the Specialty Vendor's network of providers, including any utilization management services and case management services.In such instances, Plan Benefits and member cost-share will be determined based on the Specialty Vendor's charges according to Plan terms. • Administration Capitation Payment: In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis for arranging care and other services that the Specialty Vendor may render. Such reimbursement will be in addition to the amount that the Plan pays to reimburse the provider through which the Specialty Vendor arranged for the provision of the service or supply, which will be based on the Specialty Vendor's contracted rate with that provider. In such instances,Plan Benefits and member cost-share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. 06/28/2023 44 Administrative Services Only Agreement for City of Miami Beach • All-Inclusive Capitation Payment: In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis that covers (i) the services that the Specialty Vendor may render, including arranging care, and(ii)the fees charged by the provider through which the Specialty Vendor arranged for the provision of the service or supply.In such instances,Plan Benefits and member cost-share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. CHLIC's arrangements with Specialty Vendors are subject to change at any time, and upon request,additional information can be provided that identifies current Specialty Vendors,their area of specialty(ies), whether they are CHLIC affiliates, and the form of payment that they currently receive. Notwithstanding the terms of the Plan,CHLIC shall not administer Member cost-sharing with All Products respect to charges made by Cricket Health,Inc.for its personalized,evidence-based approach (excluding HSA to managing chronic kidney disease and end-stage renal disease for clinically eligible Products) Members in CA and such cost-sharing expenses shall,instead,be reimbursed by the Plan(not applicable if Employer has o ted out). Rebate and Other CHLIC or its affiliates may contract with pharmaceutical manufacturers or other third parties All Pharmacy Remuneration for Rebates, Manufacturer Administrative Fees, and other remuneration on its or their own Products Disclosure(Pharmacy) behalf and for its and their own benefit, and not on behalf of Employer or the Plan. Accordingly,unless otherwise specified in this Schedule of Financial Charges, CHLIC and its affiliates retain all right, title and interest to any and all actual Rebates, Manufacturer Administrative Fees. and other remuneration received from manufacturers or other third parties; neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in any such remuneration, which shall be considered part of the general assets of CHLIC and its affiliates. As an example of the remuneration other than Rebates or Manufacturer Administrative Fees that CHLIC or its affiliates may earn, CHLIC or its affiliates may also directly or indirectly earn from pharmaceutical manufacturers remuneration in connection with value payments and/or services that CHLIC provides to Employer ("Value-Based Payments"). Notwithstanding anything in this Agreement to the contrary,any Value-Based Payments earned by CHLIC or its affiliates are separate and apart from any Rebates or Manufacturer Administrative Fees that CHLIC or its affiliates directly or_ 06/28/2023 45 Administrative Services Only Agreement for City of Miami Beach indirectly earn from pharmaceutical manufacturers, and CHLIC and its affiliates may retain any Value-Based Payments it earns. As examples of the value payments and/or services that CHLIC may provide to Employer in connection with Value-Based Payments that CHLIC or its affiliates may earn,CHLIC may provide care management or related services to Employer and/or remit to Employer monetary credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services, and/or monetary credits or other financial value, for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions, including the products for which monetary credits or other financial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHLIC to Employer are subject to change or termination by CHLIC as the value program(s), if any, offered by CHLIC change(s) or terminate(s). Information on the projected aggregate amount of such Rebates with respect to the Plan Pharmacy Benefit will be provided upon request. This provision shall survive termination or expiration of the Agreement. Rebate and Other CHLIC may directly or indirectly receive and retain payments under contracts with All Medical Products Remuneration pharmaceutical manufacturers or third parties with respect to Members' utilization of the Disclosure(Medical) manufacturer's products covered under the Employer's Plan medical benefit. These payments may include rebates, service fees (e.g. administrative fees), or other remuneration. CHLIC directly or indirectly contracts with pharmaceutical manufacturers or other third parties for any remuneration on its own behalf, based on its book of business, and for its own benefit, and not on behalf of Employer or the Plan. Accordingly, CHLIC retains all right, title and interest to any and all such remuneration received from manufacturer;neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in any such remuneration, which shall he considered part of the general assets of CHLIC. This provision shall survive termination or expiration of the Agreement. implementation/Referral From time to time,CHLIC,directly or through its affiliates, arranges with third parries(e.g., All Products Fee Disclosure service vendors, provider network managers)to provide various services(e.g., cost- containment services or health care services) in connection with the Plan. CHLIC and its affiliates may receive payments from such third parties to help defray CHLIC's expenses associated with its implementation and/or ongoing administration of these arrangements or as 06/28/2023 46 Administrative Services Only Agreement for City of Miami Beach a reimbursement for services or network access provided to such parties by CHLIC. CHLIC may also receive compensation from third-party vendors that Employer may retain based upon a referral from CHLIC or that Members may utilize following an introduction facilitated by CHLIC or an affiliate. CHLIC may also receive: • network administration fees from some providers participating in its provider network, • credits from banks on balances in accounts utilized to administer claims, • non-material incidental compensation/benefits from other source as a result of administering the Plan. i i-t'v tag°4'. a"k .`4.. �.�e �..'� .t.'Ic;: 4OVW zUXM*Y _. M a.,3 y ,c YY�Z 'r'''' x ,t._. ... ,air. �..>�...,. v. .ax;. CHLIC shall provide the following services to assist Employer in meeting its compliance obligations under section 2715 of the Public Health Service Act as added by the Patient Protection and Affordable Care Act and applicable regulations with respect to the provision of the Summary of Benefits and Coverage("SBC"),translation notice and glossary. Applicable to all medical plans including HRA and FSA which are considered "group health plans" subject to the SBC requirements. 1. Preparation of SBC, translation notice. CHLIC will not be responsible for any changes that No charge Employer makes to the SBC. 2. Provide SBC, translation notices prepared by CHLIC to Employer electronically as well as No charge any updates or material modifications. 3. Include in SBC a summary of benefits administered by carve-out vendor if Employer or S500 for each benefit carve-out vendor provides CHLIC with necessary carve-out benefit information at least option under the Plan twelve(12) weeks prior to the date the SBCs are to be delivered to Employer. for which carve-out vendor benefits are included in SBC `a�.�'�: Ada, .H .`.'^.z'v.-ira4 ...,..:. . Service Description Charge Third Party Individual CHLIC will provide its standard individual stop loss third party reporting package only after For OAPIN Stop Loss Interface Fee the stop loss carrier and Employer have executed CHLIC's standard hold harmless/confidentiality agreement. CHLIC's standard individual stop loss reporting package and OAP Products: 06/28/2023 47 Administrative Services Only Agreement for City of Miami Beach is based on paid claim data only(documentation and information,including but not limited to, incurred-but-not-paid claims, projected claims, pre-certifications of coverage, case S0.69/employee/month management records and notes, course of treatment or prognosis, and internal audits will not be provided). Employer should be aware that third party stop loss coverage may result in a difference of reimbursable claims under the stop loss carrier's policy versus payable covered services under the medical benefit plan. Behavioral Health Access to inpatient and outpatient behavioral health services and focused utilization review For OAPIN and case management for both inpatient and outpatient,in-network behavioral health services. When applicable,only to Members in CA/VI. and OAP Products: Included in Medical Access Fee Pharmacy Clinical inMvnd- is a clinically-based Member and provider comprehensive behavioral health Included at No Program(s) program that includes regular retrospective review of pharmacy and medical claim data to Additional Cost identify certain "at risk" (i.e., members with complex psychiatric conditions using multiple psychotropic medications) member utilization patterns to help both members and providers better recognize,treat and support mental and behavioral health conditions. Narcotics Therapy Management- is a clinically-based provider program that consists of a quarterly, retrospective review of pharmacy and medical claims data which helps to identify those individuals with utilization patterns that may be indicative of risk of substance abuse, overdose, or diversion. Pharmacy Utilization Essential Package - a utilization management program under which some pharmaceutical Included in Pharmacy Management Program products are subject to one or several coverage limitations,including prior authorization, step Administration Fee therapy and/or quantity limits. Under a prior authorization requirement, the requested drug is generally reviewed for clinical appropriateness based on the intended use in therapy. Under a step therapy requirement,the Member generally must try one or more preferred products, or demonstrate why trying the preferred product(s)would be clinically inappropriate, in order to obtain coverage for the requested drug. Clinical Program A targeted condition medication therapy management program in which CHLIC provides Included at No support for Members using specialty medications for certain chronic conditions and that are Additional Cost obtained or administered at retail pharmacies or outpatient, office or home health care settings. As part of the program, Members are counseled on their condition, medication side effects,and importance of adherence. For the sake of clarity,if a specialty pharmacy affiliate 06/28/2023 48 Administrative Services Only Agreement for City of Miami Beach of CHLIC provides therapy management for specialty medications the pharmacy dispenses to Members,then it does so in its capacity as a specialty pharmacy and not on behalf of CHLIC; CHLIC does not exert direction or control over the pharmacists at any specialty pharmacy affiliate. SafeGuardRx Program A medication therapy management and cost containment program for select therapeutic Included at No conditions such as but not limited to oncology, inflammatory conditions, and multiple Additional Cost sclerosis and select drugs within therapeutic categories. This program seeks to help reduce drug therapy costs through its program offerings. For example,employers may qualify for the payment of discontinuation drug therapy credits and/or the reimbursement of drug therapy through drug cost caps, on select medications and therapeutic conditions. This program may also provide for Member outreach or counseling on select medications. CHLIC reserves the right to revise,modify,or terminate this program,in whole or in part, at any time. Additional and specific program information is available upon request. Your Health First A proactive health education and improvement program for Members with a chronic For OAPLN condition. The program involves services that span across the Member's health needs. Behavioral coaching principles and evidence based medicine guidelines are utilized to and OAP Products: optimize self-management skills and foster sustained health improvements. Included in Medical Access Fee The program targets a chronic population at high risk for near term and future high cost medical expenses.Members are identified as having a chronic condition through a variety of sources which may include: claims data, referrals, and self-identification. A variety of resources is provided to those with a chronic condition, including access to online tools, personalized support, and targeted materials. The program includes the following components for those with a chronic condition: • Chronic condition-specific coaching • Pre-and post-discharge calls • Lifestyle management coaching: stress, weight management and tobacco cessation • Treatment decision support and coaching Transparency in CHLIC will make available an internet-based self-service tool for use by Members, as well as Included in Medical Coverage and certain data in machine-readable file format on apublic website, as required under the Administration Fee 06/28/2023 49 Administrative Services Only Agreement for City of Miami Beach Consolidated Transparency in Coverage rule.Members can access the cost estimator tool on myCigna.com. Appropriations Act, Updated machine-readable files can be found on Cigna.com and/or CignaForEmployers.com 2021 on a monthly basis. Pursuant to Consolidated Appropriations Act(CAA),Section 106,CHLIC will submit certain air ambulance claim information to the Department of Health and Human Services(HHS) in accordance with guidance issued by HI-IS. Subject to change based on government guidance for CAA Section 204, CHLIC will submit certain prescription drug and health care spending information to HHS through Plan Lists Files(P1-P3)and Data Files(D1-D8)(Dl-D2 for employers without integrated pharmacy product) aggregated at the Market Segment and State level, as outlined in guidance. Employer Fund(s) CHLIC shall establish the following fund(s)to assist the Employer in defraying certain Plan- related expenses.If CHLIC performs a service to be reimbursed by the fund, the fund amount shall be credited during the following settlement.If an external vendor provides the service to be reimbursed by the fund,an invoice from the vendor is required prior to application of fund amounts by CHLIC. Any fund shall be extinguished upon notice of termination of the Agreement and any fund amount not used prior to the notice of termination of the Agreement shall only be available to Employer for the purpose of funding the cost of those reimbursable services provided prior to such notice of termination. Innovation Fund CHLIC shall make available to Employer the designated amount to be used by Employer to: Included at No defray its non-standard expenses associated with innovation of a new Plan or program subject Additional Charge to the following terms: Fund amount: S100,000.00 Fund effective date: October 1, 2023 Fund will remain in effect until: September 30, 2024 Unused amounts will carry over and be available for use until: September 30, 2024 06/28/2023 50 Administrative Services Only Agreement for City of Miami Beach Health Improvement Fund Health Improvement ' For clinical/wellness/behavioral programs offered by CHLIC:hat are purchases, CHLIC Fund establish a Health Improvement Fund in the amount of S100,000.00.This fund will be used to defray the cost of CHLIC designated and arranged health and wellness improvement programs(e.g. biometric screenings, flu shots) for Employees of Employer and to reward participation in these programs. The Health Improvement Fund is a one-time credit to be used from October 1, 2023- September 30, 2024. Unused funds cannot be rolled over and CHLIC must pre-approve use of the Health Improvement Fund. The Health Improvement Fund shall be extinguished upon notice of termination of the Agreement and any fund amount not used prior to the notice of termination of the Agreement shall only be available to Employer for the purpose of funding the cost of those reimbursable services provided prior to such notice of termination. 06/28/2023 5 I Administrative Services Only Agreement for City of Miami Beach Exhibit A- Plan Booklet A"Plan Booklet"that describes the Plan Benefits and Members'rights and responsibilities under the Plan will be provided by Employer to CHLIC for its use in administering the Plan including denials and appeals of denials of claims for Plan Benefits. If Employer has not provided CHLIC with a copy of its finalized Plan Booklet by the time the Agreement is effective, CHLIC will administer the Plan in accordance with the Plan Benefits described in the Plan Booklet draft provided by CHLIC to Employer and Section 2 of the Agreement.CHLIC will continue to administer the Plan in this manner until CHLIC receives the finalized Plan Booklet and follows CHLICs preparation and review process. After that time CHLIC will administer the Plan in accordance with Plan Benefits described in the finalized Plan Booklet and Section 2 of the Agreement. • 06/28/2023 52 Administrative Services Only Agreement for City of Miami Beach Exhibit B —Services t a nta'`�.'*; '`t,`°. �*, .�..Y":t. .. , ,. :�:,.N Excluding Health Savings Account Furnishing CHLIC's standard Bank Account activity data reports to Employer as and when agreed All Products upon.CHLIC's administration of the Plan does not include performing obligations, if any, under state escheat or unclaimed property laws. It is Employer's responsibility to determine the extent to which these laws may apply to the Plan and to comply with such laws. If Employer has elected,pursuant to section 63 of the New York Health Care Reform Act of 1996 All Medical and (section 2807-t of the Public Health Law)("the Act"), to pay the assessment on covered lives set Pharmacy Products forth in section 63 and has consented to the conditions set forth in section 63, CHLIC shall file such forms and pay such surcharge and assessment on covered lives on behalf of Employer through the Bank Account to the extent set forth in section 63. Such obligation shall end immediately upon Employer's failure to provide any information required by CHLIC to fulfill this obligation,the failure to comply with any requirement imposed upon Employer pursuant to the Act or the failure of Employer to sufficiently fund the Bank Account. In addition,where permitted and agreed to by CHLIC, CHLIC will file applicable forms and pay on behalf of Employer and/or the Plan any assessment, surcharge, tax or other similar charge which is required to be made by Employer and/or the Plan based on covered lives and/or paid claims or otherwise in accordance with and as required by other applicable state and/or federal laws and regulations and the Bank Account will be charged for any such payments made by CHLIC. CHLIC's obligation to pay on behalf of Employer may end immediately upon Employer's failure to sufficiently fund the Bank Account. CLAIIVI ADMI�TIS TION Excluding Health Savings Account Calculate benefits, check and/or electronic payments disbursed from the Bank Account. Bank All Products Account payments will appear in Employer's standard Bank Account activity data reports. CHLIC's generic claim forms are made available to Employer and eligible individuals. All Products CHLIC's Special Investigations Unit will investigate,pend,recommend denial of claims in whole All Products or in part,and/or reprocess claims,as appropriate. Discuss claims, when appropriate,withproviders of health services. All Products Perform,based on CHLIC's book of business internal audits of plan benefit payments on a random All Products 06/28/2023 53 Administrative Services Only Agreement for City of Miami Beach sample basis. Claim control procedures reported annually in Statement on Standards for Attestation All Products Engagements(SSAE)No. 18 Report(or any applicable successor thereto). Respond to Insurance Department complaints. All Products Designated toll-free telephone line for Member and Provider calls to CHLIC Service Centers. All Products Member Explanation of Benefit("EOB")statements including, when applicable, notice of denied All Products(excluding claims, denial reason(s)and appeal rights. Pharmacy) Verify enrollment and eligibility using Member information submitted by Employer and/or its All Products authorized agent. Medical Only CHLIC's generic enrollment form is made available to Employer and eligible individuals. All Medical Products CHLIC's standard ID card with toll-free telephone number are prepared for Members. All Medical Products Administration of subrogation/conditional Claim Payment(terms described in Exhibit E). All Medical Products Prepare and make accessible Member benefit booklet drafts to Employer. All Products 5500 Schedule C reporting. All Products 5500 Schedule A or Annual Reconciliation Disclosure reporting(when applicable) All Products CHLIC's standard Underwriting services: a)benefit design analysis b) projected cost analysis. All Products HIPA ;INIVIVIIMiALR GH .r.,. , ,. a, • Handling of requests from Members for access to, amendment and accounting of protected health All Products information,and requests for restrictions and alternative communications as required under federal HIPAA law and regulations, as set out in this Agreement and its Exhibits. Maximum reimbursable charge determinations of non-Participating Provider charges for covered All Medical Products services. (with out-of-network benefits) CHLIC's standard cost containment controls: Application of non-duplication and coordination of All Medical Products benefits rules and coordination with Medicare. 06/28/2023 54 Administrative Services Only Agreement for City of Miami Beach Delivery of information, as necessary, regarding standard application of non-duplication or All Medical Products coordination of benefits. Review of medical bills in accordance with CHLIC's then current Medical Bill Review program. All Medical Products Medical Cost Containment, as described in the Schedule of Financial Charges. All Medical Products Annual reporting of CHLIC's standard cost containment results upon Employer's request. All Medical Products Pharmacy Cost Containment, as described in the Schedule of Financial Charges. All Pharmacy Products : VdAq Summary reports of medical and pharmacy cost and utilization experience (where applicable), All Medical and upon completion of internal report generation, are available through Cigna's web site, Pharmacy Products CignaforEmployers.com. CHLIC's standard pharmacy utilization reports. Pharmacy Product Only Claim Reporting: CHLIC will provide standard banking and financial report information based All Medical and upon paid claim data CHLIC will not provide information on incurred-but-not reported claims, Pharmacy Products projected claims,pre-certifications of coverage,case management information or information on a Member's prognosis or course of treatment. Individual Stop Loss Reporting is an optional service provided at an additional fee to employers All Medical Products who have individual stop loss through another entity other than CHLIC. CI-ILIC will provide its standard Individual stop loss reporting package,which includes banking and financial information based upon paid claims data,only after the stop loss carrier and Employer have executed CHLIC's standard Hold Harmless/Confidentiality Agreement. Aggregate Stop Loss Reporting is not included as part of the standard reporting package and is not provided. CHLIC will not provide documentation and information, including but not limited to, incurred-but-not-paid claims, projected claims, pre-certifications of coverage, case management records and notes, course of treatment or prognosis, and internal audits. CHLIC does not allow stop loss carriers to audit CHLIC's claims administration under the medical benefit plan, however, the Employer's audit rights are set forth in the Agreement. For the sake of clarity, as it is possible that certain information,documentation, data and/or reports that are required by the stop loss carrier prior to reimbursement under Employer's stop loss policy will not be available for stop loss policy administration,Employer is responsible for verifying any such required information with its stop 06/28/2023 55 Administrative Services Only Agreement for City of Miami Beach loss carrier. MEMBER EXTERNAL REVIEW PROGRAM CHLIC contracts with a minimum of three (3) independent review organizations that meet the All Medical Products Patient Protection and Affordable Care Act (PPACA) external review requirements. Members may appeal eligible claims requiring medical judgment to an external independent review organization which is selected by CHLIC on a random basis. If Employer has chosen not to participate in this program, the Employer may be responsible for making other arrangements to meet the Patient Protection and Affordable Care Act(PPACA)external review requirements. MEDICAL MANAGEMENT SERVIC `: CHLIC provides integrated medical management that includes(depending upon the terms of the Plan) the following core services. Pre-Admission Certification and Continued Stay Review(PAC/CSR) services to certify coverage All Medical Products of acute and sub-acute inpatient admissions/stays or provides guidance to appropriate alternative settings. Administered in accordance with CHLIC's then applicable medical management and claims administration policies, practices and procedures. Case Management, a service designed to provide assistance to a Member who is at risk of All Medical Products developing medical complexities or for whom a health incident has precipitated a need for rehabilitation or additional health care support. Assist providers with resources and tools to enable them to develop long term treatment plans in All Medical Products the management of chronic or catastrophic cases. The Cigna HealthCare Healthy Babies Program is an educational program which provides Member All Medical Products with prenatal care education and resources to help them better manage.their pregnancy. Other benefits of this program include the Health Information Line, high risk maternity and pregnancy information on myCigna.com. HealthCare Cost and Quality tools available on myCigna.com and myCigna mobile app. All Medical Products A panel of physicians and other clinicians to assess the safety and effectiveness of new and All Medical Products emerging medical technologies. The panel meets monthly to review and update coverage policies. Health Information Line is a service that provides twenty-four(24)hour toll free access to nurses All Medical Products who provide convenient and confidential services. Health Information Line nurses can help guide Members in finding the right care, make informed decisions about symptom-based health issues the Member is experiencing when they call the Health Information Line and recommend appropriate settings for care. Health Information Line nurses can help inform and educate 06/28/2023 56 Administrative Services Only Agreement for City of Miami Beach Members about a wide variety of health and medical information, including access to a library of English and Spanish podcasts. Cigna LifeSOURCE Transplant Networka contracts with more than one hundred seventy(170) All Medical Products independent transplant facilities which includes over eight hundred (800)transplant programs and provides access to solid organ and bone marrow/stem cell transplantation while improving cost containment and reducing financial risk. A health education program that delivers mailings to Members with certain conditions. All Medical Products Behavioral health services are provided/arranged by a CHLIC affiliate (details available upon OAPIN request), including utilization review and case management for both inpatient and outpatient, in- network behavioral health services. and OAP Products: (All Members) Implement a quality oversight process that includes monitoring of utilization management All Medical Products performance measurements and a continuous quality improvement process when warranted. Transition of care services to allow Members with defined conditions to continue treatment with All Medical Products non-Participating Providers after enrollment for continued uninterrupted care for a limited time. Except Comprehensive and Indemnity Focused utilization management of outpatient procedures and identification of appropriate All Medical Products alternatives. Administered in accordance with CHLIC's then applicable medical management and with Care Management claims administration policies, practices and procedures. Preferred CHLIC, and/or its affiliates or contracted vendors shall: Provide or arrange access to the applicable network of Participating Providers to furnish health All Medical and care services/products to Members at negotiated rates and methods of reimbursement(e.g. fee-for Pharmacy Products service, fixed per person per period, per diem charges, incentive bonuses, case rates, withholds etc.). The amount and type of negotiated reimbursement may vary depending upon the type of plan. For example, a hospital may accept less for patients enrolled in certain types of plans than others. In addition, CHLIC may contract with Participating Providers and other parties (for example Independent Practice Associations)for performance-based incentive payments to promote quality of care, patient safety and cost efficiency. 06/28/2023 57 Administrative Services Only Agreement for City of Miami Beach Credential and re-credential Participating Providers in accordance with CHLIC's credentialing All Medical and requirements and ensure that third-party network vendors credential/re-credential Participating Pharmacy Products Providers in accordance with CHLIC's requirements; Monitor Participating Provider compliance with protocols and procedures for quality, Member All Medical and satisfaction, and grievance resolution; Pharmacy Products Facilitate the identification of Participating Providers by Members;and All Medical and Pharmacy Products Designated toll-free telephone line for Member and Provider calls to CHLIC Service Centers, All Medical and Pharmacy Products Access to online and/or on demand medical and health-related consultations via secure All Medical Products telecommunications technologies, telephones and internet are permitted and may include MDLIVE, a CHLIC affiliate(see details on myCigna.com). MPi j ' W ';` CHLIC has contracted with an affiliate(details available upon request)to provide or arrange for These services are the provision of managed in-network behavioral health services, the affiliate is a Participating included in the following Provider, and is reimbursed primarily on a monthly fixed fee basis This fixed fee for behavioral products: health services will be paid as claims and will appear in Employer's monthly reporting and on OAPLN financial documents. Such payments will be at the relevant monthly rates then in effect. The monthly rates paid to the affiliate vary depending on geographic location of Members and on and OAP Products benefit design,and may be subject to change. The rates will be made available upon request. The fixed fee also includes applicable lifestyle management programs and a cognitive behavioral modification program. Behavioral claims from a client specific network are not included in the behavioral monthly fixed fee and will be paid from the Bank Account. In some states,payment for behavioral health services must be paid on a fee-for-service basis. In these states,fee-for-service payments for behavioral health services and the behavioral health administrative fee(including the applicable lifestyle management programs and a cognitive behavioral modification program) will be paid from the Bank Account as claims and will appear in Employer's monthly reporting. 06/28/2023 58 Administrative Services Only Agreement for City of Miami Beach The Cigna HealthCare of Arizona, Inc. staff model Evernorth Care Group (formerly known as All Medical Products Cigna Medical Group or "CMG") is a multispecialty participating provider group located in metropolitan Phoenix, Arizona. Evernorth Care Group's integrated care delivery model and population health management team work together to facilitate the way in which patients and doctors communicate and interact in order to increase patient satisfaction and improve health outcomes. Plan Participants may at some time receive treatment from an Evernorth Care Group facility or provider even if they do not reside in Arizona(as when traveling). Plan Participants utilizing Cigna participating provider networks in Arizona may access certain specialty and/or ancillary services(such as imaging and urgent care services)through the Evernorth Care Group system. For covered services provided to Participants,Evernorth Care Group is paid at the rates in effect at the time of service (as may be revised from time to time). Representative rates for routinely performed services are attached to the Schedule of Financial Charges herein. A complete copy of the rates is available on request under a mutually agreed nondisclosure agreement("NDA"). If the Plan requires or allows Participants to select a primary care provider("PCP"), Phoenix area Participants who do not select a PCP during open enrollment may be assigned to or otherwise encouraged to consider an Evernorth Care Group PCP. Evernorth Care Group has established collaborative referral relationships with specialty and ancillary providers in Cigna's affiliate and participating provider networks. Evernorth Care Group may also receive applicable performance-based incentive payments for its participation in programs designed to improve quality, patient safety and affordability. The incentive payments that Evernorth Care Group may receive will be determined using the same performance measures and reward formula as used in determining the incentive payments made to similarly situated non-Cigna affiliated provider entities. The amount of the incentive payments made to Evernorth Care Group and attributable to the plan will be provided upon request. O6/28/2023 59 Administrative Services Only Agreement for City of Miami Reach CIGNA HEALTHCARE OF ARIZONA- EVERNORTH CARE GROUP REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES EFFECTIVE JANUARY 1,2020 Ap licable to Open Access Plus Products) Department CPT Description Rate Code* All Departments 99213 OFFICE VISIT,EST EXP PROB FOC $73.81 Adult Medicine 99396 WELL EXAM, EST,40-64 YEARS $126.72 Pediatrics 99392 WELL EXAM, EST, 1-4 YEARS $106.46 Ophthalmology 66984 REMOVE CATARACT, INSERT LENS- $641.43 Professional Fee only,at a facility Podiatry 11721 DEBRIDEMENT NAIL SIX OR MORE $45.51 Radiology 71046 CHEST X-RAY PA & I,A"I' $31.28 Radiology 77067& SCREENING MAMMOGRAPHY DIGITAL $189.64 77063 General Surgery 47562 LAPAROSCOPY;CHOLECYSTECTOMY- $666.13 Professional Fee only, at a facility Optometry 92014 EYE EXAM&TREATMENT $126.12 ASC (Ambulatory surgical Grouper 2 $469.00 center)/Endoscopy Suite ASC Endoscopy Suite Grouper 8 $1,104.00 *Medicare does not assign(or may not yet have assigned)relative value units(RI/Us)for certain service codes. Codes not valued by Medicare are referred to as "gap codes."For example, Medicare does not assign values for wellness service codes (99381-99397). Evernorth Care Group refers to The Essential XARVS(Annual)guide to obtain relative values for such gap codes for billing purposes. Typically, Cigna pays Evernorth Care Group for gap codes not valued by Medicare either at the discounted fee schedule referenced above or, for new codes not yet valued by Medicare, at the same rate it pays its other participating providers. The Urgent Care case rate excluding radiology and laboratory services is$135. 06/28/2023 60 Administrative Services Only Agreement for City of Miami Beach Exhibit C—Audit Agreement (Sample) A. WHEREAS, Cigna Health and Life Insurance Company ("CHLIC") desires to cooperate with requests by (" Employer") to permit an audit for the purposes set forth below and subject to Section 6 of the Administrative Services Only Agreement between CHLIC and Employer; B. WHEREAS, ("Auditor") has been retained by Employer for the purpose of performing an audit("Audit")of claims administered by CHLIC;and C. WHEREAS, the Auditor and the Employer recognize CHLICs legitimate interests in maintaining the confidentiality of its information, protecting its business reputation, avoiding unnecessary disruption of its claim and customer service administration,and protecting itself from legal liability; NOW THEREFORE, IN CONSIDERATION of the premises and the mutual promises contained herein, CHLIC,the Employer and the Auditor hereby agree as follows: I. Audit Specifications The Auditor will specify to CHLIC in writing at least forty-five (45) days prior to the commencement of the Audit the following"Audit Specifications": a. the name,title and professional qualifications of individual Auditors; b. the Audit objectives; c. the scope of the Audit(time period, lines of coverage and number of claims/calls); d. the process by which the sample will be selected for audit; e. the records/information required by the Auditor for purposes of the Audit;and f. the length of time contemplated as necessary to complete the Audit. 2. Review of Specifications CHLIC will have the right to review the Audit Specifications and to require any changes in,or conditions on, the Audit Specifications which are necessary to protect CHLIC's legal and business interests identified in paragraph C above. 3. Access to Information CHLIC will make the records/information called for in the Audit Specifications available to the Auditor at a mutually acceptable time and place. 4. Audit Report The Auditor will provide CHLIC with a true copy of the Audit's findings, as well as the Audit Report,if any,that is submitted to the Employer.Such copies will be provided to CHLIC at the same time that the Audit findings and the Audit Report are submitted to the Employer. 06/28/2023 61 Administrative Services Only Agreement for City of Miami Beach S. Comment on Audit Report CHLIC reserves the right to provide the Auditor and the Employer with its comments on the findings and, if applicable,the Audit Report. 6. Confidentiality The Auditor understands that CHLIC is permitting the Auditor to review the records/information solely for purposes of the Audit. Accordingly,the Auditor will ensure that all information pertaining to individual claimants will be kept confidential in accordance with all applicable laws and/or regulations. Without limiting the generality of the foregoing,the Auditor specifically agrees to adhere to the following conditions: a. The Auditor shall not copy,print,photograph or otherwise duplicate or remove any of the Information without the express written consent of CIILIC; b. The Auditor shall not record any virtual session that includes Protected Health Information as defined in the I lealth Insurance Portability and Accountability Act of 1996 ("HIPAA");and e. The Auditor shall not take any screenshots during any virtual session. 7. Restricted Use of the Audit Information With respect to persons other than the Employer, the Auditor will hold and treat information obtained from CHLIC during the Audit with the same degree and standard of confidentiality owed by the Auditor to its clients in accordance with all applicable legal and professional standards.The Auditor shall not,without the express written consent of CHLIC executed by an officer of CHLIC, disclose in any manner whatsoever, the results, conclusions, reports or information of whatever nature which it acquires or prepares in connection with the Audit to any party other than the Employer except as required by applicable law.The Employer and Auditor agree to indemnify and to hold harmless CHLIC for any and all claims,costs,expenses and damages which may result from any breaches of the Auditor's obligations under paragraphs 6 and 7 of this Agreement or from CHLIC's provision of information to the Auditor. The Employer authorizes CIILIC to provide to the designated Auditor the necessary information to perform the audit in a manner consistent with all Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Privacy Standards and in compliance with the signed Business Associate Agreement("BAA"). 8. Termination CHLIC may terminate this Agreement with prior written notice. The obligations set forth in Sections 4 through 7 shall survive termination of this Agreement. 06/28/2023 62 Administrative Services Only Agreement for City of Miami Beach Cigna Health and Life Insurance Company By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Employer: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Auditor: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: 06/28/2023 63 Administrative Services Only Agreement for City of Miami Beach Exhibit Cl —Clinical Audit Agreement (Sample) A. WHEREAS, Cigna Health and Life Insurance Company ("CHLIC") desires to cooperate with a request by ("Employer") to permit a clinical audit for the purposes set forth below and subject to Section 6 of the Administrative Services Only Agreement between CHLIC and Employer; B. WHEREAS, ("Auditor") has been retained by Employer for the purpose of performing an audit("Audit")of clinical services administered by CHLIC,; C. WHEREAS, in the course of conducting the Audit, Auditor will come into possession of certain confidential and proprietary information relating to individuals who are recipients of CI-ILIC's services, medical providers who provide health services, and trade secrets of CHLIC (the "Information");and D. WHEREAS, the Auditor and the Employer recognize CHLIC's legitimate interests in maintaining the confidentiality of its Information, protecting its business reputation, avoiding unnecessary disruption of its service administration, and protecting itself from legal liability; NOW THEREFORE, IN CONSIDERATION of the premises and the mutual promises contained herein, CHLIC,the Employer and the Auditor hereby agree as follows: 1. Audit Specifications The Auditor will specify to CHLIC in writing at least ninety (90) days prior to the commencement of the Audit the following"Audit Specifications": a. the name,title and professional qualifications of individual Auditors; b. the date(s), the length of time contemplated as necessary to complete the Audit, and clinical operations location, if any to be audited; or, if the Audit is to be performed virtually, the Internet Protocol (IP) address and physical location from the individual auditors will remotely access the records/information required for the purposes of the Audit; c. the Audit period; d. the Audit objectives; e. the scope of the Audit(time period, diagnosis, enrollee participation in programs and number of claims/calls); i. Standard number of cases/calls is as follows; Number of Subscribers #Cases #Calls #Days* 5,000& under 10 3 >5,000&<25,000 I5 4 06/28/2023 64 Administrative Services Only Agreement for City of Miami Bench >25,000& <75,000 20 5 1.5 >75,000 25 6 2 *'!Takes into consideration length of time to complete the standard N cases and calls based on an one(I)year lookback scope period. f. the process by which cases and calls will be selected for audit;and g. the records/information required by the Auditor for purposes of the Audit. 2. Review of Specifications CHLIC will have the right to review the Audit Specifications and to require any changes in, or conditions on, the Audit Specifications which are necessary to protect CHL.IC's legal and business interests identified in paragraph D above.Any additional costs incurred by CHLIC to accommodate unusual audit specifications will be reimbursed as mutually agreed upon by the parties. 3. Access to Information For onsite Audits, CIILIC will make the information called for in the Audit Specifications available to the Auditor at a mutually acceptable time and place. For virtual audits performed from a remote access point, CHLIC will make the Information called for in the Audit Specifications available to Auditor at a mutual acceptable time via connection to a secure service. Access is subject to CHLIC's verification that each individual auditor meets and complies with CFILIC's remote access standards and other security requirements. 4. Audit Report The Auditor will provide CHLIC with a true copy of the Audit's findings, as well as the Audit Report, if any, that is submitted to the Employer. Such copies will be provided to CHLIC before the Audit findings and the Audit Report are submitted to the Employer to allow CHLIC the opportunity to review and respond to Audit findings and Report prior to Auditor sending finalized versions to Employer. 5. Comment on Audit Report CHLIC reserves the right to provide the Auditor and the Employer with its comments on the findings and, if applicable, the Audit Report. 6. Confidentiality The Auditor understands that CHLIC is permitting the Auditor to review the Information solely for purposes of the Audit. Accordingly, the Auditor will ensure that all information will be kept confidential in accordance with all with all Applicable Laws, Privacy Addendum in Exhibit D,including but not limited to the HIPAA Privacy and Security Rules and 42 C.F.R. Part 2. Without limiting the generality of the foregoing, the Auditor specifically agrees to adhere to the following conditions: 06/28/2023 65 Administrative Services Only Agreement for City of Miami Beach a. The Auditor shall not copy,print,photograph or otherwise duplicate or remove any of the Information without the express written consent of CHLIC; b. The Auditor shall not record any virtual session that includes Protected Health Information as defined in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA");and c. The Auditor shall not take any screenshots during any virtual session;and d. The Auditor agrees that its Audit Report or any other summary prepared in connection with the Audit shall contain no individually identifiable information. e. Notwithstanding anything to the contrary stated herein,it is understood and agreed by the parties that the Auditor may include and retain the statistical results of the Audit (performance measures expressed as percentages) in its comparative database for the purpose of comparing the results of the Audit with other audits performed by the Auditor. In no event will the results of the Audit included in the comparative database be used or disclosed in any way that identifies Cigna, Employer,or any individual;and f. Except with regard to Protected Health Information(solely with regard to(i)-(iv)below), this Agreement does not apply or restrict the Auditor from using or disclosing information: i. Which is or becomes public other than through a breach of this Agreement; ii. Already known to Auditor prior to the date of this Agreement and with respect to which the Auditor does not have an obligation of confidentiality; iii. Which is disclosed to the Auditor by a person or entity not party to this Agreement and who is entitled to disclose such information without breaching an obligation of confidentiality; iv. To Auditor's legal counsel, subject to the confidentiality obligations in this Agreement;or v. Required to be disclosed by law, whether under an order of a court, government tribunal or other legal process, except that if required by law, Auditor will disclose only the minimum information required to comply with legal mandate. 7. Restricted Use of the Audit Information With respect to persons other than the Employer, the Auditor will hold and treat information obtained from CHLIC during the Audit with the same degree and standard of confidentiality owed by the Auditor to its clients in accordance with all applicable legal and professional standards. The Auditor shall not, without the express written consent of CHLIC executed by an officer of CHLIC, disclose in any manner whatsoever, the results,conclusions, reports or information of whatever nature which it acquires or prepares in connection with the Audit to any party other than the Employer except as required by applicable law. The Employer and Auditor agree to indemnify and to hold harmless Cl ILIC for any and all claims,costs, expenses and damages which may result from any breaches of the Auditor's obligations under 06/28/2023 66 Administrative Services Only Agreement for City of Miami Beach paragraphs 6 and 7 of this Agreement or from CHLIC's provision of Information to the Auditor. The Employer authorizes CHLIC to provide to the designated Auditor the necessary Information to perform the audit in a manner consistent with all Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Privacy Standards and in compliance with the signed Business Associate Agreement("BAA"). 8. Termination CHLIC may terminate this Agreement with prior written notice. The obligations set forth in Sections 4 through 7 shall survive termination of this Agreement. 06/28/2023 67 Administrative Services Only Agreement for City of Miami Beach Cigna Health and Life Insurance Company By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Employer: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Auditor: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: 06/28/2023 68 Administrative Services Only Agreement for City of Miami Beach Exhibit D - Privacy Addendum ("Business Associate Agreement") I. GENERAL PROVISIONS Section 1. Effect. As of the Effective Date, the terms and provisions of this Addendum are incorporated in and shall supersede any conflicting or inconsistent terms and provisions of(as applicable) the Administrative Services Only Agreement and/or Flexible Spending Account or Reimbursement Accounts Administrative Services Agreement to which this Addendum is attached, including all exhibits or other attachments to,and all documents incorporated by reference in, any such applicable agreements (individually and collectively any such applicable agreements are referred to as the"Agreement").This Addendum sets out terms and provisions relating to the use and disclosure of Protected Health Information ("PHI") without written authorization from the Individual. To the extent there is a conflict between the Agreement and this Addendum, this Addendum shall control. Section 2. Amendment to Comply with Law. CHLIC, on behalf of itself and its affiliates and subsidiaries that perform services under the Agreement (collectively referred to as "CHLIC"), Employer(also referred to as"Plan Sponsor"), and the group health plan that is the subject of the Agreement(also referred to as the"Plan")agree to amend this Addendum to the extent necessary to allow either the Plan or CHLIC to comply with applicable laws and regulations including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations(45 C.F.R. Parts 160 to 164)("HIPAA Privacy and Security Rules"). Section 3.Relationship of Parties.For purposes of this Addendum,the parties intend that CHLIC is an independent contractor and not an agent of the Plan or the Plan Sponsor. Il. PERMITTED USES AND DISCLOSURES BY CHLIC Section 1. Uses and Disclosures Generally.Except as otherwise provided in this Addendum,CIILIC may use or disclose Pill to perform functions,activities or services for,or on behalf of, the Plan as specified in the Agreement, provided that such use or disclosure would not violate the HIPAA Privacy&Security Rules if done by the Plan.CHLIC shall not further use or disclose PHI other than as permitted or required by this Addendum,or as required by law. Section 2. To Carry Out Plan Obligations.To the extent CHLIC is to carry out one or more of the Plan's obligations under Subpart E of 45 C.F.R. Part 164, CHLIC agrees to comply with the requirements of Subpart E that apply to the Plan in the performance of such obligations. Section 3. Management and Administration. (A) CHLIC may use PHI for the proper management and administration of CHLIC or to carry out the legal responsibilities of CHLIC. (B) CHLIC may disclose PHI for the proper management and administration of CHLIC, provided that disclosures are:(a)required by law;or(b)CHLIC obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it is disclosed to the person,and the person notifies CHLIC of any instances of which it is aware in which the confidentiality of 06/28/2023 69 Administrative Services Only Agreement for City of Miami Beach the information has been breached. (C) CHLIC may use or disclose Pill to provide Data Aggregation services relating to the Health Care Operations of the Plan, or to de-identify PHI. Once information is de-identified, this Addendum shall not apply. Section 4. Required or Permitted By Law. CHLIC may use or disclose PHI as required by law or permitted by 45 C..F.R. §164.512. HI. OTHER OBLIGATIONS AND ACTIVITIES OF CHLIC Section 1. Receiving Remuneration in Exchange for PHI Prohibited. CHLIC shall not directly or indirectly receive remuneration in exchange for any PI TT of an Individual, unless an authorization is obtained from the Individual,in accordance with 45 C.F.R.§164.508,that specifies whether PHI rat be exchanged for remuneration by the entity receiving PHI of'that individual, unless otherwise permitted under the HIPAA Privacy Rule. Section 2. Limited Data Set or Minimum Necessary Standard and Determination. CHLIC shall,to the extent practicable, limit its use, disclosure or request of Individuals' PHI to the minimum necessary amount of Individuals'PHI to accomplish the intended purpose of such use,disclosure or request and to perform its obligations under the underlying Agreement and this Addendum. CHLIC shall determine what constitutes the minimum necessary to accomplish the intended purpose of such disclosure. Section 3.Security Standards.CHLIC shall use appropriate safeguards and comply with Subpart C of 45 C.F.R. Part 164 with respect to Electronic PHI to prevent use or disclosure of PHI other than as provided for by the Agreement. Section 4. Protection of Electronic PI II. With respect to Electronic PHI, CHLIC shall: (A) Implement administrative,physical and technical safeguards that reasonably and appropriately protect the confidentiality,integrity and availability of the Electronic Pill that CHLIC creates, receives, maintains or transmits on behalf of the Plan as required by the Security Standards; (B) Ensure that any agent or subcontractor to whom CHLIC provides Electronic PHI agrees to implement reasonable and appropriate safeguards to protect such information. Section 5.Reporting of Violations.CHLIC shall report to the Plan any use or disclosure of PHI not provided for by this Addendum of which it becomes aware,including a Breach or Security Incident. CHLIC agrees to mitigate,to the extent practicable, any harmful effect from a use or disclosure of PHI in violation of this Addendum of which it is aware.The parties agree that such reports are not required for trivial and routine incidents such as port scans, attempts to log-in with an invalid password or user name, denial of service attacks that do not result in a server being taken off-line, malware and pings or other similar types of events. Section 6. Breach Notification. CHLIC will notify the Plan of a Breach(including privacy related incidents that might, upon further investigation, be deemed to be a Breach)without unreasonable delay and, in any event, within thirty (30) business days after CI ILIC's discovery of same. This notification will include, to the extent known: 06/28/2023 70 Administrative Services Only Agreement for City of Miami Beach i. the names of the individuals whose PHi was involved in the Breach; ii. the circumstances surrounding the Breach; iii. the date of the Breach and the date of its discovery; iv. the information Breached; v. any steps the impacted individuals should take to protect themselves; vi. the steps CHLIC is taking to investigate the Breach, mitigate losses, and protect against future Breaches;and, vii. a contact person who can provide additional information about the Breach. For purposes of discovery and reporting of Breaches, CHLiC is not the agent of the Plan or the Employer(as"agent"is defined under common law).CHLIC will investigate Breaches, assess their impact under applicable state and federal law,and make a recommendation to the Plan as to whether notification is required pursuant to 45 C.F.R. §§164.404-408 and/or applicable state breach notification laws.With the Plan's prior approval,CHLIC will issue notices to such individuals, state and federal agencies-including the Department of health and Human Services, and/or the media-• as the Plan is required to notify pursuant to,and in accordance with the requirements of applicable law(including 45 C.F.R. §§164.404-408).in the event of a Breach affecting multiple Cl-iLIC clients where CHLIC believes notification to affected individuals is required in accordance with applicable law, CHLIC reserves the right to issue notifications to the affected individuals without Plan approval. CHLIC will pay the costs of issuing notices required by law and other remediation and mitigation which,in CIILIC's discretion,arc appropriate and necessary to address the Breach.CHLIC will not be required to issue notifications that are not mandated by applicable law. CHLIC shall provide the Plan with information necessary for the Plan to fulfill its obligation to report Breaches affecting fewer than 500 Individuals to the Secretary as required by 45 C.F.R. §164.408(c). Section 7. Disclosures to and Agreements with Third Parties. CHLIC agrees to ensure that any subcontractors that create,receive,maintain,or transmit PHi on behalf of CHLIC agree to the same restrictions,conditions and requirements that apply to CI-iLIC with respect to such information. Section 8. Access to PI11.CIILIC shall provide an Individual with access to such individual's PHI contained in a Designated Record Set in response to such Individual's request in the time and manner required in 45 C.F.R. §164.524. Section 9.Availability of PHI for Amendment. CHLIC shall respond to a request by an individual for amendment to such Individual's PHI contained in a Designated Record Set in the time and manner required in 45 C.F.R. §164.526. Section 10. Right to Confidential Communications and to Request Restriction of Disclosures of PHI. CHLIC shall respond to a request by an Individual for confidential communications or to restrict the uses and disclosures of PI-L1 contained in such Individual's Designated Record Set in the time and manner required by 45 C.F.R. §164.522. CHLIC shall not be obligated to agree to, or implement,any restriction,if such restriction would hinder Health Care Operations or the provision 06/28/2023 71 Administrative Services Only Agreement for City of Miami Beach of the functions, activities or services, unless such restriction would otherwise be required by 45 C.F.R. § 164.522(a). Section 11. Accounting of PHI Disclosures. CHLIC shall provide an accounting of disclosures of PI-Ii to an Individual who requests such accounting in the time and manner required in 45 C.F.R. §I64.528. Section 12.Availability of Books and Records.CHLIC hereby agrees to make its internal practices, books and records relating to the use and disclosure of PHI received from, or created or received by CHLIC on behalf of the Plan, available to the Secretary for purposes of determining the Plan's compliance with the Privacy Rule. Section 13.Standard Transactions.CHLIC certifies that it conducts any applicable transactions that are subject to the HIPAA standard transaction rules(45 C.F.R. Parts 160-164)as required under such rules. IV. TERMINATION OF AGREEMENT WITH CHLIC Section 1. Termination Upon Breach of Provisions Applicable to PHi. Any other provision of the Agreement notwithstanding,the Agreement may he terminated by the Plan upon prior written notice to CHLIC in the event that CI-iLIC materially breaches any obligation of this Addendum and fails to cure the breach within such reasonable time as the Plan may provide for in such notice. If CHLIC knows of a pattern of activity or practice of the Plan that constitutes a material breach or violation of the Plan's duties and obligations under this Addendum, CHLiC shall provide a reasonable period of time,as agreed upon by the parties, for the Plan to cure the material breach or violation.Provided,however,that,if the Plan does not cure the material breach or violation within such agreed upon time period,CHLIC may terminate the Agreement at the end of such period. Section 2. Use and Disclosure of PHI upon Termination. The parties hereto agree that it is not feasible for CHLIC to return or destroy PHI at termination of the Agreement; therefore, the protections of this Addendum for PHi shall survive termination of the Agreement,and CHLIC shall limit any further uses and disclosures of such PHI to the purpose or purposes which make the return or destruction of such PHi infeasible. V. OBLIGATIONS OF THE PLAN AND PLAN SPONSOR Section 1. Disclosures Generally. Except as otherwise provided for in this Addendum,the Plan will not request that CHLIC use or disclose PHI in any manner that would not be permissible under HIPAA. Section 2. Disclosures to the Plan or Third Parties. To the extent the Plan requests that CHLIC disclose PH-it either to the Plan or to a third party business associate acting for the Plan,the Plan represents and warrants that: (A) It only will request PHi for the purposes of Treatment,Payment,or Health Care Operations,or another permitted purpose under the HIPAA Privacy Rule; (B) The information requested is the minimum necessary to achieve the purpose of the disclosure; 06/28/2023 72 Administrative Services Only Agreement for City of Miami Beach and (C) If the PHI is to be disclosed to a third party, the Plan has a business associate agreement in place with the third party. • Section 3. Disclosure to Plan Sponsor.To the extent the Plan requests that CHLIC disclose PHI to the Plan Sponsor, the Plan and Plan Sponsor each represent and warrant that: (A) The information only will be used for one of the following purposes: i. Plan Administration functions,as defined by the HIPAA Privacy Rule, and that the Plan Sponsor has executed the required plan amendment and certification allowing the disclosure,as set out in the HIPAA Privacy Rule; ii. Enrollment functions, provided the information to be disclosed is limited to enrollment and disenrollment information;or iii. To amend, modify, or terminate the Plan, or to obtain premium bids to provide health insurance coverage under the Plan,provided the information to be disclosed is limited to Summary Health Information,as defined in the HIPAA Privacy Rule;and (B) The information requested is the minimum necessary to achieve the purpose of the disclosure. VI. DEFINITIONS FOR USE IN THIS ADDENDUM Definitions. Certain capitalized terms used in this Addendum shall have the meanings ascribed to them by HIPAA including their respective implementing regulations and guidance. If the meaning of any term defined herein is changed by regulatory or legislative amendment, then this Addendum will be modified automatically to correspond to the amended definition. All capitalized terms used herein that are not otherwise defined have the meanings described in HIPAA. A reference in this Addendum to a section in the HIPAA Privacy Rule,or HIPAA Security Rule means the section then in effect, as amended. "Breach" means the unauthorized acquisition, access, use or disclosure of Unsecured Protected Health Information which compromises the security or privacy of such information,except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information. A Breach does not include any unintentional acquisition, access or use of PHI by an employee or individual acting under the authority of CHLIC if such acquisition, access or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual with CHLIC; any inadvertent disclosure from an individual who is otherwise authorized to access PHI at a facility operated by CHLIC to another similarly situated individual at the same facility; and such information is not further acquired, accessed, used or disclosed without authorization by any person. "Business Associate" means CI-ILIC. "Covered Entity" means the Plan. "Designated Record Set" shall have the same meaning as the term "designated record set" as set forth in the Privacy Rule, limited to the enrollment, payment, claims adjudication and case or 06/28/2023 73 Administrative Services Only Agreement for City of Miami Beach medical management record systems maintained by CHLIC for the Plan,or used,in whole or in pait, by CHLIC or the Plan to make decisions about Individuals. "Effective Date" shall mean the earliest date by which CHLIC and the Plan must enter into a business associate agreement under 45 C.F.R. Part 164. "Electronic Protected Health Information"shall mean PHI that is transmitted by,or maintained in, electronic media as that term is defined in 45 C.F.R. §160.103. "Limited Data Set" shall have the same meaning as the term"limited data set"as set forth in 45 C.F.R. §164.514(e)(2). "Protected Health Information"or"PHI" shall have the same meaning as set forth at 45 C.F.R. §160.103. "Secretary" shall mean the Secretary of the United States Department of Health and Human Services. "Security Incident"shall have the same meaning as the term "security incident" as set forth in 45 C.F.R. §164.304. "Unsecured Protected Health Information" shall mean PHI that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by the Secretary in the guidance issued under Section 13402(h)(2) of the American Recovery and Reinvestment Act of 2009. 06/28/2023 74 Administrative Services Only Agreement for City of Miami Beach Exhibit E—Conditional Claim/Subrogation Recovery Services 1. Plans Without CHLIC Stop Loss Coverage If Employer has not purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan: (A) All conditional claim payment and/or subrogation recoveries under the Plan will be handled by CHLIC unless CHLIC is otherwise notified by the Employer. (B) CHLIC and its subcontractors acting as Employer's recovery shall have the discretionary authority: i. To reduce recovery amounts by as much as fifty percent (50%) of the total amount of benefits paid on Employer's behalf,and to enter into binding settlement agreements for such amounts.Any modification to this percentage shall be communicated by Employer to CHLIC and will be effective upon Employer's next renewal date, unless otherwise agreed to by CHLIC. ii. In the event a settlement offer represents a reduction greater than the percentage identified above, CHLIC and its subcontractors shall seek settlement advice from the Employer. iii. All amounts reimbursed to the Bank Account shall be refunded at the gross amount. CHLIC's and it subcontractors' subrogation administration fee on cases where CHLIC and its subcontractors' have retained counsel and in cases where no counsel has been retained by CHLIC and its subcontractors are both reflected in the Schedule of Financial Charges. (C) Except where agreed to by CHLIC and Employer,CI ILIC and its subcontractors shall have no duty or obligation to represent Employer in any litigation or court proceeding involving any matter which is the subject of the Agreement, but shall make available to Employer and/or Employer's counsel such information relevant to such action or proceeding as CHLIC and its subcontractors may have as a result of its handling of any matter under the Agreement. (D) In the event Employer purchases individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan at any time during the life of the Agreement,the provisions of paragraph II., below, shall control. II. flans with CIILIC Stop Loss Coverage If Employer has purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan: A. CHLIC and its subcontractors shall have the right and responsibility to manage all conditional claim payment and/or subrogation recoveries under the Plan. CHLIC and its subcontractors shall reimburse to the Plan the recovery minus relevant individual and aggregate stop loss payments made by CHLIC. 06/28/2023 75 Administrative Services Only Agreement for City of Miami Beach B. All amounts reimbursed to the Bank Account shall be refunded at the gross amount. CHLIC's and its subcontractors' subrogation administration fee on cases where CI-ILIC and its subcontractors' have retained counsel and in cases where no counsel has been retained by CHLIC and its subcontractors,are both reflected in the Schedule of Financial Charges. C. CHLIC and its subcontractors shall have no duty or obligation to represent Employer in any litigation or court proceeding involving any matter which is the subject of the Agreement but shall make available to Employer and/or Employer's counsel such information relevant to such action or proceeding as CHLIC and its subcontractors may have as a result of its handling of any matter under the Agreement.Notwithstanding the foregoing,CI ILIC and its subcontractors reserve to itself the right to retain counsel to represent CHLIC's own interests in any subrogation and/or conditional claim recovery action under the Plan. 06/28/2023 76 Administrative Services Only Agreement for City of Miami Beach Appendix A —Pharmacy Benefit Management Services PHARMACY BENEFIT MANAGEMENT- DEFINITIONS Definitions Any capitalized term not defined below shall have the meaning given to such term in the Agreement. Any capitalized term utilized in the Schedule of Financial Charges or Exhibit B shall have the meaning given to such term in the Agreement, including the meanings set forth below. • 340B Claim" means (i) Prescription Drug Claims submitted by 340B contracted pharmacies that adjudicate at a 340B price or are submitted with a submission clarification code of"20"or such equivalent codes for such Participating Pharmacies under the applicable NCPDP format (or any successor format); (ii) Prescription Drug Claims submitted by a 340B covered entity-owned or 340B contracted pharmacies which are categorized as Type 39 and/or 38(or such equivalent codes) in the NCPDP DataQ database or otherwise identified as a 340B Claim by the dispensing pharmacy;or(iii)Prescription Drug Claims identified as a 340B Claim by a third party administrator, and(iv) Prescription Drug Claims identified as a 340b Claim by a Pharmaceutical Manufacturer and in which PBM may reduce a subsequent Manufacturer Payment quarterly payment(or reconciliation payment,if applicable)to account for any previously-paid Manufacturer Payment amounts attributable to such claim. • "Actuarially Estimated"shall mean that the discount(s)listed in the Schedule of Financial Charges are estimated, but not guaranteed,to result in a particular average discount for Covered Drugs administered by CHLIC under this Agreement. Actuarially estimated discounts are calculated based on evaluation of an expected distribution of drug utilization across CHLIC's aggregate group client book of business. As measured in the aggregate for Employer's Pharmacy Benefit, Employer's average discount results may vary based on the Plan-specific factors such as drug mix utilization. • "Pharmacy Product Administrative Fee" means the service fee charged by PBM for providing pharmacy benefit management services to Client as described herein • "Affiliate"means any entity that directly, or indirectly,through one or more intermediaries, controls, or is controlled by, or is under common control with,PBM. For purposes of this definition,"control"means the possession,directly or indirectly,of the power to elect at least 50%of the governing board of such entity or to direct or cause the direction of,or play a significant role in,the management and policies of such entity, whether through ownership of voting securities, partnership or limited liability interests, nonprofit membership, contract or otherwise. "Authorized Generic"shall mean a pharmaceutical product sold,licensed,or marketed under a new drug application(NDA)approved by • the Food and Drug Administration(FDA)under section 505(c)of the Federal Food,Drug and Cosmetic Act(FFDCA) that is marketed, 06/28/2023 77 Administrative Services Only Agreement for City of Miami Beach sold or distributed under a different labeler code, product code, trade name, trademark, or packaging(other than repackaging the listed drug for use in institutions) than the innovator brand name drug. • "Average Wholesale Price"or"AWP" shall mean the average wholesale price of a Covered Drug as established and reported by Medi- Span. The applied AWP of a Covered Drug shall be the AWP for the actual eleven(11)digit National Drug Code("NDC"), Covered Drug specific,quantity appropriate actual package size(or the manufacturer-packaged quantity closest to the dispensed size), submitted by a Retail Pharmacy, Home Delivery Pharmacy, or Specialty Pharmacy at the time that the Covered Drug is adjudicated. Notwithstanding any other provision in this Agreement, in the event of any major change in market conditions affecting the pharmaceutical or pharmacy benefit management market,including,for example,any change in the markup.methodologies,processes or algorithms underlying the published A WP(s), CHLIC may adjust any or all of the Rebates, charges, rates,discounts,guarantees and/or fees in connection with CHLIC's administration of the Pharmacy Benefit hereunder, including any that are based on AWP, as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such change. Additionally,and notwithstanding any other provision in this Agreement,CHLIC may replace AWP as its pharmaceutical pricing benchmark with an alternative benchmark and/or may replace Medi-Span,or other such publication,as its source for the AWP or alternative benchmark with a different pricing source, provided that CHLIC adjusts any or all such AWP-based charges or such alternative benchmark-based charges as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such replacement or immediately prior to the event(s)giving rise to such replacement, as the case may be. "Biosimilar"shall mean a biological product that is licensed by the FDA as a biosimilar pursuant to Section 351(k)of the Public Health • Service Act,42 U.S.C. 262(k), based upon a showing that it is highly similar to a single FDA-licensed biological product, known as a reference product.and has no clinically meaningful differences compared to the reference product in terms of safety,purity,and potency. A biosimilar biological product may be licensed by the FDA as biosimilar or interchangeable, and in either case such biological product is a Biosimilar for the purposes of this Agreement. • "Brand Drug" shall mean a pharmaceutical product, including a Covered Drug that is a prescription drug, including over-the-counter drugs dispensed pursuant to a prescription,medicine,agent, substance, device, supply or other therapeutic product that is not a Generic Drug. Except if and where the language expressly states otherwise,a Brand Drug does not include a Specialty Brand Drug for ingredient cost discount purposes. • "Cigna Home Delivery Pharmacy" shall mean a duly licensed pharmacy operated by CHLIC or its affiliates, where prescriptions are filled and delivered via the mail service,which may include,for example,Acevedo Health Group,Inc.,ESI Mail Pharmacy Service,Inc., Express Scripts Pharmacy Inc., Express Scripts Specialty Distribution Services, Inc. and Lynnfield Drug, Inc. (dba Freedom Fertility Pharmacy). 06/28/2023 78 Administrative Services Only Agreement for City of Miami Beach • "Claim," for purposes of this Appendix A, is a claim or request for coverage under the Pharmacy Benefit. • "Compound Drug"shall mean a medication that(a)is comprised of two or more gaseous, solid, semi-solid,or liquid ingredients(other than water or flavoring added to any preparation) that are weighed or measured at a pharmacy and then prepared according to the prescriber's order and the pharmacist's art;(b)contains at least one FDA-approved federal legend drug as an active ingredient; (c) is not otherwise generally available in its compound form; and(d) is not a compound preparation administered by infusion or injection. • "Copayment"means"Cost Share","Copay","Coinsurance","Deductible"or any other charge and/or any portion of the charge for each Prescription Drug Claim that is the responsibility of the Member to pay(e.g. copay, coinsurance, deductible, physician and member selection copay penalty,excess copay charges,ancillary fees,etc.).Copayment can be a defined dollar amount or percentage of eligible expenses. • "Covered Drugs" shall mean prescription drugs, including over-the-counter drugs dispensed pursuant to a prescription, biologics, medicines,agents,substances, devices, supplies, and other therapeutic products that are prescribed for Members and are covered under the Pharmacy Benefit and shall include all associated standard services usually and customarily rendered by a pharmacy or provider in the normal course of business, including dispensing, administration, counseling and product consultation. • "Dispensing Fee" means an amount paid to a pharmacy for providing professional services necessary to dispense a Covered Drug to a Member. • "FDA" shall mean the U.S. Food and Drug Administration. • "Formulary" shall mean the list of FDA-approved prescription drugs and supplies developed and managed by CI ILIC across its self- funded and insured group book of business and that is selected and adopted by Employer. The drugs and supplies included on the Formulary will be modified by CHLIC from time to time as a result of factors including,but not limited to,economic and clinical factors like clinical appropriateness,manufacturer Rebate arrangements and patent expirations.Any changes CHLIC makes to the Formulary are hereby adopted by Employer,subject to Employer's discretion to elect not to implement any such addition or deletion through the set-up process, any such election shall be considered an Employer change to the Formulary. • "Generic Drug" means a pharmaceutical product, including a Covered Drug, whether identified by its chemical, proprietary, or non- proprietary name,that is accepted by the FDA as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient(s),and which is identified as such in CHLIC's master drug file using indicators from First Databank, Medi- Span, or other nationally recognized source as used by CHLIC across its book of business on the basis of a proprietary algorithm, a summary of which may be made available for review by Employer or,subject to CHLIC's consent,its auditor upon request in accordance 06/28/2023 79 Administrative Services Only Agreement for City of Miami Beach with the terms set forth in this Appendix A.Employer and,as applicable. its auditor shall sign a confidentiality agreement acceptable to CHLIC relating specifically to such summary.The reference to a drug by its chemical name does not necessarily mean that the product is recognized as a generic for adjudication, pricing or copay purposes. Except if and where the language expressly states otherwise, a Generic Drug does not include a Specialty Generic Drug for ingredient cost discount purposes. For pricing purposes, a Generic Drug includes a Covered Drug that is otherwise identified as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient(s)and is within its exclusivity period or other period of limited competition; provided that, notwithstanding the foregoing,a Generic Drug excludes an Authorized Generic identified as a brand name drug by the aforementioned proprietary algorithm used by CHLIC. For pricing purposes, a Generic Drug also excludes a Biosimilar. "Generics under Exclusivity"means when a patent expires for a brand drug,OTC,or supplies the FDA may grant a period of exclusivity (lasting up to six months)to one company to make the generic form of the drug.During the exclusivity period,no other manufacturer can produce the generic "Gross Drug Cost"means the total discounted cost of the Prescription Drug Claim plus any applicable Dispensing Fee, sales tax or other tax applied. "House Generic"means a brand name drug that is dispensed as a generic drug with Member cost share and client ingredient cost applied at the generic drug rate. "Ingredient Cost"means the ingredient cost portion of the claim amount charged by CHLIC for a prescription drug. • `Limited Distribution Drug"or"Exclusive Distribution Drug"shall mean a Specialty Drug that is not generally available from most or all pharmacies but is restricted to select pharmacies as determined by a pharmaceutical manufacturer. The list of Limited Distribution Drugs and Exclusive Distribution Drugs wilt be maintained by CHLIC. "Limited Supply Generic"means a generic Covered Product not available in sufficient supply in the marketplace due to limited product supply and/or not available from a sufficient number of manufacturers in the marketplace. • "Maximum Allowable Charge"shall mean the maximum unit price for a Covered Drug included on the applicable MAC List as set forth on such MAC List. • "MAC List" shall mean a then-current list maintained by CHLIC of prescription drugs, devices, supplies and over-the-counter drugs identified as readily available as a Generic Drug or generally equivalent to a Brand Drug(in which case it may also be on a MAC List) 06/28/2023 80 Administrative Services Only Agreement for City of Miami Beach and that, in each case, are deemed to require or are otherwise capable of pricing management due to the number of manufacturers, utilization and/or pricing volatility. "Manufacturer Administrative Fees"shall mean administrative fees paid by pharmaceutical manufacturers to CHLIC or its affiliate or • subcontractor directly in connection with administering, invoicing, allocating and collecting Rebates. "Multi-source Generics" are those generic Covered Products which are manufactured, produced and/or distributed by more than l manufacturer. "Net Ingredient Cost" means the Total Ingredient Cost of the Prescription Drug Claim less Copayment. "New to Market Specialty Drugs" are those Specialty medications. Biosimilar medications, Specialty Authorized Products, Specialty Authorized Generics, or Specialty Authorized Alternatives that are within 6 months or less of the product launch date. "Over the Counter"or"OTC"claim means any non-federal legend drug or product that can be purchased or sold without a prescription. `'Patent Litigated Generics"means a generic Covered Product that is under patent litigation as a result of a generic manufacturer challenging a patent is invalid or is not violated by the production of the generic version of the drug. • "Pharmacy Benefits" shall mean amounts payable for covered pharmacy benefit services and products under the terms of the Plan; Pharmacy Benefits shall be considered Plan Benefits for purposes of this Agreement. "Pharmacy Submitted Cost" means the full non-PBM negotiated cost submitted by the dispensing pharmacy to the PBM in the "Ingredient Cost Submitted"field of the most recent version of the NCDPD file layout. "Prescription Drug Claim" means a claim submitted by a Member or pharmacy, whether submitted electronically or manually, for payment for a Covered Product." • "P&T Committee"shall mean a committee comprised of clinicians that represent a range of clinical specialties. The committee regularly reviews pharmaceutical products, new pharmaceutical products, for safety and efficacy, the findings of which clinical reviews inform coverage status decisions made by CHLIC. The P&T Committee's review may be based on consideration of, without limitation, FDA- approved labeling,standard medical reference compendia,or scientific studies published in peer-reviewed English-language bio-medical journals. • "PBM Proprietary Information" shall mean information relating to CHLIC's pharmacy benefit management products and services, including, without limitation, CHLIC's reporting and web-based applications, eligibility and adjudication systems and coding 06/28/2023 81 Administrative Services Only Agreement for City of Miami Beach methodologies,system formats and databanks, clinical or formulary management operations or programs, information and agreements relating to Rebates and other financial information,prescription drug evaluation criteria and coverage policies,drug pricing information. including MAC List and Specialty Drug pricing, paid Claims information integrated into CHLIC's adjudication systems, and pharmaceutical manufacturer,vendor or pharmacy network agreements. • 'Prescription Drug Charge" shall mean the amount that, prior to application of the Plan's cost-share requirement(s), Employer is obligated to pay for a Covered Drug dispensed at a Retail Pharmacy or Cigna Home Delivery Pharmacy, including any ingredient cost, applicable Dispensing Fee.service fee,and tax. The ingredient cost charged to Employer may be expressed as. for example, a discount off of AViP or other benchmark price, or a MAC. • "Rebate"shall mean retrospective formulary rebates received by CHLIC pursuant to the terms of a formulary rebate contract negotiated independently and directly attributable to or arising from the utilization by Members of certain Covered Drugs manufactured, sold, marketed, or distributed by a manufacturer. However, "Rebates" shall exclude: (i)pricing adjustments, payments and credits made in the ordinary course by any manufacturer on account of product returns, delivery errors or shipping damage or losses arising from drugs and other products purchased from such manufacturer by or on behalf of CHLIC(ii)pricing discounts paid or credited by a manufacturer to pharmacies affiliated with CHLIC for prescription drugs and other products purchased from such manufacturer;(iii)any fees or other compensation paid by any manufacturer in consideration of any services,products,activities or programs performed,provided or implemented by CHLIC or any of its affiliates for such manufacturer: (iv) Manufacturer Administrative Fees; (v)Value-Based Payments:(vi)any rebates or other amounts that are allocated to reduce and/or partially or wholly satisfy a Member's cost-sharing obligation for a Covered Drug; and(vii)rebates or other amounts paid to CHLIC for prescription drugs that are administered or otherwise provided to Members in providers' offices,home health care settings, or outpatient clinics. • "Retail Pharmacy"shall mean any licensed retail pharmacy with which CHLIC has contracted directly or indirectly with a third party,to provide Covered Drugs to Members, and is not a mail order pharmacy. A mail order pharmacy is a pharmacy that primarily fills and delivers pharmaceutical products via the mail service. The term "Retail", when immediately preceding the term "Brand Drug Claim", "Generic Drug Claim". "Specialty Drug Claim", "Specialty Brand Drug Claim", or "Specialty Generic Drug Claim" means that the resulting term(e.g., "Retail Brand Drug Claim") refers to such claim as dispensed by a Retail Pharmacy. • "Specialty Drug"shall mean a pharmaceutical product,including a Covered Drug,considered by CHLIC to be a Specialty Drug based on consideration of the following factors: (i) whether the pharmaceutical product is prescribed and used for the treatment of a complex, chronic or rare condition; (ii) whether the pharmaceutical product has a high acquisition cost; and, (iii) whether the pharmaceutical product is subject to limited or restricted distribution, requires special handling and/or requires enhanced patient education, provider coordination or clinical oversight.A Specialty Drug may not possess all or most of the foregoing characteristics, and the presence of any 06/28/2023 82 Administrative Services Only Agreement for City of Miami Beach one such characteristic does not guarantee that a pharmaceutical product will be considered a Specialty Drug.The term"Specialty,"when immediately preceding the terms"Generic Drug"or"Brand Drug",means that the resulting term(e.g."Specialty Generic Drug")refers to a Generic Drug or Brand Drug that is considered a Specialty Drug, respectively. • 'Specialty Pharmacy"shall mean a duly licensed pharmacy designated by or operated by CHLIC or its affiliates that primarily dispenses Specialty Drugs or provides services related thereto; provided, however, that when the Cigna Home Delivery Pharmacy dispenses a Specialty Drug, it shall be considered a Specialty Pharmacy hereunder. "Total Ingredient Cost"means the total discounted cost of the Prescription Drug Claim for any Covered Product excluding Dispensing Fees, ancillary fees,Administrative Fees, sales tax or Rebates and prior to the application of any Copayment. • "U&C Charge" shall mean the price the applicable Retail Pharmacy would charge a regular cash-paying customer for a Covered Drug (and any services related to the dispensing thereof)on the day on which the Covered Drug is dispensed. "Zero Balance Due"or"ZBD"claim means any claim where the Member pays the total amount of the Gross Drug Cost of a claim and the amount of the Gross Drug Cost paid by the plan is zero. PHARMACY BENEFIT MANAGEMENT- SERVICES TO BE PROVIDED 1. Retail Pharmacy Network. (a) General. CHLIC shall maintain a Retail 30 Pharmacy network that contains at least 65,000 pharmacies and includes all chain pharmacies and a Retail 90 Pharmacy Network that contains more than 31,000 pharmacies, that includes chain pharmacies, independents,big-box and/or grocery stores.Retail Pharmacies included in the network shall provide Covered Drugs to which the Retail Pharmacies have access to Members during their normal business hours. A list of the Retail Pharmacies included in the network,as updated from time to time, shall be made available to Members online. CHLIC maintains multiple networks and/or sub-networks and may periodically consolidate networks and/or migrate clients,including Employer, between networks and sub- networks. CHLIC shall require each Retail Pharmacy included in the network to meet its requirements for participation in the Retail Pharmacy network. which include, but are not limited to, satisfaction of licensing and insurance requirements. Should CHLIC make achange in the number of participating pharmacies in the retail pharmacy network servicing Employer under this Agreement and such changeresults in more than a 5%reduction in the number of pharmacies participating in the retail pharmacy network and impacts Members access to retail network pharmacies either before Effective Date or during the term of this Agreement,CHLIC agrees to provide notification to Employer which will include an analysis that includes anticipated member 06/28/2023 83 Administrative Services Only Agreement for City of Miami Beach disruption, current GEOAccess or similar report and CHLIC agrees to renegotiate a revised financial proposal in good faith. (b) Retail Pharmacy Audits and Overpayments. CHLIC shall review 100%of all claims, with each claim to be reviewed by either desk audit or field audit as determined through the use of random risk based predictive model to ensure that each Retail Pharmacy is complying with the terms of its contract with CHLIC.In the event that CHLIC discovers that an overpayment has been made to a Retail Pharmacy, CHLIC shall take reasonable steps to recover the overpayment pursuant to the terms of this Agreement. (c) Independent Contractors.The Retail Pharmacies are independent contractors, and as such CHLIC does not direct or exercise any control over the pharmacists at Retail Pharmacies or the professional judgement exercised by any pharmacies in the dispensing or filling of prescriptions or performing other pharmac Putical services. Neither CHLIC nor any CHLIC affiliate shall have any liability to Employer, any Member or any other person or entity for any act or omission of any Retail Pharmacy or it agents or employees. (d) Collection of Cost Sharing. CHLIC shall require Retail Pharmacies to collect all applicable Plan cost-shares from Members. 2. Cigna Home Delivery Pharmacy. (a) General.Members may submit new or refill prescription orders for fulfillment through Cigna Home Delivery Pharmacy or such other mail service pharmacy that CHLIC in its sole discretion may select from time to time. Such orders may be placed via mail, telephone,or electronic means. Subject to Applicable Law, Employer shall permit communication with Members regarding the availability and use of the Cigna Home Delivery Pharmacy, and potential cost savings associated therewith, and the provision of supporting services (e.g. pharmacist consultation) in connection with any prescription dispensed by the Cigna Home Delivery Pharmacy.Cigna Home Delivery Pharmacy shall deliver all drugs to Members in accordance with its standard procedures.For the purposes of clarity,CHLIC does not exert direction or control over the pharmacists at Cigna Home Delivery Pharmacy in filling prescriptions or performing other pharmaceutical services. (b) Cost Sharing. Members are responsible for the payment of the applicable cost sharing to Cigna Home Delivery Pharmacy for each prescription or prescription refill. Employer acknowledges that Cigna Home Delivery Pharmacy may suspend services to a Member who is in default of any cost-sharing obligations, in accordance with Cigna Home Delivery Pharmacy's standard credit policy. If payment of such cost-sharing has not been received from the Member within one hundred twenty (120) days of dispensing of the product, the Plan will be billed for the outstanding amount following the one hundred twenty (120) day collection period. (b) Affiliation with CHLIC.Accredo Health Group,Inc.,ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy Inc., Express Scrpsts Specialty Distribution Services, Inc. and Lynnfield Drug, Inc. (dba Freedom Fertility Pharmacy) are licensed pharmacy 06/28/2023 84 Administrative Services Only Agreement for City of Miami Beach affiliates of CHLIC that fill and deliver Covered Drugs via the mail service. 3. Claims Processing. (a) General. CHLIC, in accordance with Section 2 of the Agreement, shall perform claims processing services for Covered Drugs dispensed by Retail Pharmacies or Cigna Home Delivery Pharmacy. In-network Claims shall be submitted via paper or electronically. Members using out-of-network covered services are required to submit a paper claim form.A separate charge may apply for the submission of any paper claim form, whether in-network or out-of-network. CHLIC is not required to provide coordination of benefits(COB)services for Claims for drugs dispensed,and electronically processed,at a pharmacy; Claims may be processed without consideration of a Member's coverage under another plan. (b) Drug Utilization Review. CHLIC shall perform a concurrent Drug Utilization Review ("DUR") analysis of each prescription submitted for processing. Such DUR Analysis may include,for example:(1)prescribed dosage within a safe range; (2) drug-to- drug interaction;(3)drug-to-allergy interaction;(4)age-to-drug interaction;(5)duplicate therapy;(6)quantity limitations;and(7) days' supply. DUR processes shall not override the prescriber's, the pharmacist's or other health care provider's professional judgment. 4. Utilization Management Program. CHLIC shall, in accordance with Section 2 of the Agreement administer the Pharmacy Benefit utilization management program(s) identified in this Agreement. Employer acknowledges that CHLIC's coverage policies and claims administration procedures, which are utilized across CHLIC's self-funded and insured book-of-business to adjudicate claims and administer appeals, may change periodically. As an example of the coverage criteria that may apply to a pharmaceutical product, a Member may have to try one or more preferred pharmaceutical products, or demonstrate why trying the preferred pharmaceutical product(s)would be clinically inappropriate, in order to obtain coverage under the Plan for a given pharmaceutical product Employer further authorizes CHLIC to allow coverage for a use that would otherwise be excluded in the event of co-morbidities,complications and other factors not expressly addressed by the coverage policies utilized by CHLIC in reviewing Claims for coverage. CHLIC may rely wholly upon information about the Member and the prescriber's diagnosis of the Member's condition. CHLIC shall not substitute its judgment for the judgment of the prescribing physician, nor shall it determine medical necessity or make other medical determinations other than for coverage purposes. 5. Rebate Management.CHLIC shall pay Employer amounts equal to the Rebate amounts specified in the Schedule of Financial Charges. 6. Drug-Related Services. (a) Specialty Drugs.CHLIC shall process Claims regarding Specialty Drugs subject to the following provisions: 06/28/2023 85 Administrative Services Only Agreement for City of Miami Beach (1) The Specialty Pharmacy shall fill prescriptions for Specialty Drugs based on the professional judgment of the dispensing pharmacist, accepted pharmacy practices and product guidelines. (2) A list of Specialty Drugs available via the Specialty Pharmacy and the pricing for those Specialty Drugs shall be made available as in effect on the Effective Date, as set forth in Appendix B. After the Effective Date, Employer may request that CHLIC provide it with an updated list of Specialty Drugs available via the Specialty Pharmacy and the pricing with respect thereto. (3) To the extent acting in the capacity as a mail order pharmacy, the Specialty Pharmacy shall ship Specialty Drugs to Members in accordance with its standard procedures. (4) Members are responsible for the payment of the applicable cost sharing to the Specialty Pharmacy for each prescription or prescription refill. Employer acknowledges that the Specialty Pharmacy may suspend services to a Member who is in default of any cost-sharing obligations,in accordance with the Specialty Pharmacy's standard credit policy.If payment has not been received from the Member within one hundred twenty(120)days of dispensing,the Plan will be billed following the one hundred twenty(120)day collection period. (5) For the purposes of clarity, CHLIC does not exert direction or control over the pharmacists at the Specialty Pharmacy in filling prescriptions or performing other pharmaceutical services. (b) Compound Drugs. CHLIC shall process prescribed Compound Drugs to the extent covered under the Plan. CHLIC shall treat as Covered Drugs only those components of a Compound Drug that would otherwise be treated as Covered Drugs were they not part of a Compound Drug. (c) Discount Card Program. In order to help reduce Member pharmacy costs,CHLIC may partner and apply pharmacy discount card program market pricing where available for certain Generic Drugs. As such, certain, eligible claims may be processed by a pharmacy discount card provider when there is price favorability to the Member. Such claims will adjudicate at the pharmacy discount card market price as a cash claim. Claims will adjudicate in accordance with Employer's Plan design and clinical rules, and Member paid amounts may be applied toward deductible and out of pocket accumulator amounts unless Employer opts out of program enrollment. Claims processed under the program will be included in Rebate and pharmacy financial guarantees, where such guarantees apply. Member direct claims are excluded from the program. Program terms and conditions are subject to change upon no less than forty-five(45)days' prior notice. 7. Member Communications and Services. 06/28/2023 86 Administrative Services Only Agreement for City of Miami Beach (a) Member Communication. CHLIC shall provide to Members an ID card and instructions to access Member materials online, including the Formulary, the Retail Pharmacy directory, Cigna Home Delivery Pharmacy information, and an out-of-network Claim reimbursement form. (b) Rx Savings Messenger. CHLIC may send personalized mailings to Members regarding the Generic Drugs and preferred Brand Drugs and savings available from Cigna Home Delivery Pharmacy. (c) Call Center. CHLIC shall maintain toll-free customer service lines twenty-four(24)hours per day, seven(7)days per week for the purpose of responding to inquiries from Members regarding Retail Pharmacy, Cigna Home Delivery Pharmacy or Claims issues. 8. Formulary Management; Clinical Programs; Other Services. CHLIC shall provide Formulary management services, which shall include implementing Formulary placement decisions and determinations to apply utilization management requirements made by CHLIC. CHLIC makes Formulary determinations based on consideration of clinical and economic factors. Clinical factors may include, but are not limited to, the CHLIC P&T Committee's evaluation of the place in therapy, relative safety or relative efficacy of the drug, as well as whether certain supply limits or other utilization management requirements should apply. Economic factors may include, but are not limited to, the drug's acquisition cost including, but not limited to, assessments on the cost effectiveness of the drug and available Rebates. Employer acknowledges that the Formulary, utilization management requirements, and coverage policies used by CHLIC to perform coverage reviews, including any changes made thereto, are adopted by Employer. When considering a drug for Formulary placement or other coverage conditions, CHLIC reviews clinical and economic factors regarding enrollees as a general population across its relevant book-of-business. CHLIC may also provide the clinical, safety and/or trend programs, or other programs and services to Employer, some of which may require payment of additional fees by Employer. If additional fees are required for such a program or service,CHLIC shall include the fee in the Schedule of Financial Charges or otherwise communicate the same in writing to by Employer. PHARMACY BENEFIT MANAGEMENT-PROGRAM OPERATIONS 1. Implementation of Agreement. (a) Project Plan.Employer and CHLIC shall develop an agreed upon implementation project plan with respect to the Agreement prior to the Effective Date or prior to the implementation with respect to any new Pharmacy Benefit under this Agreement following the Effective Date. (b) Initial Data and Commencement of Pharmacy Benefit Management Services.Prior to the Effective Date, Employer shall provide CHLIC with all data and/or documentation necessary for CHLIC to provide the services specified in this Agreement. Such data and/or documentation shall include, but is not necessarily limited to, claims history and Member prior authorization history. 06/28/2023 87 Administrative Services Only Agreement for City of Miami Beach Assuming all data specified in the preceding sentence is received sufficiently in advance of the Effective Date, CHLIC shall commence providing services under this Agreement as of the Effective Date. 2. Timely Provision of Data by Employer. Employer acknowledges that CHLIC shall not be held responsible for, and shall be released from, fulfilling any obligation or performing any service under this Agreement if Employer or its designee does not provide accurate information in a timely manner. 3. Reporting.CHLIC shall make available to Employer CHLIC's standard reporting applications,subject to Applicable Law and Exhibit D, including, without limitation, HIPAA and state privacy laws. 4. Claims Data. (a) Retention. CHLIC shall retain data with respect to Claims for at least ten (10) years from the date the prescription is filled. Following the close of such retention period, CHLIC shall retain and dispose of such Claims data pursuant to its then-current standard policies and procedures, Applicable Law and the Business Associate Agreement described in the Agreement. (b) Disclosure to Vendor. Upon Employer's written request and subject to execution of a non-disclosure agreement acceptable to CHLIC.CHLIC shall provide prescription Claims data in its standard format to a vendor contracted with Employer and otherwise acceptable to CHLIC solely for the purposes of such vendor's support of Plan administration functions. Employer agrees that its vendors may not utilize Claims data for any other purpose, including, without limitation, developing products and services, analyzing the Claims data against market benchmarks or CHLIC competitors or adding to a normative database (even if de- identified and/or blinded as to Member and PBM/carrier) for the Employer's or vendor's commercial use. Employer shall be responsible for any use or disclosure of Claims data,or any services provided, by the vendor. Notwithstanding the foregoing, all audits of any pricing guarantees,Rebate-sharing obligations or Claims processing accuracy shall be conducted in accordance with the terms in this Agreement specifically relating to such audits. (c) De-Identified Data.During and after the term of this Agreement. CHLIC may use Claims, drug, and medical data that has been de-identified in accordance with HIPAA for research,provider evaluation,database maintenance,and other commercial purposes. This provision shall survive termination or expiration of the Agreement. 5. Pharmacy Claims Processing Audits. (a) Employer may,to the extent specified below and at no additional charge, conduct a claims processing audit of CHLIC's administration of Plan Benefits, once every Plan Year provided that the Agreement has been duly executed by Employer and 06/28/2023 88 Administrative Services Only Agreement for City of Miami Beach Employer is current in the payment of all pharmacy claims under the Agreement.New audits shall not be initiated until all parties have agreed that any and all prior pharmacy-related audits are closed.In order to balance the need to adequately support the audit process for all CHLIC clients,with an efficient allocation of resources, employers who choose to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Claims processing audits shall be subject to the following conditions: (1)the audit may take place while the Agreement is in effect or within one(1)year after the termination or expiration of the Agreement;(2)the initial audit period for a retrospective claims audit shall not exceed the twenty-four(24)months period immediately preceding CHLIC's receipt of the request to audit; (3)Employer shall be responsible for its incurred costs regarding the audit;(4)Employer shall designate, with CHLIC's consent, such consent not to be unreasonably withheld,an independent,third party auditor to conduct the audit(the"Auditor")so long as such Auditor is not engaged in providing services for Employer(including, but not limited to the Auditor's engagement as an expert witness in litigation against CHLIC or its affiliates),or otherwise,that conflict with the scope or independent nature of the audit(as determined by CHLIC acting reasonably and in good faith),and provided that Employer's Auditor executes a mutually acceptable confidentiality agreement;(5)Employer shall provide to CHLIC at least thirty(30)days prior written notice of its intent to audit,and any request by Employer to permit an Auditor to perform an audit will constitute Employer's direction and authorization to CHLIC to disclose PHI to the Auditor;(6)CHLIC will provide all data as reasonably necessary for Auditor to perform the claims processing audit within thirty(30)days following the latter of the audit kick-off call and the Audit Agreement being fully executed or, when applicable, as otherwise agreed upon by the Parties;(7)following Auditor's initial review of the claims,Auditor will provide CHLIC in writing with all suspected categories of claim errors, if any,together with an electronic data file, in a mutually agreed upon format, containing up to three-hundred(300)claims, so that CHLIC may evaluate and investigate Auditor's suspected errors;(8)CHLIC will respond to the suspected errors within sixty(60)days from CHLIC's receipt of such written findings;(9)upon receipt and review of CHLIC's responses, Auditor will provide CHLIC with a written report of Auditor's findings and recommendations before or at the same time such audit report is provided to Employer;(10) CHLIC will respond to the audit report within thirty(30)days of the issuance of Auditor's report;(11)once both Parties have accepted the audit results, the audit shall be considered closed and final;(12)to the extent the mutually accepted audit results demonstrate claims errors,CHLIC will reprocess the claims and make corresponding adjustments to Employer; (13)CHLIC's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer and/or its Auditor and CHLIC,including but not limited to no new or additional issues that appear in the final report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. 6. Pharmacy Rebate Audits. 06/28/2023 89 administrative Services Only Agreement for City of Miami Beach (a) Employer may,to the extent specified below, in accordance with the following requirements, and at no additional charge, audit CHLIC's payment of Rebates provided that the Agreement has been duly executed by Employer and Employer is current in the payment of all pharmacy claims under the Agreement. Any Rebate audit shall occur following CHLIC's issuance of the annual financial reconciliation to Employer once in each twelve(12)month period. New audits shall not be initiated until all parties have agreed that all prior pharmacy-related audits are closed. In order to balance the need to adequately support the audit process for all CHLIC clients, with an efficient allocation of resources,employers who desire to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Rebate audits shall be subject to the following conditions: (1)Employer and CHLIC shall agree on a mutually acceptable, independent,third-party auditor to conduct the audit, including the individual(s)employed or contracted to perform the audit to ensure that they shall not have a conflict of interest that could reasonably diminish their impartiality(the"Auditor");(2) Employer shall be responsible for its incurred costs regarding the audit;(3)Employer shall provide CHLIC with at least forty-five (45)days prior written notice of its intent to audit;(4)a mutually agreed upon nondisclosure/nonuse agreement for rebate audits shall be executed by Employer, the Auditor and CHLIC; (5)the scope of records to be audited as being necessary to determine CHLIC's compliance with its contractual Rebate payment obligations under the Agreement shall be as mutually agreed upon by the Auditor and CHLIC;(6)the Auditor may select for audit purposes the records of up to five(5)manufacturers for two(2) calendar quarters from the last reconciled plan year immediately preceding the written request to audit;(7)the audit shall be conducted at a mutually acceptable time during regular business hours at CHLIC's offices where such records are located;(8) records shall not be removed or photocopied without CHLIC's express written consent;(9) for the sole purpose of confirming compliance with the audit Confidentiality Agreement, Auditor will first submit in draft to CHLIC, and prior to submission to Employer, its Rebate audit report, so that CHLIC can confirm that no terms of the applicable rebate agreements which are confidential,are disclosed in the audit report;(10)the Auditor shall provide its final audit report to CHLIC and Employer at the same time;and(11)the Auditor may disclose the aggregate amount of Rebates due Employer but no other details of CHLIC's rebate contracts of which the Auditor is apprised, if any. This provision shall survive termination or expiration of the Agreement. 7. Pharmacy Financial Guarantee Reconciliation Audits. (a) Employer may, to the extent specified below and at no additional charge, conduct a Financial Guarantee Reconciliation audit once every Plan Year following CHLIC's issuance of the annual financial reconciliation to Employer, provided that the Agreement has been duly executed by Employer and Employer is current in the payment of all pharmacy claims under the Agreement. New audits shall not be initiated until all parties have agreed that all prior pharmacy-related audits are closed. In order to balance the need to adequately support the audit process for all CHLIC clients,with an efficient allocation of resources, 06/28/2023 90 Administrative Services Only Agreement for City of Miami Beach employers who choose to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Financial Guarantee audits shall be subject to the following conditions: (1)the audit may take place while the Agreement is in effect or within one (1) year after the termination or expiration of the Agreement; (2) such audit may cover up to two prior contract years to the extent such prior contract years have not previously been audited;(3) Employer shall be responsible for its incurred costs regarding the audit; (4) Employer shall designate with CHLIC's consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit (the "Auditor") so long as such Auditor is not engaged in providing services for Employer(including,but not limited to the Auditor's engagement as an expert witness in litigation against CHLIC or its affiliates), or otherwise, that conflict with the scope or independent nature of the audit(as determined by CHLIC acting reasonably and in good faith), and provided that Employer's Auditor executes a mutually acceptable confidentiality agreement;(5)Employer shall provide CHLIC with at least thirty(30)days'prior written request for the audit,and any request by Employer to permit an Auditor to perform an audit will constitute Employer's direction and authorization to CHLIC to disclose PHI to the Auditor;(6)CHLIC will provide all data as reasonably necessary for Auditor to determine that CHLIC has performed in accordance with its contractual obligations regarding the financial guarantees,and CHLIC will provide such data within thirty (30)days following the latter of the audit kick-off call and the confidentiality agreement being fully executed or,when applicable, as otherwise agreed upon by the Parties; (7) any adjustments resulting from the audit will be based upon the actual Claims reviewed and not upon statistical projections or extrapolations, as the Auditor will be furnished with 100%of the paid Claims processed during the applicable contract period for purposes of the audit;(8) following Auditor's initial review and prior to the submission of its written audit report, the Auditor will provide CHLIC in writing with all of the suspected errors, if any, and CHLIC will respond to such suspected errors within sixty (60) days from CHLIC's receipt of such preliminary findings; (9) CHLIC will respond to any audit report issued by the Auditor within thirty(30)days of the issuance of same; and(10)CHLIC will reconcile mutually agreed upon amounts due to Employer within a reasonable period of time following mutual agreement regarding any amount due to the Employer. CHLIC's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer and/or its Auditor and CHLIC, including but not limited to no new or additional issues that appear in the final report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT- FUNDING AND PAYMENT OF CLAIMS; CHARGES 1. Funding and Payment of Claims. With respect to Pharmacy Benefits,(1)CHLIC may withdraw funds from the Bank Account for the purposes specified in Section 3 of the Agreement five times per month, and (2) any recovered overpayments shall be credited to Employer via a line item on its invoice, less the fee set forth on the Schedule of Financial Charges. 06/28/2023 91 Administrative Services Only Agreement for City of Miami Beach 2. Retroactive Member Changes and Terminations.Notwithstanding anything in the Agreement to the contrary, Employer shall remain responsible for all charges and Bank Account Payments incurred or charged through the date CHLIC processed Employer's notice of a retroactive change or termination of a Member's enrollment in the Plan.Notwithstanding anything to the contrary in Section 4.c. of the Agreement,with respect to Pharmacy Benefits,CHLIC generally will implement eligibility updates received from Employer that adhere to CHLIC's standard electronic format as soon as reasonably practicable following receipt of such updates. PHARMACY BENEFIT MANAGEMENT-FIDUCIARY ACKNOWLEDGMENTS CHLIC offers pharmacy benefit management services for consideration by Employer and other entities.The general parameters of such services and the supporting systems have been developed by CHLIC as part of CHLICs administration of its general business as a pharmacy benefit manager for entities that sponsor group health plans. The Parties have negotiated the terms of this Agreement in an arm's-length fashion. Except to the extent CHLIC conducts the final level of internal appeal as set forth in Section 2.c of the Agreement,the Parties assert that neither Party intends that CHLIC shall be a fiduciary with respect to Pharmacy Benefits for either ERISA(if applicable)or state law purposes, and neither Party shall name CHLIC or any of its affiliates as a"plan fiduciary"with respect to its management of Pharmacy Benefits. Employer acknowledges and agrees that CHLIC(i)does not have discretionary authority or control respecting management of the Pharmacy Benefits, and (ii)does not exercise any authority or control respecting management or disposition of the assets relating to Pharmacy Benefits or of Employer. Rather,Employer retains all such authority and control. The Parties agree that,upon reasonable notice,CHLIC shall have the right to terminate its Pharmacy Benefit services under this Agreement to any Plan and/or Members located in a state that requires a pharmacy benefit manager to be a fiduciary to Employer,the Plan or a Member. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-FINANCIAL ARRANGEMENTS 1. General.CHLIC contracts with its PBM affiliate for the provision of pharmacy benefit services and financial arrangements. As such, CHLIC or its PBM affiliate, directly or indirectly contract on their own accounts with Retail Pharmacies and Cigna Home Delivery Pharmacy to dispense covered pharmaceutical products to Employer's Members,and not on behalf of,or for the benefit of, Employer or the Plan; accordingly, any discounts or other remuneration CHLIC or its PBM affiliate earns under an arrangement with a Retail Pharmacy or Cigna Home Delivery Pharmacy are obtained for, and inure to, the sole and exclusive benefit of CHLIC or its PBM affiliate,and not the Employer or the Plan.Amounts paid by CHLIC or its PBM affiliate or by the PBM affiliate for Retail Pharmacy or Cigna Home Delivery Pharmacy for Brand Drug, Generic Drug, or Specialty Drug Claims may or may not be equal to the amount charged to Employer and/or Member.If the amount paid by Employer and/or Member does not equal the amount paid by CHLIC or its PBM affiliate or by the PBM affiliate to a particular pharmacy, CHLIC and its PBM affiliate will absorb or retain such difference. CIILIC may directly or indirectly contract for Rebates,Manufacturer Administrative Fees,and other remuneration on its own behalf and for its own benefit,and not on behalf of Employer or the Plan.As an example of other remuneration other than Rebates or Manufacturer Administrative Fees that CHLIC may earn,CHLIC may also directly or indirectly earn from pharmaceutical manufacturers remuneration 06/28/2023 92 Administrative Services Only Agreement for City of Miami Beach in connection with value payments and/or services that CHLIC provides to Employer ("Value-Based Payments"). Notwithstanding anything in this Agreement to the contrary, any Value-Based Payments earned by CHLIC are separate and apart from any Rebates or Manufacturer Administrative Fees that CHLIC directly or indirectly earns from pharmaceutical manufacturers, and CHLIC may retain any Value-Based Payments it earns. As examples of the value payments and/or services that CHLIC may provide to Employer in connection with Value-Based Payments that CHLIC may earn, CHLIC may provide care management or other services to Employer and/or remit to Employer monetary credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services, and/or monetary credits or other financial value, for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions,including the products for which monetary credits or other financial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHLIC to Employer are subject to change or termination by CHLIC as the value program(s), if any, offered by CHLIC change(s) or terminate(s). Accordingly, CHLIC retains all right, title and interest to any and all actual Rebates, Manufacturer Administrative Fees, Value-Based Payments, and other remuneration directly or indirectly received from manufacturers. CHLIC may provide Employer amounts equal to all or some portion of the Rebate and Manufacturer Administrative Fee amounts, or other financial value generated in connection with any value program(s), allocated to Employer, if any, and as specified on the Schedule of Financial Charges,from CHLIC's general assets(neither Employer, its Members,nor Employer's Plan retains any beneficial or proprietary interest in CHLIC's general assets). Rebate and Manufacturer Administrative Fee amounts received vary based on factors including, without limitation,Employer-specific utilization,the volume of utilization as well as Formulary position applicable to the drug or supplies, and adherence to various formulary management controls, benefit design requirements, and Claims volume. Employer acknowledges and agrees that neither it, its Members nor its Plan will have a right to interest on, or the time value of, any Claim payments charged by CHLIC to Employer or any Rebate,Manufacturer Administrative Fee or other payments received by CHLIC during the collection period of moneys payable under this section, if any, and that CHLIC shall retain any such remuneration. For purposes of this provision, the term CHLIC shall also include and mean CHLIC's PBM affiliate, Express Scripts, Inc. 2. Affiliates.Cigna Home Delivery Pharmacy may maintain product purchase discount arrangements and/or fee-for-service arrangements with pharmaceutical manufacturers and wholesale distributors in its capacity as a mail service and/or specialty pharmacy. Cigna Home Delivery Pharmacy may contract for these arrangements on its own account in support of its pharmacy operations, and not on behalf of, or for the benefit of,Employer or the Plan. Accordingly, Cigna Home Delivery Pharmacy retains the sole and exclusive benefit of any difference between its acquisition cost for a pharmaceutical product and the amount charged to Employer under this Agreement. Further these arrangements relate to services provided outside of this Agreement and other pharmacy benefit management arrangements and may be entered into without regard to whether a specific drug is on one of the formularies that CHLIC offers to entities that sponsor group health plans. Discounts and fee-for-service payments received by Cigna Home Delivery Pharmacy are not part of the pharmacy benefit management formulary rebates or associated administrative fees or charges paid to CHLIC in connection with CHLIC's pharmacy benefit management formulary rebate programs. 06/28/2023 93 Administrative Services Only Agreement for City of Miami Beach This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-OBLIGATIONS UPON TERMINATION Upon notice of termination of this Agreement, the following provisions shall apply with respect to Pharmacy Benefits: a) Employer shall notify Members at least thirty (30) days prior to the termination of the Agreement becoming effective of any transition to a successor pharmacy benefit manager. b) If mutually agreed upon by CHLIC and Employer, CHLIC shall provide services following termination of the Agreement at CHLIC's then-prevailing rate. Such services, if any, shall be determined by mutual agreement of CHLIC and Employer in advance of the termination of the Agreement becoming effective. c) Upon request by Employer and subject to execution of a nondisclosure agreement acceptable to CHLIC, CHLIC shall transition Claims files and/or history to the pharmacy benefit manager or other third party specified by Employer and otherwise acceptable to CHLIC,at no additional cost to the Employer. Any disclosure of Claims files and/or history shall be limited to the information the successor pharmacy benefit manager or other third party needs to implement or administer Employer's pharmacy benefits. CHLIC shall not be required to directly or indirectly release,and Employer shall not release,PBM Proprietary Information to any such third party. d) Upon termination of the Agreement for any reason, the Parties shall handle Confidential Information, PBM Proprietary Information and Protected Health Information(as defined in the Business Associate Agreement attached as Exhibit D)pursuant to the terms of the Agreement. e) In the event that CHLIC terminates the Agreement pursuant to Section l.vi of the Agreement, CHLIC shall have no further obligation following the date of such termination to pay Employer any Rebates, or any other amount that may otherwise be payable by CHLIC to Employer. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-CONFIDENTIALITY 1. General. Employer acknowledges and agrees that CHLIC's PBM Proprietary Information constitutes competitively sensitive trade secrets,and that its misuse or mis-disclosure could result in material financial and legal loss or liability to CHLIC, its affiliates and their respective subcontractors. CHLIC shall not be required to disclose PBM Proprietary Information to Employer except to the extent necessary for Employer to exercise any audit rights expressly provided hereunder or perform other Plan administration functions. If CHLIC discloses PBM Proprietary Information to Employer,or, if CHLIC consents,to the Employer's vendor or designee, CHLIC may 06/28/2023 94 Administrative Services Only Agreement for City of Miami Beach require Employer,or its vendor or designee,to execute a non-disclosure agreement specifically relaxing to the requested PBM Proprietary Information.Employer agrees that it and its vendors may not utilize PBM Proprietary Information for any purpose other than performing Plan administration functions, including,without limitation,developing products and services, de-identifying, blinding or analyzing the PBM Proprietary Information against market benchmarks or CHLIC competitors or adding to a normative database for the Employer's, or vendor's or designee's, commercial use. For the purposes of clarity, information shall not cease to qualify as PBM Proprietary Information if Employer or its vendor or designee de-identifies and/or blinds the PBM Proprietary Information such that the information cannot be traced or identified to a Member or CHLIC, its affiliates or their respective subcontractors. Employer shall be solely responsible for any disclosure of PBM Proprietary Information by CHLIC to Employer or its vendor or designee, or any subsequent use or disclosure by Employer or its vendor or designee,or services provided by the same.Notwithstanding anything herein to the contrary, in no event will CHLIC be required to disclose to Employer,or its vendor or designee,information related to,or including, its pharmacy network agreements, vendor agreements or pharmaceutical manufacturer agreements. 2. Compelled Disclosures.If at any time Employer,or its vendor or designee, is required by law,court order or other valid legal process to disclose any Confidential Information, it will promptly notify CHLIC prior to any such compelled disclosure and, upon request, cooperate with CHLIC in seeking a protective order or other available relief to contest or limit the scope of such compelled disclosure. 3. Return or Destruction of Information.At any time upon CHLIC's request or upon expiration or termination of this Appendix A or the Agreement, whichever occurs first, Employer will, at CHL1C's option, promptly deliver, or, as the case may be, compel its vendor or designee to deliver,to CHLIC all PBM Proprietary Information or other Confidential Information(or such portion thereof as requested) and not retain any copies in whole or in part of such PBM Proprietary Information or other Confidential Information,or securely destroy or dispose, or, as the case may be, compel its vendor or designee to destroy or dispose, of those portions of documents and other materials in any form, including electronic form, prepared by or received by the Employer or its vendor or designee, that contain or reflect such PBM Proprietary Information or other Confidential Information. Employer, or its vendor or designee. shall certify such return and destruction,as the case may be,to CHLIC. 06/28/2023 g5 Administrative Services Only Agreement for City of Miami (teach Appendix B - Cigna Home Delivery Pharmacy Specialty Drug List THIS SPECIALTY DRUG LIST IS CONFIDENTIAL, PROPRIETARY INFORMATION OF CHLIC. IT IS PROVIDED SOLELY FOR EMPLOYER'S PLAN ADMINISTRATION PURPOSES. RE-DISCLOSURE IS STRICTLY PROHIBITED EXCEPT AS OTHERWISE PROVIDED BY APPLICABLE LAW. CHLIC RESERVES ALL LEGAL RIGHTS AND REMEDIES TO ENFORCE THESE PROHIBITIONS ON USE AND DISCLOSURE. The Specialty Drug List shall be provided separately to Employer,and is hereby incorporated into the Agreement by reference,inclusive of any changes made subsequent to CHLIC's initial issuance of the Specialty Drug List to Employer to the pharmaceutical products included on the Specialty Drug List or the discounts pertaining to such pharmaceutical products. Upon Employer's request on or after the Effective Date,CHLIC shall provide to Employer an updated Specialty Drug List. Currently Marketed Specialty Drugs on this Specialty Drug List.The discounts in this Specialty Drug List are the discounts that will be adjudicated in CI ILICs claim processing system for the drug indicated when dispensed by Cigna Home Delivery Pharmacy, subject to all of the following. • The discounts in this Specialty Drug List are based on the terms and design of the Pharmacy Benefit that Employer has adopted and disclosed to CHLIC. Accordingly, if Employer fails to disclose to CHLIC, for example, that it uses or intends to use a consumer-driven health plan, a major cost- sharing program,or a utilization management program promoting generic or OTC drugs over brand drugs, CHLIC may adjust the discounts as it reasonably deems necessary to preserve the economic value or benefit of this Agreement as CHLIC anticipated based on the terms and design of the Pharmacy Benefit previously disclosed to CHLIC and prior to CHLICs discovery of the Pharmacy Benefit design feature that materially impacts CHLICs discounts in this Specialty Drug List. • The discounts in this Specialty Drug List shall not apply to Compound Drug claims, Claims that process at U&C, direct member reimbursement(DMR) Claims, and drugs adjudicated under the medical benefit. • Any or all of the discounts in this Specialty Drug List may be adjusted by CHLIC to the extent reasonably necessary to preserve the economic value of this Agreement as it existed immediately prior to the occurrence of any of the following events:(a)there are any significant changes in the composition of CHLICs pharmacy network or in CHLICs pharmacy network contract compensation rates,or the structure of the pharmacy stores/chains/vendors that are contracted with CHLIC,including but not limited to disruption in the retail pharmacy delivery model,or bankruptcy of a chain pharmacy;or(b)there is a change in government laws or regulations which has a significant impact on pharmacy claim costs; or(c)any material manufacturer-rebate contracts with or for the benefit of CHLIC are terminated or modified in whole or in part;or(d)there is any legal action or Law that materially affects or could materially affect the manner in which CHLICs rebate program is administered or an existing Law is interpreted so as to materially affect or potentially have a material effect on CHLICs administration of the Pharmacy Benefit;(e)there is a material change in the Plan or the Plan's Pharmacy Benefit that is initiated by Employer which impacts CHLICs costs or(f)a major change in market conditions affecting the pharmaceutical or pharmacy benefit management market,a drug shortage in the market,an issue involving the safety of the drug supply, or similar market situation. New-to-Market Specialty Products. Specialty Drug Claims,excluding Limited Distribution Drugs and 06/28/2023 96 Administrative Services Only Agreement for City of Miami Beach Exclusive Distribution Drugs,that are for new-to-market drugs will have a minimum market-introduction guaranteed discount of 11.45%off the drug's AWP. "Limited Distribution Drug"or"Exclusive Distribution Drug"shall mean a Specialty Drug that is not generally available from most or all pharmacies and is restricted to select pharmacies as determined by a pharmaceutical manufacturer. The list of Limited Distribution Drugs and Exclusive Distribution Drugs will be maintained by CFILIC. 06/28/2023 97 Administrative Services Only Agreement for City of Miami Beach Appendix C - SaveOnSP Program 1. The SaveOnSP Program is a Member cost share savings program available when the Employer makes certain pharmacy benefit plan design changes such that program specialty prescription drugs are designated as non-essential health benefits with respect to federal PPACA essential health benefit requirements, and Employer establishes Member cost share at amounts that allow the receipt of manufacturer-supported patient cost share assistance in accordance with Program parameters ("Program"). Designated specialty drugs under the Program may be revised twice on a calendar year basis. 2. Employer will be responsible for the payment of Program fees which shall be 25% of program savings and for any applicable tertiary and residual cost share. The Program fees shall be measured and calculated based on the Program's standard savings and fee calculating methodology. Payment of Program fees shall be charged to the Bank Account and invoiced on a monthly, incurred basis. 3. In order to make available Program services, CHLIC is providing Employer's claims data to CHL1C's approved third-party vendor ("Vendor") on a periodic basis to facilitate such Vendor's provision of the Services. Members' claims data is being provided under an applicable business associate agreement with such Vendor and in accordance with HIPAA including, but not limited to, the minimum necessary standards. Vendor may communicate with Employer's Member in order to provide Program services. 4. Employer acknowledges and agrees that CHLIC and Vendor is not a legal advisor and do not render any legal counseling or advice regarding the provision of Program services or benefit designs adopted by Employer. Employer understands and agrees that it is implementing a third party specialty drug program administered by Vendor. Neither CI ILIC nor Vendor is responsible for ensuring that Employer or Employer's employee benefit plans independent from or in conjunction with the Program services comply with any Applicable Law including but not limited to laws, regulations,rules,ordinances and/or other guidance related to or associated with relevant Federal and State Anti-kickback laws; IRS rules; ERISA; the Affordable Care Act, state insurance department regulations, state consumer protection requirements, or other federal state or local laws or regulations, including but not limited to laws, regulations,rules,ordinances and/or other guidance related HSA-eligible high deductible health plans(including but not limited to Code Section 223) notwithstanding anything to the contrary. CHLIC hereby advises Employer to seek legal advice and Employer acknowledges that it will consult with its own legal counsel regarding the operation, administration, and establishment of its plans and the appropriateness of the Program. Neither CHLIC nor Vendor shall be liable to Employer or any person if any plan fails to comply with any such requirement.Employer is solely responsible for determining whether to implement the Program for its USA-eligible high deductible health plan and addressing any compliance issues related to such implementation. 5. In addition to other provisions set forth in this Agreement, it is understood and agreed that for purposes of the Program,Employer(or the relevant plan sponsor and/or plan administrator)have full and final authority and responsibility for the plans,plan assets,and plan operation. Neither CHLIC nor Vendor is a fiduciary(as defined under ERISA or state law)of CNLIC clients' plans. CHLIC, CHLIC Affiliates and Vendor do not: (a) have any discretionary authority or control respecting management of CHI..IC clients' plans' prescription benefit programs or(b)exercise any authority or 06/28/2023 98 Administrative Services Only Agreement for City of Miami Beach control respecting management or disposition of the assets of CHLIC clients' plans. All such discretionary authority and control with respect to the management of CHLIC clients' plans and plans' assets arc retained by CEILIC clients and/or CHLIC clients' plans. 6. If Employer fails to timely pay in full all applicable Program fees, CHLIC reserves the right to suspend or terminate the services under the Program upon Employer failing to +fie pay all applicable Program fees and upon CHLIC providing Employer thirty (30) days written notice of nonpayment,in addition to any other rights and remedies available to CHLIC under this Agreement and Applicable Law. 7. CHLIC reserves the right to modify, revise, or terminate the Program due to market conditions that have a material impact on the Program at any time. 06/28/2023 99 MEDICARE ADVANTAGE PLANS PLAN C DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 -)(, Cigna EMPLOYER/UNION GROUP MAPD AGREEMENT • 'Ibis Employer/Union Group Medicare Advantage Prescription Drug("MA PD")Agreement(hereinafter "Agreement")is by and between Cigna Health and Life Insurance Company and HealthSpting Life&Health Insurance Company,Inc.(collectively referred to as"Cigna")and City of Miami Beach("Group"),and is effective as from January 1,2024 through December 31,2027. WHEREAS,Cigna has contracted with the Centers for Medicare&Medicaid Services("CMS")under the Social Security Act as amended by the Medicare Prescription Drug,Improvement and Modernization Act of 2003 and by the Inflation Reduction Act of 2022 and the Affordable Care Act and as further regulated by the Medicare Advantage Benefit Plan Final Rules contained in 42 CFR 422("MAPD Final Rules")and the Medicare Prescription Drug Benefit Plan Final Rules contained in 42 CFR Part 423("PDP Final Rules")to operate an MAPD Plan,and offer employer/union-only group MAPD Plans;and WHEREAS,CMS'contract addendum with Cigna(Employer/Union-Only Group Addendum)requires that Cigna obtain written agreements from each employer or union with which it contracts for employer/union-only group MAPD plans,and that such agreements contain certain terms and provisions,as set forth below;and WI IEREAS,Group wishes Cigna to provide and Cigna wishes to offer to Group an employer/union-only group MAPD(hereinafter referred to as the"Plan")for MAPD eligible individuals in accordance with this Agreement;and NOW,THEREFORE,in consideration of the mutual promises and covenants contained herein,it is hereby agreed as follows: I. Tem.This Agreement is effective as of the Effective Date set forth above and shall d. upon termination of Cigna's contract with continue in effect for an initial term of three CMS;or (3)years. Thereafter,this Agreement may be e. upon any other date mutually agreeable to renewed for two(2)additional three(3)year the Group and Cigna. terms provided that Cigna and Group mutually agree on the terns of such renewal.Group's 3. Services.Cigna shall provide coverage in City Manager shall be authorized to execute accordance with applicable federal law,the all renewal terms under this Agreement. MAPD Final Rules,PDP Final Rules,the Notwithstanding the foregoing,this Employer/Union-Only Group Addendum and Agreement may be terminated at any time in the Evidence of Coverage issued by Cigna to accordance with Section 2 below. On or about those MAPD eligible individuals who are the anniversary of each contract term,Cigna eligible for and enrolled in Group's Plan may request,and the City Manager may ("Enrollees"),as follows: approve,a cost adjustment based on documented cost increases for the following a. Cigna shall provide the Plan in Cigna's contract year.See exhibit A service area utilizing a provider network, pharmacy network and formulary that 2. Termination.This Agreement will terminate meet the requirements of its upon the earlier of any of the following events: Employer/Union-Only Group Addendum with CMS. (See 42 CFR 422 Subpart C, a. the date that Group terminates its Plan; the Medicare Managed Care Manual ("MMCM"),Ch.9,Section 40.1,and 42 h. the date Group fails to pay Premiums in CFR 423.120,and the Medicare accordance with Section 4 herein. Prescription Drug Benefit Manual ("PDItM"),('Ii. 12,Section 20.8.) c. at any time,upon thirty(30)days'prior written notice by one party to the other, b. Cigna shall provide Group Enrollees DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 • Group: City of Miami Beach 0l0 (•• Cigna fl' Effective Date:January 1,2024 coverage as described in the attached Enrollee of the change and,as applicable, •Exhibit A. refund the difference to the Enrollee,or • request payment of the difference.(See 42 4. Premium Payment and Grace Period, CPR 423.466) b. Enrollee will be responsible for any a. On or before the last day of each month claims expense paid in good faith by (the"Premium Date"),Group shall remit Cigna that arises as a result of an to Cigna on behalf of each Enrollee the adjustment referenced above in Section per member per month Premium Rate set 5a. (See 42 CFR 423.466) forth on Exhibit A,the Summary of Benefits,in payment for services rendered Enrollee Premium;Government Prograrn under this Agreement for that month. It' Benefit Payments, Group acknowledges that Group does not pay the Premium due to Enrollees will not be permitted to make Cigna within one month of the Premium payment of Premium contributions for the Date,Cigna shall provide Group with a Plan through withholding from the Enrollee's notice of late payment, Cigna may Social Security,Railroad Retirement Board,or terminate this Agreement one month after Office of Personnel Management benefit it provides Group with a notice of late payment. (See MMCM,Ch.9,Section 20.5, payment if Group has not paid the and PDBM,Ch.12,Section 20.5.) Premiums due. During this two(2)month grace period,Group may pay Premium 7. Enrollee Premium;Group Subsidization without loss of coverage under this Restrictions.Group's determination of how Agreement. In the event that this much of an Enrollee's Plan Premium it will Agreement terminates prior to Group subsidize is subject to the restrictions set forth • paying any outstanding Premium due to in(a)through(c)below. Cigna,Group will be financially responsible for such Premium until a. Group can subsidize different amounts for payment to Cigna is made in full. (Sec different classes of Enrollees in the Plan, MMCM,Ch.2,Section 50.3.1,and provided such classes are reasonable and PDBM,Ch.3,Section 50.3.1.) based on objective business criteria,such as years of service,date of retirement, b. Group shall be responsible for the business location,job category,and nature payment of all Premium due through the of compensation(e.g.,salaried v.hourly). date on which Group coverage ceases Different classes cannot be based on under this Agreement. eligibility for the Part I)l,ow Income Subsidy. 5. Payment of Claims. Cigna shall pay claims ill accordance with the Employer/Union-Only b. Group cannot vary the Premium subsidy Group Addendum and the Evidence of for individuals within a given class of Coverage issued by Cigna. Enrollees. a. Group acknowledges and agrees that from 0. Group cannot charge an Enrollee for the time to time Cigna will reprocess or adjust Plan more than the sum of the Enrollee's claims that have been processed under the monthly Premium attributable to basic Plan for many potential reasons,including coverage and 100%of the monthly but not limited to obtaining additional Premium attributable to the Enrollee's information from the Enrollee,enrollee's supplemental coverage,or other health or provider,or CMS and identifying errors. prescription drug coverage(if any). In the event that Cigna reprocesses or adjusts a processed claim(s)and this (See MMCM,Ch.9,Section 20,4.2,and results in a change to the amount due from PDBM,Ch. 12,Section 20.4 for support the Enrollee,Cigna shall notify the of all of Section 7) DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 `41 Cugna. Group: City of Miami Beach ;'/= Effective Date:January 1,2024 c. US—Premium: 8. Enrollee Premium:Increase for Late Enrollment Penalty.Cigna shall identify i. For all Enrollees eligible for the LiS, Enrollees without prior creditable prescription the Group will first use the LIS to drug coverage who are subject to the late reduce the portion of the monthly • enrollment penalty as described in 42 CFR , Premium attributable to basic Part D 423.46 and 42 CFR§423.286(d)(3). This coverage paid by the Enrollee,and identification process may include outreach to will then apply any remaining portion the Enrollee and/or Group to obtain additional of the LIS amount toward the portion information necessary to make the of the monthly Premium attributable determination. Atler CMS informs Cigna that to basic Part D coverage paid by it will assess the late enrollment penalty with Group.If the sum of the Enrollee's respect to such Enrollees Cigna will charge the portion of the monthly Part D late enrollment penalty to the Group on Premium(or the subscriber's/ Group's monthly bill, Group agrees to remit participant's Plan monthly premium, any such late enrollment penalties with if applicable)and the Group's portion Group's monthly premium submission. At of the monthly Part D Premium(i.o., Group's discretion,Group may pass the total monthly premium)are less than penalty charges to the incurring Enrollee for the monthly LIS amount,Cigna will payment;however,Group remains responsible return any portion of the LIS amount for payment of such penalties to Cigna. (See above the total monthly Part D 42 CFR§423.46 and 42 CFR§423.286(d) Premium to CMS. LIS funds above (3).) the total monthly Part D Premium cannot be retained by Cigna,the 9. fart D Low Income Subsidy—Enrollee Group,or the Enrollee(or the Premium and Cost Sharing. subscriber/participant,if applicable). a. Annually,Group shall provide Cigna with ii. Group shall be responsible for a report showing the portion of the reducing up-front the Part D Premium Premium charged to each Enrollee related contribution required for Enrollees to Part D coverage so that Cigna and eligible for the LIS, In those Group can appropriately administer the instances where Group is not able to Low Income Subsidy("LIS")received reduce up-liuut the Part D Prcniums from CMS. Each time a new Enrollee paid by the Enrollee(or the enrolls in the Plan,Group shall provide subscriber/participant,if applicable), Cigna with an updated report showing the Cigna shall directly refund to the Part D Premium charged to such Enrollee. Enrollee(or the Additionally,if any Enrollee is subscriber/participant,if applicable), responsible for cost sharing related to Part the amount of the LIS up to the Part D D services in a different amount than is Premium contribution previously reflected on Exhibit A,Group shall notify collected from the Enrollee(or the Cigna of such difference and each subscriber/participant,if applicable). Enrollee who is subject to the different Cigna will complete the refund within cost sharing. (See PDItM,Ch.12, Forty-five(45)days of the date Cigna Section 20.12.1 and Section 20.12.2.) receives from CMS the LIS payment for the LIS eligible Enrollee. b. Cigna will receive notification from CMS of any Enrollees who qualify for LIS. iii. If the LIS for which an Enrollee is Cigna will adjust the Part D Premiums due eligible is less than the portion of the from Group to reflect the adjustments monthly Part D Premium paid by the provided by CMS. Enrollee,then the Group must communicate to the Enrollee the DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 \',,I. %%Igloo • Group: City of Miami Beach •(� C' n a Effective Date:January 1,2024 7 financial consequences for the (Administrative Guidelines). Group Enrollee of enrolling in the Plan as further agrees to provide mutually agreed compared to enrolling in another plan upon eligibility information on a monthly with a monthly Part D beneficiary basis or as otherwise mutually agreed to premium equal to or below the LIS, by the parties. Cigna will notify Group when it receives incomplete eligibility (See PDBM,Ch. 12,Section 20,12.1 data for potential Enrollees or when it for support for all subsections of identifies actual or potential discrepancies Section 9.c.) in the eligibility data it receives from Group. Group shall review such data and d. LIS—Cost Sharing. Cigna shall use the reconcile any discrepancies and/or provide LIS to reduce each LIS eligible Enrollee's any missing data within twenty one(21) Part D cost sharing at the point of sale. days of the date that Cigna notifies Group Group acknowledges that LIS for Part D of such discrepancies or incomplete cost sharing can only be used tc reduce an data. Group acknowledges that an Enrollee's Part D cost sharing to the individual whose eligibility data is extent that the Enrollee was responsible incomplete or whose eligibility data for Part D cost sharing. Cigna will return contains discrepancies cannot be enrolled LiS amounts that are greater than an into the Plan until such issues are Enrollee's Part D cost sharing amount. resolved. Such individual can stay or be LIS funds above an Enrollee's Part D cost enrolled in Group's non-MAPD plan if sharing cannot be retained by Cigna,the Group's policy is to offer and allow such Group,or the Enrollee(or the subscriber/ enrollment.(See MMCM,Ch.2,Section participant,if applicable). IICMS notifies 40,1.6,and 40,2,2,and PDBM,Ch.3, Cigna that an Enrollee is LIS eligible after Sections 40.1.6 and 40.2.2.) the Enrollee has paid Part D cost sharing amounts,Cigna will refund Part D cost c. Group will provide written notice to all sharing amounts to the Enrollee within individuals eligible for the Plan informing forty five(45)days of receiving such them(i)that Group intends to information from CMS. (See PDBM,Ch. prospectively enroll them into the Plan 12,Section 20.12.2.) through a group enrollment process;(ii) that the individual may affirmatively opt 10. Etrollment. out of such enrollment,(iii)how to opt- out,and(iv)any consequences to group a. Group will restrict enrollment in the Plan benefits opting out would bring. Group to those individuals eligible for Group's will provide the required written notice to employment-based retiree group covorage all such individuals with this information who are eligible for MAPD,and either 1) at least 21 days prior to the effective date elect to participate in Group's Plan with of the individual's enrollment in the Plan. Cigna;or 2)do not opt out of Group's Group agrees that the required written enrollment in such Plan. (See MMCM, notice must include a summary of benefits Ch.2,Section 40.1.6,and Ch.9,Section offered under the Plan,and must explain 30.1,and PDBM,Ch.3,Section 40.1.6 how to get more information on such Plan, and Ch.12,Section 20.1.1.) and how to contact Medicare for information on other MAPDs that might h. Group will provide to Cigna or Cigna's be available to the individual. The Business Associate for coordination and required written notice will include all submission to Cigna all information on information referenced in and he each individual to be enrolled as required substantially similar to Exhibit 31— by Cigna to submit a complete enrollment Model Emplover/Union Sponsored MA request transaction to CMS as described in Plan Groun Enrollment Mechanism CMS guidance and Exhibit B Notice of Chapter 2—Medicare DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 (:coup: City of Miami licach �a/: Cigna Effective Date:January I,2024 t Advantage Enrollment and Disenrollment b. Group shall promptly notify Cigna of of the Medicare Managed Care Manual, Enrollees who terminate or lose eligibility and Exhibit 32 -Moclel Employer/Union under the Plan.Unless otherwise required Sponsored Prescription Drug Plan Group by law or CMS requirements,coverage for Enrollment Mechanism Notice of Chapter Enrollees shall cease at the end of the —Eligibility.Enrollment and month in which Cigna receives notice of Disenrollment of the Medicare disenrollment. (See MMCM,Ch.2, Prescription Drug Benefit Manual.(See Section 50.7 and PDBM,Ch.3,Section MMCM,Ch.2,Section 40.1.6.and 50.6.) FORM,Ch.3,Section 40.1.6) c. If an Enrollee enrolls in another MAPD or d. When Group provides an individual's Part D plan,the Enrollee will be completed enrollment request to Cigna in automatically disenrolled from the an untimely fashion and causes Cigna to Group's Plan by CMS. Cigna will notify request a retroactive enrollment,Group the Group within 30 days of receipt of the shall provide documentation to Cigna disenrollment notice from CMS. Cigna • showing that the individual completed the will send a diseurolltnent letter to the enrollment request in a timely manner and Enrollee within 10 days of receiving that the delay in providing the completed notice from CMS.(See MMCM,Ch.2, enrollment request was caused by Group. Section 50.4.1,and PDBM,Ch.3, As set forth in Exhibit 13,Cigna shall Section 511.4.1.) provide Group a form that Group shall use to disclose to Cigna the reason the d. If Grotto's policy is to disenroll Enrollees retroactive request must be made.Cigna for failure to pay their monthly Premium, may only seek to retroactively enroll an Group must apply the policy consistently individual into the Plan if the retroactive across its Enrollees. Group must give an enrollment request is necessary as a result Enrollee a minimum grace period and of Getup's delay in forwarding the provide them with written notice prior to individual's completed enrollment request disenrollment.The grace period must be at to Cigna.An individual cannot he least two calendar months that begins on retroactively enrolled into the Plan:(a) the first day of the month for which the earlier than the date on which the Premium is unpaid. If an Enrollee fails to individual completed an enrollment pay his or her Premium within the grace request,or(h) more than ninety(90)days period,the Enrollee can be disenrolled on tram when the completed enrollment the first day alter the end of the grace request is received by Cigna.(See • period. Group can attempt to collect the MMCM,Ch.2,60.6.1,and PDBM,Ch. Premium but cannot retroactively 3,Section 60.5.1.) terminate the Enrollee. (See MMCM, Ch.2,Section 50.3.1,and PDBM, • I I. Disenrollnent. Chapter 3,Section 50.3.1.) a. Group and Cigna agree that e. If an Enrollee fails to pay their Part D • — disenrollments shall be conducted in income Related Monthly Adjustment accordance with applicable CMS Amount(1RMAA)premiums to Social requirements and that Group and Cigna Security Administration,the Enrollee will will comply with such requirements, automatically be disenrolled from the (imup shall maintain and provide the Group's Employer/Union Medicare Part D information required for Cigna to submit a Plan by CMS. (See MMCM,Ch.2, complete disenrollment request Section 50.2.6 and PDBM,Ch.3. transaction to CMS as described in CMS Section 50.2.6.) guidance. t'. If this Agreement is terminated or Group DocuSiyr'Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Group: City of Miami Beach • Cigna Effective Date:January 1,2024 -' determines that an Enrollee is no longer such date until Group gives such notice. eligible to participate in the Plan,such Enrollee or Enrollees,as applicable,shall h. When Group provides an Enrollee's be disenrolled from the Plan in accordance disenrollmenl request to Cigna in an with CMS requirements subject to the untimely fashion and causes Cigna to following: request a retroactive disenrollmenl,Group shall provide documentation to Cigna i. Group shall send a letter or notice to showing when the Enrollee completed the its Enrollee(s)informing them ot'the disenrollment request,that the Enrollee termination event and other insurance had prospectively requested to be options that may be available to them disenrolled and that the delay in providing through Group. Such notice shall also the diseatrollment request was caused by explain how to contact Medicare for Group.Group shall be responsible for any information on other MAPD plans costs and claims that were paid on behalf and Medicare options that might be of the Enrollee after the Enrollee's available. effective disenrollmenl date. (See MMCM,Ch.2,Section 60.6.2),(PDBM, ii. Group agrees that,if Group offers Ch.3,Section 60.5,2.) other MAPD options,the Enrollee(s) must go through the appropriate 12. ERISA. Unless Group provides Cigna with process to make an enrollment choice written notice to the contrary,Group warrants with Group. and represents that it is subject to disclosure requirements under the Employee Retirement iii. Group shall provide timely notice of Income Security Act("ERISA")such that the Enrollee ineligibility or contract requirements of 42 CPR§*423.128 and other termination to Cigna to facilitate the CMS marketing guidelines do not apply to the notice requirements in(iv)below. Plan. Group agrees to comply with the applicable disclosure requirements under iv. Cigna shall inform Enrollee(s)at least ERISA with respect to the Plan. thirty(30)days prior to the termination date of this Agreement or 13. Group's Cooperation. the date an Enrollee will become ineligible under the Plan,that he/she a. Group shall provide information and has the option to remain as an cooperate as reasonably requested by individual member of another MAPD Cigna to enable Cigna to perform the plan offered by Cigna. services described in this Agreement and to satisfy any requirements imposed by v. Cigna shall give the Enrollee the CMS with respect to the Plan. necessary instructions to remain enrolled in another MAPD plan b. Group shall provide CMS with any offered by Cigna as an individual information Group has on Enrollees'other enrollee. insurance coverage in accordance with CMS requirements. (See MMCM,Ch.2,Section 50.7, and PDBM,Ch.3,Section 50.6 for 14. Federal Product Acknowledgement atj i. support for Section 11,f.) Regttirements.Group acknowledges that the Plan is a federally regulated product,whereby g. IfGroup fails to give written notice to any both Group and Cigna must comply with all Enrollee as required in this Section 11, applicable federal and state laws and Group will be financially responsible for regulations and CMS instructions. In addition Plan benefits provided to such Enrollee, to the requirements set forth throughout this beyond Medicare covered services,after Agreement and Exhibit B,Group agrees and DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 LIgnU. I,. • Croup: City City of Miami Beach �•\a�� Effective Date:January 1,2024 acknowledges the following: expiration of this Agreement for any reason,or until completion of any audit, a. Any activities or services performed by whichever is later. This provision shall Group under this Agreement shall be survive termination of this Agreement. consistent and comply with Cigna's CMS or its designees may have direct contractual obligations as an MAPD.(Si'e access to Group's records and 42 CFR 422.504(i)(3)(iit)and 42 CFR documentation relating to the services it 423.505(i)(3)(iii).) provides under this Agreement. b. All Enrollee communications and f. Group shall ensure that Enrollees of the materials shall be drafted and provided in Plan are not held liable for fees that are accordance with MAPD and Part D the responsibility of Group as set forth at requirements(including 42 CFR 422 and 42 CFR 422.504(i)(3)and 42 CFR 423,the Medicare Managed Care Manual 423.505(i)(3)(i). and the Medicare Prescription Drug Benefit Manual,and CMS instructions as g. In accordance with 42 CFR provided from time to time). (See 422.504(i)(4)(iii)and 42 CFR MMCM,Ch.9,Section 50,PDBM,Ch. 423.505(i)(4)(iii),Group acknowledges 12,Section 20.3.2,and the Medicare and agrees that Cigna will monitor Communications&Marketing Group's performance of its obligations Guidelines.) under this Agreement on an ongoing basis. Cigna shall have the right,at reasonable c. Cigna's management of this product may times and upon reasonable notice,to include periodic changes to the formulary examine Group's records including to meet CMS requirements or more payroll records of Enrollees,for the efficiently manage plan expenses and purpose of confirming eligibility, promote favorable clinical outcomes. enrollment and appropriate Premium (See PDBM,Ch.6,PDBM Ch.12, payment under this Agreement. Section 20.14,and 42 CFR 423.120(b).) h. if requested by CMS,Group will provide. d. Group will maintain for a period of ten any records and documentation relating to (10)years,from the final date of this the services it provides under this Agreement or from the date of completion Agreement to Cigna,CMS or CMS's of any audit,whichever is later,all records designee as required by 42 CFR and documentation relating to services it 422.504(i)(2)(ii)and 42 CFR provides under this Agreement. (See 42 423.505(i)(2)(ii). CFR 422.504(i)(2)and 42 CFR 423.505(i)(2).) 15. Entire AtzreementLModification of Agreement.This Agreement constitutes the e. Group shall make its books and records entire contract between the parties relative to available in accordance with 42 CFR the subject matter hereof and no modification 422.504(e)(2),42 CFR 422.504(i)(2),42 or amendment hereto shall be valid unless in CFR 423.505(e)(2)and 42 CFR writing and signed by an officer of each of the 423.505(i)(2). Group will give the U.S. parties. Department of Health and Human Service (HI tS)and U.S.Comptroller General,and I6. Modification by Law/Regulation. This their authorized designees,the right to Agreement shall be deemed automatically inspect,evaluate and audit all records and amended to comply with any applicable state documentation relating to the services it or federal laws,regulations or CMS provides under this Agreement during the requirements. Notwithstanding Section 4 term of the Agreement and for a period of above,Cigna may modify the Premium upon ten(10)years following termination or any change in applicable state or federal laws DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 40?:, Group: City of Miami Beach {Yf Cigna Effective Date:January 1,2024 affecting the Agreement by giving to Group at calendar days of the request for Executive least thirty(30)days prior written notice. Review under Section 18 a,above,either Party may initiate mediation by providing 17. Laws Governing Contract. This Agreement written notice to the other Party,which shall be governed by and construed in shall be conducted in Miami-Dade accordance with the laws of the State of County,in accordance with the American Florida to the extent they are not preempted by Arbitration Association commercial ERISA or the Social Security Act as modified mediation rules("Mediation"),and using by the Medicare Prescription Drug, American Arbitration Association Improvement and Modernization Act of 2003 mediators.Each Party shall assume its (MMA)(Pub.L. 108-173),the Affordable own costs and attorneys'fees,and the Care Act(ACA,Pub.L. 111-148),and the compensation and expenses of the Inflation Reduction Act of 2022(Pub.L. 117- mediator and any administrative fees or 1 6,9). costs associated with the mediation proceeding shall be borne equally by the 18. Resolution of Disputes;Arbitration; Parties.The Parties shall not,however,be indemnification required to mediate the Controversy. it.is understood and agreed that,prior to initiating c, Cigna will hold harmless and indemnify any state court,federal court or arbitration Group from and against any damages, proceeding in Miami-Dade County,Florida,the costs,claims,expenses or liabilities which Parties shall first attempt to resolve any dispute Group may incur as a result of a claim by arising from or relating to the performance or any third party arising out of any negligent interpretation of this Agreement using the acts or omissions,fraud or other criminal following dispute resolution procedures: acts by Cigna,provided that Group gives Cigna prompt written notice of any such a. Any Controversy shall first be referred to clam. an executive level employee of each Party who shall meet and confer with his/her d.This provision shall survive the termination counterpart to attempt to resolve the of the Agreement. dispute("Executive Review")as follows: The disputing Party shall initiate 19. Third Party Beneficiaries. This Agreement is Executive Review of said Controversy in for the benefit of Group and Cigna and not for such notice.Within twenty(20)calendar any other person. It shall not create any legal days of any Party's written request for relationship between Cigna and any retiree, Executive Review,the receiving Party dependent or any other party claiming any shall submit a written response.Both the right,whether legal or equitable,under the notice and response shall include a terms of this Agreement or of the Plan. statement of each Parry's position and a summary of the evidence and arguments 20. Waivers. No course of dealing or failure of supporting its position.Within thirty(30) either party to strictly enforce any term,right calendar days of any Party's request for or condition of this Agreement shall be Executive Review,an executive level construed as a general waiver or employee of each Party shall be relinquishment of such tern,right or designated by the Party to meet and confer condition. Waiver by either party of ally with his/her counterpart to attempt to default shall not be deemed a waiver of any resolve the dispute.Each representative other default. shall have full authority to resolve the dispute. 21. Headings. Article,section,or paragraph headings contained in the Agreement are for b. in the event that a Controversy has not reference purposes only and shall not affect been resolved within thirty-five(35) the meaning or interpretation of the DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Croup: City of Miami Beach �-,•` C i g n a Effective Date:January I,2024 Agreement. (b) City of Miami Beach Ann:Aline T.Hudak 22. Severability. If any provision or any part of a Tide:City Manager provision of the Agreement is held invalid or Address: 1700 Convention Center Drive unenforceable,such invalidity or Alinal ludak ijmiambeach gov unenforceability shall not invalidate or render unenforceable any other portion of the 27. Cimoa's Compliance with Florida Public Agreement. Records Law. 23. Survival. Provisions contained in the a. CIGNA shall comply with Florida Public Agreement that by their sense and context are Records law tinder Chapter 119,Florida Statutes, intended to survive completion of as may be amended from time to time. performance,termination or cancellation of the Agreement shall so survive. b. The term'public records"shall have the meaning set forth in Section 119.011(12),which 24. Force Majeure. Cigna shall not be liable for means all documents,papers,letters,maps,books, any failure to meet any of the obligations or rapes,photographs,films,sound recordings,data provide any of the services and/or benefits processing software,or other material,regardless specified or required under the Agreement of the physical form,characteristics,or means of where such failure to perform is due to any transmission,made or received pursuant to law or contingency beyond the reasonable control of ordinance or in connection with the transaction of Cigna,its employees,officers,or directors. official business of Group. Such contingencies include,but are not limited to,acts or omissions of any person or entity c. Pursuant to Section 119.0701 of the not employed or reasonably controlled by Florida Statutes,if CIGNA meets the definition of Cigna,its employees,officers,or directors, "Contractor"as defined in Section 1 19.0701(1)(a), acts of God,fires,wars,accidents,labor CIGNA shall: disputes or shortages,and governmental laws, i. Keep and maintain records required by ordinances,rules or regulations,whether valid Group to perform the service; or invalid. ii. Upon request from the City of Miami Beach's custodian of public records,provide the 25. Assignment. No assignment of rights or City of Miami Beach with a copy of the requested interests hereunder shall be binding unless records or allow the records to be inspected or approved in writing by an officer of each of copied within a reasonable time at a cost that does the parties hereto. not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law; 26. Notice. Written notice required by the iii. Ensure that records that arc exempt or Agreement shall be addressed as follows: confidential and exempt from public records disclosure requirements are not disclosed,except (a) Cigna as authorized by law,for the duration of the Attn:Shelly Tant,Manager-Employer contract term and following completion of the Group Account Management Agreement if CIGNA does not transfer the records 500 Great Circle Road to Group; Nashville,TN 37228 iv. Upon completion of the Agreement, Shelly.Tanitit.iCianallcalthcare.com transfer,at no cost to Group,all public records in possession of CIGNA or keep and maintain public With copy to: records created or prepared by CIGNA in its Cigna Legal performance under this Agreement.If CIGNA LeealandPublicAft,irs- transfers all public records to Group upon IncomitatLegrtl(wCiena.com completion of the Agreement,and subject to Attn:Group Medicare Legal CIGNA'S obligations to maintain records pursuant to Federal Law,CIGNA shall destroy any DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 S�(Troup: City of Miami Beach %)"•(1• Cigna Effective Date:January 1,2024 duplicate public records that are exempt or with Group or to CIGNA's registered agent.Such confidential and exempt from public records notices must be sent by common carrier delivery disclosure requirements.If CIGNA keeps and service or by registered,Global Express maintains public records upon completion of the Guaranteed,or certified mail,with postage or Agreement,CIGNA shall meet all applicable shipping paid by the sender and with evidence of requirements for retaining public records.All delivery,which may be in an electronic format. records stored electronically must be provided to iii. If CIGNA complies with a public records the City of Miami Beach,upon request from the request within 8 business days after the notice is custodian of public records for the City of Miami sent is not liable for the reasonable costs of Beach,in a format that is mutually agreed at the enforcement. time. (F) IF CIGNA HAS QUESTIONS (D) REQUEST FOR RECORDS; REGARDING THE APPLICATION OF NONCOMPLIANCE. CHAPTER 119,FLORIDA STATUTES,TO i. A request to inspect or copy public CIGNA'S DUTY TO PROVIDE PUBLIC records relating to Group's contract for services RECORDS RELATING TO THIS must be made directly to Group.It'Group does not AGREEMENT,CONTACT THE CUSTODIAN possess the requested records,Group shall OF PUBLIC RECORDS AT: immediately notify CIGNA of the request,and CITY OF MIAMI BEACH CIGNA must provide the records to Group or ATTENTION:RAFAEL E.GRANADO,CITY allow the records to be inspected or copied within CLERK a reasonable time. 1700 CONVENTION CENTER DRIVE ii. CIGNA's failure to comply with Group's MIAMI BEACH,FLORIDA 33139 request for records shall constitute a breach of this I MAIL: Agreement,and Group,at its sole discretion,may: RAFAELGRANADO@MIAMMEACHFL.GOV (1)unilaterally terminate the Agreement;(2)avail PHONE: 305-673-7411 itself of the remedies set forth under the Agreement;and/or(3)avail itself of any available 28. Inspector General Audit Rights. remedies at law or in equity. iii. if CIGNA fails to provide the public a. Pursuant to Section 2-256 of the Code of records to Group within a reasonable time may be City of Miami Beach,the City of Miami Beach has subject to penalties under s. 119.10. established the Office of the Inspector General which may,on a random basis,perform reviews, (E) CIVIL ACTION. audits,inspections and investigations on all Group i, If a civil action is tiled against CIGNA to contracts,throughout the duration of said compel production of public records relating to contracts, 1'his random audit is separate and Group's contract for services,the court shall assess distinct from any other audit performed by or on and award against CiGNA the reasonable coats of behalf of Group. enforcement,including reasonable attorneys'fees, if: b. The Office of the Inspector General is a. The court determines that CIGNA unlawfully authorized to investigate Group affairs and refused to comply with the public records request empowered to review past,present and proposed within a reasonable time;and Group programs,accounts,records,contracts and b. At least 8 business days before filing the transactions.in addition,the Inspector General has action,the plaintiff provided written notice of the the power to subpoena witnesses,administer oaths, public records request,including a statement that require the production of witnesses and monitor CIGNA has not complied with the request,to Group projects and programs.Monitoring of an Group and to CIGNA. existing Group project or program may include a ii. A notice complies with report concerning whether the project is on time, subparagraph(I)(b)if it is sent to the City of within budget and in conformance with the Miami Beach custodian of public records and to contract documents and applicable law.The CIGNA at CIGNA's address listed on its contract inspector General shall have the power to audit, DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 (:coup: City of Miami Beach Cigna�/� Effective Date:January 1,2024 t investigate,monitor,oversee,inspect and review (3)years atter final payment under this Agreement operations,activities,performance and or for any longer period required by statute or by procurement process including but not limited to other clauses of this Agreement.In addition: project design,bid specifications,(bid/proposal) submittals,activities of CIGNA,its officers,agents (l) If this Agreement is completely or and employees,lobbyists,Group staff and elected partially terminated,CIGNA shall make available officials to ensure compliance with the contract records relating to the work terminated until three documents and to detect fraud and corruption. (3)years atter any resulting final termination Pursuant to Section 2-378 of the City Code,Group settlement;and is allocating a percentage of its overall annual contract expenditures to fund the activities and (2) CIGNA shall make available records operations of the Office of Inspector General. relating to appeals or to litigation or the settlement of claims arising under or relating to this c. Upon ten(10)days written notice to Agreement until such appeals,litigation,or claims CIGNA,CIGNA shall make all requested records arc finally resolved. and documents available to the Inspector General for inspection and copying.The Inspector General f. The provisions in this section shall apply is empowered to retain the services of independent to CIGNA,its officers,agents,employees, private sector auditors to audit,investigate, subcontractors and suppliers.CIGNA shall monitor,oversee,inspect and review operations incorporate the provisions in this section in all activities,performance and procurement process subcontracts and all other agreements executed by including but not limited to project design,bid CIGNA in connection with the performance of this specifications,(bid/proposal)submittals,activities Agreement. of CIGNA its officers,agents and employees, lobbyists,Group staff and elected officials to g. Nothing in this section shall impair any ensure compliance with the contract documents independent right of Group to conduct audits or and to detect fraud and corruption. investigative activities.The provisions of this section are neither intended nor shall they be d. The Inspector General shall have the right construed to impose any liability on Group by to inspect and copy all documents and records in CIGNA or third parties. CIGNA's possession,custody or control which in the Inspector General's solo judgment,pertain to 29. &Verify. performance of the contract,including,but not limited to original estimate files,change order a. To the extent applicable to the services estimate files,worksheets,proposals and offered herein,CIGNA shall comply with Section agreements from and with successful 448.095,Florida Statutes,"Employment subcontractors and suppliers,all project-related Eligibility"("E-Verify Statute"),as may be correspondence,memoranda,instructions, amended from time to time. Pursuant to the E- financial documents,construction documents, Verify Statute,commencing on January I,2021, (bid/proposal)and contract documents,back- CIGNA shall register with and use the l Verify change documents,all documents and records system to verify the work authorization status of which involve cash,trade or volume discounts, all newly hired employees during the Term of the insurance proceeds,rebates,or dividends received, Agreement. Additionally,CIGNA shall expressly payroll and personnel records and supporting require any subconsultant performing work or documentation for the aforesaid documents and providing services pursuant to the Agreement to records. likewise utilize the U.S.Department of Homeland Security's E-Verity system to verify the e. CIGNA shall make available at its office employment eligibility of all new employees hired at all reasonable times the records,materials,and by the subconsultant during the contract Term. If other evidence regarding the acquisition(bid CIGNA enters into a contract with an approved preparation)and performance of this Agreement, subconsultant,the subconsultant must provide for examination,audit,or reproduction,until three CIGNA with an affidavit stating that the DocuSign Envelope ID:9FD1FBA1-AE88-46F6-88F9-E31DF1C5DA72 Group: City of Miami Beach tr Cigna. Effective Date:January I,2024 �' subconsultant dots not employ,contract with,or subconsultant. CIGNA's failure to terminate a subcontract with an unauthorized alien. CIGNA subconsultant shall be an event of default under shall maintain a copy of such affidavit for the this Agreement,entitling Group to terminate duration of the Agreement or such other extended CIGNA's contract for cause. period as may be required under this Agreement. to. A contract terminated under the foregoing Subsection(B)(I)or(B)(2)is not in breach of contract and may not be considered as such. b. TERMINATION RIGHTS. iv. Group or CIGNA or a subconsultant may i. If Group has a good faith belief that file an action with the Circuit or County Court to CIGNA has knowingly violated Section 448.09(1), challenge a termination under the foregoing Florida Statutes,Group shall terminate this Subsection(8)(1)or(B)(2)no later than 20 Agreement with CIGNA for cause,and Group calendar days after the date on which the contract shall thereafter have or owe no further obligation was terminated. or liability to CIGNA except that Group shall be v. If Group terminates the Agreement with responsible for payment for any services CIGNA under the foregoing Subsection(B)(I), previously rendered. CIGNA may not be awarded a public contract for ii. If Group has a good faith belief that a at least 1 year after the date of termination of this subconsultant has knowingly violated the Agreement. foregoing Subsection 10.9(A),but CIGNA vi, CIGNA is not liable for any additional otherwise complied with such subsection,Group costs incurred by Group as a result of the will promptly notify CIGNA and order CIGNA to termination of this Agreement under this Section immediately terminate the Agreement with the 10.926. IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed in duplicate and signed by their respective officers duly authorized to do so. Cigna Health and Life Insurance Company City of.1l' Beach By: By Printed Name:Ryan Kocher A- I Name: etK Its:Medicare.Chief Growth Officer Its. Date: November 14 2023 Date 12l Y1 Z3 Attest: City • in. each APPROVED AS TO FORM&LANGUAGE By. / &FOR EXECUTION Printed NarrfgAFAEL E. GRANADO 3 Its: 0 Ty C L k r City Attorney jp4 Da Date: (2/ 1 ek Z,CI-1 DEC 1 9 2023 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Group: City of Miami Beach %Tr Cigna Effective Date:January I,2024 Exhibit A Medicare Advantage Prescription Drug Plan Coverage Description DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 t Cigna. City of Miami Beach Cigna Medicare Advantage Employer Group Plan Effective Date: 1/1/2024 End Date: 12/31/2024 Number of Medicare Beneficiaries 2913 Funding Type Fully Insured Sites State FL Medicare Advantage PPO(MAPO) Total Premium PMPM High Coinsurance PPO/Customized Part D $330.70 Rates includes: •0%2025 Role Guarantee •5%2026 Rale Cap •$10,000 Communication Fund •$25,000 Standard Performance Guarantees •Retiree Administration Please refer to the Terms and Conditions of this proposal and the Benefit Summary with the benefit details. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation.The Cigna name,logos. and other Cigna marks are owned by Cigna Intellectual Property.Inc Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans(PDP)in select states,and with select State Medicaid programs.Enrollment In Cigna depends on contract renewal. r Cigna 2023 1 of 10 Quote created on 7/20/2023 DocuSign Envelope ID:9FD1FBAI-AE68-46F6-88F9-E31DF1C5DA72 CIIv al Wm.,Mach Cluoul AMP...Admil.0o Employ.04011,11141‘ MoS cat Suonoti•ty ul Ogoollto trosbni t)410 J.`'..n.,,2024 411,1001 AttOttototoliun Poatot C.044.021 You 111401.411 001•01.90.99 .- S2.11,‘0.4064 10 SO Han OodulSblo k0S.4 B. NO APP.... NM AvOcatio Mao Dedochbla flnool WI Apq6,T. No 9/11.404. Kid kV...A $O...Mh WO.14.+1 ond.1.11.oe*4 $O e...,,,,..•lo 0,and wol-ol.notwol 11.tanmorn Out.ol,..tal ro.4 01.100P) - 111•00.1..0.0t•O s0000t. 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A..t141y KOK...OS‘1.0011.0,00 PO.M.0,..., itt.vly Attoontoos 0 toomaino.ptoyea r-SOM 14.10.0.utx.ly tholmtilevl A.,ctio,,s v loon.ng 4 ',woo.,4414.11,444404000ed.ntrootot v leaning A "1..4,sod Inhasno...•tom.,rotmseeng men w...t.,..ovl tobacco we r ess.sson mtnt.sno 1.11 10 ljuole cg.ed opt 10011011 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Cigna. ':Head Wend Peace CIOn.Maltase Ado.enlep.Leedoy..lkuup Plan Medical lineuwrry of Motel h i paterlc aoedgd,LAN a 1,1«no V _ ._ __-L to4y.rh `IlebeaNaMwdl OifitIoNtigRacedurs,less. F0(1 ore Colorectal ScreennUe.W 900 nodCMu.aNl aenenpe•SO Ap g hu_LO M Oho•SO 1,0e*Ode.IPedeloewl-AMN.lo AS Nees.18•10. 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City of Miami Beach Cigna Medicare Advantage Employer Group Plan Pharmacy Summary of Benefits Plan Type Customized Prescription Drug Piari(Pan D) Ealective Dntes January 1,2(124-December 31,2024 Fix Formulary Enhanced Pharmacy Network Medicare Broad Network Pharmac Accumulation Period Calendar Year BenOfit Description What the Member pays Deductible Phase Individual Deducible $0 individual Deductible Apples In Not Applicable Initial Coverage Level Initial Coverage Level(Total Drug Spend) $5,030 Retail(1-30 Day Supply) Tier 1 Generic Drugs $15 Tier Profaned Brand Drugs $50 Tier 3 Non Prolerrntl Brand and Generic Drugs $75 _ Tier 4 Brand Nance and Generic High Cost Specialty Drugs $75 Retail(31.60 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic.Drugs $150 Tier 4 Bernd Name end Generic High Cost Specialty Drugs Not Available-Specially drugs only available up to 30-day Retail(01.90 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic Dregs $150 Tior 4 Brand Nania and(oneric High Cost Specially Drugs Not Available-Specialty drugs only available up to 30-day Long-Term Care(1-31 Day Supply) Tier 1 Generic Drugs $15 Tier 2 Prelerred Brand Drugs $50 Tier 3 Non Preferred Brand and Generic Drugs $75 Tier 4 Brand Name and Generic High Cost Specially Drugs $75 Mall Order(1.30 Day Supply) Tier 1 Generic Drugs $15 Tier 2 Preferred Brand Drugs $50 Tier 3 Non Preferred Brand and Generic Drugs $75 Tier 4 Brand Name and Generic High Cost Specialty Drugs $75 Mall Order(31-60 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic Drugs $150 Tier 4 Brand Name and Generic High Cost Specialty Drugs Not Available•Specialty drugs only available up to 30-day Mall Order(61.90 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic Drugs $150 Tier 4 Brand Name and Generic High Cost Specialty Drugs Not Available•Specialty drugs only available up to 30-day Out of Network Coverage(Member Liability)(30 Day Supply) Same as In-Network Member Out of Pocket Maximum $2,000 Coverage Gap(from$5,030 in Drug Spend up to True Out-of-Pocket of$1$000) Retail(1-30 Day Supply) Tier 1 Generic Drugs $15 Tier 2 Preferred Brand Drugs $50 Tier 3 Nun Preferred Beard and Generic Drugs $75 Tier 4 Brand Name and Generic High Cost Specialty Drugs $75 Retail(31-60 Day Supply) Tier 1 Generic Drugs $30 tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic Drugs $150 Tler 4 Brand Name and Generic High Cost Specialty Drags Not Available-Specially drugs only avrdlebie up to 30-day Retail(61.90 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Proferred Brand and Generic Drugs $150 Tier 4 Brand Name and Generic High Cost Specialty Drugs Nor Available•Specialty times only available up le 30-day Long-Term Care(1-31 Day Supply) Tier 1 Generic Drugs $15 Tier 2 Preferred Brand Drugs $50 Tier 3 Noe Preferred Brad and Generic Drugs $75 Tier 4 Brand Name and Generic High Cost Specially Drugs $75 Mail Order(1-30 Day Supply) Tier 1 Generic Drugs $15 Tier 2 Preferred Brand Drugs $50 liar 3 Non Preferred Brand anti Generic Drugs $75 Tier 4 Brand Name and Generic High Cast Specially Drugs $75 Mall Order(31.60 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tin 3 Non Preferred Brand and Generic Drugs $150 Tier 4 Brand Name and Generic High Cost Specialty Drugs Not Available•Specialty drugs only available up to 30-day Mail Order(e1-90 Day Supply) Tier 1 Generic Drugs $30 Tier 2 Preferred Brand Drugs $100 Tier 3 Non Preferred Brand and Generic Drugs $150 r,of 10 Quote created on 7/20/2073 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 fir- cic rtCa. Tier A Brand Name and Generic High Cost Specialty Drugs Not Available•Specialty drugs only available up le 30-day Catastrophic Phase(True Out•ot•Pocket) $8,000 Generic Drugs $0 Copay Brand Drugs SO Copay Clinical Management Are the following clinical Programs included or waived? Step Therapy Included Prior Authorizations Included Quantity Limits included Oploids Oplaids(all tiers) T Limited to one month supply Non-Part D Supplemental Coverage Are the following non-formulary drugs covered? Fertility Drugs No Prescription Vitamins Yos Cold&Cough Props Yes Weight Loss/Weight Gain Yes Erectile Dysfunction Yes Cosmetic Drugs Including Drugs for Flair Loss No Formulary Enhancements Are the following formulary enhancements covered? Select Preventive Drugs and Diabolic Drugs and Supplies at$0 Copay N/A Non-standard Benefits and/or State Mandated Benefits None See next page for Caveats and Exclusions 7 of 10 Quote creatrd on//20/2023 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E3IDF1C5DA72 (. ; Ci• gna City of Miami Beach-Cigna Medicare Advantage Prescription Drug Plan CAVEATS,EXCLUSIONS and DEFINITIONS The Employer Pan D program does not integrate with medical plan deductibles,mot-sit-pocket maximums,or annual maximums. Only retirees and their dependents who are entitled to Medicare Part A and/or enrolled In Part B are included in lies quote. If a retiree or dependent is rot entitled to Medicare Part A and/or not enrolled in Part B,then they are not eligible to loin a Medicare Pan D plan. Billing for this product is on a Por Medicare Beneficiary Per Month basis.Each enrollee will he sot up on thou own eligibility record/ID red the employer group will ho charged a single per Medicare beneficiary per month premium rale. Cigna companies reserve the right to adjust the benefits and/or premiums in this proposal If such adjustments are necessary to comply with current Centers lot Medicare&Medicaid Services(CMS)rules and regulations. prim Exctu,iens� A Medicare Prescription Drug Plan can't cover a drug that would be covered under Medicare Part A or Part 0,Also,while a Mairicare Prescripllim Drug Plan can cover off label uses(meaning he uses other than those indicated on a drug's label as approved by the Food and Drug Administration)of a prescription drug,we cover the olf-label use only in cases where Ihn use is supported by certain reference book citations.Congress specifically listed the reference books That list whether the out-label use would be permitted(these reference hooks are:(1)Amerman Hospital Formulary Service Drug Information, (2)the DRUGDEX information System). 0y law,certain types of drugs,or categories of drugs,aro not covered by Medicare Prescription Drug Plans.These drugs are net considered Part 0 drugs and may lea referred to as-exclusions"or'ion-Part D drugs.'These drugs i nclde. Non-prescription drugs(or over-the counter drugs). Drugs when used for anemia,weight fuss,or weight gain. Drugs when used to promote fertility. Drugs when used for cosmetic purposes or hair growth. Drugs when used for the symptomatic relief of cough or colds. Prescription vitamins and mineral products,except prenatal vitentns and fluoride preperallons. Outpnllenl drugs for which the manufacturer seeks to require That assoointed tests or monitoring services ho purchased exclusively from the manufacturer as a condition of salt Drugs,such as Viagra.Clouts,Levilra,and Caverjec..when used for the treatment of sexual or erectile dysfunction. In addition,the following exclusions apply to arty service that Is a Covered Exponse under this plan,butts not covered by Modtcsme •Expenses for supplies,care,treatment,or surgery that are not Medically Necessary. •To the extent That payment its unlawful where the person resides when the expenses are incurred •Chagos which you are not obligated(to pay or for which you are.not hilted or for which you would not have been pilled except that they were covered under this plan. Definitions 1-30 Day Supply for Retail and 1-31 Day Supply for Long-Tenn Caro Facilities(Proration): Usually,thu ameunl for a emceed prescription drug is a ore-month supply.However.if the amount is loss Than a urro+nontb supply for oral solid proscriptions,Mon the amount pad Is prorated based on the actual amount received. Promtlon may not apply Inn certain ctrcumslalres as milliard Inn CMS guidance. Retail Example'Plan has a$10 copay fora 30 day supply. Actual day supply Oiled is 10 day supply. Copay is prorated as follows: $10 divided by 30 or$.3333 per day.rounded to$.33,limes lire day supply of 10,equals$3.30 copay owed by member. Long-Tenn Care Facility Example Plan has a$10 repay fora 31 day supply. Actual day supply and Is 10 day supply. Copay Is prorated as follows;$10 divided by 31 or$.3228 per day,rounded to$.32,lines the day supply of 10,equals$3.20 r"upay owed by member. Coverage Gap: During the coverage gap stage,Clgnn will pay the bolter el the plan or Medicare Part D Defined Standard. Employer Group Waiver Plans(EGWP)facilitate the offering of POP plans to employer/union group health plan sponsors.trmployarlunlon plan sponsors can contract with an insurer or directly with CMS to provide coverage for medical andlor prescription drug benefits.CMS grants certain program waivers and/or modifications for EGWP plaits that do not apply to enrollee plays. Formulary Options: Basic formulary is the leanest drug list designed for the specific needs of seniors. it provides the greatest savings to the employer while still providing broad coverage. It uses the same drug list as our individual MAPD plans. Standard formulary includes all drugs as Bout and covers additional Part D brand and new generic drugs that are covered on Cigna's commercial formularies and are used by seniors. In addition,Standard automatically includes non-Pat D drugs In our Courtesy list. Courtesy refers to drugs normally Covered under commercial pharmacy plans,but are excluded by CMS. 8 or Lr Quote created on 7/20/2013 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 '9 Cigna. Enhanced formulary Includes all drugs in the Basic and Standard and adds highly utilized brand and generic drugs on Cigna's broad commercial plans and are used by seniors.This formulary adds Part D drugs at the same tier as the commercial formulary which can lower the tier for a drug common to the Standard.This formulary Is our richest formulary which Includes multi-source and single-source brand drugs as wall as some now higher cost generics. Non-Part D Drugs: The following drug categories are excluded from CMS coverage. U a plan deductible applies,any non-Part 0 coverage added to the plan wet not be subject to the plan deductible These drugs will be paid based on the cost share for generic drugs flier 1)or brand drugs(licr 2)based on the drug classification. Non-Part D Drugs automatically Included in the Standard and Enhanced Formulary options are: •Courtesy Drugs:refers to drugs normally covered under commercial pharmacy plans but are excluded by CMS. •DESI(Drug Efficacy Study Implementation)Drugs:refers to drugs that wore introduced between 1938-1982 and approved for safety but not effectiveness. DESI drugs are not"graudlatlrered"or generally recognized as safe and affective(GRASIF), Additional Non-Part D Drug Optional Buy-tips include •Fertility Drugs.drugs used to promote fertility •Proscription Vitamins-drugs used for prescription vitamins and mineral products.except preened vitamins and fluoride preparations. •Cold&Cough Props-drugs used for symptomatic relief of cough end colds •Weight LossANeight Gain-drugs used fur anorexia,weight loss,weight gain •Erectile Dysfunction-drugs used for erectile dysfunction Oploid drugs Limited to 30 day supply at Retail and Merl Order Pharmacies and 31 day supply at Long Term Care Facilities. Out-of-Network Coverage: Generally,we:over drugs filled at an out-of-rotwork pharmacy only when the plan participant is not able to use a network pharmacy.Hare are mho circumstances when we would cover presedptions filled al art out-of-network pharmacy: •If the plan participant is unable to obtain a covered drug in a timely manner within our service ate because there Is no network pharmacy within a reasonable driving distances that provides 24-hour service. •If the plan participant Is trying to fill a covered prescripton drug Urat is riot regularly stocked at'an accessible network retail or mail-order pharmacy (these drugs Irclude orphan drugs or other specialty pharmaceuticals). •If a covered Pad D drug is dispensed by an out-of-network,institution-based pharmacy to a patient who is In the emergency department,provider based clinic,outpatient surgery or other outpatient surgery or other settings. •When the plan participant is away from our service area for en extended period of lime(for example,during travel),they may use a parlleiraling mall order pharmacy.This will ensure they have a sufficient supply of medication with Them al all lanes. Prescriptions purchased out-of-network are limited to a cne•muntir supply. Preventive Drugs at$0 Copay: The Cigna Preventive Drug List Includes select preventive medications on Tier 1 and Tier 2 from the Standard Medicare Part D formulary in the following usage categories:high blood pressure,high cholesterol,diabetes,asthma,osteoporosis,stroke blood thinners,and prenatal nutrient deficiency.Those selected drugs are not subject to the Deductible(If applicable),Copay,or Coinsurance. Vaccines Part D vaccines are covered at no cost even when the deductible is not mel. Insulin Retirees won't pay more than$35 for a ono-menet supply of each insulin product covered by our plan oven when the deductible is not mot. Tier Labeling: Cigna Re Modt_.am is not always able to keep all generic medications in the Preferred Generic(Tier 1)and Non-Preferred Brand and Generic(Tier 3) drug Um.Some generic medications tray be In the Preferred Brand(Tier 2)and Specialty Drug(Tier 4)tiers.Keep In mint that the name of the tier is just a description of the majority of the drugs in the hor.Ii dons not mean that there are only generic or only brand dregs In Mt tier.Cost share shown Is for all drugs In the Tier unless otherwise noted, All Cigna products and services era provided exclusively by er through operating subsidiaries of Cigna Corporation,Including Cigna Healer and Life Insurance Company.The Cigna name,logos,and other Cigna marks are owned by Cigna Intellectual Property,Inc Cigna Is contracted with Medicare for PDP plans,HMO and PPO plans in select states,and with select Stale Medicaid programs. Enrollment in Cigna depends on contract twuuwrul. kr Cigna 2023 9 of 10 Dante created on 7/20/2023 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Cigna. City o1.land 0,wch•Cigna Mad onto Adv...Prosellldian tMrg Pion Tolnus need Can ellorn. A.Rwnrl dorms of this Propose! Coma on pktmnt Io Proecnl this Prmrosnl fora(Islay 1113oornd grDale bNn1knm Advnnta,,,+ud Cr)na 1ta M,.iooen (PUP)bonnet plan. This proposoi k vnikt tar 00 any,hwn es opal nob al Idnased 011201202).. 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Inoa are lusa Maio 26.'nova 0,lobs n1o11/0%of total 4/gib.bMlvtdlmb Immll u Ihn Plan • otnonitment Ill 11w lean of any limn vatla.by 10%Of,ado hum law nn,hens nomanld by t:ppw In asln0ullhp.a rah.and/or funs sot nnlh Moan. • Iha wnployal cnangee ds WHO otcuwloa4Mn WmlM the tool al the coVorml0. • non wilnlown ton hulas Inwood aPo cost of pwtlla.a,I aoil.Wud oxwo000 hot an•dimbleo irslwi 00 • Cigna Is not I.nschtlws pnvaha of MWken°Mom..anol PAW uw1Nas and oho mlpinym no.on cnontdndn the soma pulemlago to 0'o Doll nl oath wlrldn mowerawvwl plan warns onprr.sity cnmillumW Ito)try Comma • non enemas dam of.4mneinco doll,aimealal 0 daemad aver w. • t110,1114 n teens(to minify Commissions ninth nu.A.adv.aa fees • Gluon tw(Inalal.mlw(aa with n Nina p.Ally von oar • Chen en tormentwl to provide 11111mm1 enrols. • admmisiral'en of lent Plan 4tll 1a11an one.Man the lcn.w:at o Odlup lions.J00 n IIII.+.and Canino Hmrnh liana,(halm111 0h 0.emopo nod An dienti.n of tiddo Pmpu.al • Ilnlns,dlormaon,allealol,m,e r:nvnrnnn 141,01 d el th.s 1nnlnnai.ln,.rsins awl',Iola.,nun and w3I now roomy Cppd 011n1 of W0Ma11 w1111 trupo0 la Uw!non • Allloatd,Mao pna.n.l now Malabo noulop.olotoweimems for IIM mnnIoynr 0p0l31,111 pun,l:Igno 1aaavns Ind nghl Irt W04 00,nanbul of pklsbgaams bawl ion lltn anlulne,eslvhnalm,I and Om Iola!number W Moddlcalo s1441Ma lldiwd.nis,Fnlel pin aalaalnn to0ldlns approvallly nloolvea el Mier k•nplamentsllnn • Inn InfanwlWn and m0lwals hovel.,for evaluslaln of Its gtm1u wn,0 nsswnal Io la 00.01tl 11 malel4M a,ws or onensona.lab found IOW oho nun.I.os,Md,1:Id..era+mw.oho cued W inv.naa ma0wl oho m on. • Moedani van0o pudumwnon g anonna o own 10 320.000 nave boom tonludul In Ih s Malnn,u Pm00aa1 • ewes prounsal m<ndlwSte.PMPM for taano a numat ran • fhn main is on nn 111C,mw1!axes Canna an%Me rrtsponsih.by all nngibin clams won.rasa ollm oho 0faclive data llanuglt Inn,and owl oho rn....1•urlat. • inn.amens mnwh(rinonthonol.wllaePion In Prw.adwlonalls uag0M0 fon(hoops mnl•bwnnnl•imswl Felton gll.lp olvrvn(p01vinnn,144,pbk•ant Ahdknrn. • f Ids pnllnsal aeau111n.:11 elklllan nallv4mnln non e,uolala.Mauhc.0 Pnd A nod Purl final Ihn gnnp moulds n,a Inaadn sly hn n0.f0 town tonna.W c.nmpldo wvehPa1l • Inbnn1nan,l0uvid,:d Mon is pendiry(`MA mgntwal unlash oll.sO.rr,cal•(i GM.660dlo04 Advadnl10 IMAl and Wm.Rs Mon&Oro(POP) • flambw sou cannon newt medlgdaoavllv1WMluselinglrl inn an(vitoalto of floe Noah",MA!.11k0w Adwrdrgn OM)and Midi..n.n A(PA)pl.a fed.onooli0•ml wdl tolls1141a,on odpadn•Mission.pawary lnsapasen0s o4111a10y CM% • fho,bench s mosaoad ao 01u Proposal area Wgllapvel ewl.naly,Phw.n cons.dm s0mnrnly of 11w,alde for a mom detains'Awl of bww/ha moons.Moth*Cann plan Dun 10 a,1ua1 chtlpnv,s ChM nlowloloi aarnnls, bwn411 o n Wy delta.1111 se late swylae enl0gal0n • Ono nrogpintolym.pan0ads Wr win4,nvikaln Advn.duga an1A0 M.dh.on!Pao 0 plah.cis,mo ieon uml owning toy ddlo.Soma lamas d d1fomoeu!,aide,bowl are roe(Mnllnl b lery00:p,web.wn:1s,,0an40a now vm1mms0 n.wgammd,gtwlay anaAivas,moonbt Mouton.and n01Nod.s.cl,pbd1ty I0M,p.waw+nnoimn ponces rut pp:• mnuhnlwa and monduas Minn pion Y nerd nonik:d nom ntulfl.ln.,,vshmn.'sowm:v,dam,awl app.rds • Has armn.N NI.Ya,n Msdkam Ativa0nle 0M Idean'.O I'an(1 pltdn:h:,aeon.monma.nml,,1 snv.:us.soon as monist nil r,alhaMms,wolf ha.nln(palsd..Acaoml m0lwg.niwo nod olplato taken u1n Alva minennlod.Ind with speold aa•awto.kn Mobloola Adwmdgo and IMdlearo Pad 0, • Clop*minion a minimum of 20 onm1.d ma.boo Pal eland.,Ho doet snoop la 10n0w nn(mployol 14palsul,,d pinto • I nlo.will wad tn.bn raavnMmfol of n043 no n almdnlone 4Mnon onto Cop • the/Inopnsnllhnhde.n2 yawl...I1(p,..nla.nil.s:nd yes,ono woe of,u% • this assumes wno11m,1)of 200sf.10%. • Inn N.M.Row c.IAO,wmd0ol0*naiad In n4volioa,n„1 CMS MA,Io.onnnad Ink..hnmao by lass Moot 0 0%Illn,hgh%tort rounbaoutnwd mks.odpwbmm(s (nog-.coaahp hdoosey1 nmM.,u11te,ntrthodefuge channel to payment mhos •Any Inflation le ducha,Act(114A),el ulhor mama'a1w.Pw In 1n.and rn0 1,1101ro II sot change flfe111nrnn Ca1Wdellilbn4 and mind.uohd111g 1114 nut 411111a11o: •Cha.0as to PeA 0 now OulesMy oslhlales Coop.W gnomon...al oealaola,a kvol of,abates •A,o d.o,dn to lucent CARS qualm u W.neWnllal assumplrons for annual i.awl.0 a stnnd:ud pall I bonnIl pmewlleleas II nolwles.o rtthmnl l0 ton healed us a paint W.s.q rrvluahul in,lsy'[rota AU Coots p.n.s pod mewvkna wow Untold,.usoluMwdy by no IMlayh OPoolap a,obnahad.s owl Capwe Cmineolion.I ha Cin.. IN1114 kptn,ad o)nm Cplm,nnQ,au ovoloJ by Cyp,o Itdoluelood nlopaly,ha.,(Aim andnwls 61410 Mw1w,1e In MO! Mmhwla MW.Mago 11M0 and Pe0 ldnlw and Poe I)Pnactfpl4p 1)n3 Plano WW1 oMt:.1 slates,and vdh.Ulan Morn Moliraid telkanmh.EmohNnhl a1 CI)ne antennas to 0.mlrnal ron•I.111 10 Crypw 0123 10 of 10 Quote created on 7/20/2023 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Group: City of Miami Bench .,...��.. C i g n U Effective Date:January 1,2024 Exhibit B Group Administrative Guidelines DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Cigna Healthcare Medicare Advantage Plans '';'`;,..... 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'' ' , . ....1..t(4%,*'' .;.1.,‘..t.$''''.t,:401' :.1' ,, , '0',A7k,i1,-,t•',X,,:..:',..,''' '' ' •L r",- • :‘..•"..:,',,''i`"" . „ 41,N. ,- ' A" .„. . ,V,-..-.. - ",",,'",,‘,,`•,,;, , ' .' 44. , ' DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 • tft 3r :y ,, 4. Try hsv Ata • K ' l ! ..� 5t ✓,,, Yr a✓' i ,,. • • Thank you for We're pleased to work with you to improve the health, well-being and peace of mind of your retirees.Our goal sharing our is to provide you with resources you need for easier plan commitment to administration.Please take some time to review the plan quality care. administration topics and refer to this Cigna Healthcares"" Medicare Advantage Plans'Group Administration Guide as needed. Contents Terms to know 3 Employer Group Portal 4 Eligibility and enrollment 5 Premium billing and payment 12 Employer/Union Group MAPD Agreement 14 Customer communications 14 Customer resources 17 Claims administration 18 Additional resources 18 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Terms to know Group The term 'group"throughout this document refers to employers,unions and trusts. Customer The term'customer"throughout this document refers to retirees.covered dependents. beneficiaries and Individuals, Centers for Medicare&Medicaid Services(CMS) CMS is the federal agency that runs the Medicare program and regulates all plans and provisions.Additional information can be found at www.Medicare.gov or by calling 1-800-MEDICARE(1-800-633-4227). Employer Group Waiver Plan(EGWP) Group Medicare Advantage plans are also called Employer Group Waiver Plans(EGWPs), pronounced"egg-whips.'EGWPs are a type of Medicare Advantage plan offered to employees and retirees of some companies,unions or government agencies. Low Income Subsidy(LIS) People with limited income and resources may qualify for Extra Help for their prescription drug benefit.Extra Help is referred to as a Low Income Subsidy.The amount of Extra Help an individual may receive depends on their income and resources. Some people automatically qualify for Extra Help and do not have to apply for it.If they answer "yes"to any of the questions below,they automatically qualify for Extra Help and will receive a certain dollar amount that may go toward their premiums or their cost-shores: • Do you have Medicare and full coverage from a state Medicaid program? • Do you get Supplemental Security Income? • Do you get help from your state Medicaid program paying your Medicare premiums? For example.do you belong to a Medicare Savings Program.such as the Qualified Medicare Retiree(OMB).Specified Low Income Medicare Retiree(SLMB)or Qualified Individual(QI)program? Medicare will mail a gray Loss of Deemed Status Notice to individuals in September if Social Security determines that they no longer automatically qualify for Extra Help for the coming year.Our plan will also mail a notice to encourage people to apply to determine if they still qualify for Extra Help. Customers who no longer qualify for Extra Help will receive a notice in December. If your enrollees have questions about Extra Help with prescription drug costs or need assistance completing an application,they can contact the Social Security Administration(SSA)at 1-800-772-1213 or visit www.SocialSecurlty.gov, 3 DocuSign Envelope ID 9FD 1 FBA 1-AE68-46F6-88F9-E31 DF1 C5DA72 • Ito, II'i ^ 0.1 Ip<,,I.I' 1I,AAINI.II '1,v' ,,I11,. Terms to know(continued) Federal exemption Medicare Advantage Plan(Part C) The Medicare Modernization Act of 2003 has a very strong preemption provision.This means A type of Medicare plan offered by private that in general.state laws don't apply to health insurance carriers that contract with standard Part C and Part D benefits unless they Medicare to provide Medicare Part A and pertain to state licensing or financial solvency Part B benefits.Cigna Healthcare is one of the insurer.Beginning in 2014,Part D coverage such carrier. under an Employer Group Waiver Plan(EGWP) that provides customers with supplemental Medicare Prescription Drug Plan(Part D) benefits beyond the parameters of the defined A stand-alone drug plan offered by Insurers standard Part D benefit are treated as non Medicare Other Health Insurance(OHI)that and other private companies to people who wraps around Part D.Employers/unions offering get benefits through the Original Medicare Plan or through a Medicare Private Fee-for- comply must ensure any supplemental benefits Service Plan that doesn't offer prescription comply with any applicable requirements for drug coverage.Medicare Advantage Plans issuance under state insurance laws and/or may also offer prescription drug coverage the Employee Retirement Income Security Act that must follow the same rules as Medicare (FRIBA)rules.This is similar to commercial health Prescription Drug Plans, care products that are subject to both state laws and federal laws.Certain state exemptions may apply. Employer Group Portal Go online to save time The Cigna Healthcare Medicare Employer Group Portal helps you manage your plan.From requesting replacement identification(ID)cards to having access to various reporting and plan documents,you have immediate access to information to help simplify plan administration.The Employer Group Portal will provide employers the ability to: • View Group Enrollment Reports. • Submit address change requests. • View Group Billing Reports(Invoices). • View customer eligibility details,including • View when a customer's ID card was last information for access to care(enrolled, ordered/mailed. future and disenrolled in the last 12 months). • Submit ID card replacement requests. • View/print plan documents and forms. Getting started to request Employer Group Portal access,provide your name and email address to your designated Medicare Client Account Manager.Soon after,you will receive an email invitation to register and access the portal at Employer.HSConnectOnline.com/Home/Logln.Your Medicare Client Account Manager can provide training and/or a user guide to get you started, 4 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 • ffit ft.z. } Eligibility and enrollment Plan eligibility Customers must be enrolled in both Medicare groups to simultaneously enroll their members in an Part A and Part B to enroll in a Cigna Healthcare "800 Series"Local MA-only Coordinated Care Plan Medicare Advantage plan and must be entitled (HMO,HMOPOS.PPO)and an"800 series"stand- to Medicare Part A and Part B benefits as of the alone prescription drug plan(PDP).CMS requires effective date of coverage under the plan.If not, the separate medical and prescription drug CMS will reject the application and the customer carriers to work closely together with the employer will not have coverage under the Cigna Healthcare sponsor to provide coordinated care and disease Group Medicare plan.To avoid these situations, management services between the medical and the Group must validate the customer's Medicare pharmacy portions of the benefit.This coordination status by requesting their Medicare ID card. is similar to the kind that would be offered if the Prior to sendng pre-enrollment packages.Cigna employer purchased the medical coverage and Healthcare can verify Medicare Part A and B the drug coverage from a single carrier under one enrollment to confirm eligibility for potential Medicare Advantage plan with Part D. enrollees.In order to perform the verification,the A customer is eligible to enroll in the Cigna following demographic information is required: Healthcare Medicare EGWP as long as the enrollee Medicare Beneficiary Identifier(MBI).name. permanently resides in the Cigna Healthcare date of birth(DOB)and gender.If the Group Medicare service area.To determine the service has customers who don't meet the eligibility area for your plan,enrollees should refer to their requirements to enroll in the Cigna Healthcare Evidence of Coverage(EOC)document.For Medicare EGWP,the Group should contact their purposes of enrollment in the Cigna Healthcare Cigna Healthcare Sales Representative to discuss Medicare EGWP,incarcerated customers are to be possible alternative plans. considered as residing out of the plan service area, There are specific sign-up periods when a regardless of the location of the correctional facility. customer con enroll in Medicare Part A and/or B. Customers must be U.S.citizens or lawfully present If the customer does not enroll during their Initial in the United States.CMS will notify Cigna Enrollment Period or a Special Enrollment Period, Healthcare if the customer is not eligible to enroll they will need to enroll during the General on this basis at the time of enrollment.Cigna Enrollment Period,between January I and March 31 Healthcare will notify the Group via the Group each year.Coverage will start the first day of the Enrollment Report. month after they sign up.The customer may have to pay a higher Part A and/or Part B premium for Please reference Chapter 2 of the Medicare late enrollment. Advantage Enrollment and Disenrollment manual found on www.CMS.gov for complete enrollment A customer may not be enrolled in more than one and disenrollment information. Medicare plan at any given time.However,CMS has granted a waiver for all employer and union 5 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 ('IFfi:hiN Ill , AS,. •:'r1.1. Ar, AI VA;41A1,t ICI if..,c.,. ;It... ,,IIP., � •i,/, ;ll it Eligibility and enrollment(continued) Medicare eligibility Medicare is usually available for people age 65 or older.younger people with disabilities,and people with permanent k,dney failure requiring dialysis or transplant.also known as End Stage Renal Disease(ESRD). Customers must be in a non-working status(i.e.,retiree or disabled)or entitled to benefits due to a retirement status(i.e.,spouse of retiree),and Medicare must be primary. (Age ESRD Customers are typically eligible for Medicare at age Customers can become Medicare 65.To be eligible for our plan,the customer must also eligible due to an ESRD diagnosis. meet eligibility requirements outlined In the Eligibility . If Medicare already pays primary Policies section. for the customer due to age or • For employer groups with 20 or more employees, disability and subsequently they are Medicare will pay secondary if the customer has diagnosed with ESRD.Medicare will other coverage through their employer or spouse continue to pay as primary. based on their current employment status. • If the customer becomes eligible for • For employer groups with under 20 employees, Medicare because of ESRD only, Medicare will pay primary. Medicare coverage will start the fourth month of dialysis treatments. Disability unless certain criteria is met. Medicare will pay secondary for Customers can become Medicare eligible due to the first 30 months.At the end of disability.To be eligible for our plan,the customer the 30-month coordination period. must also meet eligibility requirements outlined in the the customer becomes eligible to Eligibility Policies section. enroll in the Employer Group • For employer groups with 100 or more employees, Medicare Advantage plan.' Medicare will pay secondary if the customer has • If the customer turns age 65 during other coverage through their employer or spouse the 30-month coordination period. based on their current employment status. Medicare remains secondary until • For employer groups with under 100 employees. the end of the coordination period. Medicare will pay primary. • ,' ,{( DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 i.„ �, n r •.iVi,ri L`4 I r; i4. ;. .i;r• r. 1.. rr �Iii Eligibility and enrollment(continued) Medicare Beneficiary Identifier(MBI) CMS requires that the customer MBI be included with each enrollment application.The MBI can be found on the customer's Medicare ID card.The Group is responsible for providing the customer's MBI to Cigna Healthcare with their enrollment application.Eligibility received without the MBI will be considered an incomplete enrollment application(see Incomplete enrollment information).The customer will not have access to care due to incomplete enrollment.As a reminder.Cigna Healthcare can verify Medicare Part A and B enrollment along with MBI for potential enrollees.See the Plan Eligibility section for more details. Enrollment information required by CMS and Cigna Healthcare for Medicare customers The Group must provide all the information required by CMS and Cigna Healthcare in order to successfully enroll the customer into the elected plan. Required information • Customer name > Required for Medicare Advantage HMO: • Customer DOB if not received,a PCP will be auto-assigned • Customer gender > Optional.but highly recommended for • Permanent residence address: Medicare Advantage PPO > If a P.O.Box is used for the mailing address. then the Group must also provide the customer's physical address. > Enrollment applications received without Highly recommended information the permanent residence address will be . Phone number considered an incomplete application • Email address (see Incomplete Enrollment Information). Newly enrolled customers with phone > If the permanent residence address cannot numbers and email addresses will receive a be provided due to security concerns. Welcome Call and Welcome Emails to answer a Permanent Residence Attestation can any questions they may have and review key be provided by the client or the customer. benefits,features and resources to help • Customer MBI them make the most of their new plan. • Account number At other points during the year,phone • Branch code numbers and email addresses maybe used • Benefit option code for clinical care outreaches or to share plan information and updates. • Coverage effective date • • Coverage cancel date(required for all Other insurance information disenroilments,excluding those initiated by CMS) Complete insurance details support • Primary care physician(PCP)name,provider ID accurate claim processing. or National Provider Identifier(NPI) 7 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 r �• t t t!= Eligibility and enrollment(continued) Eligibility format and processing Incomplete enrollment information The following methods are acceptable for Enrollment information that is incomplete is not submitting enrollments to Cigna Healthcare: legally valid for enrollment into the Cigna Healthcare • Automated eligibility file Medicare EGWP.In addition,an enrollment is not legally valid if it is later determined that the customer • CMS-compliant spreadsheet did not meet all of the CMS eligibility requirements. Enrollment requests via phone call or email are never allowed,even in an emergency situation. If there is missing or incorrect information•including a missing permanent residence address when a P.Q. CMS requires a seven calendar-day processing Box is provided,the customer will receive a letter time from the date completed Medicare instructing them to contact the Cigna Healthcare eligibility is received by Cigna Healthcare.We Dedicated Medicare Customer Service Team(see will send all enrollment information to CMS.In Section 7.Customer Resources-Phone Numbers): the event an enrollment is rejected,a letter will they can immediately update the missing information be sent to the customer indicating the reason in order to expedite processing the initial enrollment. (or the rejection.The Group will receive a Group Cigna Healthcare will notify the Group of the missing Enrollment Report that identifies the customers information on the Group Enrollment and Critical who have not been accepted by CMS. Error Reports for the Group to update their records. Group Enrollment Report The customer has 21 days to respond to the request This report is generated weekly upon for missing information.If a valid MBI or permanent receipt of the CMS response file and residence address cannot be obtained within 21 includes all accepted enrollments, days.Cigna Healthcare will send the customer a disenrollments and address changes into Denial of Enrollment letter and they will notify the the plan.The report will indicate when Group that the customer must be terminated from action is required by the Group. the Cigna Healthcare Medicare EGWP on the Group • Critical Error Report Enrollment Report.The Group may choose to move This report contains errors encountered customers to a non-EGWP or terminate coverage.If when the eligibility file is processed. the information is provided after the 21 days,the customer's effective date will be postponed until the following month,when the customer's completed information is received and validated by CMS. 8 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 :IK,ht;�IIfA1II AI41:bt114, 6r11-AlA/ANIAt;tP1A•Iis(1K7l1PAl'M1t11'.IiaFIVF(AIU)1' Eligibility and enrollment(continued) Effective dates Terminations CMS has sole authority to verify effective dates:however. Terminations will always be the last day a proposed effective date may be communicated to the of the month,including terminations customer.Effective dates will always be the first day of the resulting from the death of the customer. month.The effective date may not be earlier than the first The disenrollment is effective the last day of the month following the month in which the customer of the month in which the customer(or his/ enrollment request was made.The effective date may not her egal representative)provides notice to be earlier than the first day of the customer's entitlement disenroll to the Group and the Group sends to Medicare.If a customer's enrollment is submitted with a the disenrollment to Cigna Healthcare.The date prior to their entitlement date.Cigna Healthcare will disenrollment date may not be earlier than process the enrollment using the Medicare entitlement the end of the month in which the customer date.Enrollments cannot be processed earlier than three disenrollment request was mode or the months prior to the effective date. customer no longer qualifies for the plan. • Retroactivity Retroactive enrollments and disenrollments are not allowed,except in extraordinary circumstances (subject to audit by CMS)when the Group knew of the customer's enrollment or disenrollment intent prior to the requested effective date.The effective date may be retroactive up to,but not exceeding,three months from the date Cigna Healthcare received the request from the Group.The ability to submit limited retroactive enrollment transactions is to be used only for the purpose of submitting a retroactive enrollment made necessary due to the Group's delay in forwarding the completed enrollment request to Cigna Healthcare.Repeated retroactive requests by a Group may indicate an ongoing problem to CMS and lead to a request from CMS to review the Group's documentation of their records. CMS requires a special review process when requesting enrollment/disenrollment effective dates that are older than three months.If the Group submits a request older than three months,Cigna Healthcare will request a completed form,including the required CMS documentation: • The customer's enrollment/disenrollment intent(election form,call notes.opt-out form,etc.. dated prior to the requested effective date). • The premium impact to the customer if the request is approved. • Hardship created for the customer if the request is not approved. • The reason for the Group's delay in submission to Cigna Healthcare and preventive actions to avoid future occurrences. Once received.we will review the documentation to determine if it meets CMS requirements.If it doesn't, we will work with you for alternative options.If the documentation supports the requested enrollment/ disenrollment effective date.we will submit the request to CMS for review.This review can take CMS up to 60 days.In the event that CMS denies the retroactive request.we will work with you to determine an alternative solution within CMS guidelines that minimizes customer impact. 9 DocuSign Envelope ID:9FD1F8A1-AE68-46F6-88F9-E31DF1C5DA72 Eligibility and enrollment(continued) I CMS-initiated disenrollments CMS will automatically disenroll a customer: Disenrollrnent/cancellation • Upon notification of his/her death. A customer may disenroll from a Medicare Disenroliments due to date of death con only Advantage plan with or without Part D be initiated by CMS. only during one of the CMS-approved election periods.If the customer is • Upon enrollment in another PDP or MAPD plan, enrolled in an EGWP-sponsored plan, • Who is no longer entitled to either Medicare they are not required to comply with the Part A and/or B benefits/ CMS-approved election period which • For failure to pay their Part D Income-related allows them to submit a disenrollment at Monthly Adjustment Amount(IRMAA)to the any time during the plan year.The government. customer must elect another Part 0 plan • Upon notification of a change in residence that or other creditable prescription drug results in the customer being outside of the coverage that is at least as good as the service area(including incarceration). standard Medicare prescription drug • If it is determined he or she is unlawfully present coverage or they may be subject to a late in the United States. enrollment penalty.When the customer elects another Medicare Advantage plan with or without Part D,CMS will generate CMS initiated reinstatements an automatic disenrollment from the CMS will automatically reinstate a customer in the current Medicare Advantage plan.CMS following situations: will notify Cigna Healthcare,and Cigna • Customer was disenrolled due to enrollment in Healthcare will send the customer a letter another plan and the new plan was cancelled. and notify the Group through the Group Enrollment Report.The Group must • CMS disenrolled customer due to erroneous terminate the customer from their plan report of death and CMS has corrected the upon notification from Cigna Healthcare retiree's nForrnation. using the date provided by CMS.This • CMS disenrolled customer for failure to pay individual may not remain enrolled in the IRMAA and the customer has been approved Cigna Healthcare Medicare EGWP. for reinstatement due to good cause and customer fulfills requirements. Cancellations may be necessary in cases of mistaken enrollment or disenrollment Customers who have been automatically reinstated made by a customer.Requests for will appear on the Enrolled Members tab of the cancellations can only be accepted prior Group Enrollment Report.If the Group does not to the effective date of the enrollment or agree to the reinstatement,Cigna Healthcare will disenrollment request.If a cancellation submit a disenrollment transaction to CMS.If the occurs after the effective date. Group agrees to reinstate the customer.the retroactive disenrollment and customer will remain enrolled in the plan.For failure reinstatement actions may be necessary. to pay IRMAA,If CMS notifies Cigna Healthcare This is only available on a very limited prior to reinstating the customer,we will verify if exception basis per CMS guidelines. the Group agrees to the reinstatement prior to See Retroactivity. providing CMS approval for the reinstatement.If the } Group agrees to reinstate the customer,notification must be received within five calendar days. 10 DocuSign Envelope ID'9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 ,i, t�.0 ..i;, nn,Inn, nILL 4'�`�,Aflt:�t V, "I 1 u Eligibility and enrollment(continued) Termination due to nonpayment of premiums If the Group's policy is to disenroll enrollees for failure to pay their monthly premium,the Group must apply the policy consistently across its enrollees.The Group must give an enrollee a minimum grace period and provide them with written notice prior to disenrollment.The grace period must be at least two calendar months,and it begins on the first day of the month for which the premium is unpaid.If an enrollee fails to pay his or her premium within the grace period,the enrollee can be disenrolled on the first day after the end of the grace period.The Group can attempt to collect the premium but cannot retroactively terminate the enrollee. Income-related Monthly Adjustment IRMAA Terminations Amount(IRMAA) • When a customer does not pay their IRMAA to Medicare-eligible Lustorners with Part D the SSA,CMS will notify Cigna Healthcare that the coverage could be assessed a higher Part D customer rrust be terminated.Cigna Healthcare premium based on their annual income. will then notify the Group via the Group Enrollment • Customers with a single annual income Report that the customer must be terminated over$97,000 or joint income of over per CMS. $194,000 will be charged additional • CMS provides an opportunity for reinstatement premiums by the SSA.' of customers into their Medicare Part D Plan for NOTE These amounts are subject to good cause situations.If the customer advises the change annually. Group they have a good reason for failure to pay Part D IRMAA premiums.the Group should tell • They may either hove premiums deducted the customer to contact I-800-MEDICARE from their monthly Social Security payment (1-800-633-4227)within 60 calendar days of the or if they are not receiving Social Security disenrollment effective date to see if they qualify yet.Medicare will bill them directly. for a good cause reinstatement and,if so.make • Customers who fail to pay the additional payment arrangements in order to get reinstated premium will be involuntarily terminated into the plan. from the plan. • CMS will notify Cigna Healthcare if the customer • IRMAA is administered by Medicare and qualifies for reinstatement for good cause. the SSA.Cigna Healthcare is not provided Cigna Healthcare will reach out to the Group to any information regarding which persons confirm if the customer can be added back Into are affected by IRMAA.Any questions the plan based on the Group's eligibility rules. about IRMAA should be directed to the Once the customer makes all the required SSA at I-800-772-12I3. payments.CMS will reinstate the customer and Cigna Healthcare will notify the Group via the Group Enrollment Report. Record retention CMS requires that Cigna Healthcare has a record of all enrollment requests.CMS guidelines require customer enrollment elections to be retained for 10 years.Additionally.the Group will maintain all records and documentation relating to enrollment for a period of 10 years from the final date of group coverage. 11 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 410. !k. Premium billing and payment Wire and Automated Billing invoice Clearing House(ACH)details A separate invoice will be generated for your Cigna Healthcare Bank: Medicare plans.If there are multiple account numbers,each Bank of America.N.A. account number will generate a separate invoice.The invoice ACH ABA Routing/Transit will include a monthly summary and a detailed roster. Number 011900571 Payment due date Bank Account Number: 385015921381 Premium is due by the end of the month.Any premium not received after the last day of the month is considered past due. Bank Account Name: Cigna Healthcare will provide notice of the unpaid premiums on Cigna Health and Life the next month's invoice and may provide a separate notice of Insurance Company late payment if unpaid premiums are more than one month past Bank ACH Address: due.Cigna Healthcare may terminate the agreement one month 10I S Tryon Street after it provides the Group with a notice of late payment if the Charlotte,NC 28255 Group has not paid the premiums due. Wire Transfer ABA: 026009593 Payment remittance method Eligibility-based billing or Pay as Billed(PAB)is the Cigna Swift:BOFAUS3N Healthcare remittance method.The Group will need to remit Bank:Bank of America payment for Cigna Healthcare Medicare plan coverage Bank Address: separately from other Cigna Healthcare plans.A separate W-9 101 West 33rd Street is not required for Cigna Healthcare Medicare clients with a New York.NY 10001 Cigna Healthcare commercial relationship.A W-9 is required for clients with Cigna Healthcare Medicare plans only. LIS premium adjustment Medicare provides a premium subsidy for those who qualify due to limited income or resources. CMS will notify Cigna Healthcare of any customers eligible for LIS premium adjustments.CMS will pass the adjustment on to Cigna Healthcare,and we in turn will pass the adjustment on to the Group via the monthly billing invoice.A separate detailed monthly billing adjustment report will provide the names of the applicable customers and will contain the amount of the LIS premium adjustments. The billing roster indicates the retirees who are eligible for the LIS with the adjustment code of LIS. Customers eligible for LIS and the LIS premium adjustment amounts are subject to change on a monthly basis.Retroactive LIS premium adjustments may appear on the billing roster. 12 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 ti,Pfa III A l A, ,l,n:.I 1.1 Id:,,,t:r II n,.l„,�'I. .:I•,, Premium billing and payment(continued) LIS premium adjustment(continued) The Group will reduce the premium amount due up to the amount the customer contributes toward premiums by reducing the premium amount due up front. In those instances where the Group is not able to reduce the premium paid by the customer up front. Cigna Healthcare and the Group may agree that either the Group or Cigna Healthcare shall directly refund to the customer the amount of the LIS premium up to the Cigna Healthcare Group Medicare plan contribution previously collected from the customer.The Group or Cigna Healthcare is required to complete the refund on behalf of Cigna Healthcare within 45 days of the date Cigna Healthcare receives the LIS amount for the US-eligible customer from CMS. Any remaining portion of the subsidy amount is then applied toward the monthly customer premium paid by the Group. If the LIS premium amount for which a customer is eligible is less than the portion of the monthly premium paid by the customer,then the Group should communicate the potential financial impact to the customer in the Cigna Healthcare Medicare plan as compared to enrolling in another Part D plan with a monthly premium equal to or below the LIS premium amount. Late Enrollment Penalty(LEP) Customers may have to pay an LEP in addition to CMS will inform Cigna Healthcare of the LEP their monthly plan premium if there is a continuous amount that the customer would be responsible period of 63 days or more at any time after the for paying.Cigna Healthcare will pass the penalty end of their Part D initial enrollment period during on to the Group via the employer monthly billing which they were eligible to enroll but were not invoice.The detailed billing roster will provide the enrolled in a Medicare Part D plan and were not names of the applicable customers and the covered under any creditable prescription drug amount of the LEP. coverage.Creditable prescription drug coverage The Group is responsible for paying the penalty is coverage that is at least as good as the on behalf of the customer and may choose to standard Medicare prescription drug coverage. collect the LEP amount from the customer.The The customer may have to pay this LEP for as long as they have Medicare prescription drug amount of the LEP may change every year. coverage.The amount of the LEP may change If a customer has been assessed an LEP under every year. a non-Cigna Healthcare plan and disagrees with the penalty.the customer must initiate the If the customer must pay an LEP,the penalty is appeal process by contacting Medicare at applied when a customer joins a Medicare plan I-800-MEDICARE(I-800-633-4227);TTY users with drug coverage and has a gap in coverage of should call I-877-486-2048.The customer'will 63 days or more.The penalty amount may change need to fill out a reconsideration request form and each year based on the national base beneficiary provide proof that they had previous creditable premium amount.Although you can estimate,only coverage.Cigna Healthcare is unable to assist in CMS is authorized to calculate the actual amount the appeal process when the customer did not of the penalty. have coverage through Cigna Healthcare. 13 DocuSgn Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 It Premium billing and payment (continued) Attestation Customer communications Cigna Healthcare will accept on attestation from the Group that all customers submitted Required group communications on the eligibility file for initial enrollment into to customers the Cigna Healthcare Medicare EGWP were previously enrolled in a plan that provided Pre-enrollment kits creditable pharmacy coverage and did Group pre-enrollment kits are required to go out not have a gap in creditable coverage for to all eligible customers and must be received no 63 days or longer. later than 21 days prior to the effective date for passive enrollment or 21 days before the Open if the retirees were enrolled in a Retiree Enrollment Period for active enrollment. Drug Subsidy filed plan.Cigna Healthcare will also accept an attestation that the Further.pre-enrollment kits are required to customers have been notified of the be sent to retirees as they reach the age of opportunity to enroll and the process Medicare eligibility and meet the Group's for opting out of coverage in the Cigna enrollment rules.Cigna Healthcare will provide Healthcare Medicare EGWP. the client with a bulk shipment of pre-enrollment (or age-in)kits prior to the start of the calendar These attestations apply to valid and year.The client will send a kit to each retiree 60 complete enrollment applications/records days prior to their Medicare eligibility.Both the processed prior to the Initial effective date pre-enrollment and age-in kits will include: of the plan.Enrollment requests processed after the initial effective date will receive • Pre-enrollment/Age-in letter communications regarding creditable • Summary of Benefits coverage and/or Retiree Drug Subsidy • Online Resource insert as required by CMS. (Directory and Drug List) • Information Guide Employer/Union Group • How to Find a Provider guide MAPD Agreement • Notice of Non-discrimination and Multi-language insert • Formulary Addendum The CMS contract addendum with Cigna Optional flyers(if applicable): Healthcare(Employer/Union-only Group Addendum)requires that Cigna Healthcare • Access to Care obtain written agreements from each • Home-based Care employer or union with which it contracts • Vaccinations for employer/union-only group MAPD plans • and that such agreements contain certain Part B vs.Part D terms and provisions.This agreement will be Additional general plan information is available provided to you by your account team and at CignaMedicare.com/group/MAresources. will need to be fully executed prior to the See page 17 for more details. effective date.A full agreement is provided with the initial plan year.and an amendment is provided for each renewing year. 14 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 11,,1 ,, :.I I '� h,1 i�' .-I..� I I I.r Customer communications(continued) Renewal kits Group renewal kits are required to go out to all enrolled customers and must be received 15 days before the beginning of the Group's health plan Open Enrollment Period.If the Group does not have an Open Enrollment Period.then the materials are required to be received or available to review online by customers no later than 15 days before the beginning of the plan year. • Renewal cover letter Optional flyers • Annual Notice of Change(ANOC) (if applicable): • EOC snapshot • Access to Care • On'ine Resource insert(Directory and Drug List) • Home-based Core • How to Find a Provider guide • Vaccinations • Privacy Practices • Part B vs.Part D • Notice of Non-discrimination and Multi-language insert Post-enrollment communications Upon completion of the customer's enrollment into the Cigna Healthcare Medicare EGWP,the following will be mailed to the customer within 10 calendar days from receipt of CMS confirmation of enrollment or by the last day of the month prior to the effective date,whichever Is later: • Welcome letter • Acknowledgment/Confirmation of Enrollment • EOC snapshot Acceptance letters(mailed separately) • Online Resource insert(Directory and • Cigna Healthy Today card(mailed separately) Drug List) Optional flyers(if applicable): • Customer Handbook • Access to Care • • Benefit Guide • Home-based Care • Privacy Practices • Vaccinations • ID card(mailed separately) • Part B vs.Part D • Notice of Non-discrimination and Multi-language Interpreter Services Newly enrolled customers with phone numbers and email addresses c5 ) will also receive a Welcome Call and Welcome Emails to answer any questions they may have and review key benefits,features,and resources to help them make the most of their new plan. 15 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 . 1._Iv:.Ili.A,IYIi 1 1,f{11,I' i I:, Customer communications(continued) Required plan communications to customers Cigna Healthcare will provide a copy of the following items and other communications to the Group and/or broker,if requested. • Acknowledgment/Confirmation • Acknowledgment of Disenrollment Notice of Enrollment Acceptance Notices The notice is mailed to the customer within The notices are mailed to the customer within 10 calendar days of Cigna Healthcare receiving 7 to 10 calendar days of the CMS confirmation the disenrollment election. of enrollment.The notices can be used by the • Confirmation of Disenrollment Notice customer as proof of coverage prior to receiving This notice is mailed within 7 to 10 calendar days the ID card. of the CMS confirmation of disenrollment. • Identification(ID)Card • Explanations of Benefits(EOBs) ID cards are mailed to the customer's home within EOBs will be produced for claim activity and 10 days of CMS confirmation of enrollment.It is will be mailed to the customer's mailing address required that the contract be executed prior to in accordance with CMS guidelines. the effective date in order to trigger the release • Research Potential Out-of-area Status Notice of ID cards to those enrolled.Replacement Cigna This notice is mailed to the customer when we Healthcare Medicare ID cards can be ordered receive notice(returned mail,CMS notification, by calling the dedicated customer service team (see Customer Resources).Cigna Healthcare etc.)that they may have moved out of the customers will receive a new customer identifier service area.The customer must confirm that when moving to the Cigna Healthcare Medicare they still live in the service area within six months EGWP.Cigna Healthcare Medicare Plans are or they will be disenrolled from the plan. member-based products.which require all Notice of Disenrollment Due to customers to be loaded as individual subscribers. Out-of-area Status • Low Income Subsidy(LIS)Rider(if applicable) (upon new address verification from customer) The rider is mailed to the customer's mailing This notice is mailed within 10 calendar days of address within 30 calendar days of notification Cigna Healthcare verifying that the customer from CMS that the customer qualifies for a low has permanently moved out of the service area. income subsidy. • Termination Letter Late Enrollment Penalty(LEP) CMS allows a Group to disenroll its customers • Attestation Notice from a Medicare plan using a group This notice is mailed to the customer within disenrollment process.The group disenrollment 10 calendar days of receipt of application when process must Include a letter of notification of there is a potential gap in coverage of 63 days disenrollment to each customer 30 days prior or more,and it must be returned within to the effective date of their disenrollment from 30 calendar days of the date on the form. the Group sponsored Medicare plan. This is not a complete list of all communications that may be sent throughout the plan year.There are system-generated letters that are sent to request information in order to process claims,update customer records,etc.Electronic samples of these system-generated letters can be provided upon request. 16 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 • 1. 0 • rd +Y • ey f/ . t- +r Customer resources Medicare Advantage dedicated customer service team phone number Phone number:1-888-281-7867(TTY/TDD users should call 711) Hours of operation: October I -March 31.7 days a week.8 a.m.to 8 p.m.local time. April I-September 30,Monday-Friday,8 a.m.to 8 p.m.local time. Our automated phone system may answer your call during weekends or holidays and after hours. Home Delivery with Express Scripts Pharmacy5 To set up an account,retirees should have their Cigna Healthcare Medicare ID card and medication list nearby and call Express Scripts('Pharmacy at 1-877-860-0982(TTY 711). 24 hours a day.365 days a year. Customer web access Customers can sign in to myCigna.com®,which is a personalized website where they can: • View Medicare Advantage benefits • Manage prescriptions • Manage profiles and preferences • Price a medication • View drug lists • Access Healthy Rewards`"16 discount programs • Find a doctor,including telehealth • View and print ID cards • Find a network pharmacy • Complete incentive program registration • Review daim history and EOB details The CignaMedicare.com/group/MAresources public website provides customers with access to general plan information that does not list client-specific benefits. • EOC shell(the legal language of the plan) • Claim forms • The ability to find a Medicare Advantage • Medication therapy management provider or pharmacy • Quantity limit criteria • Chain pharmacy listing • Step therapy criteria • Informat on on how to transition to • Prior authorization criteria a new plan policy • Health Risk Assessment(MAPD only) • Drug lists • Personal medication list 17 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 it,i,,. ,I 1.1, A II /V I-I, nrc: .,, ,h vi r.lc�.,l:�,ut "I ,'.n ,tc Claims administration Claims When a manual claim is necessary(majority of providers will submit electronically),customers will need to complete a claim form to request payment.Copies of the form can be downloaded from CignaMedicare.com/group/MAresources.or customers can contact customer service to request a form be mailed to them.Claims should be mailed to: Pharmacy Medicare Advantage Cigna Healthcare Cigna Healthcare Attn:Medicare Part D Attn:Direct Member Reimbursement, P.O.Box 14718 Medical Claims Lexington,KY 40512-4718 P.O.Box 20002 Nashville,TN 37202 Claims payment Cigna Healthcare will administer claims in accordance with the EOC document.From time to time. Cigna Medicare will reprocess or adjust claims that have been processed under the Plan for several potential reasons including,but not limited to,obtaining additional information from the customer,the customer's provider or CMS and upon identifying errors.If Cigna Healthcare reprocesses or adjusts a processed claim(s)and this results in a change to the amount due from the customer.Cigna Healthcare shall notify the customer of the change and,as applicable,refund the difference to the customer or request payment of the difference. 1 Additional resources Medicare website:www.Medicare.gov GAN. Cigna Healthcare website:Cigna.com Employer Group customer resources: CignaMedicare.com/Group/MAresources Group Medicare Online Provider and Pharmacy Directory: Providersearch.HSConnectOnline.com/EGWP Group Employer Portal: Employer.HSConnectOnline.com/home/login 18 DocuSign Envelope ID:9FDIFBA1-AE68-46F6-88F9-E31DF1C5DA72 ti p cIgna healthcare I.f tfective January 1,2011,Medicare allowed individuals with an I.SI&)diagnosis to enroll in Medicare Advantage plans at the end of the 30-month cootdrration period 1 A r ustorner tan ask C igna Ile,dthiare in reinstate coverage it they feel Ihal(MS disenrolfed them in nitro II the Group inures,(got Healthcare will reinstate(overage for the I rnlonter la a penne of 60 days.If(MS systems ate updated within 60 days,the reinstatement will he sr brnilteri to MS and the r minim will trreive Ihr Acknowti tNpnent of Reinstatement letter II CMS systems are not updated of ter 60 days,Cigna Healthcare will dlsenroll the r ustonrer hack to the output disenrollmenl date and the customer will receive a feller to close the reinstatement request 3 for most up to nateincomeranges,vtvlhlgnaAwwwMedicare.gov/Druq•(ovetrge Part U/(mis or Medway!Ding(ovet,gefMoidhly Premium Ior Clog Plans. d.(MS Understanding Med'kare Advamage&Menu are Drug Plan l.nollrrwnl Periods.(MS Product No.11119.Page last accessed September I4,1013 hilps.!/wwwiredicare.gov/Pubslpol/1'119-llnderstandmg Medicare Part-CO.pol. S.f xpless Scripts"Phatrnacy is the home delivery pitamnac y of EVE101O11DH•°ueanh Services.Ivrmorur is a division of the Cigna Growl • wnt programs ate not.wadable in all states and pm>yrants may be discoid-noted at any nice A discount program is NOT insurance,and customers must pay the onto Iiscounted charge.All goods,services and discounts offered through discount programs ate provided bythad parties who are solely responsible Mr then products,services t qua i, rare piano,:Is and sei vices are provided exclusively by or through operating subsidiaries of I he Cigna Group.I he l igna names,logos,and marks,including lilt C IGNA GROUP aidtIGNA HEALTH(AI*,are tnvned try Cigna Intellectual Property,Inc.Subsidiaries ofthe(ignaGroupcontractwithMedicatetoofferMeditateAdvantageHMOand(•Pt) plans and Part O Prescription Drug Plans(PO>F'sl'n celet I stiles,and with serer I Stale Mettirand programs hxollmenl III a C igna Ilealliware pink(I depends on crnlr w r renewal '119318 I IR 1611011(lava Healthcare DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement By and Between City of Miami Beach "Employer" And Cigna Health and Life Insurance Company "CHLIC" Effective Date: October 1, 2023 EXCEPT AS PROVIDED BY APPLICABLE LAW,THIS AGREEMENT AND ITS TERMS ARE PROPRIETARY AND CANNOT BE DISCLOSED WITHOUT THE PERMISSION OF EACH OF THE PARTIES DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 Table of Contents Definitions 3 Section 1. Term and Termination of Agreement 4 Section 2.Claim Administration and Additional Services 5 Section 3.Funding and Payment of Claims 6 Section 4.Charges 7 Section 5.Enrollment and Determination of Eligibility 7 Section 6.Audit Rights 8 Section 7.Plan Benefit Liability;Indemnification 10 Section 8.Modification of Plan and Charges 11 Section 9.Modification of Agreement 11 Section 10.Choice of Law 1 I Section 11.Information in CHLIC Processing Systems t I Section 12.Resolution of Disputes 12 Section 13.Third Party Beneficiaries 12 Section 14.No Waivers 12 Section 15.Headings 12 Section 16.Severability 13 Section 17.Force Majeure 13 Section 18.Assignment and Subcontracting 13 Section 19.Notices 13 Section 20.Identifying Information,Internet Usage and Trademark 13 Section 21. Confidentiality 14 Section 22.Independent Contractors 14 Section 23.Reservation of Intellectual Property Rights 14 Section 24 CULIC's Compliance with Florida Public Records Law 15 Section 25 Inspector General Audit Rights 16 Section 26 E-verify ..18 Section 27.Insurance Requirements 19 Section 28.Entire Agreement 20 Section 29.Request for Proposal 20 SIGNATURES 21 Schedule of Financial Charges 22 Exhibit A-Plan Booklet 54 Exhibit B-Services 55 Exhibit C-Audit Agreement(Sample) 63 Exhibit CI -Clinical Audit Agreement(Sample) 66 Exhibit D-Privacy Addendum 71 Exhibit E-Conditional Claim/Subrogation Recovery Services 77 Appendix A-Pharmacy Benefit Management Services 79 Appendix B-Cigna llomc Delivery Pharmacy Specialty Drug List 98 Appendix C-SaveOnSP Program 100 DocuSign Envelope ID 9FD1FBAI-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach THIS AGREEMENT. effective October 1, 2023 (the "Effective Date") is by and between City of Miami Beach("Employer")and Cigna Health and Life Insurance Company("CHLIC"). RECITALS: WHEREAS, Employer, as Plan sponsor, has adopted the benefit described in Exhibit A, as may be amended, ("Plan") for certain of its employees/members and their eligible dependents (collectively " Members");and WHEREAS, Employer has requested that CHLIC provide certain administration services in connection with the Plan (for its own internal purposes, CHLIC identifies Employer's account by the following number(s)3340006). NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, it is hereby agreed as follows: Definitions Agreement means this entire document including the Schedule of Financial Charges and all Exhibits and Addenda,as attached hereto,as well as any subsequent amendments. Applicable Law means the state, federal and/or international law and/or regulation that apply to a Party or the Plan. Bank Account means a benefit plan account with a bank designated by CHLIC; established and maintained by Employer in its or a nominee's name. ERISA means the Employee Retirement Income Security Act of 1974, as amended and related regulations.CHLIC acknowledges that Employer's Plan may not be subject to ERISA. Extra-Contractual Benefits means payments which Employer has instructed CHLIC to make for health care services and/or products that CHLIC has determined are not covered under the Plan. Member means a person eligible for and enrolled in the Plan as an employee or dependent. Participant/Participating Members means Member(s) who is(are) participating in a specific program and/or product available to Members under the Plan. Participating Providers means providers of health care services and/or products, who/which contract direct l} or indirectly with CHLIC to provide services and/or products to Members. Party/Parties means Employer and CHLIC,each a"Party"and collectively,the"Parties". Plan Benefits means amounts payable under the terms of the Plan for expenses incurred by Members for .$ervices/items covered under the Plan. Plan Year means the twelve (12) month period, beginning on the Effective Date and, thereafter, each subsequent twelve(12)month period. 08/04/2023 3 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Run-Out Claims means claims for Plan Benefits relating to health care services and products that are incurred but not processed prior to termination of this Agreement;termination of a Plan benefit option or termination of Member eligibility,as applicable. Subscriber means the Member whose employment or participation is the basis for eligibility under the Plan. Section I. Term and Termination of Agreement This Agreement is effective on the Effective Date and shall remain in effect until the earliest of any of the following dates: i. The date which is at least one hundred and twenty(120)days from the date that either Employer or CHLIC provides written notice to the other of termination of this Agreement; ii. The effective date of any Applicable Law or governmental action which prohibits performance of the activities required by this Agreement; iii. The date upon which Employer fails to fund the Bank Account as required by this Agreement provided CHLIC notifies Employer in writing of its election to terminate and Employer does not fund the Bank Account as soon as possible but no longer than within thirty (30)days of receipt of such written notice; iv. The date upon which Employer fails to pay CHLIC any charges identified in this Agreement when due,provided CHLIC notifies Employer in writing of its election to terminate and Employer does not make such payments as soon as possible but no longer than within thirty(30)days of receipt of such notice;or v. Any other date mutually agreed upon by Employer and CHLIC, vi. Notwithstanding the foregoing, all provisions in this Agreement reasonably related to CHLIC's administration of the Plan's Pharmacy Benefit (as such term is defined in Appendix A) (the "Pharmacy Benefit Provisions"), shall continue in effect for no less than thirty six (36) months commencing on the Effective Date,except that, if any of the following dates occurs, the Pharmacy Benefit Provisions set forth in the Schedule of Financial Charges and Appendix A will cease being in effect as of such date: a. The effective date of any Applicable Law or governmental action which prohibits performance of the activities in connection with the Pharmacy Benefit required by this Agreement; b. The date upon which Employer fails to fund the Bank Account as required by this Agreement for claims under the Pharmacy Benefit provided CHLIC notifies Employer in writing of its election to terminate the Pharmacy Benefit Provisions and Employer does not fund the Bank Account as soon as possible but no longer than within thirty(30)days of receipt of such written notice; c. The date upon which Employer fails to pay CHLIC any charges in connection with the Pharmacy Benefit identified in this Agreement when due, provided CHLIC notifies Employer in writing of its election to terminate the Pharmacy Benefit Provisions and Employer does not make such payments as soon as possible but no longer than within thirty(30)days of receipt of such notice; or d. The date that is sixty (60) days after written notice by either Employer or CHLIC ("non- defaulting party") of the material breach by the other (the "defaulting party") of a material 08/04/2023 4 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach obligation of the defaulting party related to the Pharmacy Benefit(other than failure to fund the Bank Account or failure to pay any charges when due pursuant to Sections I.vi.b and I.vi.c above) that is not cured to the reasonable satisfaction of the non-defaulting party within a reasonable time following the initial notice of breach. During such thirty six(36)month period(or shorter period,as applicable under(a),(b),(c)or(d)above), CHLIC will continue to be the exclusive provider of Pharmacy Benefit administration services for the Plan's Pharmacy Benefit. Section 2.Claim Administration and Additional Services a. While this Agreement is in effect,CHLIC shall,consistent with,the claim administration policies and procedures then applicable to its own health care insurance business(i)receive and review claims for Plan Benefits;(ii)determine the Plan Benefits,if any,payable for such claims;(iii)disburse payments of Plan Benefits to claimants; and(iv)provide in the manner and within the time limits required by Applicable Law, notification to claimants of(a) the coverage determination or(b) any anticipated delay in making a coverage determination beyond the time required by Applicable Law. b. Following(i)termination of this Agreement,except pursuant to Section I.iii and I.iv;(ii)termination of a Plan benefit option or(iii)termination of eligible Members,if any required fees have been paid in full,CHLIC shall process Run-Out Claims for the applicable Run-Out Period(Refer to Schedule of Financial Charges for applicable fees and Run-Out Period).At the termination of any applicable Run- Out Period, CHLIC shall cease processing Run-Out Claims and, subject to the requirements of Section 21.a,make all relevant records in its possession relating to such claims,other than CHLIC's proprietary information, available to Employer or Employer's designee in electronic format. CHLIC is not required to provide proprietary information to Employer or any other party. c. Employer hereby delegates to CHLIC the authority, responsibility and discretion to determine coverage under the Plan based on the eligibility and enrollment information provided to CHLIC by Employer.Employer also hereby delegates to CHLIC the authority,responsibility and discretion to(i) make factual determinations and to interpret the provisions of the Plan to make coverage determinations on claims for Plan Benefits,(ii)conduct a full and fair review of each claim which has been denied (as defined by ERISA), (iii) conduct level one of internal appeals of "Urgent Care Claims," "Concurrent," "Pre-service," and "Post-service" claims (as those terms are defined under ERISA)and notify the Member or the Member's authorized representative of its decision. Employer will ensure that all summary plan description materials provided to Members reflect the delegation of discretionary authority outlined above. If the Plan provides a level two internal appeal. Employer shall conduct and retain full responsibility and discretionary authority for such appeals including notification to the Member and/or the Member's authorized representative of its decision. Employer will ensure that the summary plan description materials provided to Members properly outline the internal appeal process and Employer's responsibility for level two internal appeals. d. In addition to the basic claim administrative duties described above, COLIC shall also perform the Plan-related administrative duties agreed upon by the Parties and specified in Exhibit B. Unless otherwise agreed to in writing by CHLIC,all services identified in this Agreement shall be provided by CHLIC to Members covered by this Agreement on an exclusive basis with respect to that portion of the Plan administered by CHLIC pursuant to this Agreement. e. As part of the Plan Benefits provided under this Agreement,CHLIC and Employer agree that CHLIC will provide the Pharmacy Benefit(as defined in Appendix A)services described in the Schedule of 08/04/2023 5 DocuSign Envelope ID 9FD1 FBA 1-AE68-46F6-88F9-E3IDF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Financial Charges and Appendix A as attached hereto,if any(the"Pharmacy Benefit Provisions"). In the event of any conflict between the terms set forth in the Pharmacy Benefit Provisions and any other terms set forth in this Agreement, including Exhibits hereto, the Pharmacy Benefit Provisions shall control solely with respect to the Pharmacy Benefit services. Section 3. Funding and Payment of Claims a. Employer shall establish a Bank Account,and maintain in the Bank Account an amount sufficient at all times to fund payments from it for the following(collectively "Bank Account Payments"): (i) Plan Benefits;(ii)those charges and fees identified in the applicable Schedule of Financial Charges as payable through the Bank Account and(iii)any sales tax,or similar benefit-or Plan-related charge, surcharge or assessment however denominated, which may be imposed by any governmental authority. Bank Account Payments may include without limitation:(a)fixed per person payments and pay-for-performance payments to Participating Providers;(b)amounts owed to CHLIC which are not billed to Employer in accordance with Section 4 of this Agreement;and(c)amounts paid to CHLIC's affiliates and/or subcontractors for, among other things, network access or in- and out-of-network health care services/products provided to Members. CHLIC may credit the Bank Account with payments due Employer under a stop loss policy issued by CHLIC or an affiliate. b. CHLIC,as agent for the Employer, shall make Bank Account Payments from the Bank Account, in the amount CHLIC reasonably determines to be proper under the Plan and/or under this Agreement. c. In the event that sufficient funds are not available in the Bank Account to pay all Bank Account Payments when due, CHLIC shall cease to process and issue payment for claims for Plan Benefits including Run-Out Claims and CHLIC may notify claimants and Members regarding such insufficient funding. d. CHLIC will promptly adjust any underpayment of Plan Benefits or pay-for-performance payments by drawing additional funds due the claimant from the Bank Account. In the event CHLIC determines that it has overpaid a claim for Plan Benefits or paid Plan Benefits to the wrong party,it shall take all reasonable steps consistent with the policies and procedures applicable to its own health care insurance business to recover the overpayments of Plan Benefits. CHLIC shall also take all reasonable steps consistent with the policies and procedures applicable to its own health care insurance business to collect pay-for-performance payments due to Employer or to recover pay-for- performance overpayments (collectively "Pay-for-Performance Recoveries"). CHLIC shall not be required to initiate court, mediation, arbitration or other administrative proceedings to recover any overpayment of Plan Benefits or to collect or recover Pay-for-Performance Recovery.However.when it elects to do so, CFILIC is expressly authorized by Employer to take all actions on behalf of the Employer and/or the Plan to pursue overpayment recovery of Plan Benefits or to collect or recover Pay-for-Performance Recovery including, but not limited to, retaining counsel, settling and compromising claims or Pay-for-Performance Recoveries,in which case CHLIC shall be responsible for the attorney fees,court costs or arbitration fees incurred by CHLIC in the specific overpayment recovery action of Plan Benefits (not applicable to subrogation or conditional claim payment recoveries) or to collect or recover Pay-for-Performance Recovery, but not any indirect, associated third party costs absent consent of CHLIC. CFILIC shall be responsible for reimbursing any unrecovered payments of Plan Benefits or Pay-for-Performance Recoveries resulting from CHILC's (I) failure to perform its duties under the Plan or this Agreement with the degree of skill and judgment possessed by other third party administrators experienced in furnishing claims administration services to plans of similar size and characteristics as the Plan and/or (2) gross negligence or intentional wrongdoing. 08/04/2023 6 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach e. Employer shall promptly reimburse CFILIC for any Bank Account Payments paid by CHLIC with its own funds on behalf of the Employer or the Plan and no such payment by CFILIC shall be construed as an assumption of any of Employer's liability for such Bank Account Payments. f. Following termination of this Agreement, Employer shall remain liable for payment of all Plan Benefits and other due Bank Account Payments and for all reimbursements due Members under the Plan. The obligations set forth in this Section 3 shall survive termination of this Agreement. Section 4.Charges a. charges.CHLIC shall provide to Employer a monthly statement of all charges Employer is obligated to pay, in full, under this Agreement that are not paid as Bank Account Payments. Payment of all billed charges shall be due on the first day of the month, as indicated on the monthly statement. Employer shall remit payment of charges billed by the sixtieth (601h) day of receipt of a proper invoice may be subject to late charges as provided for by Florida Statutes Section 218"FLORIDA PROMPT PAYMENT ACT." b. Changes - Additions and Terminations. If a Subscriber's effective date is on or before the fifteenth (I 5th)day of the month, full charges applicable to that Subscriber shall be due for that Subscriber for that month.If coverage does not start or ceases on or before the fifteenth(15th)day of the month for a Subscriber,no charges shall be due for that Subscriber for that month. c. Retroactive Changes and Terminations. Employer shall remain responsible for payment of all applicable charges and Bank Account Payments incurred or charged through the date CHLIC processed Employer's notice of a retroactive change or termination of a Member. However, if the change or termination would result in a reduction in charges, CFILIC shall credit to Employer the reduction in charges charged for the shorter of(a)the sixty(60)day period preceding the date CHLIC processes the notice,or(b)the period from the date of the change or termination to the date CHLIC processes the notice. The obligations set forth in this Section 4 shall survive termination of this Agreement. Section 5.Enrollment and Determination of Eligibility a. Eligibility Determinations and Information. Employer is responsible for administering Plan enrollment. In determining any person's right to benefits under the Plan, CHLIC shall rely upon enrollment and eligibility information provided by the Employer and CHLIC shall have no liability for administering the Plan in reliance upon enrollment and eligibility information provided by Employer. Such eligibility information shall identify the effective date of eligibility and the termination date of eligibility and shall be provided promptly to CHLIC on at least a monthly basis (unless otherwise agreed to in writing by CHLIC)using a method and with such other information as mutually agreed upon by Employer and reasonably may be required by CHLIC for the proper administration of the Plan. b. Release of Liability.Notwithstanding any inconsistent provision of this Agreement to the contrary,if Employer fails to provide CHLIC with accurate enrollment and eligibility information,benefit design requirements, or other agreed-upon information in a mutually agreed upon timeframe and format, CHLIC shall have no liability under this Agreement for any act or omission by CHLIC, or its employees,affiliates,subcontractors,agents or representatives,caused by such failure. 08/04/2023 7 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 Administrative Services Only Agreement for City of Miami Beach c. Reconciliation of Eligibility Information and Default Termination. CHLIC will periodically share potential discrepancies in eligibility information with Employer. Employer will review and reconcile any discrepancies within thirty (30) days of receipt and provide CHLIC corrected eligibility information. If Employer fails to timely do so.CI-ILIC may terminate coverage for any Member not listed as eligible in Employer's submitted eligibility information. Section 6.Audit Rights a. Employer may audit CHLIC's administration of Plan Benefits in accordance with the following requirements: i. Except for clinical audits, Employer shall provide to CHLIC a scope of audit letter and the fully executed Audit Agreement, a sample of which is attached hereto as Exhibit C,together with a forty-five(45)day advance written request for audit. For a clinical audit,Employer shall provide to CHLIC a ninety(90)day advance written request to audit,together with a scope of audit letter, which scope shall be mutually agreed upon between the parties. CHLIC will provide the Auditor and Employer, if Employer is participating in the audit, with a draft Clinical Audit Agreement,sample of which is attached hereto as Exhibit C I,within a week of receiving the request to audit and scope of audit letter. ii. Employer may designate with CHLIC's consent (which consent shall not to be unreasonably withheld)an independent,third-party auditor to conduct the audit(the"Auditor"). iii. Employer and CHLIC will agree upon the date for the audit during regular business hours in a virtual/remote audit environment or at CHLIC's office(s).as business needs require. iv. Except as otherwise agreed to by the parties in writing prior to the commencement of the audit, the audit shall be conducted in accordance with the terms of CHLIC's Audit Agreement attached hereto as Exhibit C and/or Exhibit Cl,as applicable,which would hereby be agreed to by Employer and which shall be signed by the Auditor prior to the start of the audit. v. If the audit identifies any errors requiring adjustments, such adjustments will be made in accordance with this Agreement and based upon the actual claims and fees reviewed and not upon statistical projections or extrapolations. vi. Employer shall be responsible for its Auditor's costs. vii. If Employer has five thousand(5,000)or more employees who are Members, Employer may conduct one such audit every Plan Year (but not within six (6) months of a prior audit); otherwise. Employer may conduct one such audit every two (2) Plan Years (but not within eighteen(18)months of a prior audit). viii. In no event shall any audit involve Plan benefit payments or administration prior to the most recent two (2) plan years, (unless otherwise noted) or involve Plan benefit payment or administration that has been previously audited. ix. New audits shall not be initiated until all parties have agreed that the prior audit is closed. 08/04/2023 8 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach In the event Employer requests to alter the scope of the audit, CHUG will endeavor to reasonably accommodate the Employer's request, which may be subject to additional charges to be mutually agreed upon by the Employer and CHLIC prior to the start of the audit. Employer may(as determined by CHLIC based upon the resources required by the audit requested) be responsible for CHLIC's reasonable costs with respect to the audit,except that while this Agreement is in effect there shall be no additional cost to Employer for an audit of the following: • Claims: Payment documents relating to a random,statistically valid sample of two-hundred twenty- five(225)claims paid. o Requests to review provider contracts will be subject to CHLIC's current criteria and contrary terms in Participating Provider Agreements. • Aoueals;, Documents, including payment documents as appropriate, relating to a random sample of up to thirty-five(35)appeals. • Customer Service: Documentation and review of call recordings relating to a random sample of up to thirty-five(35)Member calls. r CHLIC maintains call recordings for up to twelve(12)months,and any customer service audit is limited to the availability of the call recordings. • Accumulator/Combined Deductible: Audits are allowed based on mutually agreed-upon scope of up to thirty(30)cases. • Benefit Implementation: Audits are allowed based on mutually agreed-upon scope and timing. CHLIC will support the benefit implementation audits for review of benefit set up related to claim processing. • Clinical Cases/Calls: The standard annual allowable number of cases/calls for audit and standard number of days allowed to conduct the audit is as follows,based on number of Employer Subscribers during the time period covered by the audit: Number of Subscribers #Cases #Calls #Days* 5,000&under 10 3 1 >5,000&<25,000 15 4 >25,000&<75,000 20 5 1.5 >75,000 25 6 2 All cases and calls related to case selection will be prepared and presented in compliance with all Applicable Laws, Privacy Addendum in Exhibit D, including but not limited to the HIPAA Privacy and Security Rules and 42 C.F.R. Part 2. Cases selected will have been managed during the rolling twelve (12)month period prior to the date of the written request to conduct an audit and not previously audited for the current audit scope. • Medical Cost Containment Program Fees(MCCP): MCCP audits are limited to confirmation of fees paid by the Employer related to the programs in place. The audits will not include review of 08/04/2023 9 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach documentation that is not applicable to claim administration. In addition, Auditor agrees that it will not outreach to Participating Providers or Members for claim or medical record information. MCCP fee audits are based on the following criteria: i Random samples based on the following: • Twenty-five(25)claims in which fees were paid for the Non-Participating Provider Cost Containment Programs which include Network Savings Program; Supplemental Network and Medical Bill Review(Pre-payment Cost Containment for Non-contracted claims) • One-hundred (100) claims related to Other Cost Containment Programs which include Medical Bill Review(Bill Audit; DRG Validation Audits and Recovery; Medical Implant Device Audits);COB Vendor Recoveries;Secondary Vendor Recovery Program;Provider Credit Balance Program; High Cost Specialty Pharmaceutical Audits; Eligibility Overpayment Recovery Vendor Services; Class Action Recoveries and Subrogation/Conditional Claim Payment. b. Pharmacy Audits.The rights and obligations regarding pharmacy audits are set forth in Appendix A. Section 7.Plan Benefit Liability; Indemnification a. Employer Liability for Plan Benefits. Employer is responsible for all Plan Benefits including any Plan Benefits paid as a result of any legal action,CHLIC shall reasonably cooperate with Employer in its defense of any action or proceeding involving a claim for Plan Benefits. If Employer directs CHLIC.in writing to pay Extra-Contractual Benefits, Employer is responsible for funding the payment and such payments shall not be considered in determining reimbursements or payments under stop loss insurance provided by CFILIC or CHLIC affiliate or in determining any CHLIC or CHLIC affiliate risk-sharing or performance guarantee reimbursements. Employer shall reimburse CHLIC for any liability or expenses (including reasonable attorneys' fees) CHLIC may incur in defense of its making such payments. b. Employer Liability for Plan-Related Expenses. Unless Employer qualifies for a tax exemption, Employer shall reimburse CFILIC for any amounts CHLIC may be required to pay(i)for any sales tax or similar benefit-or Plan-related charge.surcharge or assessment,or(ii)under any unclaimed or abandoned property,or escheat law,with respect to Plan Benefits and any penalties and/or interest thereon. c. In performing its obligations under this Agreement, CHLIC shall use reasonable diligence and that degree of skill and judgment possessed by one experienced in furnishing claim administration services to plans of similar size and characteristics as the Plan.This includes making a good faith effort to correct any mistake or clerical error which may occur due to actions or inaction by CI-ILIC,undertaken in good faith once the error or mistake is discovered. d. CHLIC shall be liable to and indemnify the Employer for any loss, cost or expense (including court costs and reasonable attorney's fees)for which Employer may become liable in consequence of'(1) any acts or omissions of CFILIC or its employees,agents,or representatives,which constitute a failure,on the part of CHLIC,to perform its claim administration and other services in accordance with the standard set forth in section 7(c)above;(2)CFILIC's failure to perform the claim administration and other services pursuant to the Plan or this Agreement; or(3) fraud, embezzlement, willful misconduct or intentional disregard on the part of the provisions of the Plan or CHLIC or its employees,agents,or representatives. 08/04/2023 10 DocuSIgn Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach CHLIC shall not be liable to the Employer for actions taken in good faith and performed in accordance with the provisions of the Plan or this Agreement. The obligations set forth in this Section 7 shall survive termination of this Agreement. Section 8.Modification of Plan and Charges a. Except as may be otherwise provided in the Schedule of Financial Charges,and no earlier than sixty (60)months after the Effective Date, CHLIC shall have the right to revise the charges identified in this Agreement (i) by giving Employer at least sixty (60) days' prior written notice, (ii) upon any modification or amendment of the benefits under the Plan, (iii) upon any variation of ten percent (15%) or more in the number of Members used by CHLIC to calculate its charges under this Agreement, and/or (iv) upon any change in law or regulation that materially impacts C}ILIC's liabilities and/or responsibilities under this Agreement. b. Employer shall provide CHLIC written notice of any modification or amendment to the Plan sufficiently in advance of any such change as to allow CHLIC to implement the modification or amendment. Employer and CHLIC shall agree upon the manner and timing of the implementation of such modification or amendment subject to CI-ILIC's system and operational capabilities. c. Employer is solely responsible for communicating any Plan modification or amendment to Members or individuals considering enrolling in the Plan. Section 9.Modification of Agreement This Agreement constitutes the entire contract between the Parties regarding the subject matter herein. Except, as otherwise provided herein, the provisions of this Agreement shall control in the event of a conflict with the terms of any other agreements. No modification or amendment hereto shall be valid unless in writing and signed by an authorized person of each of the Parties,except that modification of charges pursuant to Section 8 above may be made by written notice to Employer by CHLIC. Section IP.Choice of Law a. This Agreement shall be interpreted and construed in accordance with the laws of the State of Florida. Any and all claims,controversies, and causes of action arising out of or relating to this Agreement, whether sounding in contract, tort, or statute,shall be governed by the laws of the State of Florida, including its statutes of limitations, without regard to any conflict-of-laws or other rule that would result in the application of the law of a different jurisdiction. Both CHLIC and Employer consent to Miami-Dade County, Florida, as the sole venue for resolving any state court, federal court, or arbitration proceedings arising from or relating to the performance or interpretation of this Agreement. b. The Parties shall perform their obligations under this Agreement in conformance with all Applicable Laws and regulatory requirements. Section 11.Information in CHLIC Processing Systems CHLIC may retain and use all Plan-related claim/payment information recorded/integrated into CHLIC's business records (including claim processing systems) in the ordinary course of business. Such information will be available to Employer pursuant to Section 21. CHLIC will retain such Plan-related claim/payment information in accordance with its record retention policy and Applicable Law. 08/04/2023 II DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of N1iami Beach Section 12.Resolution of Disputes It is understood and agreed that,prior to initiating any state court. federal court or arbitration proceeding in Miami-Dade County, Florida, the Parties shall first attempt to resolve any dispute arising from or relating to the performance or interpretation of this Agreement using the following dispute resolution procedures: a. Any Controversy shall first be referred to an executive level employee of each Party who shall meet and confer with his/her counterpart to attempt to resolve the dispute ("Executive Review") as follows: The disputing Party shall initiate Executive Review by giving the other Party written notice of the Controversy and shall specifically request Executive Review of said Controversy in such notice. Within twenty (20) calendar days of any Party's written request for Executive Review, the receiving Party shall submit a written response. Both the notice and response shall include a statement of each Party's position and a summary of the evidence and arguments supporting its position. Within thirty(30)calendar days of any Party's request for Executive Review,an executive level employee of each Party shall be designated by the Party to meet and confer with his/her counterpart to attempt to resolve the dispute. Each representative shall have full authority to resolve the dispute. b. In the event that a Controversy has not been resolved within thirty-five (35) calendar days of the request for Executive Review under Section 12.a, above, either Party may initiate mediation by providing written notice to the other Party, which shall be conducted in Miami-Dade County, in accordance with the American Arbitration Association commercial mediation rules ("Mediation"), and using American Arbitration Association mediators. Each Party shall assume its own costs and attorneys' fees, and the compensation and expenses of the mediator and any administrative fees or costs associated with the mediation proceeding shall be borne equally by the Parties. The Parties shall not,however,be required to mediate the Controversy. The obligations set forth in this Section 12 shall survive termination of this Agreement. Section 13.Third Party Beneficiaries This Agreement is for the exclusive benefit of Employer and CHLIC. It shall not be construed to create any legal relationship between CHLIC and any other party. Section 14. No Waivers No waiver by any party of a breach or default of any provision of this Agreement,failure by any party,on one or more occasions, to enforce any of the provisions of this Agreement, or failure by any party to exercise any right or privilege hereunder shall be construed as a waiver of any subsequent breach or default of a similar nature,or as a waiver of such rights or privileges hereunder, unless and solely to the extent waived by the party against whom the waiver is sought in writing and signed. Section 15.Headings Article,section, or paragraph headings contained in this Agreement are for reference purposes only and shall not affect the meaning or interpretation of this Agreement. 08/04/2023 12 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Section 16.Severability If any provision or any part of a provision of this Agreement is held invalid or unenforceable by a court of competent jurisdiction, such invalidity or unenforceability shall not invalidate or render unenforceable any other portion of this Agreement. Section 17. Force Maicure CHLIC shall not be liable for any failure to meet any of its obligations under this Agreement where such failure to perform is due to any contingency beyond the reasonable control of CHLIC or its affiliates or subcontractors, its employees, officers,or directors. Such contingencies include, but are not limited to, acts of God, fires, wars, accidents, labor disputes or shortages, and governmental actions, laws, ordinances,rules or regulations. Section 18.Assignment and Subcontracting No Party may assign any right,interest,or obligation hereunder without the express written consent of the other Party; provided, however that CHLIC may assign any right, interest, or responsibility under this Agreement to their affiliates and/or subcontract specific obligations under this Agreement provided that CHLIC shall not be relieved of its obligations under this Agreement when doing so. Section 19.Notices Except as otherwise provided,all notices or other communications hereunder shall be in writing and shall be deemed to have been duly made when(a)delivered in person,(b)delivered to an agent, such as an overnight or similar delivery service, (c)delivered electronically, or(d) deposited in the United States mail,postage prepaid,and addressed as follows: To CHLIC: Cigna Health and Life Insurance Company 900 Cottage Grove Road Bloomfield,CT 06152 Attention:Jeremy Rainha,Risk&Underwriting Senior Director To Employer: City of Miami Beach 1700 Convention Center Dr.,Fourth.Floor Miami Beach,FL 33139 Attention:Sonia Walthour Risk Management/Benefits Division Director The address to which notices or communications may be given by any Party may be changed by written notice given by one Party to the other pursuant to this Section. Section 20. Identifying Information,Internet Usage and Trademark Each Party reserves all right, title, and interest in and to its respective trademarks, service marks, trade names,trade dress, logos,and other proprietary trade designations.whether presently existing or hereafter authored, developed, established, or acquired (collectively, "Marks"). Except as necessary in the performance of their duties under this Agreement or as separately agreed to in writing,no Party shall use 08/04/2023 13 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach the other Party's Marks in advertising or promotional materials or otherwise. All use of a Party's Marks shall remain subject to such Party's reasonable quality control and brand usage guidelines. Additionally, no Party shall establish a link to the other's World Wide Web site, without the owner's prior written consent. All goodwill arising from use of a Party's Marks shall inure exclusively to such Party's benefit. The obligations set forth in this Section 20 shall survive termination of this Agreement. Section 21. Confidentiality a. Subject to the requirements of Applicable Law, the terms of this Agreement and the Privacy Addendum in Exhibit D, a signed Business Associate Agreement between Employer and its designec(s), and a signed Confidentiality Agreement between CHLIC and applicable designee(s), CHLIC shall release copies of confidential claims and Plan Benefit payment information in CHLIC's claims system ("Confidential Information") and may release copies of proprietary information relating to the Plan in CHLIC's claims system("Proprietary Information")to the Employer and/or its designee(s).Employer will keep Confidential Information and Proprietary Information confidential and will use Confidential Information and Proprietary Information solely for the purpose of administering the Plan or as otherwise required by law. Employer is solely responsible for any unauthorized use or disclosure of Confidential Information and/or Proprietary Information provided by CHLIC pursuant to this Section 21 whether by Employer or its designee and the consequences thereof. b. CI ILIC and any of its affiliates or subsidiaries which have any Protected Health Information in their possession will maintain the confidentiality of such Protected Health Information in accordance with the Privacy Addendum in Exhibit D and any applicable state privacy laws, including, without limitation, 201 CMR 17.00: Massachusetts Standards for the Protection of Personal Information of Residents of the Commonwealth. c. Upon termination of this Agreement and subject to the provisions of Section 21.a above,CHLIC shall make information available to a third party such as a "successor administrator" as requested by Employer, to the extent administratively feasible, if the Parties agree upon the charge to be paid by Employer. The obligations set forth in this Section 21,shall survive termination of this Agreement. Section 22.Independent Contractors The Parties' relationship with respect to each other is that of independent contractors and nothing in this Agreement is intended, and nothing shall be construed to, create an employer/employee, partnership, principal-agent, or joint venture relationship, or to exercise control or direction over the manner or method by which CHLIC performs services hereunder. No Party shall make any statement or take any action that might cause a third party to believe such Party has the authority to transact any business,enter into any agreement.or in any way bind or make any commitment on behalf of the other Party, unless set forth in this Agreement or expressly authorized in writing by a duly authorized officer of the other Party. For the avoidance of doubt,CHLIC is authorized to perform certain services on behalf of Employer under this Agreement and this provision is not intended to in any way diminish that authorization. Section 23. Reservation of intellectual Property Rights Each Party reserves all right, title, and interest in and to its respective copyrights, patents. trade secrets, trademarks, and other intellectual property, whether presently existing or hereafter authored, invented. 08/04/2023 14 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach developed,or acquired. Without limiting the foregoing, as between the Parties,CHLIC shall solely and exclusively own the systems, methodologies, and technology used to provide the services, all modifications, enhancements, and improvements thereto, and all associated intellectual property rights. No rights or licenses are granted to Employer other than the limited right to receive and use the services under and in accordance with this Agreement. CHLIC shall own and be free to use and incorporate without payment or other consideration to Employer any ideas, suggestions, recommendations, or other feedback provided to CHLIC in connection with its provision of the services. Nothing in this Agreement is intended or shall be construed to create any joint authorship,joint inventorship,or similar relationship or endeavor between the Parties. The obligations set forth in this Section 23 shall survive termination of this Agreement. Section 24.CHLIC'S Compliance with Florida Public Records Law a. CHLIC shall comply with Florida Public Records law under Chapter 119, Florida Statutes, as may be amended from time to time. b, The term"public records"shall have the meaning set forth in Section 119.011(12),which means all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material,regardless of the physical form,characteristics,or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of Employer. c. Pursuant to Section 119.0701 of the Florida Statutes, if CHLIC meets the definition of "Contractor"as defined in Section 119.0701(I)(a),CHLIC shall: i, Keep and maintain public records required by Employer to perform the service; ii. Upon request from Employer's custodian of public records, provide Employer with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes or as otherwise provided by law; iii. 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 Agreement if CHLIC does not transfer the records to Employer; iv, Upon completion of the Agreement,transfer,at no cost to Employer,all public records in possession of CHLIC or keep and maintain public records required by Employer to perform the service. If CHLIC transfers all public records to Employer upon completion of the Agreement,CHLIC shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If CHLIC keeps and maintains public records upon completion of the Agreement, CHLIC shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to Employer, upon request from Employer's custodian of public records, in a format that is compatible with the information technology systems of Employer. (0) REQUEST FOR RECORDS;NONCOMPLIANCE. i. A request to inspect or copy public records relating to Employer's contract for services must be made directly to Employer. If Employer does not possess the requested records, Employer shall immediately notify CHLIC of the request,and CHLIC must provide the records to Employer or allow the records to be inspected or copied within a reasonable 08/04/2023 IS DocuSign Envelope ID:9FD1 FBAI-AE68-46F6-88F9-E3 I DF I C5DA72 Administrative Services Only Agreement for City of Miami Beach time. ii. CHLIC's failure to comply with Employer's request for records shall constitute a breach of this Agreement, and Employer, at its sole discretion, may: (I) unilaterally terminate the Agreement;(2)avail itself of the remedies set forth under the Agreement; and/or(3) avail itself of any available remedies at law or in equity. iii. If CHLIC fails to provide the public records to Employer within a reasonable time may be subject to penalties under s. 119.10. (E) CIVIL ACTION. i. If a civil action is filed against CHLIC to compel production of public records relating to Employer's contract for services, the court shall assess and award against CHLIC the reasonable costs of enforcement,including reasonable attorneys' fees,it`. a. The court determines that CHLIC unlawfully refused to comply with the public records request within a reasonable time;and b. At least 8 business days before filing the action,the plaintiff provided written notice of the public records request, including a statement that CHLIC has not complied with the request,to Employer and to CHLIC. ii. A notice complies with subparagraph(t)(b)if it is sent to Employer's custodian of public records and to CHLIC at CHLIC's address listed on its contract with Employer or to CHLIC's registered agent.Such notices must be sent by common carrier delivery service or by registered, Global Express Guaranteed,or certified mail, with postage or shipping paid by the sender and with evidence of delivery.which may be in an electronic format. iii. If CHLIC complies with a public records request within 8 business days after the notice is sent is not liable for the reasonable costs of enforcement. (F) IF CHLIC HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CHLIC'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: CITY OF MIAMI BEACH ATTENTION:RAFAEL E.GRANADO,CITY CLERK 1700 CONVENTION CENTER DRIVE MIAMI BEACH,FLORIDA 33139 E-MAIL: RA FA E LG RANADOQMIAMI BEACHFL.GOV PHONE: 305-673-7411 Section 25.Insnector General Audit Rights a. Pursuant to Section 2-256 of the Code of Employer of Miami Beach, Employer has established the Office of the Inspector General which may, on a random basis, perform reviews, audits, inspections and investigations on all Employer contracts, throughout the duration of said contracts. This random audit is separate and distinct from any other audit performed by or on behalf of Employer. 08/04/2023 16 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach b. The Office of the Inspector General is authorized to investigate Employer affairs and empowered to review past, present and proposed Employer programs, accounts, records, contracts and transactions. In addition,the Inspector General has the power to subpoena witnesses,administer oaths, require the production of witnesses and monitor Employer projects and programs. Monitoring of an existing Employer project or program may include a report concerning whether the project is on time, within budget and in conformance with the contract documents and applicable law. The Inspector General shall have the power to audit, investigate, monitor, oversee, inspect and review operations, activities, performance and procurement process including but not limited to project design.bid specifications,(bid/proposal)submittals,activities of CHLIC, its officers, agents and employees, lobbyists, Employer staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. Pursuant to Section 2-378 of the City Code,Employer is allocating a percentage of its overall annual contract expenditures to fund the activities and operations of the Office of Inspector General. c. Upon ten (10) days written notice to CHLIC, CHLIC shall make all requested records and documents available to the Inspector General for inspection and copying.The Inspector General is empowered to retain the services of independent private sector auditors to audit, investigate, monitor,oversee, inspect and review operations activities,performance and procurement process including but not limited to project design,bid specifications,(bid/proposal)submittals,activities of CHLIC its officers, agents and employees, lobbyists, Employer staff and elected officials to ensure compliance with the contract documents and to detect fraud and corruption. d. The Inspector General shall have the right to inspect and copy all documents and records in CHLIC's possession,custody or control which in the Inspector General's sole judgment, pertain to performance of the contract, including, but not limited to original estimate files,change order estimate files,worksheets,proposals and agreements from and with successful subcontractors and suppliers, all project-related correspondence, memoranda, instructions, financial documents, construction documents, (bid/proposal) and contract documents, back-change documents, all documents and records which involve cash, trade or volume discounts, insurance proceeds, rebates, or dividends received, payroll and personnel records and supporting documentation for the aforesaid documents and records. e. CHLIC shall make available at its office at all reasonable times the records, materials,and other evidence regarding the acquisition (bid preparation) and performance of this Agreement, for examination,audit,or reproduction,until three(3)years after final payment under this Agreement or for any longer period required by statute or by other clauses of this Agreement.In addition: (1) If this Agreement is completely or partially terminated, CHLIC shall make available records relating to the work terminated until three (3) years after any resulting final termination settlement;and 08/04/2023 17 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative set vices Unh Agreement for City of Miami Beach (2) CHLIC shall make available records relating to appeals or to litigation or the settlement of claims arising under or relating to this Agreement until such appeals. litigation, or claims are finally resolved. f. The provisions in this section shall apply to CHLIC, its officers, agents, employees, subcontractors and suppliers. CHLIC shall incorporate the provisions in this section in all subcontracts and all other agreements executed by CHLIC in connection with the performance of this Agreement. g. Nothing in this section shall impair any independent right of Employer to conduct audits or investigative activities. The provisions of this section are neither intended nor shall they be construed to impose any liability on Employer by CHLIC or third parties. Section 26,E-verify a. To the extent applicable to the services offered herein, CHLIC shall comply with Section 448.095, Florida Statutes, "Employment Eligibility" ("E-Verif), Statute"), as may be amended from time to time. Pursuant to the E-Verify Statute, commencing on January I, 2021, CHLIC shall register with and use the E-Verify system to verify the work authorization status of all newly hired employees during the Term of the Agreement. Additionally,CHLIC shall expressly require any subconsultant performing work or providing services pursuant to the Agreement to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subconsultant during the contract Term. If CHLIC enters into a contract with an approved subconsultant, the subconsultant must provide CHLIC with an affidavit stating that the subconsultant does not employ, contract with, or subcontract with an unauthorized alien. CHLIC shall maintain a copy of such affidavit for the duration of the Agreement or such other extended period as may be required under this Agreement. b. TERMINATION RIGHTS. i. If Employer has a good faith belief that CHLIC has knowingly violated Section 448.09(1), Florida Statutes, Employer shall terminate this Agreement with CHLIC for cause, and Employer shall thereafter have or owe no further obligation or liability to CHLIC. ii. If Employer has a good faith belief that a subconsultant has knowingly violated the foregoing Subsection 10.9(A), but CHLIC otherwise complied with such subsection. Employer will promptly notify CHLIC and order CHLIC to immediately terminate the Agreement with the subconsultant. CHLIC's failure to terminate a subconsultant shall be an event of default under this Agreement, entitling Employer to terminate CFILIC's contract for cause. iii. A contract terminated under the foregoing Subsection(BX1)or(BX2)is not in breach of contract and may not be considered as such. iv. Employer or CHLIC or a subconsultant may tile an action with the Circuit or County Court to challenge a termination under the foregoing Subsection(Bxl)or(B)(2)no later than 20 calendar days after the date on which the contract was terminated. v. If Employer terminates the Agreement with CHLIC under the foregoing Subsection (B)(I),CHLIC may not be awarded a public contract for at least I year after the date of termination of this Agreement. vi. CHLIC is liable for any additional costs incurred by Employer as a result of the 08/04/2023 18 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach termination of this Agreement under this Section 26. Section 27.Insurance Requirements CI-ILIC shall maintain the below required insurance in effect prior to awarding the contract and for the duration of the contract. The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage may be treated as a material breach of the contract, which could result in withholding of payments or termination of the contract. a. Worker's Compensation Insurance for all employees of the CHLIC as required by Florida Statute 440, and Employer Liability Insurance for bodily injury or disease. Should CHLIC be exempt from this Statute,CHLIC and each employee shall hold the City harmless from any injury incurred during performance of the Contract. If exempt, CFILIC shall also submit (i) a written statement detailing the number of employees and that they arc not required to carry Workers' Compensation insurance and do not anticipate hiring any additional employees during the term of this contract or(ii)a copy of a Certificate of Exemption. b. Commercial General Liability Insurance on an occurrence basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than S 1,000,000 per occurrence,and$2,000,000 general aggregate. c.Automobile Liability Insurance covering any automobile,if CHLIC has no owned automobiles, then coverage for hired and non-owned automobiles,with Limit no less than S 1,000,000 combined Der accident for bodily injury and property damage. d. Professional Liability(Errors&Omissions)Insurance appropriate to CHLIC,with limit no less than S1,000,000. Additional Insured-Employer must be included by endorsement as an additional insured with respect to all liability policies (except Professional Liability and Workers' Compensation) arising out of work or operations performed on behalf of the CHLIC including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned,leased,hired or borrowed in the form of an endorsement to the CHLIC's insurance. Notice of Cancellation - Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach do EXIGIS Insurance Compliance Services. Waiver of Subrogation -CHLIC agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. Flowever, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. Acceptability of Insurers — Insurance must be placed with insurers with a current A.M. Best rating of A:VII or higher. If not rated, exceptions may be made for members of the Florida Insurance Funds(i.e. FWCICA, FAJUA). Carriers may also be considered it'they are licensed and authorized to do insurance business in the State of Florida. Verification of Coverage —CHLIC shall furnish the Employer with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the Employer before work 08/04/2023 19 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for(fit of Miami Beach commences. However, failure to obtain the required documents prior to the work beginning shall not waive the CHLIC's obligation to provide them. Employer reserves the right to require complete,certified copies of all required insurance policies, including endorsements,required by these specifications,at any time. CERTIFICATE HOLDER MUST READ: City of Miami Beach c/o Exigis Insurance Compliant Services P.O.Box 947 Murrieta,CA 92564 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent. EXIGIS,at: Certificates-m iamibeach@riskworks.com Special Risks or Circumstances - Employer reserves the right to modify these requirements, including limits,based on the nature of the risk,prior experience, insurer,coverage,or other special circumstances. Compliance with the foregoing requirements shall not relieve CHLIC of his liability and obligation under this section or under any other section of this agreement. Section 28.Entire Agreement As of the Effective Date,this Agreement constitutes the entire agreement between the Parties regarding the subject matter herein and supersedes all previous and contemporaneous agreements, understandings, inducements or conditions expressed or implied, oral or written, between the Parties, except as herein contained. Further,this Agreement shall not be modified by any shrink-wrap,click-wrap, browse-wrap, click-through, web-site based, online or use agreements ("Click-Wrap") that purport to be accepted or deemed accepted by download or online acknowledgment and to the extent of any conflict between this Agreement and the Click-Wrap, this Agreement shall control. Each Party acknowledges that in entering into this Agreement, it is not relying on any statement, representation, or warranty, other than those expressly set forth herein. Except as otherwise provided herein the provisions of this Agreement shall control in the event of a conflict with the terms of any other agreement regarding the subject matter herein. Section 29.Request for Proposal The Provisions of REP 2023-259-WG Health, Pharmacy (Rx), and Medicare Advantage Plans and all attachments,amendments,and addendums thereto,attached as Exhibit _,are hereby incorporated into this Agreement. To the extent the provisions of the REP and all Amendments thereto conflict with any other terms of the Agreement, Schedules, Exhibits, Addendums. Amendments or like documents, the terms of the Agreement, Schedules, Exhibits, Addendums, Amendments, or the like documents,control. For the avoidance of doubt, the following order of precedent shall prevail: this Agreement(including its Schedules, Exhibits, Addendums, Amendments, or the like documents); the REP; and the CHLIC proposal. 08/04/2023 20 DocuSipn Envelope ID 9FDIFEIA1•AE88-48F8-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach SIGNATURES IN WITNESS WHEREOF, the Parties have caused this Agreement, to be executed in duplicate and signed by their respective officers duly authorized to do so as of the dates given below. Employer executes as the authorized representative of the Plan with respect to the Privacy Addendum to this City of Miami Beach Dated at City of Miami Beath 12-4-2023 _ By: _ J 4+444 Dated: Na .Aline T.Iludak It ity Manager Duly Authorized Dated at Hartford,Connecticut CIGNA HEALTH AND LIFE INSURANCE COMPANY Dated:August 4,2023 By: Name:Aimee E.Burnham Attest Its Contractual Agreement Unit Manager Duly Authorized City of Miami Beach By: Name:Rafael E.Granado,City Clerk Date: DEC 1 9 2023 APPROVED AS TO FORM&LANGUAGE &FOR EXECUTION 0(3 1z3 ,City Attomeyj4 Date 08/04/2023 21 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DFIC5DA72 Administrative Services Only Agreement for City of Miami Beach Schedule of Financial Charges Certain fees and charges identified in this Schedule of Financial Charges will be billed to Employer monthly in accordance with CHLIC's then standard billing practices. However,CHLIC is authorized to pay all fees and charges from the Bank Account unless otherwise specified in this Agreement. MEDICAL ADMINISTRATION CHARGES (Including Benefit Advisor Fees payments agreed to by Employer) Product Description Charge Medical Open Access Plus In-Network(OAPIN) S26.50/employee/month with Care Management Preferred Medical Open Access Plus(OAP) S26.50/employee/month with Care Management Preferred(All Plans) Medical Benefit Advisor Fees For OAPIN and OAP Products: S9.36/employee/month MEDICAL NETWORK ACCESS FEE,UTILIZATION MANAGEMENT FEE AND OPTIONAL PROGRAM FEE Product Description Charge Medical OAPIN S17.25/employee/month Access Fee Included in Medical Administration Charge Medical OAP S17.25/employee/month Access Fee(All Plans) Included in Medical Administration Charge • MULTI-YEAR CHARGE/FEE GUARANTEES The maximum increase for the Medical Administration Charge(s)and Network Access Fee(s)for the 2024 Plan Year will be 0.0%over the 2023 Plan Year charges/fees. The maximum increase for the Medical Administration Charge(s)and Network Access Fee(s)for the 2025 Plan Year will be 0.0%over the 2024 Plan Year charges/fees. 08/04/2023 72 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DFIC5DA72 Administrative Services Only Agreement for City of Miami Beach The maximum increase for the Medical Administration Charge(s)and Network Access Fee(s)for the 2026 Plan Year will be 0.0%over the 2025 Plan Year charges/fees. The maximum increase for the Medical Administration Charge(s)and Network Access Fee(s)for the 2027 Plan Year will be 0.0%over the 2026 Plan Year charges/fees. The maximum increase for the Medical Administration Charges(s)and Network Access Fee(s)for the 2028 Plan Year will be 0.0%over the 2027 Plan Year charges/fees. The above fee guarantees are not applicable to Pharmacy Administration Fee. The above charges/fees are guaranteed for the time periods identified above,provided, however,that CHLIC may revise the above charges/fees pursuant to Section 8.a.ii.8.a.iii and!or 8.a.iv of this Agreement- AMOUNTS OWED TO CHLIC CI-11.1C may pay amounts with its own funds on behalf of Employer or the Plan for charges which Employer or the Plan is obligated to pay under the Agreement including Plan Benefits. Bank Account Payments (including fixed per person payments and pay-for-performance payments to Participating Providers), governmental taxes or assessments and those amounts paid by CHLIC shall be the Employer's financial responsibility. CHLIC is authorized to recover all such amounts from the Rank Account. CIGNA PHARMACY BENEFIT MANAGEMENT SERVICES CHARGES AND RELATED PROVISIONS PHARMACY ADMINISTRATION FEE Cigna Pharmacy Product Administration Fee:$5.53 per script. FINANCIAL GUARANTEES FOR DRUGS COVERED UNDER THE PLAN'S PHARMACY BENEFIT Covered Drugs Dispensed by Cigna Home Delivery Pharmacy: CHLIC will guarantee the following charges for Covered Drugs dispensed by Cigna Home Delivery Pharmacy,subject to the provisions in the section titled"PBM Pricing—Additional Provisions": Brand Drug Claims: For all Cigna Home Delivery Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 25.50%. Generic Drug Claims: For all Cigna Home Delivery Pharmacy Generic Drug Claims,the Employer's guaranteed annual average discount will be.: AWP minus 87.25% for Plan Year 2023, AWP minus 87.50% for plan year 2024; AWP minus 87.75% for plan year 2025; AWP minus 88.00% for plan year 2026 and AWP minus 88.25%for plan year 2027. 08 04/'2023 23 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Dispensing Fees for Drug Claims: For all Cigna Home Delivery Pharmacy Brand Drug Claims and Generic Drug Claims the Employer's guaranteed annual average Dispensing Fee will be S0.00. Covered Drugs Dispensed by Retail Pharmacies in 30-day* supplies: CHLIC will guarantee the following charges for Covered Drugs dispensed by Retail Pharmacies in 30-day supplies.subject to the provisions in the section titled"PBM Pricing—Additional Provisions": *A 30-day supply means any Covered Drug dispensed by a Retail Pharmacy in an amount less than an 83-day supply. Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 20.00%. Generic Drug Claims: For all Retail Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be: AWP minus 83.50%for Plan Year 2023;AWP minus 83.75%for Plan Year 2024;AWP minus 84.00%for Plan Year 2025 ;AWP minus 84.25%for Plan Year 2026 and AWP minus 84.50%for Plan Year 2027. Dispensing Fees for Both Brand Drug Claims and Generic Drug Claims: For all Retail Pharmacy Brand Drug Claims and Generic Drug Claims,the Employer's guaranteed annual average Dispensing Fee will be$0.50. Covered Drugs Dispensed by Retail Pharmacies in 90-day** supplies: CHLIC will guarantee the following charges for Covered Drugs dispensed by Retail Pharmacies in 90-day supplies,subject to the provisions in the section titled"PBM Pricing-Additional Provisions": **A 90-day supply means any Covered Drug dispensed by a Retail Pharmacy in an amount equal to or greater than an 83-day supply. Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 25.25%. Generic Drug Claims: For all Retail Pharmacy Generic Drug Claims,the Employer's guaranteed annual average discount will be: AWP minus 85.25% for Plan Year 2023;AWP minus 85.50% for Plan Year 2024; AWP minus 85.75% for Plan Year 2025 ; AWP minus 86.00%for Plan Year 2026 and AWP minus 86.25%for Plan Year 2027. Dispensing Fees for Both Brand Drug Claims and Generic Drug Claims: For all Retail Pharmacy Brand Drug Claims and Generic Drug Claims,the Employer's guaranteed annual average Dispensing Fee will be S0.00. 08/04/2023 24 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach AGGREGATE SPECIALTY DRUG DISCOUNT GUARANTEE CIILIC shall guarantee an aggregate annual average discount of AWP minus 21.00%for covered Specialty Drug prescriptions dispensed by Retail Pharmacies and Cigna Home Delivery Pharmacy. CHLIC's performance will be measured based on analysis of Plan-specific utilization for the contract year. AGGREGATE LIMITED DISTRIBUTION DRUG AND EXCLUSIVE DISTRIBUTION DRUG DISCOUNT GUARANTEE Limited Distribution Drug and Exclusive Distribution Drug Claims: For all covered Limited Distribution Drugs and Exclusive Distribution Drugs that are dispensed to Members by a Cigna Specialty Drug Pharmacy,the Employer's guaranteed annual average aggregate discount will be AWP minus 17.00%. RECONCILIATION OF PHARMACY BENEFIT MANAGEMENT FINANCIAL GUARANTEES Pricing Guarantee Calculation. The following calculation will be performed on an aggregated basis for all paid Claims for Covered Drugs processed during the applicable contract year in order to reconcile against the average annual ingredient cost discount guarantees set forth above: 1 —[(the total ingredient cost charged to the Employer prior to application of the?Ian's Member cost-share requirements)' (the total AWP)for all Covered Drugs] For the purposes of the pricing guarantee calculation, and notwithstanding anything herein to the contrary, the total ingredient cost shall also include the ingredient cost for a Covered Drug for which a Member pays 100% in the form of cost-share. The application of brand and generic pricing may be subject to certain "dispensed as written" ("DAW") protocols and Employer defined plan design and coverage policies for adjudication and Member Copayment purposes. For example. DAW 5 (House Generic) claims will be considered a Generic Drug claim for pricing purposes. Pricing Guarantee Exclusions. The following Claims or products shall be excluded from the calculation of any pricing guarantee set forth in this Agreement: -Specialty Drugs,unless otherwise noted in this Schedule of Financial Charges. -Workers'Compensation Claims. -Claims for Supplies. -Non-standard facility Claims(Indian Tribal,Veterans Administration,or Dep.of Defense facilities). - Limited Distribution Drugs and Exclusive Distribution Drugs except with respect to the Aggregate Limited Distribution Drug and Exclusive Distribution Drug Guarantee above) -Subrogation Claims. -Repackaged products. - Products tilled through Pharmacies not participating in the network accessed by Employer under this Agreement (including a contracted 08/04/2023 '_5 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach pharmacy that does not participate in a sub-network or preferred network tier). -Over-the-counter(OTC)products,with the exception of diabetic supplies and insulin. -Secondary Payer Claims. -Direct Member Reimbursement Claims. -Compound Drugs. -Claim reversals. -Outlier Claims. -Products identified as prescriptions covered under the federal 340B drug pricing program. -Claims paid at the Retail Pharmacy's U&C Charge. -Claims where pharmacy reimbursement is determined or mandated by Applicable Law,not based on CHLIC's contracted rates with the Retail Pharmacy(applicable to Retail dispensing fee guarantees only). For the avoidance of doubt and clarity,any type of Paid Claim not excluded in this Agreement shall be considered included in the Financial Guarantees stated above RECONCILIATION AND OFFSETS REGARDING FINANCIAL GUARANTEES CHLIC will report on the guaranteed amounts within one-hundred eighty(180)days following the end of each contract year. Upon reconciliation, CHLICs performance with respect to each ingredient cost discount or Dispensing Fee offered under this Agreement will be individually measured and reconciled.CHLIC's performance with respect to ingredient cost discount or Dis.ensin• Fee shall not be reconciled in the aggregate_ PBM PRICING -ADDITIONAL PROVISIONS • For a specific Claim for a Covered Drug dispensed by a Retail Pharmacy or Cigna Home Delivery Pharmacy, and after application of any Plan cost-share requirements,CHLIC shall charge the Employer the lowest of the following amounts: (I) The Prescription Drug Charge;or (2) The pharmacy's submitted U&C Charge, if any. • For a specific Claim for a Covered Drug dispensed by a Retail Pharmacy or Cigna Home Delivery Pharmacy, CHLIC shall charge the Member in accordance with the terms of the Pharmacy Benefit. For example, for a Covered Drug subject to a fixed dollar copayment requirement,CHLIC shall charge the Member the lowest of the following amounts: (1) The fixed dollar copayment for the Covered Drug_ if any; (2) The Prescription Drug Charge;and 08/04/2023 26 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach (3) The pharmacy's submitted U&C Charge,if any. • CHLIC may apply,if available and based on price favorability to the Member,a discount card market price for certain non-specialty drug generic products(unless Employer opts out of program enrollment). • Unless specifically noted herein,the discounts to Employer for Covered Drugs set forth in this Agreement are not guaranteed to result in an average aggregate discount oft'the aggregate AWP of all such Covered Drugs. • Home Delivery Pharmacy Dispensing Fees and Dispensing Fee Guarantees are inclusive of shipping and handling. If carrier rates(i.e., U.S. mail and/or applicable commercial courier services) increase during the term of this Agreement. the Home Delivery Pharmacy Dispensing Fee and Home Delivery Pharmacy Dispensing Fee Guarantee will be increased to reflect such increase(s). • Any pricing guarantees. including any ingredient cost discount or Dispensing Fee guarantee,set forth in this Agreement shall be rendered null and void in the event Employer terminates CHL1C's administration of the Pharmacy Benefit prior to completion of the then-current Plan Year.CHLIC's fees, Rebates(if any),discounts or guarantees(if any)are,among other conditions communicated in this Agreement or otherwise in writing to Employer,contingent on,and assume,adoption by Employer of a specific Formulary,Retail Pharmacy network, and Plan design features(e.g.cost-share structure,utilization/cost management programs). • HIV/transplant medications that appear on the Specialty Drug List are included in the specialty drug pricing and specialty drug Rebates based on the dispensing channel.as applicable. • DAW penalties and/or mandatory generic penalty amounts will not be included in the discount guarantee calculations or reconciliations; however, such Claims will be included in the discount guarantee calculations and reconciliations and valued at the Total Ingredient Cost. • The MAC list used for Home Delivery Pharmacies will include at least the same identical drugs on the MAC list used for Retail Pharmacies or more. • There is no minimum,charge to either a Member or Employer for any claims dispensed by a Home Delivery Pharmacy. • Notwithstanding anything to the contrary,CHLIC will charge Employer for retail pharmacy claims on a Pass-Through Pricing basis. For purposes of this Agreement,the term"Pass-Through Pricing"means the actual ingredient cost and dispensing fee amount paid by CHLIC for the prescription drug claim when the claim is adjudicated by a Participating Pharmacy, as set forth in the specific Participating Pharmacy remittances related to Employer's claims. 08/04/2023 '-7 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach • Notwithstanding any other provision of this Agreement. CHLIC may_ effective upon written notice to Employer. adjust any or all of the fees, Rebates(if any),discounts or guarantees(if any)in this Agreement to the extent reasonably necessary to preserve the economic value of this Agreement to CHLIC as it existed immediately prior to any of the following events or changes:(a)there are any significant changes in the composition of the CHLIC pharmacy network utilized by Employer hereunder or in such pharmacy network's contract compensation rates,or the structure of the pharmacy stores/chains/vendors that are contracted with CHLIC, including but not limited to disruption in the retail pharmacy delivery model, or bankruptcy of a chain pharmacy; or there is a change in or to the pharmacy network reflected in the pharmacy pricing summary; or(b)there is a change in government laws or regulations which has a significant impact on pharmacy claim costs; or(c)any material manufacturer-rebate contracts with, or for the benefit of,CHLIC are terminated or modified in whole or in part; or (d) there is any legal action or law that materially affects, or could materially affect the manner in which CHLIC's rebate program is administered or an existing law is interpreted so as to materially affect or potentially have a material effect, on CHLIC's administration of the Plan:(e)a major change in market conditions affecting the pharmaceu-ical or pharmacy benefit management market,a drug shortage in the market,an issue involving the safety of the drug supply.an unexpected introduction of a new drug(e.g.authorized generic),or similar market event occurs; (f)the Pharmacy Benefit enrollment decreases by equal to or greater than ten(10)% from the enrollment on which Cl-ILIC's financial offer is based; or(g) Employer fails to disclose a material feature of the Plan or the Plan's Pharmacy Benefit or there is a change to the Plan's Pharmacy Benefit including but not limited to the Formulary, benefit designs,OTC plans,clinical or trend programs or otherwise that has the effect of lowering the amount of Rebates earned hereunder or materially impacting any guarantee. DRUG MANUFACTURER-PAYMENT SHARING Subject to the caveats below,CI-ILIC will remit to Employer the following porticn of Rebates and Manufacturer Administrative Fees that CHLIC collects with respect to utilization of Covered Drugs under the Plan's Pharmacy Benefit: For All Products: The greater of: 100.00% of Rebates and Manufacturer Administrative Fees on such utilization dispensed in the full calendar year immediately preceding CHLIC's remittance,or the sum of: S253.15 for the Plan Year 2023; 5274.1 1 for the Plan Year 2024: S288.05 for the Plan Years 2025 through 2027 multiplied by the number of Retail Pharmacy Brand Drug Claims(excluding Specialty Brand Drug Claims) dispensed in 30-day* supplies plus S595.50 for the Plan Year 2023; S627.03 for the Plan Year 2024; S664.68 for the Plan Year 2025 through 2027, multiplied by the number of Retail Pharmacy Brand Drug Claims (excluding Specialty Brand Drug Claims) dispensed in 90-day** supplies plus S732.95 for the Plan Year 2023; S799.I4 for the Plan Year 2024; S842.82 for the Plan Years 2025 through 2027 multiplied by the number of Cigna Home Delivery Pharmacy Brand Drug Claims(excluding Specialty Brand Drug Claims)plus S418.73 for the Plan Year 2023;$594.87 for the Plan Year 2024 :$626.87 for the Plan Years 2025 through 2027. multiplied by the number of Retail Pharmacy Specialty Brand Drug Claims plus S2,029.06 for Plan Year 2023 : $2,608.98 for Plan Year 2024; S3,034.61 for Plan Years 2025 through 2027 multiplied by the number of Cigna Home 08/04/2023 28 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrati%e Services Only Agreement for City of Miami Beach Delivery Pharmacy Specialty Brand Drug Claims processed in such full calendar year Caveats: (I) CHLIC or its agents contract with drug manufacturers on CHLIC's own behalf.and not as agent of the Employer or the Plan. Rebates are paid based on the contractual terms set forth in this Agreement. (2) Should Employer terminate this Agreement before completion of the then-current Plan Year, no Rebates shall be due and owing with respect to that Plan Year, and any Rebate minimum or fixed dollar guarantees shall be null and void, as the payment of Rebates is conditioned on CHLIC exclusively administering the Pharmacy Benefits for the entire Plan Year. (3) For percentage-based sharing arrangements, Rebate payout amounts may differ slightly from the stated percentage when payout occurs before manufacturers' final reconciliations and payments are made to CHLIC. For purposes of clarity, CHLIC shall reconcile its performance with respect to any Rebate payment guarantees,including,without limitation,any minimum or fixed dollar guarantees,in the aggregate. Moreover,any amount directly or indirectly provided by a manufacturer or other third party that is allocated to reduce and/or wholly or partially satisfy a Member's cost-sharing obligation for a Covered Drug shall not be considered a`Rebate" for the purposes of Rebate payments to Employer but may be included when reconciling CHLIC's performance against any Rebate minimum guarantee set forth in this Agreement. (4) For percentage-based sharing arrangements, the percentage share payment of Rebates shall not include the payment of any Rebates received, if any, for Run-Out Claims,340b Claims. Medical Specialty Claims, Direct Member Reimbursement Claims, Reversed Claims. and Compound Claims. (5) The Rebate payment commitments, including any minimum or fixed dollar guarantees, if any, set forth in this Schedule of Financial Charges are, among any other conditions communicated in this Agreement or otherwise in writing to Employer, contingent on the availability of Rebates to CHLIC and Employer's Pharmacy Benefit applying a 30-day supply limit for Specialty Drugs. and standard days' supply limits. (6) Rebate Guarantees are paid on a per Brand Claim Basis regardless of days supply. Timing of Rebate Pay-Out: Remittance will be provided within ninety(90)days after the close of each applicable calendar quarter for the portion of such calendar quarter that coincides with the Plan Year. 08/04/2023 79 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach REBATE PAYMENT EXCLUSIONS The Rebate Guarantee payment obligations set forth in this Schedule of Financial Charges shall exclude the following types of claims and/or products: Claims paid pursuant to a Dispense as Written(DAW)5 code. Direct Member Reimbursement Claims. Vaccines. Compound Drugs. Claim reversals. Products identified as prescriptions covered under the federal 340E drug pricing program. Employer shall be solely responsible for ensuring that any pharmacy affiliated with or operated by Employer or its affiliate,such as an in-house pharmacy,systematically identifies 340B prescriptions on Claim transactions administered by CHLIC. If such pharmacy fails to systematically identify 340B prescriptions on Claim transactions submitted to Cl ILIC,then CHLIC may withhold all Rebates,or modify any minimum or fixed dollar Rebate guarantee, otherwise attributable to utilization at such pharmacy. Run-Out Claims. Rebate guarantee reconciliation calculations will not include member-submitted coupon copay assistance. For the avoidance of doubt and clarity,any type of Paid Claim not excluded in this Agreement shall be considered included in the Rebate Guarantees stated above GENERIC DISPENSING RATE Retail The number of covered Retail Equivalent Generic Drug Claims (including single-source Included at No generics notwithstanding any other provision herein) divided by the total number of all Additional Cost covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed to Members under the Plan's Pharmacy Benefit by CHLIC's contracted Retail Pharmacies during the applicable annual period. expressed as a percentage, will equal or exceed 90.20% ("Target Retail GDR") during the applicable annual period. Supplies, such as diabetic testing supplies, dispense as written claims, over the counter products, vaccines, compounds, and Specialty Drug Claims, are not considered Retail Equivalent Generic Drug Claims or Retail Equivalent Brand Drug Claims and will be excluded from the calculation. If the actually achieved GDR with respect to covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed by CHl,1C's contracted Retail Pharmacies falls below the applicable Target Retai: GDR, CHLIC will pay Employer a dollar-for-dollar adjustment for each percentage point by which the actually achieved GDR falls below the applicable Target Retail GDR, up to an aggregate maximum 08/04/2023 30 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Onl.v Agreement for City of Miami Beach payment of S260,000.00.A shortfall in achieving the Target Retail GDR will be offset by an overage in achieving the Target Mail GDR (assuming :his Agreement includes a separate Target Mail GDR), before any penalty is determined with respect to the Target Retail GDR shortfall. "Retail Equivalent Claims" shall mean a method for counting claims. where claims with days' supply equal to or less than thirty-three(33)are counted as one claim and claims with days' supply equal to or greater than thirty-four(34)are counted as the number of days'supply divided by thirty(30). Mail The number of covered Retail Equivalent Generic Drug Claims (including single-source Included at No generics notwithstanding any other provision herein) divided by the total number of all Additional Cost covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed to Members under the Plan's Pharmacy Benefit by CHLIC's Mail Service Pharmacy during the applicable annual period, expressed as a percentage, will equal or exceed 86.30%("Target Mail GDR") during the applicable annual period. Supplies, such as diabetic testing supplies, dispense as written claims, over the counter products, vaccines, compounds, and Specialty Drug Claims, are not considered Retail Equivalent Generic Drug Claims or Retail Equivalent Brand Drug Claims and will be excluded from the calculation. If the actually achieved GDR with respect to covered Retail Equivalent Brand Drug Claims and covered Retail Equivalent Generic Drug Claims dispensed by CHLIC's Mail Service Pharmacy falls below the applicable target Mail GDR,CHLIC will pay Employer a dollar- for-dollar adjustment for each percentage point by which the actually achieved GDR falls below the applicable Target Mail GDR, up to an aggregate maximum payment of SI5,000.00. A shortfall in achieving the Target Mail GDR will be offset by an overage in achieving the Target Retail GDR(assuming this Agreement includes a separate Target Retail GDR). before any penalty is determined with respect zo the Target Mail GDR shortfall. "Retail Equivalent Claims" shall mean a method for counting claims, where claims with days' supply equal to or less than thirty-three(33)are counted as one claim and claims with days' supply equal to or greater than thirty-four (34) are counted as the number of days' supply divided by thirty(30). PHARMACY VACCINE PROGRAM Notwithstanding anything to the contrar in this Agreement or otheru ise,the following terms and conditions shall apply to the administration of vaccines by CHLIC under the Cigna Pharmacy Program. Vaccine Claims will adjudicate at the lower of the U&C Charge or the amounts shown in the Vaccine Pricing Schedule below. For Vaccine Claims,the U&C Charge shall be the retail price charged by an in-network participating retail pharmacy for the particular vaccine. including 08/04/2023 3i DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach administration and dispensing fees,in a cash transaction on the date the vaccine is dispensed as reported to CHLIC by the in-network participating pharmacy. "Vaccine Claim"means a claim for a Covered Drug which is a vaccine. Notwithstanding anything to the contrary in this Agreement or otherwise,all Vaccine Claims shall be excluded from the calculation,measurement, and payment of any and all financial guarantees,including but not limited to rebate guarantees,ingredient cost guarantees,and dispensing fee guarantees set forth in this Agreement. CHLIC reserves the right to revise and modify the Vaccine Pricing Schedule below.including but not limited to revising or adding an additional Pharmacy Vaccine Administration Fee or Vaccine Program Fee, based on changing market dynamics,the entrant of new vaccines,or changes in law or interpretation of law. Vaccine Pricing Schedule fo the extent.if any.Employers Schedule of Financial Charges includes a Pharmacy Administrative Fee charged on a per prescription basis.thus such fee shall apply for Vaccine Claims. Retail Pharmacy Retail Pharmacy Member Submitted INFLUENZA ALL OTHER VACCINES Vaccine Claims Pharmacy Vaccine Pass-Through Pass-Through Submitted amount Administration Fee (Capped at S15 per in-network (capped at S20 per in-network Vaccine Claim) Vaccine Claim) Ingredient Cost Retail Pharmacy Ingredient Cost as Retail Pharmacy Ingredient Cost as set tbrth in Submitted amount set forth in this Agreement this Agreement Dispensing Fee Retail Pharmacy Dispensing Fee as Retail Pharmacy Dispensing Fee as set forth in Submitted amount set forth in this Agreement this Agreement Vaccine Program Fee $2.50 per vaccine claim N :\ 08/04/2023 32 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach MARKETCHECK On an annual basis, Employer or its designee may provide CFILIC with a written comparison, prepared by an independent pharmacy benefit management consultant, for pharmacy benefit management services offered by a third party PBM provider which includes and takes into account similar plan design, formulary exclusions,clinical and trend programs,retail pharmacy,mail pharmacy,and specialty pharmacy mix and utilization,size,demographics,and other relevant factors necessary to provide an appropriate comparison("Employer's Current Market Price"). In evaluating whether Employer's Current Market Price is comparable to pricing CHLIC offers Employer under the terms of this Agreement,C:1LIC will validate that,at a minimum,price points used in determining Employer's Current Market Price were selected from benchmark plans that satisfy the comparable Employer Current Market Price factors listed herein. Employer's Current Market Price shall be evaluated on the basis of a total,aggregate comparison of the pricing terms offered by a single vendor to a single plan, and not on the basis of individual or best price points available from multiple vendors to a single plan or a single vendor to multiple plans. A copy Employer's Current Market Price analysis prepared by the consultant will be submitted to both Employer and to CHLIC. The consultant will also provide a reasonably detailed description of the methods and assumptions used in the analysis including the methods and assumptions related to the calculation of the individual pricing components and the Net Plan Costs,as defined below. CHLIC shall have a reasonable opportunity(i.e.,not less than twenty(20)business days after all information necessary to perform the analysis is received) to evaluate Employer's Current Market Price. In a format specified by CHLIC, Employer, or its designee, shall provide any information necessary for CHLIC to validate Employer's compliance with the terms of this Section including, but not limited to, relevant details about any benchmark plans Employer relied upon in selecting any price point(s)/financial guarantees used to determine Employer's Current Market Price or Net Plan Cost. If the Parties agree that the comparison analysis concludes that Employer's Current Market Price would yield an annual X percent (3%) or more savings of`Net Plan Costs" (with Net Plan Costs defined as the sum of the cost of Covered Drugs, dispensing fees, and claims Administrative Fees, less Rebates received by Employer)under the Agreement,then the Parties shall negotiate in good faith a modification of the pricing terms herein. The revised pricing terms will become effective on the first day of the Plan Year following the issuance of the report or sixty(60)days following a fully executed amendment or agreement memorializing the revised pricing terms, whichever is later. The market check shall be at Employer's expense,except that CHLIC shall be responsible for its costs related to responding to the market check. 08/04/2023 33 DocuSign Envelope ID:9FD1F8A1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach PHARMACY MANAGEMENT FUND("PMF") CHLIC will provide Employer up to $30,000.00, to reimburse Employer the actual, fair market value of expense items and services related to transitioning, implementing and administering the pharmacy benefit initially and throughout the term of the Agreement. The foregoing reimbursement is subject to submission of adequate documentation to support reimbursement within one hundred-eighty (180)days of incurring the applicable expense. All reimbursement under the PMF is subject to CHLIC's standard PMF business practices for all clients Employer represents and warrants that: (i) it will only request reimbursement under the PMF for its actual expenses incurred in transitioning, implementing, and administering the pharmacy benefit managed by CHLIC hereunder, and/or the additional clinical or other similar program provided by CHLIC throughout the Plan Year; (ii) that the applicable service, item, or program was actually performed or provided; (iii) the amount of the reimbursement is equal to or less than the reasonable fair market value of the actual expenses incurred by Employer; (iv) it will notify and disclose the amount and the terms of any PMF reimbursements to Members and other third parties to the extent required by applicable laws and regulations. In addition, if the Employer and the Plan are subject to ERISA, Employer represents and warrants that it will only request reimbursement under the PMF for items or services for which Employer, in the absence of the PMF, would be allowed reimbursement from the Plan(i.e.,not"settlor functions"). Employer shall comply with all applicable federal and state requirements, including, but not limited to, all applicable federal and state reporting requirements with respect to any expense,item or service reimbursed under this section. CHLIC reserves the right to periodically audit the books and records of Employer on-site, during normal business hours and after giving reasonable advance notice, for the purposes of verifying Employer's compliance with the PMF requirements set forth in this Agreement. CHLIC intends to amortize the PMF over the Plan Year for pharmacy services on a straight-line basis. In the event of a termination of this Agreement for any reason other than CHLIC's uncured material breach prior to the expiration of the initial term,Employer will reimburse CHLIC an amount equal to any paid but unamortized portion of the PMF. Reimbursement to CHLIC by Employer pursuant to this Section will not be in lieu of any other rights or remedies CHLIC may have in connection with the termination of this Agreement,including monetary or other damages. PMF reimbursements shall not be paid prior to the Effective Date of this Agreement and are not payable until this Agreement is executed. Employer will have no right to interest on,or the time value of,any PMF,and unused funds shall be retained by CHLIC. 08/0412023 34 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach CIGNA HOME DELIVERY PHARMACY DISCLOSURE Product Charge Cigna Home Specialty drugs dispensed by Cigna Home Delivery Pharmacy and administered under the The drug's charge under Delivery Pharmacy Plan's medical benefit. a national specialty drug (a CHLIC affiliated discount schedule that company(ies)) "Cigna Home Delivery Pharmacy"means a duly licensed pharmacy operated by CHLIC or generates a 19.00% its affiliates, where prescriptions are filled and delivered via the mail service. Cigna Home annual average aggregate Delivery Pharmacy may maintain product purchase discount arrangements and/or fee-for- discount off AWP across service arrangements with pharmaceutical manufacturers and wholesale distributors. Cigna specialty drug claims Home Delivery Pharmacy contract for these arrangements on its own account in support of dispensed at Cigna Home its pharmacy operations. These arrangements relate to services provided outside of this Delivery Pharmacy to Agreement and other pharmacy benefit management arrangements and may be entered into CHLIC's self-funded and without regard to whether a specific drug is on one of the formularies that CHLIC offers to insured group-client entities like Employer that sponsor group health plans. Discounts and fee-for-service book of business. payments received by Cigna Home Delivery Pharmacy are not part of the administrative fees or other charges paid to CHLIC in connection with CHLIC's services hereunder. This provision shall survive termination or expiration of the Agreement. FEES FOR PROCESSING RUN-OUT CLAIMS OAPIN Run-Out Period of twelve(12)months The sum of the last two (2)months of billed fees and OAP CHLIC shall not be required to process Run-Out Claims until it has received full payment of applicable to the the required fees. terminated(i) Agreement,(ii)Plan benefit option or(iii) Member eligibility. CHLIC MEDICAL COST CONTAINMENT FEES CI ILIC administers the programs listed below to contain costs with respect to charges for health care service.supplies that are covered by the Plan (the"Cost Containment Programs"). In administering these Cost Containment Programs,CHLIC may contract with vendors to perform various tasks related to the Cost Containment Programs. These Cost Containment Programs include services that are performed on claims that are subject to the federal No Surprises Act and are not otherwise subject to state law("NSA Services"). CHLIC's charge for administering a Cost Containment Program is the applicable?ercentage indicated in the table below of the: 08/04/2023 35 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach I) "gross savings' (i.e., the difference between the charge the provider made and the allowable amount resulting from the Cost-Containment Program); 2) "net savings"(i.e.,the gross savings less the applicable vendor charge):or 3) "gross recovery"(i.e.,the amount recovered as a result of the Cost-Containment Program). CHLIC will make a per claim charge to the Bank Account that includes both CI ELIC's applicable Cost Containment Program charge,as shown in the Sections A through C of the table below,and the applicable vendor charge.CHLIC will pay the vendor its charge. For charges for covered services received from a non-Participating Provider(including NSA Services and emergency/urgent care services that are covered at the in-network benefit level),CHLIC may apply discounts available under agreements with third parties or through negotiation of the non-Participating Provider's charges whether on a claim-by-claim basis or in advance of services being rendered("Discounts"). The programs for obtaining the Discounts are identified in Section A and Section B of the table below. CHLIC's per claim charge for administering the programs listed in Section A and Section B of the table below plus any per claim vendor charges associated with those programs shall not exceed S30,000.00 per claim. Vendor charges for the programs listed in Section A and Section B of the table generally range from 5-11%of gross savings. Specific rates charged by vendors for the programs in Section A and Section B of the table are available upon request,subject to execution of a mutually agreed upon non-disclosure agreement to protect the proprietary vendor information from unauthorized use/disclosure.The administration of charges for covered services from non-Participating Providers described above and in Section A and Section B of the table below is consistent with the claim administration practices with respect to CHLIC's own health care insurance business,unless state law requires otherwise. A. Cost Containment for Services/Supplies that are not NSA Services For services/supplies that are not NSA Services.applying the Discounts may result in higher payments than if the maximum reimbursable charge is applied. Whereas application of the maximum reimbursable charge may result in the patient being balance billed for the entire unreimbursed amount applying the Discounts may avoid balance billing and substantially reduce the patient's out-of-pocket cost. If no Discount is available or negotiated,reimbursement will be based upon: (i) If charges are not subject to CHLIC's benefit enhancement policy—the plan's maximum reimbursable charge(in which case the patient may be balance billed by the non-Participating Provider if the provider's charge exceeds the plan's maximum reimbursable charge);or (ii) If charges are subject to CHLIC's benefit enhancement policy—depending upon the Employer's election: 0810412023 36 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach a. the amount of the non-Participating Provider's billed charge not exceeding the greater of a CHLIC determined percentage of the Medicare allowable amount(the 80th percentile of the reasonable and customary charge if there is no Medicare allowable charge)or the amount required by state or federal law(in some instances, the patient may be balance billed by the non-Participating Provider if the provider's charge exceeds such amount),or b. the provider's billed charge. Non-Participating Provider Cost Containment Programs for Services/Supplies that are not NSA Services 1. Network Savings Program 29%of net savings 2. Supplemental Network 29%of net savings 3. Medical Bill Review-(Pre-payment Cost Containment for Non-contracted claims): Inpatient Hospital Bill Review 29%of net savings • Professional Fee Negotiation • Line Item Analysis Re-pricing Lesser of 5%of hospital bill or the gross savings achieved Outpatient Hospital Bill Review 29%of net savings • Professional Fee Negotiation • Line Item Analysis Re-pricing 29%of net savings Physician/Professional Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings 4. For employers that are subject to state laws providing protections from surprise bills: 29%of net savings Payment based on amounts other than Network Savings Program, Supplemental Network.and Medical Bill Review. These payments include amounts determined through negotiation or independent dispute resolution under state law. (The charges indicated in the column to the right include the fees charged by government departments or agencies for administering the 08/04/2023 37 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach independent dispute resolution process and the tees charged by entities conducting 1 independent dispute resolution.) B. Cost Containment for NSA Services For NSA Services, CI-ILIC will issue initial payments at amounts determined by CHLIC or its vendors("Initial Allowed Amount"). The Initial Allowed Amount may be based on Discounts and may be higher than, equal ta, or lower than the qualifying payment amount, as calculated by CHLIC("QPA"). Patient cost-share will be based on the lower of the QPA,the non-Participating Provider's billed charges,the amount determined by CHLIC to be required by state law(if applicable),or the Initial Allowed Amount. Patient cost-share will not increase as a result of negotiations or independent dispute resolution determinations under the No Surprises Act. If additional payment above the Initial Allowed Amount is owed as a result of negotiations or independent dispute resolution under the No Surprises Act,CHLIC. as agent for the Employer, shall make Bank Account Payments from the Bank Account in the amount of such additional payment. Non-Participating Provider Cost Containment Programs for NSA Services 1. Network Savings Program 29%of net savings 2. Supplemental Network 29%of net savings 3. Medical Bill Review—(Pre-payment Cost Containment for Non-contracted claims): Inpatient Hospital Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing Lesser of 5%of hospital bill or the gross savings achieved Outpatient Hospital Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings Physician/Professional Bill Review • Professional Fee Negotiation 29%of net savings • Line Item Analysis Re-pricing 29%of net savings 08/04/2023 38 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Reach 4. Payment based on amounts other than Network Savings Program,Supplemental Network,and 29%of net savings Medical Bill Review. These payments include amounts determined through negotiation or independent dispute resolution under the No Surprises Act. (The charges indicated in the column to the right include the fees charged by government departments or agencies for administering the independent dispute resolution process and the fees charged by entities conducting independent dispute resolution.) C.Other Cost Containment Programs I. Clinical Complex Claim Review — (Pre- or Post-payment Cost Containment for Non- contracted and Contracted claims): Bill Audit 29%of the gross ° savings/gross recovery achieved plus hospital fees or expenses passed through Diagnosis Related Grouping(DRG) Validation/Audits and Recovery. An overpayment audit 29%of gross and recovery program in which CHLIC or its vendors review paid claim data to identify savings/gross overpayments based on inaccurate DRG coding. recovery plus any fees or expenses passed through by the hospital or regulatory agency • Medical Implant Device Audits 29%of the gross savings/gross recovery 2. COB Vendor Recoveries (Exclusive of pharmacy programs where claims are adjudicated at 29%of the gross time prescription is received.j recovery 3_ Secondary Vendor Recovery Program 29%of the gross recovery 4. Provider Credit Balance Recovery Program 29%of the gross recovery 08/04/2023 39 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach 5. High Cost Specialty Pharmaceutical Audits (this service is only provided with respect to 29%of the gross Medical coverage) recovery 6. Eligibility Overpayment Recovery Vendor Services. Identification and recovery of funds in 29%of the gross situations where the overpayment is due to the late receipt of Member termination recovery information. (This service is only provided with respect to Medical coverage). 7. Class Action Recoveries 35%of the gross recovery R. Subrogation/Conditional Claim Payment. ldentificat.on, investigation and recovery of claim 5%of the gross payments involving other party liability or where another entity is responsible for payment recovery plus (including by way of example but not by limitation automobile insurance, homeowner litigation costs if insurance, commercial property insurance, worker's compensation). (This service is only counsel is retained provided with respect to Medical coverage.) and an appearance is filed on behalf of CHLIC or Employer in any litigation,or a lawsuit is filed on their behalf; 29%of the gross recovery if no counsel is retained and in all other instances, including cases where state law requires that employee benefit plans be named as party defendants or involuntary plaintiffs. 08/04/2023 40 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach CHLIC PHARMACY COST CONTAINMENT FEES CHLIC administers the following programs to contain costs with respect to charges for health care service,supplies that are covered by the Plan. In administering these programs, CHLIC contracts with vendors to perform program related services. CI-ILIC's charge for administering these programs is the percentage(indicated below)of the"recovery"(i.e.the amount recovered)or percentage of"program savings",as applicable. 1. Pharmacy Vendor Recoveries. CHLIC performs periodic audits of contracted pharmacies in 30.00%of recovery order to determine the accuracy of payments to the pharmacy(ies). CHLIC's recovery vendor collects and remits to CHLIC all overpayments to pharmacy(ies), and CHLIC remits to the Bank Account the balance collected from the recovery vendor, less the recovery fee set forth herein. 2 Class Action Recoveries. CHLIC identifies, monitors and may (but is not required to) 35.00%of recovery participate, on behalf of Employer, in class action lawsuits or similar legal proceedings against pharmaceutical manufacturers, including, without limitation, lawsuits alleging legal or equitable claims like fraud, anti-trust violations, or unfair trade practices by a manufacturer. As part of this authority, CHLIC may participate in a settlement, exclude Employer from a settlement and/or otherwise represent Employer's interests outside the settlement. CHLIC collects and retains as a recovery fee set forth herein of any recovery (net of attorneys' fees) attributable to Employer's Plan. 3. SaveOnSP Program. A Member cost share program available when the Employer makes plan 25.00%of program design changes to certain,designated covered prescription drugs as non-essential health savings plus any benefits and establishes Member cost share at amounts that allow for receipt of manufacturer- applicable tertiary supported patient copay assistance. The program fee shall be charged to the Bank Account cost share and measured and calculated based on the program's standard savings methodology. Payment of program fees shall be invoiced on a monthly,incurred basis. Additional terms and conditions of the SaveOnSP program are set forth in the attached SaveOnSP Appendix C. ADVANCED CELLULAR THERAPY PROGRAM Advanced Cellular The Advanced Cellular Therapy Program (ACT) is an enhanced network benefit solution Therapy Program designed to manage the high cost of advanced cellular therapies (e.g. CAR T-cell therapy). This program delivers predictability, clinically appropriate care and maximizes affordability by leveraging a specially selected provider network, with benefit language that includes a travel benefit and a dedicated care management team to support Participating Members receiving these therapies. O8/04/2023 4 I DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach For all in-network medical claims covered under the ACT Program at an existing ACT participating provider. Employer shall pay CHLIC (who in turn will pay the rendering ACT participating provider) a Guaranteed Price for the covered advanced cellular therapy. The Guaranteed Price shall equal the Average Wholesale Price (AWP) of the covered advanced cellular therapy minus 10%and will be charged to the Bank Account. Guaranteed Price for the covered advanced cellular therapy(ACT) AWP minus 10% Employer understands and agrees that the amount paid by CHLIC for the therapy may or may not be equal to the Guaranteed Price charged to Employer and CI-ILIC will absorb or retain any difference. There are related costs for Participating Members receiving these therapies that will be paid as covered services according to the Plan. CARE MANAGEMENT/COST CONTAINMENT PROGRAM FEES CHLIC arranges for third parties to provide care management services to: Specific vendor fees and care management (i) contain the cost of specified health care services/items overall with respect to all plans program services are insured and/or administered by CHLIC.and/or available upon (ii) improve adherence to evidence based guidelines designed to promote patient safety and request. efficient patient care. Charges for these services will be processed through the Bank Account. Medical Management(inclusive of Medical Necessity Review)of Chiropractic services. National Average is S0.16 PMPM;rates vary by market and are available upon request. In addition to such third parties,CHLIC has arranged for an affiliate,eviCore,to provide the following care management/cost-containment programs: 08/04/2023 42 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Pre-certification of coverage of radiation therapy services. S912.00 per episode of care(EOC) Pre-certification of coverage of diagnostic cardiology services. (If Employer has elected Basic $0.19 PMPM Standard Medical Management(see Administration Charges section above)this program and charge is not applicable to that membership). Pre-certification of coverage of medical oncology services. S1,050.00 per episode of care(EOC) Pre-certification of coverage of musculoskeletal therapy services (If Employer has elected S0.40 PMPM Basic Standard Medical Management (see Administration Charges section above) this program and charge is not applicable to that membership). Services related to the coverage of high tech radiology which may include pre-certification. Fee reimbursement method and rates may In certain instances,the Plan will pay eviCore a fee on a per member/per month basis for vary by market and pre-certification, arranging care, and other services that eviCore may render. Such are available upon reimbursement will be in addition to the amount that the Plan pays to reimburse the request. provider through which eviCore arranged for the provision of the service or supply,which will be based on eviCore's contracted rate with that provider. In such instances, Plan Benefits and member cost-share will be determined based on the rate that eviCore contracted to pay the provider for the provision of-he service or supply. (If Employer has elected Basic Standard Medical Management (see Administration Charges section above)this program and a charge is not applicable to that membership). eviCore may also charge for services related to the provision of high tech radiology as described below in"Other Vendors and Health Care Services Providers." Pre-certification of coverage of gastroenterology services. (If Employer has elected Basic S0.09 PMPM Standard Medical Management(see Administration Charges section above)this program and charge is not applicable to that membership). Pre-certification of coverage for appropriate setting of care/service for high tech radiology No more than S0.20 services (If Employer has elected Basic Standard Medical Management(see Administration PMPM. Billing method may vary by 08/04/2023 43 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Charges section above)this program and charge is not applicable to that membership). market and is available upon request. Pre-certification of coverage for appropriate setting of care/service for certain medical 30.00%of shared oncology drugs(redirection may be to Aceredo,a CHLIC affiliate). savings(where savings is derived from the difference between drug dose cost at higher cost provider initially requested and drug dose cost at lower cost provider). Fee shall not exceed S5,000.00 per dose for a maximum of three doses resulting in a maximum total of 515,000.00. Note: CHLIC may retain a portion of the shared savings fee before reimbursing eviCore. Pre-certification of coverage of sleep management services. (If Employer has elected Basic S0.I I I'iMI',M Standard Medical Management(see Administration Charges section above)this program and charge is not applicable to that membership). Network management and care coordination of coverage of home health. durable medical S0.31 PM PM equipment and home infusion services. CI-ILIC may revise charges/fees by giving Employer at least sixty(60)days'prior written notice. 08/04/2023 44 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach EXTERNAL REVIEW AND CONSULTATIVE REVIEW FEES When a Member elects an External Review(as that term is defined in the Patient Protection S500-S1,500 Per and Affordable Care Act(PPACA))of a benefit determination by an independent third party, Review the cost of a specific third party review is dependent on the nature and complexity of the issue on appeal. Third party review charges will be commensurate with the level of expertise necessary and the time required to complete the review. STRATEGIC ALLIANCES CHLIC contracts directly or indirectly with other managed care entities and third party All Medical Products network vendors for access to their provider networks and discounts. These third parties charge a network access fee,which is included in CHLIC's monthly charges,as a result of the application of their discounts. Additional details regarding specific charges will be provided upon request. OTHER VENDORS AND HEALTH CARE SERVICES PROVIDERS The fixed per person per period and/or fee-for-service charges that CHLIC has directly or All Products indirectly negotiated with Participating Providers for in-network health care services and/or supplies will be charged to the Bank Account and will be used in calculating any applicable Member cost-sharing. In addition, performance-based payments to Participating Providers will be charged to the Bank Account. Such payments will be at the payment rates then in effect,which may be amended from time to time. For certain types of specialty care, including. but not limited to,home health care,durable medical equipment,sleep management,high tech radiology,chiropractic care,acupuncture, physical medicine(such as physical and occupational therapy),speech therapy,orthotics and prosthetics, implants,and hearing,in certain markets CHLIC may contract with various third parties and/or affiliated companies, including eviCore,("Specialty Vendors")to arrange for the provision of care through their own networks of health care providers on a fee-for-service basis. In addition to arranging for care through their own networks of providers,these Specialty Vendors may also provide additional services, including utilization management services and case management services designed to(i)improve adherence to coverage guidelines;and(ii)contain overall healthcare costs to the Plan.Specialty Vendors are included within the definition of"Participating Provider"set forth in this Agreement and in any benefit booklet covering the Plan. When care is arranged through a Specialty Vendor's network of providers,the form of 08/04/2023 45 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach reimbursement to the Specialty Vendor will be through one of the following methods: • Fee-For-Service Payment: In certain instances, the Plan will pay the Specialty Vendor rather than the treating provider on a fee-for-service basis as a claim for Plan Benefits. The Specialty Vendors' fee-for-service charges may be higher than the amounts that the Specialty Vendor contracts to pay the provider for the provision of any particular service or supply,and some portion of the Specialty Vendor's charges may be attributable to the services that the Specialty Vendor provides in addition to those services or supplies provided by the Specialty Vendor's network of providers, including any utilization management services and case management services. In such instances, Plan Benefits and member cost-share will be determined based on thz Specialty Vendor's charges according to Plan terms. • Administration Capitation Payment: In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis for arranging care and other services that the Specialty Vendor may render. Such reimbursement will be in addition to the amount that the Plan pays to reimburse the provider through which the Specialty Vendor arranged for the provision of the service or supply, which will be based on the Specialty Vendor's contracted rate with that provider. In such instances,Plan Benefits and member cost-share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. • All-Inclusive Capitation Payment: In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis that covers (i) the services that the Specialty Vendor may render, including arranging care, and (ii) the fees charged by the provider through which the Specialty Vendor arranged for the provision of the service or supply. In such instances, Plan Benefits and member cost-share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. CHLIC's arrangements with Specialty Vendors are subject to change at any time,and upon request,additional information can be provided that identifies current Specialty Vendors.their area of specialty(ies),whether they are CHLIC affiliates,and the form of payment that they currently receive. Notwithstanding the terms of the Plan,CHLIC shall not administer Member cost-sharing with All Products respect to charges made by Cricket Health, Inc. for its personalized,evidence-based approach_(excluding HSA 08/04/2023 46 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach to managing chronic kidney disease and end-stage renal disease for clinically eligible Products) Members in CA and such cost-sharing expenses shall, instead, be reimbursed by the Plan(not applicable if Employer has opted out). - NOTICE REGARDING PAYMENTS FROM THIRD PARTIES Rebate and Other CHLIC or its affiliates may contract with pharmaceutical manufacturers or other third parties All Pharmacy Remuneration for Rebates, Manufacturer Administrative Fees, and other remuneration on its or their own Products Disclosure(Pharmacy) behalf and for its and their own benefit, and not on behalf of Employer or the Plan. Accordingly, unless otherwise specified in this Schedule of Financial Charges,CHLIC and its affiliates retain all right, title and interest to any and all actual Rebates, Manufacturer Administrative Fees, and other remuneration received from manufacturers or other third parties; neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in any such remuneration, which shall be considered part of the general assets of CHLIC and its affiliates. As an example of the remuneration other than Rebates or Manufacturer Administrative Fees that CHLIC or its affiliates may earn, CHLIC or its affiliates may also directly or indirectly earn from pharmaceutical manufacturers remuneration in connection with value payments and/or services that CHLIC provides to Employer ("Value-Based Payments"). Notwithstanding anything in this Agreement to the contrary,any Value-Based Payments earned by CHLIC or its affiliates are separate and apart from any Rebates or Manufacturer Administrative Fees that CHLIC or its affiliates directly or indirectly earn from pharmaceutical manufacturers, and CHLIC and its affiliates may retain any Value-Based Payments it earns. As examples of-he value payments and/or services that CHLIC may provide to Employer in connection with Value-Based Payments that CHLIC or its affiliates may earn,CHLIC may provide care management or related services to Employer and/or remit to Employer monetary credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services, and/or monetary credits or other financial value, for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions, including the products for which monetary credits or other financial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHLIC to Employer are subject to change or termination by CHLIC as the value program(s), if any,offered by CHLIC change(s)or terminate(s). Information on the projected aggregate amount of such Rebates with respect to the Plan 08/04/2023 47 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Pharmacy Benefit will be provided upon request. This provision shall survive termination or expiration of the Agreement. Rebate and Other CHLIC may directly or indirectly receive and retain payments under contracts with All Medical Products Remuneration pharmaceutical manufacturers or third parties with respect to Members' utilization of the Disclosure(Medical) manufacturer's products covered under the Employer's Plan medical benefit. These payments may include rebates, service fees (e.g. administrative fees), or other remuneration. CHLIC directly or indirectly contracts with pharmaceutical manufacturers or other third parties for any remuneration on its own behalf, based on its bock of business, and for its own benefit, and not on behalf of Employer or the Plan. Accordingly. CIILIC retains all right, title and interest to any and all such remuneration received from manufacturer: neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in any such remuneration,which shall be considered part of the general assets of CHLIC. This provision shall survive termination or expiration cf the Agreement. Implementation/Referral From time to time,CHLIC.directly or through its affiliates,arranges with third parties(e.g.. All Products Fee Disclosure service vendors,provider network managers)to provide various services(e.g.,cost- containment services or health care services)in connection with the Plan.CHLIC and its affiliates may receive payments from such third parties to help defray CHLIC's expenses associated with its implementation and/or ongoing administration of these arrangements or as a reimbursement for services or network access provided to such parties by CI-ILIC.CHLIC may also receive compensation from third-party vendors that Employer may retain based upon a referral from CHLIC or that Members may utilize following an introduction facilitated by CHLIC or an affiliate.CHLIC may also receive: • network administration fees from some providers participating in its provider network, • credits from banks on balances in accounts utilized to administer claims, • non-material incidental compensation/benefrts from other source as a result of administerir g the Plan. 08/04/2023 48 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach COMPLIANCE ASSISTANCE CHLIC shall provide the following services to assist Employer in meeting its compliance obligations under section 2715 of the Public Health Service Act as added by the Patient Protection and Affordable Care Act and applicable regulations with respect to the provision of the Summary of Benefits and Coverage ("SBC"),translation notice and glossary. Applicable to all medical plans including HRA and FSA which are considered "group health plans" subject to the SBC requirements. I. Preparation of SBC, translation notice. CHLIC will not be responsible for any changes that No charge Employer makes to the SBC. 2. Provide SBC, translation notices prepared by CHLIC to Employer electronically as well as No charge any updates or material modifications. 3. Include in SBC a summary of benefits administered by carve-out vendor if Employer or S500 for each benefit carve-out vendor provides CHLIC with necessary carve-out benefit information at least option under the Plan twelve(12)weeks prior to the date the SBCs are to be delivered to Employer. for which carve-out vendor benefits are included in SBC ADDITIONAL SERVICES Service Description Charge Third Party Individual CHLIC will provide its standard individual stop loss third party reporting package only after For OAP1N Stop Loss Interface Fee the stop loss carrier and Employer have executed CHLIC's standard hold harmless/confidentiality agreement. CHLIC's standard individual stop loss reporting package and OAP Products: is based on paid claim data only(documentation and information,including but not limited to, incurred-but-not-paid claims, projected claims,pre-certifications of coverage,case S0.69/employee/month management records and notes,course of treatment or prognosis,and internal audits will not be provided). Employer should be aware that third party stop loss coverage may result in a difference of reimbursable claims under the stop loss carrier's policy versus payable covered services under the medical benefit plan. Behavioral Health Access to inpatient and outpatient behavioral health services and focused utilization review For OAPIN and case management for both inpatient and outpatient, in-network behavioral health services. When applicable, only to Members in CA/Vl. and OAP Products: Included in Medical 08/04/2023 49 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Access Fee Pharmacy Clinical inMynd-is a clinically-based Member and provider comprehensive behavioral health Included at No Program(s) program that includes regular retrospective review of pharmacy and medical claim data to Additional Cost identify certain"at risk"(i.e.,members with complex psychiatric conditions using multiple psychotropic medications)member utilization patterns to help both members and providers better recognize,treat and support mental and behavioral health conditions. Narcotics Therapy Management-is a clinically-based provider program that consists of a quarterly,retrospective review of pharmacy and medical claims data which helps to identify those individuals with utilization patterns that may be indicative of risk of substance abuse, overdose,or diversion. Pharmacy Utilization Essential Package - a utilization management program under which some pharmaceutical Included in Pharmacy Management Program products are subject to one or several coverage limita:ions. including prior authorization,step Administration Fee therapy and/or quantity limits. Under a prior authorization requirement,the requested drug is generally reviewed for clinical appropriateness based on the intended use in therapy. Under a step therapy requirement, the Member generally mus:try one or more preferred products, or demonstrate why trying the preferred product(s)would be clinically inappropriate, in order to obtain coverage for the requested dry. Clinical Program A targeted condition medication therapy management program in which CHLIC provides Included at No support for Members using specialty medications for certain chronic conditions and that are Additional Cost obtained or administered at retail pharmacies or outpatient,office or home health care settings. As part of the program,Members are counseled on their condition,medication side effects,and importance of adherence. For the sake of:laxity,if a specialty pharmacy affiliate of CHLIC provides therapy management for specialty medications the pharmacy dispenses to Members,then it does so in its capacity as a specialty pharmacy and not on behalf of CHLIC; CHLIC does not exert direction or control over the pharmacists at any specialty pharmacy affiliate. SafeGuardRx Program A medication therapy management and cost containment program for select therapeutic Included at No conditions such as but not limited to oncology, inflammatory conditions, and multiple Additional Cost sclerosis and select drugs within therapeutic categores. This program seeks to help reduce drug therapy costs through its program offerings. For example,employers may qualify for the payment of discontinuation drug therapy credits and/or the reimbursement of drug therapy through drug cost caps. on select medications and therapeutic conditions. This program may 08/04/2023 50 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach also provide for Member outreach or counseling on select medications. CIILIC reserves the right to revise,modify,or terminate this program,in whole or in part,at any time.Additional and specific program information is available upon request. Your Health First A proactive health education and improvement program for Members with a chronic For OAPIN condition.The program involves services that span across the Member's health needs. Behavioral coaching principles and evidence based medicine guidelines are utilized to and OAP Products: optimize self-management skills and foster siictained health improvements. Included in Medical Access Fee The program targets a chronic population at high risk for near term and future high cost medical expenses.Members are identified as having a chronic condition through a variety of sources which may include:claims data,referrals,and self-identification. A variety of resources is provided to those with a chronic condition,including access to online tools, personalized support,and targeted materials. The program includes the following components for those with a chronic condition: • Chronic condition-specific coaching • Pre-and post-discharge calls • Lifestyle management coaching:stress,weight management and tobacco cessation • Treatment decision support and coaching Transparency in CHLIC will make available an internet-based self-service tool for use by Members,as well as Included in Medical Coverage and certain data in machine-readable file format on a public website,as required under the Administration Fee Consolidated Transparency in Coverage rule. Members can access the cost estimator tool on myCigna.com. Appropriations Act. Updated machine-readable files can be found on Cigna.com and/or CignaForEmployers.com 2021 on a monthly basis. Pursuant to Consolidated Appropriations Act(CAA),Section 106,CHLIC will submit certain air ambulance claim information to the Department of Health and Human Services(HHS)in accordance with guidance issued by HHS. Subject to change based on government guidance for CAA Section 204.CHLIC will submit certain prescription drug and health care spending information to HHS through Plan Lists 08/04/2023 51 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Files(P1-P3)and Data Files(Dl-D8)(D1-D2 for employers without integrated pharmacy product)aggregated at the Market Segment and State level,as outlined in guidance. Employer Fund(s) CHLIC shall establish the following fund(s)to assist the Employer in defraying certain Plan- related expenses. if CHLIC performs a service to be reimbursed by the fund,the fund amount shall be credited during the following settlement. If an external vendor provides the service to be reimbursed by the fund,an invoice from the vendor is required prior to application of fund amounts by CHLIC. Any fund shall be extinguished upon notice of termination of the Agreement and any fund amount not used prior to the notice of termination of the Agreement shall only be available to Employer for the purpose of funding the cost of those reimbursable services provided prior to such notice of termination. Innovation Fund CHLIC shall make available to Employer the designated amount to be used by Employer to: Included at No defray its non-standard expenses associated with innovation of a new Plan or program subject Additional Charge to the following terms: Fund amount: $100,000.00 Fund effective date:October 1,2023 Fund will remain in effect until: September 30,2024 Unused amounts will carry over and be available for use until:September 30,2024 08/04/2023 52 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach ' ia(?i i ti -�� .� -,n:t� iii, ._. ,. - Health Improvement For clinical/wellness/behavioral programs offered by CHLIC that are purchased,CHLIC will Fund establish a Health Improvement Fund in the amount of S100,000.00.This fund will be used to defray the cost of CHLIC designated and arranged health and wellness improvement programs (e.g. biometric screenings, flu shots) for Employees of Employer and to reward participation in these programs. The Health Improvement Fund is a one-time credit to be used from October 1, 2023- September 30,2024. Unused funds cannot be rolled over and CHLIC must pre-approve use of the Health Improvement Fund. The Health Improvement Fund shall be extinguished upon notice of termination of the Agreement and any fund amount not used prior to the notice of termination of the Agreement shall only be available to Employer for the purpose of funding the cost of those reimbursable services provided prior to such notice of termination. 08/04/2023 53 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of!1liami Beach Exhibit A - Plan Booklet A"Plan Booklet"that describes the Plan Benefits and Members'rights and responsibilities under the Plan will be provided by Employer to CHLIC for its use in administering the Plan including denials and appeals of denials of claims for Plan Benefits. If Employer has not provided CHLIC with a copy of its finalized Plan Booklet by the time the Agreement is effective, CHLIC will administer the Plan in accordance with the Plan Benefits described in the Plan Booklet draft provided by CHLIC to Employer and Section 2 of the Agreement.CHLIC will continue to administer the Plan in this manner until CHLIC receives the finalized Plan Booklet and follows CHLIC's preparation and review process. After that time CHLIC will administer the Plan in accordance with Plan Benefits described in the finalized Plan Booklet and Section 2 of the Agreement. 08/04/2023 54 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Exhibit B — Services BANKING AND ADMINISTRATION Excluding Health Savings Account Furnishing CHLIC's standard Bank Account activity data reports to Employer as and when agreed All Products upon. CHLIC's administration of the Plan does not include pe-forming obligations, if any, under state escheat or unclaimed property laws. It is Employer's responsibility to determine the extent to which these laws may apply to the Plan and to comply with such laws. If Employer has elected,pursuant to section 63 of the New York Health Care Reform Act of 1996 All Medical and (section 2807-t of the Public Health Law) ("the Act"), to pay tie assessment on covered lives set Pharmacy Products forth in section 63 and has consented to the conditions set forth in section 63. CHLIC shall tile such forms and pay such surcharge and assessment on covered lives on behalf of Employer through the Bank Account to the extent set forth in section 63. Such obligation shall end immediately upon Employer's failure to provide any information required by CHLIC to fulfill this obligation,the failure to comply with any requirement imposed upon Employer pursuant to the Act or the failure of Employer to sufficiently fund the Bank Account. In addition, where permitted and agreed to by CHLIC, CHLIC will file applicable forms and pay on behalf of Employer and/or the Plan any assessment, surcharge. tax or other similar charge which is required to be made by Employer and/or the Plan based on covered lives and/or paid claims or otherwise in accordance with and as required by other applicable state and/or federal laws and regulations and the Bank Account will be charged for any such payments made by CHLIC. CHLIC's obligation to pay on behalf of Emplcyer may end immediately upon Em_ployer's failure to sufficiently fund the Bank Account. CLAIM ADMINISTRATION Excluding Health Savings Account Calculate benefits, check and/or electronic payments disbursed from the Bank Account. Bank All Products Account payments will appear in Employer's standard Bank Account activity data reports. CH1.IC's generic claim forms are made available to Employer and eligible individuals. All Products CHLIC's Special Investigations Unit will investigate, pend, recommend denial of claims in whole All Products or in part,and/or reprocess claims,as appropriate. Discuss claims,when appropriate,with providers of health services. All Products Perform, based on CIILIC's book of business internal audits of plan benefit payments on a random All Products 08/04/2023 55 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach sample basis. Claim control procedures reported annually in Statement on Standards for Attestation All Products Engagements(SSAE)No. 18 Report(or any applicable successor thereto). Respond to Insurance Department complaints. All Products Designated toll-free telephone line for Member and Provider calls to CHLIC Service Centers. All Products Member Explanation of Benefit("EOB") statements including, when applicable, notice of denied All Products(excluding claims,denial reason(s)and appeal rights. Pharmacy) Verify enrollment and eligibility using Member information submitted by Employer and/or its All Products authorized agent. Medical Only CHLIC's generic enrollment form is made available to Employer and eligible individuals. All Medical Products CHLIC's standard ID card with toll-free telephone number are prepared for Members. All Medical Products Administration of subrogation/conditional Claim Payment(terms described in Exhibit E). All Medical Products PLAN BOOKLET Prepare and make accessible Member benefit booklet drafts to Employer. I All Products UNDERWRITING SERVICES 5500 Schedule C reporting. All Products 5500 Schedule A or Annual Reconciliation Disclosure reporting(when applicable) All Products CHLIC's standard Underwriting services:a)benefit design analysis b)projected cost analysis. All Products HIPAA INDIVIDUAL RIGHTS Handling of requests from Members for access to, amendment and accounting of protected health All Products information,and requests for restrictions and alternative communications as required under federal HIPAA law and regulations,as set out in this Agreement and its Exhibits. COST CONTAINMENT Maximum reimbursable charge determinations of non-Participating Provider charges for covered All Medical Products services. (with out-of-network benefits) CHLIC's standard cost containment controls: Application of non-duplication and coordination of All Medical Products benefits rules and coordination with Medicare. 08/04/2023 56 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Delivery, of information. as necessary, regarding standard application of non-duplication or All Medical Products coordination of benefits. Review of medical bills in accordance with CHLIC's then current Medical Bill Review program. All Medical Products Medical Cost Containment,as described in the Schedule of Financial Charges. All Medical Products Annual reporting of CHLIC's standard cost containment results upon Emplcyer's request. All Medical Products Pharmacy Cost Containment,as described in the Schedule of Financial Charges. All Pharmacy Products REPORTING Summary reports of medical and pharmacy cost and utilization experience (where applicable), All Medical and upon completion of internal report generation, are available through Cigna's web site, Pharmacy Products CignaforEmployers.com. CHLIC's standard pharmacy utilization reports. Pharmacy Product Only Claim Reporting: CHLIC will provide standard banking and financial report information based All Medical and upon paid claim data. CHLIC will not provide information on incurred-but-not reported claims, Pharmacy Products projected claims,pre-certifications of coverage,case management information or information on a Member's prognosis or course of treatment. Individual Stop Loss Reporting is an optional service provided at an additional fee to employers All Medical Products who have individual stop loss through another entity other than CHLIC. CHLIC will provide its standard Individual stop loss reporting package, which includes banking and financial information based upon paid claims data, only after the stop loss carrier and Employer have executed CHLIC's standard Hold Harmless/Confidentiality Agreement. Aggregate Stop loss Reporting is not included as part of the standard reporting package and is not provided. CHLIC will not provide documentation and information, including hut not limited to, incurred-but-not-paid claims, projected claims, pre-certifications of coverage, case management records and notes, course of treatment or prognosis, and internal audits. CHLIC does not allow stop loss carriers to audit CHLIC's claims administration under the medical benefit plan, however. the Employer's audit rights are set forth in the Agreement. For the sake of clarity, as it is possible that certain information, documentation, data and/or reports that are required by the stop loss carrier prior to reimbursement under Employer's stop loss policy will not be available for stop loss policy administration, Employer is responsible for verifying any such required information with its stop 08/04/2023 i7 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach loss carrier. MEMBER EXTERNAL REVIEW PROGRAM CHLIC contracts with a minimum of three (3) independent review organizations that meet the All Medical Products Patient Protection and Affordable Care Act (PPACA) external review requirements. Members may appeal eligible claims requiring medical judgment to an external independent review organization which is selected by CHLIC on a random basis. If Employer has chosen not to participate in this program, the Employer may be responsible for making other arrangements to meet the Patient Protection and Affordable Care Act(PPACA)external review requirements. MEDICAL MANAGEMENT SERVICES CHLIC provides integrated medical management that includes (depending upon the terms of the Plan)the following core services. Pre-Admission Certification and Continued Stay Review(PACCSR) services to certify coverage All Medical Products of acute and sub-acute inpatient admissions/stays or provides guidance to appropriate alternative settings. Administered in accordance with CHLIC's then applicable medical management and claims administration policies,practices and procedures. Case Management, a service designed to provide assistance to a Member who is at risk of All Medical Products developing medical complexities or for whom a health incident has precipitated a need for rehabilitation or additional health care support. Assist providers with resources and tools to enable them to develop long term treatment plans in All Medical Products the management of chronic or catastrophic cases. The Cigna HealthCare Healthy Babies Program is an educational program which provides Member All Medical Products with prenatal care education and resources to help them better manage their pregnancy. Other benefits of this program include the Health Information Line, :sigh risk maternity and pregnancy information on myCigna.com. HealthCare Cost and Quality tools available on myCigna.com and myCigna mobile app. All Medical Products A panel of physicians and other clinicians to assess the safety and effectiveness of new and All Medical Products emerging medical technologies. The panel meets monthly to review and update coverage policies. Health Information Line is a service that provides twenty-four(24) hour toil free access to nurses All Medical Products who provide convenient and confidential services. Health Information Line nurses can help guide Members in finding the right care, make informed decisions about symptom-based health issues the Member is experiencing when they call the Health Information Line and recommend appropriate settings for care. Health Information Line nurses can help inform and educate 08/04/2023 58 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Members about a wide variety of health and medical informat.on, including access to a library of English and Spanish podcasts. Cigna LifeSOURCE Transplant Network contracts with mo:e than one hundred seventy (170) All Medical Products independent transplant facilities which includes over eight hundred(800) transplant programs and provides access to solid organ and bone marrow/stem cell transplantation while improving cost containment and reducing financial risk. A health education program that delivers mailings to Members with certain conditions. All Medical Products Behavioral health services are provided/arranged by a CHLIC affiliate (details available upon OAPIN request), including utilization review and case management for both inpatient and outpatient, in- network behavioral health services. and OAP Products: (All Members) Implement a quality oversight process that includes monitoring of utilization management All Medical Products performance measurements and a continuous quality improvement process when warranted. Transition of care services to allow Members with defined conditions to continue treatment with All Medical Products non-Participating Providers after enrollment for continued uninterrupted care for a limited time. Except Comprehensive and Indemnity Focused utilization management of outpatient procedures and identification of appropriate All Medical Products alternatives. Administered in accordance with CHLIC's then applicable medical management and with Care Management claims administration policies,practices and procedures. Preferred NETWORK MANAGEMENT SERVICES CHLIC,and/or its affiliates or contracted vendors shall: Provide or arrange access to the applicable network of Participating Providers to furnish health All Medical and care services/products to Members at negotiated rates and methods of reimbursement(e.g. fee-for Pharmacy Products service, fixed per person per period, per diem charges, incentive bonuses, case rates, withholds etc.). The amount and type of negotiated reimbursement may vary depending upon the type of plan. For example, a hospital may accept less for patients enrolled in certain types of plans than others. In addition, CIILIC may contract with Participating Providers and other parties (for example Independent Practice Associations)for performance-based incentive payments to promote quality of care,patient safety and cost efficiency. 08,/04/2023 59 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Credential and re-credential Participating Providers in accordance with CHLIC's credentialing All Medical and requirements and ensure that third-party network vendors credential/re-credential Participating Pharmacy Products Providers in accordance with CHLIC's requirements; Monitor Participating Provider compliance with protocols ard procedures for quality, Member All Medical and satisfaction,and grievance resolution: Pharmacy Products Facilitate the identification of Participating Providers by Members;and All Medical and Pharmacy Products Designated toll-free telephone line for Member and Provider calls to CHLIC Service Centers. All Medical and Pharmacy Products Access to online and/or on demand medical and health-related consultations via secure All Medical Products telecommunications technologies, telephones and interne are permitted and may include MDLIVE,aClILIC affiliate(see details on myCigna.com). BEHAVIORAL HEALTH CHI.IC has contracted with an affiliate (details available upon request) to provide or arrange for These services are the provision of managed in-network behavioral health services, the affiliate is a Participating included in the following Provider. and is reimbursed primarily on a monthly fixed fee basis This fixed fee for behavioral products: health services will be paid as claims and will appear in Employer's monthly reporting and on OAPIN financial documents. Such payments will be at the relevant monthly rates then in effect. The monthly rates paid to the affiliate vary depending on geographic location of Members and on and OAP Products benefit design,and may be subject to change. The rates will be made available upon request. The fixed fee also includes applicable lifestyle management programs and a cognitive behavioral modification program. Behavioral claims from a client specific network are not included in the behavioral monthly fixed fee and will be paid from the Bank Account. In some states,payment for behavioral health services must be paid on a fee-for-service basis. In these states, fee-for-service payments for behavioral health services and the behavioral health administrative fee(including the applicable lifestyle management programs and a cognitive behavioral modification program) will be paid from the Bank Account as claims and will appear in Employer's monthly reporting. 08/04/2023 60 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach EVERNORTH CARE GROUP SERVICES The Cigna HealthCare of Arizona. Inc. staff model Evernorth Care Group (formerly known as All Medical Products Cigna Medical Group or "CMG") is a multispecialty participating provider group located in metropolitan Phoenix, Arizona. Evernorth Care Group's integrated care delivery model and population health management team work together to facilitate the way in which patients and doctors communicate and interact in order to increase patient satisfaction and improve health outcomes. Plan Participants may at some time receive treatment from an Evernorth Care Group facility or provider even if they do not reside in Arizona (as when traveling). Plan Participants utilizing Cigna participating provider networks in Arizona may access certain specialty and/or ancillary services(such as imaging and urgent care services)through the Evernorth Care Group system. For covered services provided to Participants, Evernorth Care Group is paid at the rates in effect at the time of service (as may be revised from time to time). Representative rates for routinely performed services are attached to the Schedule of Financial Charges herein. A complete copy of the rates is available on request under a mutually agreed nondisclosure agreement("NDA"). if the Plan requires or allows Participants to select a primary care provider("PCP"), Phoenix area Participants who do not select a PCP during open enrollment may be assigned to or otherwise encouraged to consider an Evernorth Care Group PCP. Evernorth Care Group has established collaborative referral relationships with specialty and ancillary providers in Cigna's affiliate and participating provider networks. Evernorth Care Group may also receive applicable performance-based incentive payments for its participation in programs designed to improve quality, patient safety and affordability. The incentive payments that Evernorth Care Group may receive will be determined using the same performance measures and reward formula as used in determining the incentive payments made to similarly situated non-Cigna affiliated provider entities. The amount of the incentive payments made to Evernorth Care Group and attributable to the plan will he provided upon request. 08/04/2023 61 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF 1 C5DA72 Administrative Services Only Agreement for City of Miami Beach CIGNA HEALTHCARE OF ARIZONA-EVERNORTH CARE GROUP REPRESENTATIVE RATES FOR ROUTINELY PERFORMED MEDICAL SERVICES EFFECTIVE JANUARY 1,2020 A..licable to O.en Access Plus Products Department CPT Description Rate Code* All Departments 99213 OFFICE VISIT,EST EXP PROB FOC $73.81 Adult Medicine 99396 WELL EXAM,EST,40-64 YEARS $126.72 Pediatrics 99392 WELL EXAM,EST, 1-4 YEARS $106.46 Ophthalmology 66984 REMOVE CATARACT, INSERT LENS- $641.43 Professional Fee only,at a facility Podiatry 11721 DEBRIDEMENT NAIL.SIX OR MORE $45.51 Radiology 71046 CIIEST X-RAY,PA&LAT $31.28 Radiology 77067& SCREENING MAMMOGRAPHY DIGITAL $189.64 77063 General Surgery 47562 LAPAROSCOPY;CHOLECYSTECTOMY- $666.13 Professional Fee only,at a facility Optometry 92014 EYE EXAM&TREATMENT $126.12 ASC (Ambulatory surgical Grouper 2 $469.00 center)I Endoscopy Suite ASC Endoscopy Suite Grouper 8 $1,104.00 *Medicare does not assign(or may not yet have assigned)relative value units(RIVlJs)for certain service codes. Codes not valued by Medicare are referred to as "gap codes," For example, Medicare does not assign values for wellness service codes (99381-99397). Evernorth Care Group refers to The Essential RBR['S(Annual)guide to obtain relative values for such gap codes for billing purposes. Typically, Cigna pays Evernorth Care Group for gap codes not valued by Medicare either at the discounted fee schedule referenced above or, for new codes not yet valued by Medicare, at the same rate it pays its other participating providers. The Urgent Care case rate excluding radiology and laboratory services is$135. 08/04/2023 62 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement Ibr City of iAtiami Beach Exhibit C— Audit Agreement (Sample) A. WHEREAS, Cigna Health and Life Insurance Company ("CHLIC") desires to cooperate with requests by (" Employer") to permit an audit for the purposes set forth below and subject to Section 6 of the Administrative Services Only Agreement between CHLIC and Employer; B. WHEREAS, ("Auditor") has been retained by Employer for the purpose of performing an audit("Audit")of claims administered by CHLIC;and C. WHEREAS, the Auditor and the Employer recognize CHLIC's legitimate interests in maintaining the confidentiality of its information, protecting its business reputation, avoiding unnecessary disruption of its claim and customer service administration,and protecting itself from legal liability; NOW THEREFORE, IN CONSIDERATION of the premises and the mutual promises contained herein,CHLIC,the Employer and the Auditor hereby agree as follows: I. Audit Specifications The Auditor will specify to CHLIC in writing at least forty-five (45) days prior to the commencement of the Audit the following"Audit Specifications". a. the name,title and professional qualifications of individual Auditors; h. the Audit objectives; c. the scope of the Audit(time period,lines of coverage and number of claims/calls); d. the process by which the sample will be selected for audit; c. the records/information required by the Auditor for purposes of the Audit;and U. the length of time contemplated as necessary to complete the Audit. 2, Review of Specifications CHLIC will have the right to review the Audit Specifications and to require any changes in,or conditions on, the Audit Specifications which are necessary to protect CIILIC's legal and business interests identified in paragraph C above. 3. Access to Information CHLIC will make the records/information called for in the Audit Specifications available to the Auditor at a mutually acceptable time and place. 4. Audit Report The Auditor will provide CHLIC with a true copy of the Audit's findings,as well as the Audit Report,if any,that is submitted to the Employer.Such copies will be provided to CHLIC at the same time that the Audit findings and the Audit Report are submitted to the Employer. 08/04/2023 63 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach 5. Comment on Audit Report CHLIC reserves the right to provide the Auditor and the Employer with its comments on the findings and,if applicable,the Audit Report. 6. Confidentiality The Auditor understands that CHLIC is permitting the Auditor to review the records/information solely for purposes of the Audit. Accordingly,the Auditor will ensure that all information pertaining to individual claimants will be kept confidential in accordance with all applicable laws and/or regulations. Without limiting the generality of the foregoing. the Auditor specifically agrees to adhere to the following conditions: a. The Auditor shall not copy,print,photograph or otherwise duplicate or remove any of the Information without the express written consent of CHLIC; b. The Auditor shall not record any virtual session that includes Protected Health Information as defined in the Health Insurance Portability and Accountability Act of 1996 ("H1PAA");and c The Auditor shall not take any screenshots during any virtual session. 7, Restricted Use of the Audit Information With respect to persons other than the Employer. the Auditor will hold and treat information obtained from CHLIC during the Audit with the same degree and standard of confidentiality owed by the Auditor to its clients in accordance with all applicable legal and professional standards.The Auditor shall not,without the express written consent of CHLIC executed by an officer of CHLIC, disclose in any manner whatsoever, the results, conclusions, reports or information of whatever nature which it acquires or prepares in connection with the Audit to any party other than the Employer except as required by applicable law. The Employer and Auditor agree to indemnify and to hold harmless CHLIC for any and all claims,costs,expenses and damages which may result from any breaches of the Auditor's obligations under paragraphs 6 and 7 of this Agreement or from CHLIC's provision of information to the Auditor. The Employer authorizes CHLIC to provide to the designated Auditor the necessary information to perform the audit in a manner consistent with all Health insurance Portability and Accountability Act of 1996 ("HiPAA"), Privacy Standards and in compliance with the signed Business Associate Agreement("BAA"). S. Termination CHLIC may terminate this Agreement with prior written notice. The obligations set forth in Sections 4 through 7 shall survive termination of this Agreement. 08/04/2023 64 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Cigna Health and Life Insurance Company By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: title: )ate: Employer: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Auditor: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: 08/04/2023 65 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Nliami Beach Exhibit Cl — Clinical Audit Agreement (Sample) A. WHEREAS, Cigna Health and Life Insurance Company ("CHLIC") desires to cooperate with a request by ("Employer")to permit a clinical audit for the purposes set forth below and subject to Section 6 of the Administrative Services Only Agreement between CHLIC and Employer; B. WHEREAS, � ("Auditor") has been retained by Employer for the purpose of performing an audit("Audit")of clinical services administered by CHLIC; WHEREAS, in the course of conducting the Audit, Auditor will come into possession of certain confidential and proprietary information relating to individuals who are recipients of CHLIC's services, medical providers who provide health services, and trade secrets of CHLIC (the "Information");and D. WHEREAS, the Auditor and the Employer recognize CHLIC's legitimate interests in maintaining the confidentiality of its Information, protecting its business reputation, avoiding unnecessary disruption of its service administration,and protecting itself from legal liability; NOW THEREFORE, IN CONSIDERATION of the premises and the mutual promises contained herein,CHLIC,the Employer and the Auditor hereby agree as follows: I. Audit Specifications The Auditor will specify to CHLIC in writing at least ninety (90) days prior to the commencement of the Audit the following"Audit Specifications": a. the name,title and professional qualifications of individual Auditors: b. the date(s), the length of time contemplated as necessary to complete the Audit, and clinical operations location, if any to be audited; or, if the Audit is to be performed virtually, the Internet Protocol (IP) address and physical location from the individual auditors will remotely access the records/information required for the purposes of the Audit; c. the Audit period: d. the Audit objectives; e. the scope of the Audit (time period, diagnosis, enrollee participation in programs and number of claims/calls); i. Standard number of cases/calls is as follows; Number of Subscribers #Cases #Calls # Days?' 5,000&under I 0 3 >5,000&<25,000 15 a I 08/04/2023 66 DocuSign Envelope ID 9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach >25,000&<75,000 20 5 1.5 >75,000 25 6 2 *Takes into consideration length of time to complete the standard;t cases and calls based on an one(1)year lookback scope period f. the process by which cases and calls will be selected for audit;and g. the records/information required by the Auditor for purposes of the Audit. 2. Review of Specifications CHLIC will have the right to review the Audit Specifications and to require any changes in,or conditions on, the Audit Specifications which are necessary to protect CHLIC's legal and business interests identified in paragraph D above.Any additional costs incurred by CHLIC to accommodate unusual audit specifications will be reimbursed as mutually agreed upon by the parties. 3. Access to Information For onsite Audits, CHLIC will make the Information called for in the Audit Specifications available to the Auditor at a mutually acceptable time and place. For virtual audits performed from a remote access point, CHLIC will make the Information called for in the Audit Specifications available to Auditor at a mutual acceptable time via connection to a secure service. Access is subject to CHLIC's verification that each individual auditor meets and complies with CHLIC's remote access standards and other security requirements. I. Audit Report The Auditor will provide CHLIC with a true copy of the Audit's findings,as well as the Audit Report, if any, that is submitted to the Employer. Such copies will be provided to CHLIC before the Audit findings and the Audit Report are submitted to the Employer to allow CHLIC the opportunity to review and respond to Audit findings and Report prior to Auditor sending finalized versions to Employer. 5. Comment on Audit Report CHLIC reserves the right to provide the Auditor and the Employer with its comments on the findings and,if applicable,the Audit Report. 6. Confidentiality The Auditor understands that CHLIC is permitting the Auditor to review the Information solely for purposes of the Audit. Accordingly, the Auditor will ensure that all Information will be kept confidential in accordance with all with all Applicable Laws, Privacy Addendum in Exhibit D, including but not limited to the HIPAA Privacy and Security Rules and 42 C.F.R. Part 2. Without limiting the generality of the foregoing, the Auditor specifically agrees to adhere to the following conditions: 08/04/2023 67 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement tier City of Miami Beach a. The Auditor shall not copy,print,photograph or otherwise duplicate or remove any of the Information without the express written consent of CHLIC; b. The Auditor shall not record any virtual session that includes Protected Health Information as defined in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA");and c. The Auditor shall not take any screenshots during any virtual session;and d. The Auditor agrees that its Audit Report or any other summary prepared in connection with the Audit shall contain no individually identifiable information. e. Notwithstanding anything to the contrary stated herein,it is understood and agreed by the parties that the Auditor may include and retain the statistical results of the Audit (performance measures expressed as percentages) in its comparative database for the purpose of comparing the results of the Audit with other audits performed by the Auditor. In no event will the results of the Audit included in the comparative database be used or disclosed in any way that identifies Cigna,Employer,or any individual;and f. Except with regard to Protected Health Information(solely with regard to(i)-(iv)below), this Agreement does not apply or restrict the Auditor from using or disclosing in formation: i. Which is or becomes public other than through a breach of this Agreement; ii. Already known to Auditor prior to the date of this Agreement and with respect to which the Auditor does not have an obligation of confidentiality; iii. Which is disclosed to the Auditor by a person or entity not party to this Agreement and who is entitled to disclose such information without breaching an obligation of confidentiality; iv. To Auditor's legal counsel, subject to the confidentiality obligations in this Agreement;or v. Required to be disclosed by law, whether under an order of a court. government tribunal or other legal process, except that if required by law, Auditor will disclose only the minimum information required to comply with legal mandate. 7. Restricted Use of the Audit Information With respect to persons other than the Employer, the Auditor will hold and treat information obtained from CHLIC during the Audit with the same degree and standard of confidentiality owed by the Auditor to its clients in accordance with all applicable legal and professional standards. The Auditor shall not, without the express written consent of CHLIC executed by an officer of CHLIC, disclose in any manner whatsoever, the results, conclusions, reports or information of whatever nature which it acquires or prepares in connection with the Audit to any party other than the Employer except as required by applicable law. The Employer and Auditor agree to indemnify and to hold harmless CHLIC for any and all claims,costs,expenses and damages which may result from any breaches of the Auditor's obligations under 08/04/2023 68 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach paragraphs 6 and 7 of this Agreement or from CHL.IC's provision of Information to the Auditor. The Employer authorizes CHLIC to provide to the designated Auditor the necessary Information to perform the audit in a manner consistent with all Health Insurance Portability and Accountability Act of 1996 (`•l-IIPAA"), Privacy Standards and in compliance with the signed Business Associate Agreement("BAA"). 8. Termination CHLIC may terminate this Agreement with prior written notice. The obligations set forth in Sections 4 through 7 shall survive termination of this Agreement. 08/04/2023 69 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Cigna Health and Life Insurance Company By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Employer: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: Auditor: By:TO BE SIGNED AT TIME OF AUDIT Duly Authorized Print Name: Title: Date: 08/04/2023 70 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach Exhibit D - Privacy Addendum ("Business Associate Agreement") I. GENERAL PROVISIONS Section 1. Effect. As of the Effective Date, the terms and provisions of this Addendum are incorporated in and shall supersede any conflicting or inconsistent terms and provisions of(as applicable) the Administrative Services Only Agreement and/or Flexible Spending Account or Reimbursement Accounts Administrative Services Agreement to which this Addendum is attached, including all exhibits or other attachments to, and all documents incorporated by reference in, any such applicable agreements (individually and collectively any such applicable agreements are referred to as the "Agreement"). This Addendum sets out terms and provisions relating to the use and disclosure of Protected Health Information ("PHI") without written authorization from the Individual. To the extent there is a conflict between the Agreement and this Addendum, this Addendum shall control. Section 2. Amendment to Comply with Law. CHLIC, on behalf of itself and its affiliates and subsidiaries that perform services under the Agreement (collectively referred to as "CHLIC"), Employer(also referred to as"Plan Sponsor"),and the group health plan that is the subject of the Agreement(also referred to as the"Plan")agree to amend this Addendum to the extent necessary to allow either the Plan or CHLIC to comply with applicable laws and regulations including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations(45 C.F.R.Parts 160 to 164)("HIPAA Privacy and Security Rules"). Section 3. Relationship of Parties. For purposes of this Addendum,the parties intend that CHLIC is an independent contractor and not an agent of the Plan or the Plan Sponsor. IL PERMITTED USES AND DISCLOSURES BY CHLIC Section 1.Uses and Disclosures Generally.Except as otherwise provided in this Addendum,CHLIC may use or disclose PHI to perform functions,activities or services for,or on behalf of,the Plan as specified in the Agreement, provided that such use or disclosure would not violate the HIPAA Privacy&Security Rules if done by the Plan.CHLIC shall not further use or disclose PHi other than as permitted or required by this Addendum,or as required by law. Section 2. To Carry Out Plan Obligations. To the extent CHLIC is to carry out one or more of the Plan's obligations under Subpart E of 45 C.F.R. Part 164, CHLIC agrees to comply with the requirements of Subpart E that apply to the Plan in the performance of such obligations. Section 3.Management and Administration. (A) CHLIC may use PHI for the proper management and administration of CEILIC or to carry out the legal responsibilities of CHLIC. (B) CHLIC may disclose PHI for the proper management and administration of CHLIC. provided that disclosures are:(a)required by law;or(b)CHLIC obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it is disclosed to the person,and the person notifies CHLIC of any instances of which it is aware in which the confidentiality of 08/04/2023 71 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach the information has been breached. (C) CHLIC may use or disclose PHI to provide Data Aggregation services relating to the Health Care Operations of the Plan, or to de-idcntify PHI. Once information is de-identified. this Addendum shall not apply. Section 4. Required or Permitted By_Law. CHLIC may use or disclose PHI as required by law or permitted by 45 C.F.R.§I64.512. III. OTHER OBLIGATIONS AND ACTIVITIES OF CHLIC Section I. Receiving Remuneration in Exchange for PHI Prohibited. CHLIC shall not directly or indirectly receive remuneration in exchange for any PHI of an Individual,unless an authorization is obtained from the Individual,in accordance with 45 C.F.R.§164.508,that specifies whether PHI can be exchanged for remuneration by the entity receiving PHI of that individual, unless otherwise permitted under the HiPAA Privacy Rule. Section 2. Limited Data Set or Minimum Necessary Standard and Determination. CHLIC shall, to the extent practicable, limit its use, disclosure or request of Individuals' PHI to the minimum necessary amount of individuals'PHI to accomplish the intended purpose of such use,disclosure or request and to perform its obligations under the underlying Agreement and this Addendum.CHi.IC' shall determine what constitutes the minimum necessary to accomplish the intended purpose of such disclosure. Section 3. Security Standards. CHLIC shall use appropriate safeguards and comply with Subpart C of 45 G.F.R. Part 164 with respect to Electronic PHi to prevent use or disclosure of PHI other than as provided for by the Agreement. Section 4. Protection of Electronic PHi.With respect to Electronic PHi,CHLIC shall: (A) Implement administrative,physical and technical safeguards that reasonably and appropriately protect the confidentiality,integrity and availability of the Electronic PHI that CHLIC creates, receives,maintains or transmits on behalf of the Plan as required by the Security Standards; (B) Ensure that any agent or subcontractor to whom CHLIC provides Electronic PHI agrees to implement reasonable and appropriate safeguards to protect such information. Section 5.Reporting of Violations.CHLIC shall report to the Plan any use or disclosure of PHI not provided for by this Addendum of which it becomes aware, including a Breach or Security Incident. CHLIC agrees to mitigate, to the extent practicable,any harmful effect from a use or disclosure of PHI in violation of this Addendum of'which it is aware. The parties agree that such reports are not required for trivial and routine incidents such as port scans, attempts to log-in with an invalid password or user name, denial of service attacks that do not result in a server being taken off-line, malware and pings or other similar types of events. Section 6. Breach Notification. CHLIC will notify the Plan of a Breach (including privacy related incidents that might, upon further investigation, be deemed to be a Breach) without unreasonable delay and, in any event, within thirty (30) business days after CHLIC's discovery of same. This notification will include,to the extent known: 08/04/2023 72 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach i. the names of the individuals whose PHi was involved in the Breach; ii. the circumstances surrounding the Breach; iii. the date of the Breach and the date of its discovery. iv. the information Breached; v. any steps the impacted individuals should take to protect themselves; vi. the steps CHLIC is taking to investigate the Breach, mitigate losses, and protect against future Breaches;and, vii. a contact person who can provide additional information about the Breach. For purposes of discovery and reporting of Breaches, CHLIC is not the agent of the Plan or the Employer(as`agent"is defined under common law).CHLIC will investigate Breaches,assess their impact under applicable state and federal law,and make a recommendation to the Plan as to whether notification is required pursuant to 45 C.F.R. §§164.404-408 and/or applicable state breach notification laws. With the Plan's prior approval,CHLIC will issue notices to such individuals,state and federal agencies -including the Department of Health and Human Services,and/or the media- as the Plan is required to notify pursuant to, and in accordance with the requirements of applicable law(including 45 C.F.R.§§164.404-408). In the event of a Breach affecting multiple CHLIC clients where CHLIC believes notification to affected individuals is required in accordance with applicable law, CHLIC reserves the right to issue notifications to the affected individuals without Plan approval. CHLIC will pay the costs of issuing notices required by law and other remediation and mitigation which,in CHLIC's discretion,are appropriate and necessary to address the Breach.CHLIC will not be required to issue notifications that are not mandated by applicable law.CHLIC shall provide the Plan with information necessary for the Plan to fulfill its obligation to report Breaches affecting fewer than 500 Individuals to the Secretary as required by 45 C.F.R.§164.408(c). Section 7. Disclosures to and Agreements with Third Parties. CHLIC agrees to ensure that any subcontractors that create, receive,maintain,or transmit PHI on behalf of CHLIC agree to the same restrictions,conditions and requirements that apply to CHLIC with respect to such information. Section 8.Access to PHI. CHLIC shall provide an individual with access to such Individual's PHI contained in a Designated Record Set in response to such Individual's request in the time and manner required in 45 C.F.R.§164.524. Section 9.Availability of PHI for Amendment. CHLIC shall respond to a request by an Individual for amendment to such Individual's PHI contained in a Designated Record Set in the time and manner required in 45 C.F.R.§164.526. Section 10. Right to Confidential Communications and to Request Restriction of Disclosures of PHt. CHLIC shall respond to a request by an Individual for confidential communications or to restrict the uses and disclosures of PHI contained in such Individual's Designated Record Set in the time and manner required by 45 C.F.R. §164.522. CHLIC shall not be obligated to agree to, or implement,any restriction,if such restriction would hinder Health Care Operations or the provision 08/04/2023 73 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach of the functions, activities or services, unless such restriction would otherwise be required by 45 C.F.R.§ 164.522(a). Section I I.Accounting of PHi Disclosures. CHLIC shall provide an accounting of disclosures of PHI to an individual who requests such accounting in the time and manner required in 45 C.F.R. §164.528. Section 12.Availability of Books and Records.CHLIC hereby agrees to make its internal practices, books and records relating to the use and disclosure of PHI received from,or created or received by CHLIC on behalf of the Plan, available to the Secretary for purposes of determining the Plan's compliance with the Privacy Rule. Section 13.Standard Transactions.CHLIC certifies that it conducts any applicable transactions that are subject to the HIPAA standard transaction rules (45 C.F.R. Parts 160-164) as required under such rules. IV. TERMINATION OF AGREEMENT WiTH CHLIC Section I. Termination Upon Breach of Provisions Applicable to PHI. Any other provision of the Agreement notwithstanding,the Agreement may be terminated by the Plan upon prior written notice to CHLIC in the event that CHi,IC materially breaches any obligation of this Addendum and fails to cure the breach within such reasonable time as the Plan may provide for in such notice. If CHLIC knows of a pattern of activity or practice of the Plan that constitutes a material breach or violation of the Plan's duties and obligations under this Addendum, CHLIC shall provide a reasonable period of time,as agreed upon by the parties.for the Plan to cure the material breach or violation. Provided, however, that,if the Plan does not cure the material breach or violation within such agreed upon time period,CHLIC may terminate the Agreement at the end of such period. Section 2. Use and Disclosure of PHI upon Termination. The parties hereto agree that it is not feasible for CHLIC to return or destroy PHI at termination of the Agreement; therefore, the protections of this Addendum for PHI shall survive termination of the Agreement,and CHLIC shall limit any further uses and disclosures of such PHi to the purpose or purposes which make the return or destruction of such PHI infeasible. V. OBLIGATIONS OF THE PLAN AND PLAN SPONSOR Section 1.Disclosures Generally. Except as otherwise provided for in this Addendum,the Plan will not request that CHLIC use or disclose PHI in any manner that would not be permissible under HIPAA. Section 2. Disclosures to the Plan or Third Parties. To the extent the Plan requests that CHLIC disclose PHI either to the Plan or to a third party business associate acting for the Plan, the Plan represents and warrants that: (A) It only will request PHI for the purposes of Treatment,Payment,or Health Care Operations,or another permitted purpose under the HIPAA Privacy Rule; (B) The information requested is the minimum necessary to achieve the purpose of the disclosure; 08/04/2023 74 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach and (C) If the PHI is to be disclosed to a third party, the Plan has a business associate agreement in place with the third party. Section 3. Disclosure to Plan Sponsor. To the extent the Plan requests that CHLIC disclose PHI to the Plan Sponsor,the Plan and Plan Sponsor each represent and warrant that: (A) The information only will be used for one of the following purposes: i. Plan Administration functions,as defined by the HIPAA Privacy Rule,and that the Plan Sponsor has executed the required plan amendment and certification allowing the disclosure,as set out in the HIPAA Privacy Rule; ii. Enrollment flnctions, provided the information to be disclosed is limited to enrollment and disenrollment information;or iii. To amend, modify, or terminate the Plan, or to obtain premium bids to provide health insurance coverage under the Plan,provided the information to be disclosed is limited to Summary Health Information,as defined in the HIPAA Privacy Rule;and (El) The information requested is the minimum necessary to achieve the purpose of the disclosure. VI. DEFINITIONS FOR USE IN THiS ADDENDUM Definitions. Certain capitalized terms used in this Addendum shall have the meanings ascribed to them by l-iiPAA including their respective implementing regulations and guidance. If the meaning of any term defined herein is changed by regulatory or legislative amendment,then this Addendum will be modified automatically to correspond to the amended definition. All capitalized terms used herein that are not otherwise defined have the meanings described in HIPAA. A reference in this Addendum to a section in the HIPAA Privacy Rule,or HIPAA Security Rule means the section then in effect,as amended. "Breach" means the unauthorized acquisition, access, use or disclosure of Unsecured Protected Health Information which compromises the security or privacy of such information,except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information. A Breach does not include any unintentional acquisition,access or use of PHI by an employee or individual acting under the authority of CHLIC if such acquisition,access or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual with CI•iLIC; any inadvertent disclosure from an individual who is otherwise authorized to access PHI at a facility operated by CHLIC to another similarly situated individual at the same facility; and such information is not further acquired, accessed,used or disclosed without authorization by any person. "Business Associate"means CHLIC. "Covered Entity"means the Plan. "Designated Record Set" shall have the same meaning as the term "designated record set" as set forth in the Privacy Rule, limited to the enrollment, payment, claims adjudication and case or 08/04/2023 75 DocuSign Envelope ID.9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach medical management record systems maintained by CHLIC for the Plan,or used,in whole or in part, by CHLIC or the Plan to make decisions about Individuals. "Effective Date". shall mean me earliest date by which CHLIC and the Plan must enter into a business associate agreement under 45 C.F.R.Part 164. "Electronic Protected Health Information" shall mean PHI that is transmitted by,or maintained in,electronic media as that term is defined in 45 C.F.R. §160.103. "Limited Data Set" shall have the same meaning as the term "limited data set" as set forth in 45 C.F.R. §164.514(e)(2). "Protected Health Information" or "PHI" shall have the same meaning as set forth at 45 C.F.R. §160.103. "Secretary" shall mean the Secretary of the United States Department of Health and Human Services. "Security Incident" shall have the same meaning as the term "security incident" as set forth in 45 C.F.R.§164.304. "Unsecured Protected Health Information" shall mean PHI that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by the Secretary in the guidance issued under Section 13402(h)(2) of the American Recovery and Reinvestment Act of 2009. 08/04/2023 76 DocuSign Envelope ID.9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach Exhibit E — Conditional Claim/Subrogation Recovery Services I. Plans Without CHLIC Stop Loss Coverage If Employer has not purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan: (A) All conditional claim payment and/or subrogation recoveries under the Plan will be handled by CHLIC unless CHLIC is otherwise notified by the Employer. (B) CHLIC and its subcontractors acting as Employer's recovery shall have the discretionary authority: i. To reduce recovery amounts by as much as fitly percent (50%) of the total amount of benefits paid on Employer's behalf, and to enter into binding settlement agreements for such amounts. Any modification to this percentage shall be communicated by Employer to CHLIC and will be effective upon Employer's next renewal date, unless otherwise agreed to by CHLIC. ii. In the event a settlement offer represents a reduction greater than the percentage identified above,CHLIC and its subcunitaetuta shall seek settlement advice from the Employer. iii. All amounts reimbursed to the Bank Account shall be refunded at the gross amount. CHLIC's and it subcontractors' subrogation administration fee on cases where CHLIC and its subcontractors' have retained counsel and in cases where no counsel has been retained by CHLIC and its subcontractors are both reflected in the Schedule of Financial Charges. (C) Except where agreed to by CHLIC and Employer,CHLIC and its subcontractors shall have no duty or obligation to represent Employer in any litigation or court proceeding involving any matter which is the subject of the Agreement, but shall make available to Employer and/or Employer's counsel such information relevant to such action or proceeding as CHLIC and its subcontractors may have as a result of its handling of any matter under the Agreement. (D) In the event Employer purchases individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan at any time during the life of the Agreement,the provisions of paragraph II.,below,shall control. I I. Plans with CHLIC Stop Loss Coverage If Employer has purchased individual or aggregate stop loss coverage from CHLIC or an affiliate with respect to its self-funded employee welfare benefit plan: A. CHLIC and its subcontractors shall have the right and responsibility to manage all conditional claim payment and/or subrogation recoveries under the Plan. CHLIC and its subcontractors shall reimburse to the Plan the recovery minus relevant individual and aggregate stop loss payments made by CHLIC. 08/04/2023 77 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of:Miami Beach B. All amounts reimbursed to the Bank Account shall be refunded at the gross amount. CHLIC's and its subcontractors' subrogation administration fee on cases where CHLIC and its subcontractors' have retained counsel and in cases where no counsel has been retained by CHLIC and its subcontractors,are both reflected in the Schedule of Financial Charges. C. CHLIC and its subcontractors shall have no duty or obligation to represent Employer in any litigation or court proceeding involving any matter which is the subject of the Agreement but shall make available to Employer and/or Employer's counsel such information relevant to such action or proceeding as CHLIC and its subcontractors may have as a result of its handling of any matter under the Agreement.Notwithstanding the foregoing,CHLIC and its subcontractors reserve to itself the right to retain counsel to represent CHLIC's own interests in any subrogation and/or conditional claim recovery action under the Plan. 08/04/2023 78 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Appendix A— Pharmacy Benefit Management Services PHARMACY BENEFIT MANAGEMENT-DEFINITIONS Definitions Any capitalized term not defined below shall have the meaning given to such term in the Agreement. Any capitalized term utilized in the Schedule of Financial Charges or Exhibit B shall have the meaning given to such term in the Agreement, including the meanings set forth below. • 340B Claim" means (i) Prescription Drug Claims submitted by 340B contracted pharmacies that adjudicate at a 340B price or are submitted with a submission clarification code of"20"or such equivalent codes for such Participating Pharmacies under the applicable NCPDP format (or any successor format); (ii) Prescription Drug Claims submitted by a 340B covered entity-owned or 340B contracted pharmacies which are categorized as Type 39 and/or 38(or such equivalent codes)in the NCPDP DataQ database or otherwise identified as a 340E Claim by the dispensing pharmacy; or(iii) Prescription Drug Claims identified as a 340B Claim by a third party administrator, and(iv) Prescription Drug Claims identified as a 340b Claim by a Pharmaceutical Manufacturer and in which PBM may reduce a subsequent Manufacturer Payment quarterly payment(or reconciliation payment, if applicable)to account for any previously-paid Manufacturer Payment amounts attributable to such claim. • "Actuarially Estimated" shall mean that the discount(s) listed in the Schedule of Financial Charges are estimated, but not guaranteed,to result in a particular average discount for Covered Drugs administered by CHLIC under this Agreement.Actuarially estimated discounts are calculated based on evaluation of an expected distribution of drug utilization across CHLIC's aggregate group client book of business. As measured in the aggregate for Employer's Pharmacy Benefit, Employer's average discount results may vary based on the Plan-specific factors such as drug mix utilization. • "Pharmacy Product Administrative Fee" means the service fee charged by PBM for providing pharmacy benefit management services to Client as described herein • "Affiliate" means any entity that directly, or indirectly, through one or more intermediaries, controls, or is controlled by,or is under common control with,PBM. For purposes of this definition,"control"means the possession,directly or indirectly,of the power to elect at least 50%of the governing board of such entity or to direct or cause the direction of,or play a significant role in,the management and policies of such entity, whether through ownership of voting securities, partnership or limited liability interests, nonprofit membership,contract or otherwise. "Authorized Generic"shall mean a pharmaceutical product sold,licensed,or marketed under a new drug application(NDA)approved by • the Food and Drug Administration(FDA)under section 505(c)of the Federal Food,Drug and Cosmetic Act(FFDCA)that is marketed, 08/04/2023 79 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach sold or distributed under a different labeler code,product code,trade name,trademark,or packaging(other than repackaging the listed drug for use in institutions)than the innovator brand name drug. • "Average Wholesale Price" or"AWP" shall mean the average wholesale price of a Covered Drug as established and reported by Medi- Span. The applied AWP of a Covered Drug shall be the AWP for the actual eleven (II) digit National Drug Code("NDC"), Covered Drug specific,quantity appropriate actual package size(or the manufacturer-packaged quantity closest to the dispensed size),submitted by a Retail Pharmacy, Home Delivery Pharmacy, or Specialty Pharmacy at the time that the Covered Drug is adjudicated. Notwithstanding any other provision in this Agreement, in the event of any major change in market conditions affecting the pharmaceutical or pharmacy benefit management market.including,for example.any change in the markup,methodologies,processes or algorithms underlying the published AWP(s), CHLIC may adjust any or all of the Rebates,charges, rates,discounts, guarantees and/or fees in connection with CHLIC's administration of the Pharmacy Benefit hereunder, including any that are based on AWP, as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such change, Additionally,and notwithstanding any other provision in this Agreement,CHLIC may replace AWP as its pharmaceutical pricing benchmark with an alternative benchmark and/or may replace Medi-Span,or other such publication,as its source for the AWP or alternative benchmark with a different pricing source, provided that CHLIC adjusts any or all such AWP-based charges or such alternative benchmark-based charges as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such replacement or immediately prior to the event(s)giving rise to such replacement,as the case may be. "Biosimilar"shall mean a biological product that is licensed by the FDA as a biosimilar pursuant to Section 351(k)of the Public Health • Service Act,42 U.S.C.262(k),based upon a showing that it is highly similar to a single FDA-licensed biological product,known as a reference product,and has no clinically meaningful differences compared to the reference product in terms of safety,purity,and potency. A biosimilar biological product may be licensed by the FDA as biosimilar or interchangeable,and in either case such biological product is a Biosimilar for the purposes of this Agreement. • "Brand Drug" shall mean a pharmaceutical product, including a Covered Drug that is a prescription drug, including over-the-counter drugs dispensed pursuant to a prescription, medicine,agent. substance,device, supply or other therapeutic product that is not a Generic Drug.Except if and where the language expressly states otherwise,a Brand Drug does not include a Specialty Brand Drug for ingredient cost discount purposes. • "Cigna Home Delivery Pharmacy" shall mean a duly licensed pharmacy operated by CHLIC or its affiliates, where prescriptions are filled and delivered via the mail service,which may include,for example. Accredo Health Group,Inc.,ESI Mail Pharmacy Service,Inc., Express Scripts Pharmacy Inc.. Express Scripts Specialty Distribution Services, Inc. and Lynnfield Drug, Inc. (dba Freedom Fertility Pharmacy). 08/04/2023 80 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach • "Claim,"for purposes of this Appendix A,is a claim or request for coverage under the Pharmacy Benefit. • "Compound Drug" shall mean a medication that(a)is comprised of two or more gaseous,solid,semi-solid,or liquid ingredients(other than water or flavoring added to any preparation)that are weighed or measured at a pharmacy and then prepared according to the prescriber's order and the pharmacist's art;(b)contains at least one FDA-approved federal legend drug as an active ingredient;(c)is not otherwise generally available in its compound form;and(d)is not a compound preparation administered by infusion or injection. • "Copayment"means"Cost Share","Copay","Coinsurance"."Deductible"or any other charge and/or any portion of the charge for each Prescription Drug Claim that is the responsibility of the Member to pay(e.g.copay,coinsurance,deductible,physician and member selection copay penalty,excess copay charges,ancillary fees,etc.).Copayment can be a defined dollar amount or percentage of eligible expenses. • "Covered Drugs" shall mean prescription drugs, including over-the-counter drugs dispensed pursuant to a prescription, biologics, medicines,agents,substances, devices,supplies, and other therapeutic products that are prescribed for Members and are covered under the Pharmacy Benefit and shall include all associated standard services usually and customarily rendered by a pharmacy or provider in the normal course of business, including dispensing,administration.counseling and product consultation. • "Dispensing Fee" means an amount paid to a pharmacy for providing professional services necessary to dispense a Covered Drug to a Member. • "FDA"shall mean the U.S.Food and Drug Administration. • "Formulary" shall mean the list of FDA-approved prescription drugs and supplies developed and managed by CHLIC across its self- funded and insured group book of business and that is selected and adopted by Employer. The drugs and supplies included on the Formulary will be modified by CHLIC from time to time as a result of factors including,but not limited to,economic and clinical factors like clinical appropriateness,manufacturer Rebate arrangements and pater t expirations.Any changes CHLIC makes to the Formulary are hereby adopted by Employer,subject to Employer's discretion to elect not to implement any such addition or deletion through the set-up process,any such election shall be considered an Employer change to the Formulary. • "Generic Drug"means a pharmaceutical product,including a Covered Dreg,whether identified by its chemical,proprietary,or non- proprietary name,that is accepted by the FDA as therapeutically equivalert and interchangeable with drugs having an identical amount of the same active ingredient(s),and which is identified as such in CHLIC's toaster drug file using indicators front First Datatrank,Medi- Span,or other nationally recognized source as used by CHLIC across its book of business on the basis of a proprietary algorithm,a summary of which may be made available for review by Employer or,subject to CHLIC's consent,its auditor upon request in accordance 08,104/2023 81 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach with the terms set forth in this Appendix A.Employer and,as applicable,i-s auditor shall sign a confidentiality agreement acceptable to CHLIC relating specifically to such summary.The reference to a drug by its chemical name does not necessarily mean that the product is recognized as a generic for adjudication,pricing or copay purposes. Except if and where the language expressly states otherwise,a Generic Drug does not include a Specialty Generic Drug for ingredient cost discount purposes.For pricing purposes,a Generic Drug includes a Covered Drug that is otherwise identified as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient(s)and is within its exclusivity period or other period of limited competition;provided that, notwithstanding the foregoing,a Generic Drug excludes an Authorized Generic identified as a brand name drug by the aforementioned proprietary algorithm used by CI-L1C.For pricing purposes.a Generic Drug also excludes a Biosimilar. "Generics under Exclusivity"means when a patent expires for a brand drug,OTC,or supplies the FDA may grant a period of exclusivity (lasting up to six months)to one company to make the generic form of the drug. During the exclusivity period,no other manufacturer can produce the generic "Gross Drug Cost"means the total discounted cost of the Prescription Drug Claim plus any applicable Dispensing Fee,sales tax or other tax applied. -House Generic"means a brand name drug that is dispensed as a generic drug with Member cost share and client ingredient cost applied at the generic drug rate. "Ingredient Cost"means the ingredient cost portion of the claim amount charged by CHLIC for a prescription drug. • "Limited Distribution Drug"or"Exclusive Distribution Drug"shall mean a Specialty Drug that is not generally available from most or all pharmacies but is restricted to select pharmacies as determined by a pharmaceutical manufacturer.The list of Limited Distribution Drugs and Exclusive Distribution Drugs will be maintained by CHLIC. `"Limited Supply Generic"means a generic Covered Product not available in sufficient supply in the marketplace due to limited product supply and/or not available from a sufficient number of manufacturers in the marketplace. • "Maximum Allowable Charge"shall mean the maximum unit price for a Covered Drug included on the applicable MAC List as set forth on such MAC List. • "MAC List" shall mean a then-current list maintained by CHLIC of prescription drugs, devices, supplies and over-the-counter drugs identified as readily available as a Generic Drugor generally equivalent to a Brand Drug(in which case it may also be on a MAC List) 08/04/2023 82 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement Tor City of Miami Beach and that, in each case, are deemed to require or are otherwise capable of pricing management due to the number of manufacturers, utilization and/or pricing volatility. "Manufacturer Administrative Fees"shall mean administrative fees paid by pharmaceutical manufacturers to CHLIC or its affiliate or • subcontractor directly in connection with administering,invoicing,allocating and collecting Rebates. "Multi-source Generics" are those generic Covered Products which are manufactured, produced and/or distributed by more than I manufacturer. "Net Ingredient Cost"means the Total Ingredient Cost of the Prescription Drug Claim less Copayment. "New to Market Specialty Drugs"are those Specialty medications, Biosimilar medications, Specialty Authorized Products, Specialty Authorized Generics,or Specialty Authorized Alternatives that are within 6 months or less of the product launch date. "Over the Counter"or"OTC"claim means any non-federal legend drug or product that can be purchased or sold without a prescription. "Patent Litigated Generics"means a generic Covered Product that is under patent litigation as a result of a generic manufacturer challenging a patent is invalid or is not violated by the production of the generic version of the drug. • "Pharmacy Benefits" shall mean amounts payable for covered pharmacy benefit services and products under the terms of the Plan; Pharmacy Benefits shall be considered Plan Benefits for purposes of this Agreement. "Pharmacy Submitted Cost" means the full non-PBM negotiated cost submitted by the dispensing pharmacy to the PBM in the "Ingredient Cost Submitted"field of the most recent version of the NCDPD file layout. "Prescription Drug Claim" means a claim submitted by a Member or pharmacy, whether submitted electronically or manually, for payment for a Covered Product." • "P&T Committee" shall mean a committee comprised of clinicians that represent a range of clinical specialties.The committee regularly reviews pharmaceutical products. new pharmaceutical products, for safety and efficacy,the findings of which clinical reviews inform coverage status decisions made by CHLIC. The P&T Committee's review may be based on consideration of, without limitation, FDA- approved labeling,standard medical reference compendia,or scientific studies published in peer-reviewed English-ianguage bio-medical journals. • "PBM Proprietary Information" shall mean information relating to CHLIC's pharmacy benefit management products and services, including, without limitation, CHLIC's reporting and web-based applications, eligibility and adjudication systems and coding • 08/0412023 83 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach methodologies, system formats and databanks, clinical or formulary management operations or programs, information and agreements relating to Rebates and other financial information,prescription drug evaluation criteria and coverage policies,drug pricing information, including MAC List and Specialty Drug pricing, paid Claims infornation integrated into CHLIC's adjudication systems, and pharmaceutical manufacturer,vendor or pharmacy network agreements. • "Prescription Drug Charge" shall mean the amount that, prior to application of the Plan's cost-share requirement(s), Employer is obligated to pay for a Covered Drug dispensed at a Retail Pharmacy or Cigna Home Delivery Pharmacy,including any ingredient cost, applicable Dispensing Fee,service fee,and tax. The ingredient cost charged to Employer may be expressed as,for example,a discount off of AWP or other benchmark price,or a MAC. • "Rebate" shall mean retrospective formulary rebates received by CHLIC pursuant to the terms of a formulary rebate contract negotiated independently and directly attributable to or arising from the utilization by Members of certain Covered Drugs manufactured, sold, marketed.or distributed by a manufacturer. However, "Rebates" shall exclude: (i) pricing adjustments, payments and credits made in the ordinary course by any manufacturer on account of product returns, delivery errors or shipping damage or losses arising from drugs and other products purchased from such manufacturer by or on behalf of CHLIC(ii)pricing discounts paid or credited by a manufacturer to pharmacies affiliated with CHL1C for prescription drugs and other products purchased from such manufacturer;(iii)any fees or other compensation paid by any manufacturer in consideration of any services,products, activities or programs performed, provided or implemented by CHLIC or any of its affiliates for such manufacturer; (iv) Manufacturer Administrative Fees; (v) Value-Based Payments; (vi) any rebates or other amounts that are allocated to reduce and/or partially or wholly satisfy a Member's cost-sharing obligation for a Covered Drug; and(vii) rebates or other amounts paid to CHLIC for prescription drugs that are administered or otherwise provided to Members in providers'offices,home health care settings,or outpatient clinics. • "Retail Pharmacy"shall mean any licensed retail pharmacy with which CHLIC has contracted directly or indirectly with a third party,to provide Covered Drugs to Members, and is not a mail order pharmacy_ A mail order pharmacy is a pharmacy that primarily tills and delivers pharmaceutical products via the mail service. The term "Retail"_ when immediately preceding the term "Brand Drug Claim", "Generic Drug Claim", "Specialty Drug Claim", "Specialty Brand Drug Claim", or "Specialty Generic Drug Claim" means that the resulting term(e.g.,"Retail Brand Drug Claim'')refers to such claim as dispensed by a Retail Pharmacy. • "Specialty Drug"shall mean a pharmaceutical product.including a Covered Drug,considered by CHLIC to be a Specialty Drug based on consideration of the following factors: (i) whether the pharmaceutical product is prescribed and used for the treatment of a complex, chronic or rare condition; (ii) whether the pharmaceutical product has a high acquisition cost; and, (iii) whether the pharmaceutical product is subject to limited or restricted distribution, requires special handling and/or requires enhanced patient education, provider coordination or clinical oversight.A Specialty Drug may not possess all or most of the foregoing characteristics,and the presence of any O8/04/2023 84 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach one such characteristic does not guarantee that a pharmaceutical product will be considered a Specialty Drug.The term"Specialty,"when immediately preceding the terms"Generic Drug"or"Brand Drug",means that the resulting term(e.g."Specialty Generic Drug")refers to a Generic Drug or Brand Drug that is considered a Specialty Drug,respectively. • "Specialty Pharmacy" shall mean a duly licensed pharmacy designated by or operated by CHLIC or its affiliates that primarily dispenses Specialty Drugs or provides services related thereto; provided, however, that when the Cigna Home Delivery Pharmacy dispenses a Specialty Drug,it shall be considered a Specialty Pharmacy hereunder. "Total Ingredient Cost"means the total discounted cost of the Prescription Drug Claim for any Covered Product excluding Dispensing Fees,ancillary fees,Administrative Fees,sales tax or Rebates and prior to the application of any Copayment. • "U&C Charge" shall mean the price the applicable Retail Pharmacy would charge a regular cash-paying customer for a Covered Drug (and any services related to the dispensing thereof)on the day on which the Covered Drug is dispensed. "Zero Balance Due"or"ZBD"claim means any claim where the Member pays the total amount of the Gross Drug Cost of a claim and the amount of the Gross Drug Cost paid by the plan is zero. PHARMACY BENEFIT MANAGEMENT-SERVICES TO BE PROVIDED 1. Retail Pharmacy Network. (a) General. CHLIC shall maintain a Retail 30 Pharmacy network that contains at least 65,000 pharmacies and includes all chain pharmacies and a Retail 90 Pharmacy Network that contains more than 31,000 pharmacies, that includes chain pharmacies, independents,big-box and/or grocery stores.Retail Pharmacies included in the network shall provide Covered Drugs to which the Retail Pharmacies have access to Members during their normal business hours, A list of the Retail Pharmacies included in the network, as updated from time to time,shall be made available to Members online. CHLIC maintains multiple networks and/or sub-networks and may periodically consolidate networks and/or migrate clients,including Employer,between networks and sub- networks. CHLIC shall require each Retail Pharmacy included in the network to meet its requirements for participation in the Retail Pharmacy network, which include, but are not limited to, satisfaction of licensing and insurance requirements. Should CHLIC make a change in the number of participating pharmacies in the retail pharmacy network servicing Employer under this Agreement and such changeresults in more than a 5%reduction in the number of pharmacies participating in the retail pharmacy network and impacts Members access to retail network pharmacies either before Effective Date or during the term of this Agreement,CHLIC agrees to provide notification to Employer which will include an analysis that includes anticipated member 08/04/2023 85 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach disruption,current GEOAccess or similar report and CHLIC agrees to renegotiate a revised financial proposal in good faith. (b) Retail Pharmacy Audits and Overpayments. CHLIC shall review 100% of all claims, with each claim to be reviewed by either desk audit or field audit as determined through the use of random risk based predictive model to ensure that each Retail Pharmacy is complying with the terms of its contract with CHLIC. In the event that CHLIC discovers that an overpayment has been made to a Retail Pharmacy,CHLIC shall take reasonable steps to recover the overpayment pursuant to the terms of this Agreement. (c) Independent Contractors.The Retail Pharmacies are independent contractors,and as such CHLIC does not direct or exercise any control over the pharmacists at Retail Pharmacies or the professional judgement exercised by any pharmacies in the dispensing or filling of prescriptions or performing other pharmaceutical services. Neither CHLIC nor any CHLIC affiliate shall have any liability to Employer, any Member or any other person or entity for any act or omission of any Retail Pharmacy or it agents or employees. (d) Collection of Cost Sharing.CHLIC shall require Retail Pharmacies to collect all applicable Plan cost-shares from Members 2. Cigna Home Delivery Pharmacy. (a) General. Members may submit new or refill prescription orders for fulfillment through Cigna Home Delivery Pharmacy or such other mail service pharmacy that CHLIC in its sole discretion may select from time to time. Such orders may be placed via mail, telephone, or electronic means. Subject to Applicable Law, Employer shall permit communication with Members regarding the availability and use of the Cigna Home Delivery Pharmacy,and potential cost savings associated therewith,and the provision of supporting services (e.g, pharmacist consultation) in connection with any prescription dispensed by the Cigna Home Delivery Pharmacy.Cigna Home Delivery Pharmacy shall deliver all drugs to Members in accordance with its standard procedures.For the purposes of clarity,CHLIC does not exert direction or control over the pharmacists at Cigna Home Delivery Pharmacy in filling prescriptions or performing other pharmaceutical services. (b) Cost Sharing. Members are responsible for the payment of the applicable cost sharing to Cigna Home Delivery Pharmacy for each prescription or prescription refill. Employer acknowledges that Cigna Home Delivery Pharmacy may suspend services to a Member who is in default of any cost-sharing obligations, in accordance with Cigna Home Delivery Pharmacy's standard credit policy. If payment of such cost-sharing has not been received from the Member within one hundred twenty (120) days of dispensing of the product, the Plan will be billed for the outstanding amount following the one hundred twenty (120) day collection period. (b) Affiliation with CHLIC. Accredo Health Group, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy lac.,Express Scripts Specialty Distribution Services, Inc_ and Lynnfield Drug, Inc, (dba Freedom Fertility Pharmacy)are licensed pharmacy 08/04/2023 86 DocuSign Envelope ID 9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach affiliates of CHLIC that fill and deliver Covered Drugs via the mal service. 3. Claims Processing. (a) General. CHLIC, in accordance with Section 2 of the Agreement, shall perform claims processing services for Covered Drugs dispensed by Retail Pharmacies or Cigna Home Delivery Pharmacy. In-network Claims shall be submitted via paper or electronically.Members using out-of-network covered services are required to submit a paper claim form.A separate charge may apply for the submission of any paper claim form, whether in-network or out-of-network. CHLIC is not required to provide coordination of benefits(COB)services for Claims for drugs dispensed,and electronically processed,at a pharmacy;Claims may be processed without consideration of a Member's coverage under another plan. (b) Drug Utilization Review. CHLIC shall perform a concurrent Drug Utilization Review ("DUR") analysis of each prescription submitted for processing. Such DUR Analysis may include, for example:(1)prescribed dosage within a safe range;(2)drug-to- drug interaction;(3)drug-to-allergy interaction;(4)age-to-drug interaction;(5)duplicate therapy;(6)quantity limitations;and(7) days' supply. DUR processes shall not override the prescriber's. the pharmacist's or other health care provider's professional judgment. 4. Utilization Management Program. CHLIC shall, in accordance with Section 2 of the Agreement administer the Pharmacy Benefit utilization management program(s) identified in this Agreement. Employer acknowledges that CHLIC's coverage policies and claims administration procedures, which are utilized across CHLIC's self-funded and insured book-of-business to adjudicate claims and administer appeals, may change periodically. As an example of the coverage criteria that may apply to a pharmaceutical product, a Member may have to try one or more preferred pharmaceutical products, or demonstrate why trying the preferred pharmaceutical product(s) would be clinically inappropriate, in order to obtain coverage under the Plan for a given pharmaceutical product Employer further authorizes CHLIC to allow coverage for a use that would otherwise be excluded in the event of co-morbidities,complications and other factors not expressly addressed by the coverage policies utilized by CHLIC in reviewing Claims for coverage. CHLIC may rely wholly upon information about the Member and the prescriber's diagnosis of the Member's condition. CHLIC shall not substitute its judgment for the judgment of the prescribing physician,nor shall it determine medical necessity or make other medical determinations other than for coverage purposes. S. Rebate Management.CHLIC shall pay Employer amounts equal to the Rebate amounts specified in the Schedule of Financial Charges. 6. Drug-Related Ser%ices. 1 Specialty Drugs.CHLIC shall process Claims regarding Specialty Drugs subject to the following provisions: 08/04/202 X7 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach (I) The Specialty Pharmacy shall fill prescriptions for Specialty Drugs based on the professional judgment of the dispensing pharmacist.accepted pharmacy practices and product guidelines. (2) A list of Specialty Drugs available via the Specialty Pharmacy and the pricing for those Specialty Drugs shall be made available as in effect on the Effective Date, as set forth in Appendix B. After the Effective Date, Employer may request that CHLIC provide it with an updated list of Specialty Drugs available via the Specialty Pharmacy and the pricing with respect thereto. (3) To the extent acting in the capacity as a mail order pharmacy, the Specialty Pharmacy shall ship Specialty Drugs to Members in accordance with its standard procedures. (4) Members are responsible for the payment of the applicable cost sharing to the Specialty Pharmacy for each prescription or prescription refill. Employer acknowledges that the Specialty Pharmacy may suspend services to a Member who is in default of any cost-sharing obligations,in accordance with the Specialty Pharmacy's standard credit policy. If payment has not been received from the Member within one hundred twenty(120)days of dispensing,the Plan will be billed following the one hundred twenty(120)day collection period. (5) For the purposes of clarity, CHLIC does not exert direction or control over the pharmacists at the Specialty Pharmacy in filling prescriptions or performing other pharmaceutical services. (h) Compound Drugs. CHLIC shall process prescribed Compound Drugs to the extent covered under the Plan.CHLIC shall treat as Covered Drugs only those components of a Compound Drug that would otherwise be treated as Covered Drugs were they not part of a Compound Drug. (c) Discount Card Program. In order to help reduce Member pharmacy costs,CHLIC may partner and apply pharmacy discount card program market pricing where available for certain Generic Drugs. As such, certain, eligible claims may be processed by a pharmacy discount card provider when there is price favorability to the Member. Such claims will adjudicate at the pharmacy discount card market price as a cash claim. Claims will adjudicate in accordance with Employer's Plan design and clinical rules, and Member paid amounts may be applied toward deductible and out of pocket accumulator amounts unless Employer opts out of program enrollment. Claims processed under the program will be included in Rebate and pharmacy financial guarantees,where such guarantees apply. Member direct claims are excluded from the program. Program terms and conditions are subject to change upon no less than forty-five(45)days' prior notice. 7. Member Communications and Services. 08/04/2023 88 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach (a) Member Communication, CHLIC shall provide to Members an ID card and instructions to access Member materials online, including the Formulary, the Retail Pharmacy directory, Cigna :-tome Delivery Pharmacy information, and an out-of-network Claim reimbursement form. (b) Rx Savings Messenger. CHLIC may send personalized mailings to Members regarding the Generic Drugs and preferred Brand Drugs and savings available from Cigna Home Delivery Pharmacy. (c) Call Center. CHLIC shall maintain toll-free customer service lines twenty-four(24) hours per day, seven(7)days per week for the purpose of responding to inquiries from Members regarding Retail Pharmacy, Cigna Home Delivery Pharmacy or Claims issues. 8. Formulary Management:Clinical Programs;Other Services. CHLIC shall provide Formulary management services, which shall include implementing Formulary placement decisions and determinations to apply utilization management requirements made by CHLIC. CHLIC makes Formulary determinations based on consideration of clinical and economic factors. Clinical factors may include, but are not limited to, the CHLIC P&T Committee's evaluation of the place in therapy, relative safety or relative efficacy of the drug, as well as whether certain supply limits or other utilization management requirements should apply. Economic factors may include, but are not limited to, the drug's acquisition cost including,but not limited to, assessments on the cost effectiveness of the drug and available Rebates. Employer acknowledges that the Formulary, utilization management requirements, and coverage policies used by CHLIC to perform coverage reviews, including any changes made thereto, are adopted by Employer. When considering a drug for Formulary placement or other coverage conditions, CHLIC reviews clinical and economic factors regarding enrollees as a general population across its relevant book-of-business. CHLIC may also provide the clinical, safety and/or trend programs, or other programs and services to Employer, some of which may require payment of additional fees by Employer. If additional fees are required for such a program or service,CHLIC shall include the fee in the Schedule of Financial Charges or otherwise communicate the same in writing to by Employer. PHARMACY BENEFIT MANAGEMENT-PROGRAM OPERATIONS 1. Implementation of Agreement (a) Project Plan.Employer and CHLIC shall develop an agreed upon implementation project plan with respect to the Agreement prior to the Effective Date or prior to the implementation with respect to any new Pharmacy Benefit under this Agreement following the Effective Date. (b) Initial Data and Commencement of Pharmacy Benefit Management Services.Prior to the Effective Date,Employer shall provide CHLIC with all data and/or documentation necessary for CHLIC to provide the services specified in this Agreement. Such data and/or documentation shall include, but is not necessarily limited to, claims history and Member prior authorization history. 08/04/2023 89 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Assuming all data specified in the preceding sentence is received sufficiently in advance of the Effective Date, CHLIC shall commence providing services under this Agreement as of the Effective Date. 2. Timely Provision of Data by Employer. Employer acknowledges that CHLIC shall not be held responsible for,and shall be released from, fulfilling any obligation or performing any service under this Agreement if Employer or its designee dues not provide accurate information in a timely manner. 3. Reporting.CHLIC shall make available to Employer CHLIC's standard r_porting applications,subject to Applicable Law and Exhibit D, including,without limitation,H1PAA and state privacy laws. 4. Claims Data. (a) Retention. CHLIC shall retain data with respect to Claims for at least ten (10) years from the date the prescription is filled. Following the close of such retention period, CHLIC shall retain and dispose of such Claims data pursuant to its then-current standard policies and procedures,Applicable Law and the Business Associate Agreement described in the Agreement. (b) Disclosure to Vendor. Upon Employer's written request and subject to execution of a non-disclosure agreement acceptable to CHLIC,CHLIC shall provide prescription Claims data in its standard format to a vendor contracted with Employer and otherwise acceptable to CHLIC solely for the purposes of such vendor's support of Plan administration functions. Employer agrees that its vendors may not utilize Claims data for any other purpose, including, without limitation, developing products and services, analyzing the Claims data against market benchmarks or CHLIC competitors or adding to a normative database (even if de- identified and/or blinded as to Member and PBM/carrier) for the Employer's or vendor's commercial use. Employer shall be responsible for any use or disclosure of Claims data,or any services provided,by the vendor.Notwithstanding the foregoing,all audits of any pricing guarantees,Rebate-sharing obligations or Claims processing accuracy shall be conducted in accordance with the terms in this Agreement specifically relating to such audits. (c) De-Identified Data. During and after the term of this Agreement,CHLIC may use Claims,drug,and medical data that has been de-identified in accordance with HIPAA for research,provider evaluation,database maintenance,and other commercial purposes. This provision shall survive termination or expiration of the Agreement. 5. Pharmacy Claims Processine Audits. (a) Employer may,to the extent specified below and at no additional charge,conduct a claims processing audit of CHLIC's administration of Plan Benefits,once every Plan Year provided that the Agreement has been duly executed by Employer and 08/04/2023 90 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Employer is current in the payment of all pharmacy claims under the Agreement.New audits shall not be initiated until all parties have agreed that any and all prior pharmacy-related audits are closed.In order to balance the need to adequately support the audit process for all CHLIC clients,with an efficient allocation of resources,employers who choose to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Claims processing audits shall be subject to the following conditions:(I)the audit may take place while the Agreement is in effect or within one(I)year after the termination or expiration of the Agreement;(2)the initial audit period for a retrospective claims audit shall not exceed the twenty-four(24)months period immediately preceding CHLIC's receipt of the request to audit; (3)Employer shall be responsible for its incurred costs regarding the audit;(4)Employer shall designate,with CHLIC's consent, such consent not to be unreasonably withheld,an independent.third party auditor to conduct the audit(the"Auditor")so long as such Auditor is not engaged in providing services for Employer(including,but not limited to the Auditor's engagement as an expert witness in litigation against CHLIC or its affiliates),or otherwise,that conflict with the scope or independent nature of the audit(as determined by CHLIC acting reasonably and in good faith),and provided that Employer's Auditor executes a mutually acceptable confidentiality agreement:(5)Employer shall provide to CHLIC at least thirty(30)days prior written notice of its intent to audit,and any request by Employer to permit an Auditor.o perform an audit will constitute Employer's direction and authorization to CHLIC to disclose PHI to the Auditor;(6)CHLIC will provide all data as reasonably necessary for Auditor to perform the claims processing audit within thirty(30)days following the latter of the audit kick-off call and the Audit Agreement being fully executed or,when applicable,as otherwise agreed upon by the Parties;(7)following Auditor's initial review of the claims,Auditor will provide CHLIC in writing with all suspected categories of claim errors,if any,together with an electronic data file,in a mutually agreed upon format,containing up to three-hundred(300)claims,so that CHLIC may evaluate and investigate Auditor's suspected errors;(8)CHLIC will respond to the suspected errors within sixty(60)days from CHL1C's receipt of such written findings;(9)upon receipt and review of CHLIC's responses,Auditor will provide CHLIC with a written report of Auditors findings and recommendations before or at the same time such audit report is provided to Employer;(10) CHLIC will respond to the audit report within thirty(30)days of the issuance of Auditor's report;(I I)once both Parties have accepted the audit results,the audit shall be considered closed and final;(12)to the extent the mutually accepted audit results demonstrate claims errors,CHLIC will reprocess the claims and make corresponding adjustments to Employer;(13)CHLIC's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer and/or its Auditor and CHLIC,including but not limited to no new or additional issues that appear in the final report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. 6. Pharmacy Rebate Audits 08/04/2023 91 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach (a) Employer may,to the extent specified below,in accordance with the following requirements,and at no additional charge,audit CHLIC's payment of Rebates provided that the Agreement has been duly executed by Employer and Employer is current in the payment of all pharmacy claims under the Agreement. Any Rebate audit shall occur following CHLIC's issuance of the annual financial reconciliation to Employer once in each twelve(12)month period. New audits shall not be initiated until all parties have agreed that all prior pharmacy-related audits are closed. In order to balance the need to adequately support the audit process for all Cl ILIC clients,with an efficient allocation of resources,employers who desire to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Rebate audits shall be subject to the following conditions:(I)Employer and CHLIC shall agree on a mutually acceptable, independent,third-party auditor to conduct the audit,including the individual(s)employed or contracted to perform the audit to ensure that they shall not have a conflict of interest that could reasonably diminish their impartiality(the"Auditor");(2) Employer shall be responsible for its incurred costs regarding the audit;(3)Employer shall provide CHLIC with at least forty-five (45)days prior written notice of its intent to audit;(4)a mutually agreed upon nondisclosure/nonuse agreement for rebate audits shall be executed by Employer,the Auditor and CHLIC:(5)the scope of records to be audited as being necessary to determine CHLIC's compliance with its contractual Rebate payment obligations under the Agreement shall be as mutually agreed upon by the Auditor and CHLIC;(6)the Auditor may select for audit purposes the records of up to five(5)manufacturers for two(2) calendar quarters from the last reconciled plan year immediately preceding the written request to audit;(7)the audit shall be conducted at a mutually acceptable time during regular business hours at CHLIC's offices where such records are located;(8) records shall not be removed or photocopied without CHLIC's express written consent;(9)for the sole purpose of confirming compliance with the audit Confidentiality Agreement,Auditor will first submit in draft to CI ILIC,and prior to submission to Employer,its Rebate audit report,so that CHLIC can confirm that no terms of the applicable rebate agreements which are confidential,are disclosed in the audit report;(10)the Auditor shall provide its final audit report to CHLIC and Employer at the same time;and(I I)the Auditor may disclose the aggregate amount of Rebates due Employer but no other details of CHLIC's rebate contracts of which the Auditor is apprised,if any. This provision shall survive termination or expiration of the Agreement. 7. Pharmacy Financial Guarantee Reconciliation Audits. (a) Employer may, to the extent specified below and at no additional charge, conduct a Financial Guarantee Reconciliation audit once every Plan Year following CHLIC's issuance of the annual financial reconciliation to Employer, provided that the Agreement has been duly executed by Employer and Employer is current in the payment of all pharmacy claims under the Agreement. New audits shall not be initiated until all parties have agreed that all prior pharmacy-related audits are closed. In order to balance the need to adequately support the audit Process for all CHLIC clients,with an efficient allocation of resources, 08/04/2023 92 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach employers who choose to audit one or more components of the pharmacy arrangement must do so through a single annual audit. (b) Financial Guarantee audits shall be subject to the following cond_tions: (1)the audit may take place while the Agreement is in effect or within one (l) year after the termination or expiration of the Agreement; (2) such audit may cover up to two prior contract years to the extent such prior contract years have not previously been audited; (3)Employer shall be responsible for its incurred costs regarding the audit; (4) Employer shall designate with CHLIC's consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit(the "Auditor") so long as such Auditor is not engaged in providing services for Employer(including, but not limited to the Auditor's engagement as an expert witness in litigation against CHLIC or its afliates),or otherwise,that conflict with the scope or independent nature of the audit(as determined by CHLIC acting reasonably and in good faith), and provided that Employer's Auditor executes a mutually acceptable confidentiality agreement;(5)Employer shall provide CHLIC with at least thirty(30)days'prior written request for the audit,and any request by Employer to permit an Auditor to perform an audit will constitute Employer's direction and authorization to CHLiC to disclose PHI to the Auditor;(6)CHLIC will provide all data as reasonably necessary for Auditor to determine that CHLIC has performed in accordance with its contractual obligations regarding the financial guarantees,and CHLIC wilt provide such data within thirty (30)days following the latter of the audit kick-off call and the confidentiality agreement being fully executed or,when applicable, as otherwise agreed upon by the Parties; (7) any adjustments resulting from the audit will be based upon the actual Claims reviewed and not upon statistical projections or extrapolations, as the Auditor will be furnished with 100%of the paid Claims processed during the applicable contract period for purposes of the audit; (8)following Auditor's initial review and prior to the submission of its written audit report, the Auditor will provide CHLIC in writing with all of the suspected errors, if any, and CHLIC will respond to such suspected errors within sixty (60) days from CHLIC's receipt of such preliminary findings; (9) CHLIC will respond to any audit report issued by the Auditor within thirty(30)days of the issuance of same; and(10)CHLIC will reconcile mutually agreed upon amounts due to Employer within a reasonable period of time following mutual agreement regarding any amount due to the Employer.CHL1C's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer and/or its Auditor and CHLIC, including but not limited to no new or additional issues that appear in the final report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-FUNDING AND PAYMENT OF CLAIMS;CHARGES I. Fnndine and Payment of Claims.With respect to Pharmacy Benefits,(1)CHLIC may withdraw funds from the Bank Account for the purposes specified in Section 3 of the Agreement five times per month, and (2) any recovered overpayments shall be credited to Employer via a line item on its invoice,less the fee set forth on the Schedule of Financial Charges. 08/04/2023 93 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach 2. Retroactive Member Changes and Terminations.Notwithstanding anything in the Agreement to the contrary, Employer shall remain responsible for all charges and Bank Account Payments incurred or charged through the date CHLIC processed Employer's notice of a retroactive change or termination of a Member's enrollment in the Plan.Notwithstanding anything to the contrary in Section 4.c.of the Agreement,with respect to Pharmacy Benefits,CHLIC generally will implement eligibility updates received from Employer that adhere to CHLIC's standard electronic format as soon as reasonably practicable following receipt of such updates. PHARMACY BENEFIT MANAGEMENT-FIDUCIARY ACKNOWLEDGMENTS CHLIC offers pharmacy benefit management services for consideration by Employer and other entities.The general parameters of such services and the supporting systems have been developed by CHLIC as part of CHLIC's administration of its general business as a pharmacy benefit manager for entities that sponsor group health plans. The Parties have negotiated the terms of this Agreement in an arm's-length fashion. Except to the extent CHLIC conducts the final level of internal appeal as set forth in Section 2.c of the Agreement,the Parties assert that neither Party intends that CHLIC shall be a fiduciary with respect to Pharmacy Benefits for either ERISA (if applicable) or state law purposes, and neither Party shall name CHLIC or any of its affiliates as a"plan fiduciary"with respect to its management of Pharmacy Benefits. Employer acknowledges and agrees that CHLIC(i)dues not have discretionary authority or control respecting management of the Pharmacy Benefits,and (ii)does not exercise any authority or control respecting management or disposition of the assets relating to Pharmacy Benefits or of Employer. Rather, Employer retains all such authority and control. The Parties agree that,upon reasonable notice,CHLIC shall have the right to terminate its Pharmacy Benefit services under this Agreement to any Plan and/or Members located in a state that requires a pharmacy benefit manager to be a fiduciary to Employer,the Plan or a Member. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-FINANCIAL ARRANGEMENTS 1. General.CHLIC contracts with its PBM affiliate for the provision of pharmacy benefit services and financial arrangements. As such, CHLIC or its PBM affiliate, directly or indirectly contract on their own accounts with Retail Pharmacies and Cigna Home Delivery Pharmacy to dispense covered pharmaceutical products to Employer's Members,and not on behalf of,or for the benefit of,Employer or the Plan; accordingly, any discounts or other remuneration CHLIC or its PBM affiliate earns under an arrangement with a Retail Pharmacy or Cigna Home Delivery Pharmacy are obtained for, and inure to, the sole and exclusive benefit of CHLIC or its PBM affiliate,and not the Employer or the Plan.Amounts paid by CHLIC or its PBM affiliate or by the PBM affiliate for Retail Pharmacy or Cigna Home Delivery Pharmacy for Brand Drug, Generic Drug, or Specialty Drug Claims may or may not be equal to the amount charged to Employer and/or Member. If the amount paid by Employer and/or Member does not equal the amount paid by CHLIC or its PBM affiliate or by the PBM affiliate to a particular pharmacy, CHLIC and its PBM affiliate will absorb or retain such difference. CHLIC may directly or indirectly contract for Rebates,Manufacturer Administrative Fees,and other remuneration on its own behalf and for its own benefit,and not on behalf of Employer or the Plan. As an example of other remuneration other than Rebates or Manufacturer Administrative Fees that CHLIC may earn,CHLIC may also directly or indirectly earn from pharmaceutical manufacturers remuneration 08/04/2023 94 DocuSign Envelope ID.9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach in connection with value payments and/or services that CHLIC provide to Employer ("Value-Based Payments"). Notwithstanding anything in this Agreement to the contrary,any Value-Based Payments earned by CHLIC are separate and apart from any Rebates or Manufacturer Administrative Fees that CHLIC directly or indirectly earns from pharmaceutical manufacturers, and CHLIC may retain any Value-Based Payments it earns. As examples of the value payments and/or services that CHLIC may provide to Employer in connection with Value-Based Payments that CHLIC may earn, CHLIC may provide care management or other services to Employer and/or remit to Employer monetary credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services, and/or monetary credits or other financial value, for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions,including the p oducts for which monetary credits or other financial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHLIC to Employer are subject to change or termination by CHLIC as the value program(s), if any, offered by CHLIC change(s)or terminate(s). Accordingly, CHLIC retains all right, title and interest to any and all actual Rebates, Manufacturer Administrative Fees, Value-Based Payments, and other remuneration diectly or indirectly received from manufacturers. CHLIC may provide Employer amounts equal to all or some portion of the Rebate and Manufacturer Administrative Fee amounts,or other financial value generated in connection with any value program(s), allocated to Employer,if any,and as specified on the Schedule of Financial Charges,from CHLIC's general assets(neither Employer,its Members,nor Employer's Plan retains any beneficial or proprietary interest in CHLIC's general assets). Rebate and Manufacturer Administrative Fee amounts received vary based on factors including, without limitation, Employer-specific utilization, the volume of utilization as well as Formulary position applicable to the drug or supplies, and adherence to various formulary management controls, benefit design requirements, and Claims volume. Employer acknowledges and agrees that neither it, its Members nor its Plan will have a right to interest on,or the time value of, any Claim payments charged by CHLIC to Employer or any Rebate,Manufacturer Administrative Fee or other payments received by CHLIC during the collection period of moneys payable under this section, if any, and that CHLIC shall reta n any such remuneration. For purposes of this provision, the term CHLIC shall also include and mean CHLIC's PBM affiliate,Express Scripts,Inc. 2. Affiliates. Cigna Home Delivery Pharmacy may maintain product purchase discount arrangements and/or fee-for-service arrangements with pharmaceutical manufacturers and wholesale distributors in its capacity as a mail service and/or specialty pharmacy.Cigna Home Delivery Pharmacy may contract for these arrangements on its own account in support of its pharmacy operations,and not on behalf of, or for the benefit of, Employer or the Plan. Accordingly, Cigna Home Delivery Pharmacy retains the sole and exclusive benefit of any difference between its acquisition cost for a pharmaceutical product and the amount charged to Employer under this Agreement. Further these arrangements relate to services provided outside of this Agreement and other pharmacy benefit management arrangements and may be entered into without regard to whether a specific drug is on one of the formularies that CHLIC offers to entities that sponsor group health plans. Discounts and fee-for-service payments received by Cigna Home Delivery Pharmacy are not part of the pharmacy benefit management formulary rebates or associated administrative fees or charges paid to CHLIC in connection with CHLIC's pharmacy benefit management formulary rebate programs. 08/04/2023 95 DocuSign Envelope ID:9 FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-OBLIGATIONS UPON TERMINATION Upon notice of termination of this Agreement,the following provisions shall apply with respect to Pharmacy Benefits: a) Employer shall notify Members at least thirty (30) days prior to the termination of the Agreement becoming effective of any transition to a successor pharmacy benefit manager. b) If mutually agreed upon by CHLIC and Employer, CHLIC shall provide services following termination of the Agreement at CHLIC's then-prevailing rate. Such services, if any, shall be determined by mutual agreement of CHLIC and Employer in advance of the termination of the Agreement becoming effective. c) Upon request by Employer and subject to execution of a nondisc.osure agreement acceptable to CHLIC, CHLIC shall transition Claims files and/or history to the pharmacy benefit manager or other third party specified by Employer and otherwise acceptable to CHLIC,at no additional cost to the Employer. Any disclosure of Claims files and/or history shall be limited to the information the successor pharmacy benefit manager or other third party needs to implement or administer Employer's pharmacy benefits. CHLIC shall not be required to directly or indirectly release,and Employer shall not release,PBM Proprietary Information to any such third party. d) Upon termination of the Agreement for any reason, the Parties shall handle Confidential Information, PBM Proprietary Information and Protected Health Information(as defined in the Business Associate Agreement attached as Exhibit D)pursuant to the terms of the Agreement. e) In the event that CHLIC terminates the Agreement pursuant to Section 1.vi of the Agreement, CHLIC shall have no further obligation following the date of such termination to pay Employer any Rebates, or any other amount that may otherwise be payable by CHLIC to Employer. This provision shall survive termination or expiration of the Agreement. PHARMACY BENEFIT MANAGEMENT-CONFIDENTIALITY 1. General. Employer acknowledges and agrees that CHLIC's PBM Proprietary Information constitutes competitively sensitive trade secrets,and that its misuse or mis-disclosure could result in material financial and legal loss or liability to CHLIC, its affiliates and their respective subcontractors. CHLIC shall not be required to disclose PBM Proprietary Information to Employer except to the extent necessary for Employer to exercise any audit rights expressly provided hereunder or perform other Plan administration functions. If CHLIC discloses PBM Proprietary Information to Employer,or, if CHLIC consents,to the Employer's vendor or designee,CHLIC may 08/04/2023 96 DocuSign Envelope ID:9FD1 FBA 1-AE68-46 F6-88 F9-E31 DF 1 C 5DA72 Administrative Services Only Agreement for City of Miami Beach require Employer,or its vendor or designee,to execute a non-disclosure agreement specifically relating to the requested PBM Proprietary Information.Employer agrees that it and its vendors may not utilize PBM Proprietary Information for any purpose other than performing Plan administration functions, including,without limitation,developing products and services,de-identifying,blinding or analyzing the PBM Proprietary Information against market benchmarks or CHLIC competitors or adding to a normative database for the Employer's, or vendor's or designee's, commercial use. For the purposes of clarity, information shall not cease to qualify as PBM Proprietary Information if Employer or its vendor or designee de-identifies and/or blinds the PBM Proprietary Information such that the information cannot be traced or identified to a Member or CHLIC, its affiliates or their respective subcontractors. Employer shall be solely responsible for any disclosure of PBM Proprietary Information by CHLIC to Employer or its vendor or designee,or any subsequent use or disclosure by Employer or its vendor or designee,or services provided by the same.Notwithstanding anything herein to the contrary, in no event will CHLIC be required to disclose to Employer,or its vendor or designee,information related to,or including, its pharmacy network agreements.vendor agreements or pharmaceutical manufacturer agreements. 2. Compelled Disclosures. If at any time Employer,or its vendor or designee,is required by law,court order or other valid legal process to disclose any Confidential Information, it will promptly notify CHLIC prior to any such compelled disclosure and, upon request, cooperate with CHLIC in seeking a protective order or other available relief to contest or limit the scope of such compelled disclosure. 3. Return or Destruction of Information. At any time upon CHLIC's request or upon expiration or termination of this Appendix A or the Agreement, whichever occurs first, Employer will, at CHLIC's option, promptly deliver, or, as the case may be, compel its vendor or designee to deliver,to CHLIC all PBM Proprietary Information or other Confidential Information(or such portion thereof as requested) and not retain any copies in whole or in part of such PBM Proprietary Information or other Confidential Information,or securely destroy or dispose. or, as the case may be, compel its vendor or designee to destroy or dispose, of those portions of documents and other materials in any form, including electronic form, prepared by or received by the Employer or its vendor or designee, that contain or reflect such PBM Proprietary Information or other Confidential Information. Employer, or its vendor or designee, shall certify such return and destruction,as the case may be,to CHLIC. • 08/04/2023 97 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach Appendix B - Cigna Home Delivery Pharmacy Specialty Drug List THIS SPECIALTY DRUG LIST IS CONFIDENTIAL, PROPRIETARY INFORMATION OF CHLIC. IT IS PROVIDED SOLELY FOR EMPLOYER'S PLAN ADMINISTRATION PURPOSES. RE-DISCLOSURE IS STRICTLY PROHIBITED EXCEPT AS OTHERWISE PROVIDED BY APPLICABLE LAW. CHLIC RESERVES ALL LEGAL RIGHTS AND REMEDIES TO ENFORCE THESE PROHIBITIONS ON USE AND DISCLOSURE. The Specialty Drug List shall be provided separately to Employer,and is hereby incorporated into the Agreement by reference.inclusive of any changes made subsequent to CHLIC's initial issuance of the Specialty Drug List to Employer to the pharmaceutical products included on the Specialty Drug List or the discounts pertaining to such pharmaceutical products. Upon Employer's request on or after the Effective Date,CHLIC shall provide to Employer an updated Specialty Drug List. Currently Marketed Specialty Drugs on this Specialty Drug List.The discounts in this Specialty Drug List are the discounts that will be adjudicated in CHLIC's claim processing system for the drug indicated when dispensed by Cigna Home Delivery Pharmacy,subject to all of the following. • The discounts in this Specialty Drug List are based on the terms and design of the Pharmacy Benefit that Employer has adopted and disclosed to CHLIC. Accordingly, if Employer fails to disclose to CHLIC, for example, that it uses or intends to use a consumer-driven health plan, a major cost- sharing program,or a utilization management program promoting generic or OTC drugs over brand drugs,CHLIC may adjust the discounts as it reasonably deems necessary to preserve the economic value or benefit of this Agreement as CHLIC anticipated based on the terms and design of the Pharmacy Benefit previously disclosed to CHLIC and prior to CHL'lC's discovery of the Pharmacy Benefit design feature that materially impacts CHLIC's discounts in this Specialty Drug List. • The discounts in this Specialty Drug List shall not apply to Compound Drug claims, Claims that process at U&C, direct member reimbursement (DMR) Claims, and drugs adjudicated under the medical benefit. • Any or all of the discounts in this Specialty Drug List may be adjusted by CFILIC to the extent reasonably necessary to preserve the economic value of this Agreement as it existed immediately prior to the occurrence of any of the following events:(a)there are any significant changes in the composition of CHLIC's pharmacy network or in CHLIC's pharmacy network contract compensation rates,or the structure of the pharmacy stores/chains/vendors that are contracted with CHLIC,including but not limited to disruption in the retail pharmacy delivery model,or bankruptcy of a chain pharmacy;or(b)there is a change in government laws or regulations which has a significant impact on pharmacy claim costs;or(c)any material manufacturer-rebate contracts with or for the benefit of CHLIC are terminated or modified in whole or in part;or(d)there is any legal action or Law that materially affects or could materially affect the manner in which CHLIC's rebate program is administered or an existing Law is interpreted so as to materially affect or potentially have a material effect on CHLIC's administration of the Pharmacy Benefit;(e)there is a material change in the Plan or the Plan's Pharmacy Benefit that is initiated by Employer which impacts CI-ILIC's costs or(I)a major change in market conditions affecting the phannaceutical or pharmacy benefit management market.a drug shortage in the market,an issue involving the safety of the drug supply,or similar market situation. New-to-Market Specialty Products. Specialty Drug Claims,excluding Limited Distribution Drugs and 08/04/2023 98 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1 C5DA72 Administrative Services Only Agreement for City of Miami Beach Exclusive Distribution Drugs,that are for new-to-market drugs will have a minimum market-introduction guaranteed discount of 11.45%off the drug's A WP. "Limited Distribution Drug"or"Exclusive Distribution Drug"shall mean a Specialty Drug that is not generally available from most or all pharmacies and is restricted to select pharmacies as determined by a pharmaceutical manufacturer. The list of Limited Distribution Drugs and Exclusive Distribution Drugs will be maintained by CHLMC. 08/04/2023 99 DocuSign Envelope ID:9FD1 FBA1-AE68-46F6-88F9-E31 DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach Appendix C - SaveOnSP Program t. The SaveOnSP Program is a Member cost share savings program available when the Employer makes certain pharmacy benefit plan design changes such that program specialty prescription drugs are designated as non-essential health benefits with respect to federal PPACA essential health benefit requirements, and Employer establishes Member cost share at amounts that allow the receipt of manufacturer-supported patient cost share assistance in accordance with Program parameters ("Program"). Designated specialty drugs under the Program may be revised twice on a calendar year basis. 2. Employer will be responsible for the payment of Program tees which shall be 25% of program savings and for any applicable tertiary and residual cost share. The Program fees shall be measured and calculated based on the Program's standard savings and fee calculating methodology. Payment of Program fees shall be charged to the Bank Account and invoiced on a monthly,incurred basis. 3. In order to make available Program services, CHLIC is providing Employer's claims data to CHLIC's approved third-party vendor ("Vendor") on a periodic basis to facilitate such Vendor's provision of the Services. Members' claims data is being provided under an applicable business associate agreement with such Vendor and in accordance with HIPAA including, but not limited to, the minimum necessary standards. Vendor may communicate with Employer's Member ir, order to provide Program services. 4. Employer acknowledges and agrees that CHLIC and Vendor is not a legal advisor and do not render any legal counseling or advice regarding the provision of Program services or benefit designs adopted by Employer. Employer understands and agrees that it is implementing a third party specialty drug program administered by Vendor. Neither CHLIC nor Vendor is responsible for ensuring that Employer or Employer's employee benefit plans independent from or in conjunction with the Program services comply with any Applicable Law including but not limited to laws, regulations,rules,ordinances and/or other guidance related to or associated with relevant Federal and State Anti-kickback laws; IRS rules; ERISA; the Affordable Care Act, state insurance department regulations, state consumer protection requirements, or other federal state or local laws or regulations, including but not limited to laws, regulations, rules, ordinances and/or other guidance related HSA-eligible high deductible health plans (including but not limited to Code Section 223) notwithstanding anything to the contrary.CHLIC hereby advises Employer to seek legal advice and Employer acknowledges that it will consult with its own legal counsel regarding the operation, administration, and establishment of its plans and the appropriateness of the Program. Neither CHLIC nor Vendor shall be liable to Employer or any person if any plan fails to comply with any such requirement. Employer is solely responsible for determining whether to implement the Program for its 1-ISA-eligible high deductible health plan and addressing any compliance issues related to such implementation. 5. In addition to other provisions set forth in this Agreement, it is understood and agreed that for purposes of the Program,Employer(or the relevant plan sponsor and/or plan administrator)have full and final authority and responsibility for the plans. plan assets,and plan operation. Neither CHLIC nor Vendor is a fiduciary (as defined under ERISA or state law)of CHLIC clients' plans. CHLIC, CHLIC Affiliates and Vendor do not: (a) have any discretionary authority or control respecting management of CIILIC clients' plans' prescription benefit programs or(b)exercise any authority or 08/04/2023 100 DocuSign Envelope ID:9FD1FBA1-AE68-46F6-88F9-E31DF1C5DA72 Administrative Services Only Agreement for City of Miami Beach control respecting management or disposition of the assets of CHLIC clients' plans. MI such discretionary authority and control with respect to the management of CHLIC clients' plans and plans'assets are retained by CHLIC clients and/or CHLIC clients'plans. 6. If Employer fails to timely pay in full all applicable Program fees, CHLIC reserves the right to suspend or terminate the services under the Program upon Employer failing to make pay all applicable Program fees and upon CHLIC providing Employer thirty (30) days written notice of nonpayment, in addition to any other rights and remedies available to CHLIC under this Agreement and Applicable Law. 7. CHLIC reserves the right to modify, revise,or terminate the Program due to market conditions that have a material impact on the Program at any time. 08/04/2023 10I RESOLUTION NO. 2023-32624 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSALS (RFP) NO. 2023-259-WG FOR HEALTH, PHARMACY, AND MEDICARE ADVANTAGE PLANS, AND AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH CIGNA HEALTH AND LIFE INSURANCE COMPANY, THE TOP-RANKED PROPOSER FOR PLAN A (HEALTH AND PHARMACY PLANS) AND PLAN C (MEDICARE ADVANTAGE PLAN); AND, IF UNSUCCESSFUL IN NEGOTIATING AN AGREEMENT WITH THE TOP-RANKED PROPOSER, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH AETNA LIFE INSURANCE COMPANY, THE SECOND-RANKED PROPOSER FOR PLAN A (HEALTH AND PHARMACY PLANS), AND HUMANA, INC., THE SECOND- RANKED PROPOSER FOR PLAN C (MEDICARE ADVANTAGE PLAN); AND FURTHER AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. WHEREAS, on October 1, 2016, pursuant to Request for Proposals (RFP) No. 2016- 086-WG, the City entered into an Administrative Services Only (ASO) agreement with Cigna Health and Life Insurance Company ("Cigna") for the administration of its health plan and pharmacy benefits, which services included, but were not limited to, utilization review, claims management, case management, disease management, nationwide access to physician network, concierge services, administration of COBRA benefits, a 24/7 nurse line, and pharmacy benefits management; and WHEREAS, the ASO Agreement with Cigna is scheduled to expire on September 30, 2023; and WHEREAS, on February 22, 2023, the Mayor and City Commission approved the issuance of RFP No. 2023-259-WG for Health, Pharmacy, and Medicare Advantage Plans (the "RFP"); and WHEREAS, the intent of the RFP was to solicit proposals for an ASO agreement, to administer the City's self-insured health plan covering employees, retirees, and dependents, effective October 1, 2023, as well as soliciting pharmacy benefit management and a new offering for Medicare-eligible employees and retirees; and WHEREAS, on February 23, 2023, the RFP was issued; and WHEREAS, on April 14, 2023, the City received proposals from the following firms: Plan A—ASO Health and Pharmacy Services • Aetna Life Insurance Company • AvMed Inc. • Cigna Plan B— Pharmacy Benefits Only • Drexi, Inc. • CerpassRx • Cigna • MedImpact Healthcare Systems, Inc. Plan C—Medicare Advantage Plans • Cigna • Humana, Inc.; and WHEREAS, the proposal submitted by Drexi, Inc. was determined to be non-responsive for failure to meet the minimum experience requirement and received no further consideration; and WHEREAS, on May 8, 2023, an Evaluation Committee, comprised of Marvin Adams, Employee Benefits Manager, Human Resources Department; Andrew Bejel, Assistant Human Resources & Risk Management Director, City of North Miami Beach; Thomas Curitore, Assistant Director, Code Compliance Department; Jennifer Sanchez, Senior Human Resources Specialist, Human Resources Department; and Elizabeth Miro, Assistant Director, Facilities and Fleet Management Department, convened to consider the proposals; and WHEREAS, the Committee was provided an overview of the project, information relative to the City's Cone of Silence Ordinance, the Government Sunshine Law, general information on the scope of services and a copy of each proposal; and WHEREAS, the Committee was instructed to score and rank each proposal pursuant to the evaluation criteria established in the RFP; and WHEREAS, the evaluation process resulted in the proposers being ranked by the Evaluation Committee in the following order: Plan A—ASO Health and Pharmacy Services 1st ranked - Cigna 2nd ranked -Aetna Life Insurance Company 3rd ranked —AvMed Inc. Plan B— Pharmacy Benefits Only 1st ranked - Cigna 2nd ranked - MedImpact Healthcare Systems, Inc. 3rd ranked - CerpassRx Plan C— Medicare Advantage Plans 1st ranked - Cigna 2nd ranked — Humana, Inc.; and WHEREAS, Cigna is the top-ranked firm for Plan A ASO Health and Pharmacy Services, Plan B Pharmacy Benefits Only, and Plan C Medicare Advantage Plans for 65+ Active employees and Retirees; and WHEREAS, since Cigna is also the top-ranked firm for Plan B Pharmacy Benefits, the City Manager recommends that the pharmacy benefit plan be awarded alongside the medical ASO services (Plan A) instead of as a separate Plan B; and WHEREAS, while all of the proposing firms have sufficient experience to provide services for the City, Cigna provides a unique familiarity with the City's employees and retirees and is able to assist the City in tailoring plan designs; has a robust network of doctors and medical facilities, where 96% of visits are in-network; is the current ASO services provider and therefore eliminates the potential for disruption to the City's members; Cigna's proposal includes a reduction in ASO fees and a flat renewal thereafter through plan year 2026; and Cigna's proposal includes the on-site Cigna representative at no additional cost; and WHEREAS, after reviewing the proposals and the results of the evaluation committee, the City Manager exercised her due diligence and recommends that the Administration negotiate an agreement with Cigna, the top-ranked proposer for Plan A (Health and Pharmacy Plans) and Plan C (Medicare Advantage Plans); and, if unsuccessful in negotiating an agreement with the top-ranked proposer, authorize the Administration to negotiate with Aetna Life Insurance Company, the second-ranked proposer, for Plan A (Health and Pharmacy Plans), and Humana, Inc., the second-ranked proposer for Plan C (Medicare Advantage Plans). 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, pursuant to Request for Proposals (RFP) No. 2023-259-WG for Health, Pharmacy, and Medicare Advantage Plans, and authorize the Administration to negotiate with Cigna Health and Life Insurance Company, the top-ranked proposer for Plan A (Health and Pharmacy Plans) and Plan C (Medicare Advantage Plans); and, if unsuccessful in negotiating an agreement with the top-ranked proposer, authorize the Administration to negotiate with Aetna Life Insurance Company, the second-ranked proposer for Plan A (Health and Pharmacy Plans), and Humana, Inc., the second-ranked proposer for Plan C (Medicare Advantage Plan); and further authorize the City Manager and City Clerk to execute an agreement upon conclusion of successful negotiations by the Administration. PASSED AND ADOPTED this ° D day of /6"e 2023. ATTEST: tit( JUL - 5 2023 RAFAEL E. GRANADO, CITY CLERK DAN GELBER, MAYOR .IM[OA?D ,,RCH 2'.:= APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION Ca )\ 23 City Attorney ` Date Competitive Bid Reports -C2 E MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Alina T. Hudak, City Manager DATE: June 28, 2023 SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2023-259-WG FOR HEALTH, PHARMACY, AND MEDICARE ADVANTAGE PLANS, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH CIGNA HEALTH AND LIFE INSURANCE COMPANY, THE TOP-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS)AND PLAN C (MEDICARE ADVANTAGE PLAN); AND, IF UNSUCCESSFUL, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH AETNA LIFE INSURANCE COMPANY, THE SECOND-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS) AND HUMANA, INC., THE SECOND-RANKED PROPOSER, FOR PLAN C (MEDICARE ADVANTAGE PLAN); FURTHER,AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMI NI STRATI ON. RECOMMENDATION See Memorandum attached. SUPPORTING SURVEY DATA Not Applicable FINANCJAL INFORMATION See attached. Is this a"Residents Right Does this item utilize G.O. to Know" item.pursuant to Bond Funds? City Code Section 2-14? No No Legislative Tracking Human Resources/Procurement Page 68 of 1808 ATTACHMENTS: Description ❑ Memorandum ❑ Resolution Page 69 of 1808 MIAM BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov COMMISSION MEMORANDUM TO: Honorable Mayor Dan Gelber and Me bers of the City Commission FROM: Aline T. Hudak, City Manag- `' DATE: May 17, 2023 SUBJECT: A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2023-259-WG FOR HEALTH, PHARMACY, AND MEDICARE ADVANTAGE PLANS, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH CIGNA HEALTH AND LIFE INSURANCE COMPANY, THE TOP-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS) AND PLAN C (MEDICARE ADVANTAGE PLAN); AND, IF UNSUCCESSFUL, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH AETNA LIFE INSURANCE COMPANY, THE SECOND-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS) AND HUMANA, INC., THE SECOND-RANKED PROPOSER, FOR PLAN C (MEDICARE ADVANTAGE PLAN); FURTHER, AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. ADMINISTRATION RECOMMENDATION The Administration recommends that the Mayor and City Commission of the City of Miami Beach, Florida, approve the Resolution accepting this recommendation, pursuant to Request for Proposals (RFP) 2023-259-WG for health, pharmacy, and Medicare Advantage plans, authorizing the Administration to negotiate with Cigna Health and Life Insurance Company, the top-ranked proposer, for Plan A(health and pharmacy plans)and Plan C (Medicare Advantage plan). If negotiations with Cigna are not successful,the Resolution authorizes the Administration to negotiate with Aetna Life Insurance Company,the second-ranked proposer,for Plan A(health and pharmacy plans) and Humana, Inc., the second-ranked proposer, for Plan C (Medicare Advantage plan). Finally, the Resolution authorizes the City Manager and City Clerk to execute an agreement upon the conclusion of successful negotiations by the Administration. This solicitation is currently under the cone of silence. BACKGROUND/ HISTORY Effective January 1, 2009, the City went from a fully-insured health insurance plan to a self- insured program. The day-to-day administration of the self-insured plan is managed through an Administrative Services Only ("ASO") agreement. On October 1, 2016, pursuant to RFP 2016- 086-WG, the City entered into an ASO agreement with Cigna Health and Life Insurance Company ("Cigna") for the administration of its health plan and pharmacy benefits. The ASO services include but are not limited to, utilization review, claims management, case management, disease management, nationwide access to physician network, concierge services, administration of COBRA benefits, a 24/7 nurse line, and pharmacy benefits management.The existing ASO Agreement with Cigna is scheduled to expire on September 30, 2023. There are approximately 2,678 members on the plan, including 1,574 employees, 437 retirees, Page 70 of 1808 Request for Proposals(RFP)No,2023-259-WG,Health, Pharmacy,and Medicare Advantage Plans May 17,2023 Page 2 and dependents. Approximately 50%of the retirees are Medicare-eligible.There are three plan designs — Open Access Plus ("OAP)/(operates as an HMO), High Deductible Health Plan ("HDHP"), and a Preferred Provider Organization ("PPO"), which was closed for enrollment as ,of October 1, 2019. In light of the expiring contract with Cigna, the Administration prepared RFP 2023-259-WG seeking proposals from qualified firm(s) with whom a replacement agreement could be negotiated. The intent of the RFP was to solicit proposals for ASO services for the City's health plan covering employees, retirees, and dependents, effective October 1, 2023. The issuance also solicited pharmacy benefit management and a new offering for Medicare-eligible employees and retirees. Standalone Pharmacy Benefit Managers ("PBM") and Pharmacy Benefit Administrators("PBA")were encouraged to respond to the pharmacy services portion of the RFP. The RFP was structured to receive proposals in the following manner: • Plan A—ASO and Pharmacy Services • Plan B—Pharmacy Benefits Only • Plan C—Medicare Advantage Plans ANALYSIS On February 22, 2023, the Mayor and City Commission approved the issuance of RFP 2023- 259-WG for Health, Pharmacy, and Medicare Advantage Plans. On February 23, 2023, the RFP was issued. A voluntary pre-proposal conference to provide information to proposers submitting a response was held on March 9, 2023. Two (2) addenda were issued. The Procurement Department issued bid notices to 13,615 companies utilizing the City's e-procurement system, with 53 prospective bidders accessing the solicitation. RFP responses were due and received on April 14, 2023. The City received proposals from the following firms: Plan A— ASO and Pharmacy Services • Aetna Life Insurance Company • AvMed • Cigna Health and Life Insurance Company Plan B—Pharmacy Benefits Only • Drexi, Inc. • CerpassRx • Cigna Health and Life Insurance Company • Medlmpact Healthcare Systems, Inc. Plan C— Medicare Advantage Plans • Cigna Health and Life Insurance Company • Humana The proposal submitted by Drexi, Inc., was determined to be non-responsive for failure to meet the minimum experience requirement and received no further consideration. On May 8, 2023, the Evaluation Committee convened to consider the proposals received. The Committee was comprised of Marvin Adams, Employee Benefits Manager, Human Resources Department, Andrew Bejel, Assistant Human Resources & Risk Management Director, City of North Miami Beach, Thomas Curitore, Assistant Director, Code Compliance Department, Jennifer Sanchez, Senior Human Resources Specialist, Human Resources Department, and Elizabeth Miro, Assistant Director, Facilities and Fleet Management Department. Page 71 of 1808 Request for Proposals(RFP)No.2023-259-WG,Health, Pharmacy,and Medicare Advantage Plans May 17,2023 Page 3 The Committee was provided an overview of the project, and information relative to the City's Cone of Silence Ordinance and the Government Sunshine Law. The Committee was also provided with general information on the scope of services and a copy of each proposal. The Committee was instructed to score and rank each proposal pursuant to the evaluation criteria established in the RFP. The evaluation process resulted in the proposers being ranked by the Evaluation Committee in the following order(See Attachment A): Plan A—ASO and Pharmacy Services 1st ranked - Cigna Health and Life Insurance Company 2nd ranked -Aetna Life Insurance Company 3rd ranked -AvMed Plan B—Pharmacy Benefits Only 15t ranked -Cigna Health and Life Insurance Company 2"d ranked - Medlmpact Healthcare Systems, Inc. 3`d ranked - CerpassRx Plan C—Medicare Advantage Plans 1st ranked -Cigna Health and Life Insurance Company 2nd ranked - Humana The following is a summary of the recommended firms for Plans A and C (Attachment B describes in detail the benefits and cost-savings from each proposer relating to Plan A—ASO and Pharmacy): Cigna Health and Life Insurance Company(top-ranked firm for Plans A and C): Cigna has been providing benefits to the government and education sector for over fifty years. Today, they have over 1.6 million covered lives in this sector and also currently provide integrated benefits to many of our neighboring government and education districts, including the City of Miami, the City of Fort Lauderdale, and Miami-Dade County Public Schools. Cigna has been the ASO administrator for Health, Pharmacy, Dental, and EAP since the plan year beginning October 1, 2016. Some of the benefits and cost savings experienced with Cigna during the contract period of October 2016 to the present are: • Employees and retirees have great access to healthcare providers under the Cigna Open Access Plus ("OAP") network. Currently, 96% of utilized providers are in-network. • During plan year 2021 the City was provided a month fee holiday which resulted in $96,000 in savings • On-site Cigna representative assisting employees with plan navigation and claims management • In 2022 the City re-negotiated its pharmacy contract terms and conditions with Cigna with projected cost impact improvements in excess of$500k for the 1st year • During this period, a high-deductible health plan was implemented. The plan now has about 17% of the City's healthcare population enrolled • Cigna reduced administrative fees in the plan year 2019 and held flat thereafter • Cigna increased the City's annual Wellness credit from $50,000 to $100,000 in 2019 Page 72 of 1808 Request for Proposals(RFP)No.2023-259-WG,Health,Pharmacy,and Medicare Advantage Plans May 17,2023 Page 4 Aetna Life Insurance Company(2"d ranked firm for Plan A): Aetna offers a broad network, of high-performance, and accountable care arrangements that connect members with high-quality, cost-effective care. They go beyond the traditional network with local options that provide greater convenience and savings. As part of CVS Health, convenient MinuteClinic, and CVS HealthHUB, locations offer care that's affordable and readily accessible. They have over 299K national employees, including more than 5,000 in Florida with local offices in Orlando, Ft. Lauderdale, Miami, Jacksonville, and Tampa. Over 40 of their Florida employees work exclusively with Public Sector entities like the City of Miami Beach. Some of their references include Sarasota County Government, Manatee County, and Lee County Board of County Commissioners. Humana (2nd ranked firm for Plan C): Humana Inc., headquartered in Louisville, Kentucky, offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. Medicare is a significant part of Humana's business and a major contributor to their success. They offered their first private Medicare plans in 1985 and their first Medicare plans for employers in 1990,giving them more than 32 years of experience offering group Medicare plans. Humana services over 630 Group Medicare clients today representing 560,000 group members, with 28 public sector clients in Louisiana. In addition, Humana agrees to provide the City with the requested retiree concierge advocacy model for its Medicare-eligible retirees through their partnership and seamless integration with RetireeFirst. RetireeFirst complements its high-touch member service model by providing an engaging personalized concierge solution with Retiree Healthcare Advocates available to guide retirees through every phase of their healthcare benefit. Today, Humana is licensed to offer employee-sponsored, network-based Medicare Advantage solutions in all 50 states plus the District of Columbia and Puerto Rico. Humana is also licensed to cover retirees residing in USVI, Guam, Marianas Islands, and American Samoa. Some of their references include El Paso County, Colorado, the City of Lynn Massachusetts, and the City of Dento, Texas. Plan B—Pharmacy Benefits Only Of the three proposers in this category, Cigna ranked number one and thus is being recommended to provide the pharmacy benefit plan along with the medical ASO services(Plan A). Plan C—Medicare Advantage Plan for 65+Active and Retirees The City sought proposals for Medicare-eligible employees and retirees and received two responses. The Administration is recommending the proposal received from Cigna, which provides the following benefits: • Implementation flexibility allowing for a 10/1/2023 or 01/01/2024 plan start date • 0% rate increase through 2025; 5% rate cap for 2026 • In-home support for members • Pro-active outreach to all new members • Concierge and Administration services provided by Retiree First Page 73 of 1808 Request for Proposals(RFP)No.2023-259-WG,Health, Pharmacy,and Medicare Advantage Plans May 17,2023 Page 5 FINANCIAL INFORMATION ASO Services for this contract are processed through the internal service fund accounts, managed by the Human Resources Department, Employee Benefits Division. The funding for the medical and pharmacy plans is analyzed and projected through actuarial services and approved in the budget process each year. Currently,the annual ASO fee for the plan year 2023 is $711,948, and the per-script fee is $2.50 this does not include the claims costs associated with each plan). Cigna is proposing an annual ASO fee of $692,988, and a per-script fee of $2.25 for the plan year 2024. This results in annual savings in ASO fees of$18,958. CONCLUSION After reviewing the proposals and the results of the evaluation committee, it is recommended that the Administration negotiate with Cigna Health and Life Insurance Company,the top-ranked proposerwho is most qualified to provide ASO services for the City's health and pharmacy plan covering employees, retirees, and dependents. While all of the proposing firms have sufficient, experience to provide services for the City of Miami Beach, Cigna Health and Life Insurance Company, provides a unique familiarity with the City's employees and retirees and is able to assist the City in tailoring plan designs. Cigna has a robust network of doctors and medical facilities,where 96%of visits are in-network. In selecting Cigna, the City eliminates the potential for disruption to our members. The proposal includes a reduction in ASO fees and a flat renewal thereafter through plan year 2026. Additionally, Cigna is including the on-site Cigna representative at no additional cost. For the reasons stated herein, it is recommended that the Mayor and City Commission approve the Resolution authorizing the Administration to enter into negotiations with Cigna Health and Life Insurance Company, as the top-ranked proposer, for Plan A (health and pharmacy plans) and Plan C (Medicare Advantage plans), and, if unsuccessful, authorizing negotiations with Aetna Life Insurance Company, the second-ranked proposer, for Plan A(health and pharmacy plans) and Humana, Inc., the second-ranked proposer, for Plan C (Medicare Advantage plan); further authorizing the City Manager and City Clerk to execute an agreement upon the conclusion of successful negotiations by the Administration. MT/MA/ /K Page 74 of 1808 Attachment A cur aa�so-wG __ _ . . . _ .. I - . I IEALM,mAaYAcyclut,ua ji fEDIGARE AMA6E , rm00AdoN.PLAJOI ' Mimees11r I mmoM.O.a.. Hindi w. ,f_ e J�WFOreA. 001,0100014. 1 I ] nide PanAASO ants la&Mon '_ _ _ �.__..-.-_._._.._ i .. _) O0Mr.� TOeewOr wiM%^ Odl,.rtaumediusf U Ml/ 0,1,08 w Ora OMMlY1� 1OiiYO�� YIr�M� _.u.r.wo..wi!.. P ....__ . 41_ .�3 •w B.. w ip_ . s ;:i a _ o . i�. is s N_. 2 ..-.� _ •: .- -- 0 . .� .p ... .. ... 1 0 p .. _.� ._.... .._.. - - -- Ii�adCwliiwd_._ ..._-.. _ 0 77 7i7 10. ._ _>f .. .._ .. SS.. G .. 06 .2 so._. 0 I W I: SO . ... Y . . .1, 7 1 1 1 ...... comwre•Pers Fier•va,71 1Cb.•w.rt/.w ON tn.,,..nc. 1 FOR OI.PIAY PURPOSES ONLY.FINAL RANKING DOES MOT CONSTITUTE AN AWARD RECONNENOATION. Page 75 of 1808 —RFP 2023.259•WG HEALTH,PHARYACY(Rx�, p p AND MEDICARE Marvin Adams AndrewGa)et Tuatara Cullom J Elisabeth Mtro f Jarr,Ns(s.,wa Low I ADVANTAGE PLANS 8 '°� 8 Totals Pleb B Rs Benefits Only QuNeunM Quentlbtllva Subtotal quaMrs. QuarttNrlva '.subtotal Quadrats. Qu.,UMMaa Subtotal QuaMMWa Quenteasve Subtotal Qualitative Ottantllrlva8ubtotal CerpaseRa 71 0 71 3 85 0 65 3 70 0 70 2 73 0 73 �3 60 0 60 3 14 3 Cigna Heahh and V&ti•um.* Company 93 0 93 1 83 0 93 1 85 0 85 14 1 90 0 90 1 85 0 85 1 , 5 1 Aadlmpact Haahhcare Systems, Inc. 78 C 78 2 60 0 80 2 70 0 70 I 2 82 1 0 82 2 75 0 75 2 10 2 Total Ouudea w Veteran'. (Coat• Propc.er Pratt. Vatann's) Oral ------ 5 0 CoNtwaaa 5 0 Clan NNNh and Ufa Insurance 5 0 Company • - NWhnpact Healthcare Systems, 5 0 Inc. FOR DISPLAY PURPOSES ONLY.FINAL RANIONG DOE3 NOT CONSTITUTE AN AWARD RECOMMENDATION. Page 76 of 1808 RFP 2023-259-WG HEALTH,PHARMACY(Ra), AND MEDICARE ADVANTAGE PLANS Marne"Adams Z Ana...BsHI 4 Thomas Curtto. I' lltntas&tiro $ 2.nnn..Sanchez 4 Law a a a a a - To►. Plan C Medicare Advantage Plan Oualtaalr+,Quantltath.I Subtotal Ov.@.Vv.,Quantitative Subtotal Qualitative GuanatatM,Subtotal QWltdv.'Quantitative...Subtotal O.nitaay. Qu.nUta8va Subtotal L� Cigna Heath and Ufa In.um rc.Company _ 91 0 91 1 9e 0 9e 1 95 0 95 1 e9 0 09 1 30 0 e0 2 6 1 'Hunan. e3 0 83 2 93 0 93 2 95 0 95 1 86 0 86 2 85 - 0 85 1 8 2 --ILL Rabb Quantitative V.1ar.n'. (Cast• Propour Point. Vatarsn•.I Cigna Hearth and Lit. 5 0 Insurance C. • Human■ __-• 1111.2M0 FOR DISPLAY PURPOSES ONLY:FINAL RANKING DOESNOTCONSTTTLTE AN AWARD RECOMMENDATION. Page 77 of 1808 Attachment B The following chart displays the benefits and cost-savings from each proposer for Plan A-ASO and Pharmncy: Administrator Cigna(Currant) Cigna(Renweal) Aetna AvM od Opt I Availed Opt Y Enrollment .►IMQ Elm MP Employee 753 94 144 Employee t 1 240 21 59 Fannly i 1_ 74 Total Enrollmen 1,167 118 277 Total Account 1.580 64mtnlikrstlon Fees(FIe.1 Mudlcal AdraneVatO' $10.25 59.25 S33.29 $47.51 540.77 Case Management Included InUuded Included Included Indudad peease Management Included InUuded 'ncluded(Aetna One Flee) See ASO Proposal.Fee/Partrcpant See ASO Proposal.Fee/Partcpant Sehav!oral Health Included InUuded Induced Included Included Network Access $17.25 517.25 Included InctIded Included Con corps Services Included Included Included Included Included Reinsurer Interface Fee(if any) $0.69 $0,89 Included Included Included Wellness Vendor Interface Fee(d any) Included Included Included Included Included CEG COnsuhw9 Ftd; $9.36 19 6 EU§ ;t9_ N:§ Monthly Medical Administration(Per Subscriber Per Montle) 137.55 136.55 $42.65 $56.87 150.13 Total AdralMstraean Fens(Annualized) 1711,948 1692,988 1808,841 11,078,255 1950,486 Pharmacy Adminl Craton Cldna ;halal Aetna �'� ArMed Contract Traditional Traditional Tradl bon ad Pass Through Pass Through Per ScrIpl Fee 12.50 32.25 $0.00 81.10 11.10 Miscellaneous Notes • Onsde Claims and E'g ldlry Represenlallve(Fue-Tune Annual) Included Included ---- 1128,000 ... $72.133 Nat Included ,. Medical Carney Included Included .._____�__._.._.� Included Included Included FSA vendor Included Included .._._._^ TOO 19.930 _._.,___$' ..... Remedy Re enuytres Included Included TOO 15,000 Not IAdrded Fee Renewal Guarantee • Flat Thru 9r3072026 Fiat Thnu 9r30/202e Flat Tlwu Of30f202e Not Included Not Included Fee Holiday Not Included 1 Mo Yr 1 8 2 Mo Yr 2 2 Month Nol Included _.__ Not Included Irnovehon Fund T--.—__NIA $100.000 Not Included Not Included Not Included Implementation Fund Not Included Not Included S10.000 125,000 Not Included. —» Annual Wellness Fund 1100,000 $100.000 _ $100,000 1100,000 S100,000 Page 78 of 1808 t Competitive Bid Reports - C2 F MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Alina T. Hudak, City Manager DATE: May 17, 2023 SUBJECT: A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, ACCEPTING THE RECOMMENDATION OF THE CITY MANAGER, PURSUANT TO REQUEST FOR PROPOSAL (RFP) 2023-259-WG FOR HEALTH, PHARMACY, AND MEDICARE ADVANTAGE PLANS, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH CIGNA HEALTH AND LIFE INSURANCE COMPANY, THE TOP-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS) AND PLAN C (MEDICARE ADVANTAGE PLAN); AND, IF UNSUCCESSFUL, AUTHORIZING THE ADMINISTRATION TO NEGOTIATE WITH AETNA LIFE INSURANCE COMPANY, THE SECOND-RANKED PROPOSER, FOR PLAN A (HEALTH AND PHARMACY PLANS) AND HUMANA, INC., THE SECOND-RANKED PROPOSER, FOR PLAN C (MEDICARE ADVANTAGE PLAN); FURTHER, AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE AN AGREEMENT UPON CONCLUSION OF SUCCESSFUL NEGOTIATIONS BY THE ADMINISTRATION. RECOMMENDATION See Memorandum attached. SUPPORTING SURVEY DATA Not Applicable FINANCIAL INFORMATION Pending Is this a "Residents Right to Does this item utilize G.O. Know" item, pursuant to Bond Funds? City Code Section 2-14? No No Legislative Tracking Human Resources/Procurement ATTACHMENTS: Description ❑ Memorandum ❑ Resolution ATTACHMENT B ADDENDUM AND RFP SOLICITATION M I A M I BE/\cF-I PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 2 REQUEST FOR PROPOSALS NO. 2023-259-WG HEALTH, PHARMACY (Rx), AND MEDICARE ADVANTAGE PLANS April 4, 2023 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). I. REVISION: RFQ DUE DATE AND TIME. The deadline for the electronic receipt of bids is extended until 3:00 p.m., on Friday,April 14, 2023. All bids received and time stamped through BidSync, prior to the bid submittal deadline shall be accepted as timely submitted. Bids will be opened promptly at the time and date specified. Hard copy bids or bids received electronically, either through email or facsimile, submitted prior to or after the deadline for receipt of bids are not acceptable and will be rejected. Late bids cannot be submitted, bidders are cautioned to plan sufficiently. The City will in no way be responsible for delays caused by technical difficulty or caused by any other occurrence. II. REVISION: Revise Scope of Work for Health Plan—Medical ASO Services, Medical Questionnaires as follows: Medical Questionnaires Please complete Attachment G — RFP Medical Questionnaire. As part of your Medical ASO services response, the Self-Funded Questionnaire worksheets must be completed and submitted with your response. Please do not copy/paste lengthy, generalized answers to the questions but create responses that are specific to this RFP and to the point. If you would like to submit additional information that is not easily submitted in Attachment G, please include it in your bardcopy electronic response as part of Tab 5 and title it"Additional Information for Attachment G". Attachment G must be submitted back in Word or PDF Excel format as part of your proposal. III. REVISION: Section 0300 has been revised as follows, delete Attachments K4, K5, and K6 from the Required Attachments List. Those Attachments are for informational purposes only. Required Attachments The following attachments are required: ATTACHMENT D—CIGNA MEDICAL CLAIMS DATA-REPRICING ATTACHMENT F—CIGNA PROVIDER DISRUPTION REPORT ATTACHMENT G—MEDICAL RFP QUESTIONNAIRE ATTACHMENT I—PHARMACY(RX)SERVICES CHECKLIST ATTACHMENT J—CPT CODE LISTING ATTACHMENT K3—PBM VENDOR OFFERING WORKSHEET ATTACHMENT K4 TOP DRUG SUBMITTALS ATTACHMENT K5 RX CLAIMS UTILIZATION ATTACHMENT K6 MAC LIST SUBMITTAL 1 ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I B E AC H PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ATTACHMENT K7—SPECIALTY LIST"SAMPLE" ATTACHMENT L-GROUP MEDICARE ADVANTAGE QUESTIONNAIRE ATTACHMENT M—FEE PROPOSAL(ASO, PBM) IV. ATTACHMENTS: Attachment G REVISED MEDICAL RFP QUESTIONNAIRE Attachment J REVISED CPT CODE LISTING Attachment L REVISED MEDICAL ADVANTAGE PLAN V. RESPONSES TO QUESTIONS RECEIVED: Q1: Please confirm exactly what you are wanting Vendors to provide back for these two attachments as there are no instructions and these reports seem to be summary reports of Cigna pharmacy information. Please advise what you are looking for vendors to return. Attachment K4—Top Drug Submittals Attachment K5- RX Claims Utilization Al: The referenced attachments are for informational purposes only. Refer to Revision III above. Q2: Pursuant to the Scope of Work for Pharmacy (Rx,) Formulary Information, please confirm that Attachment K2 should be used to provide the results to the following request. Using the claim history file provided, provide a disruption analysis to your proposed formulary. Include the number of Rx's and the number of unique members disrupted by both tier changes and/or exclusions. A2: Yes,Attachment K2 should be used to respond to the disruption analysis. Q3: In regards to the Part D plan your current RX runs on a plan year RX OOP but Medicare requires plans to run on a calendar year. Please advise how you would like for Vendors to handle the plan year to calendar year change. A3: Medicare shall run on a calendar year. Therefore, the existing retiree plans must be canceled on December 31. Q4: After reviewing Attachment L— Medicare Advantage we would like to ask the following questions. Tab PPO Design Deviations — please provide the plan design that you are wanting Vendors to quote for this new Product offering. Tab Part D Plan Design Deviations - please provide the plan design that you are wanting Vendors to quote for this new Product offering. A4: Plan designs should mirror existing retiree medical plans. Any deviations should be specified. ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I AM I BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov Q5: In reviewing the census file provided we would like to request a revised Medicare Advantage census. To ensure all carriers quote consistently, can you provide the member-level census that should be used for the Medicare Advantage quote? A5: Refer to Attachment E, Column J. There currently is not a Medicare Advantage program in place; only a retiree plan that mirrors the active plans. Q6: What are the current funds you are receiving for these items under the ASO arrangement: o Wellness Allowance o Implementation Allowance o Communication Allowance o Audit Allowance A6: The Wellness Allowance is $100,000. There are no allowances for Implementation, Communication, or Audit. Q7: Describe what is covered under the Virgin Pulse Program and what the cost is. A7: The Virgin Pulse Program is a wellness tracking and incentive program for active employees (excluding employees eligible for the Police & Fire Health Trusts), with targeted programming and content delivered in an automated fashion to members based on their interests, health risks, & demographics to ensure a personalized experience. As members engage in healthy behaviors and participate in differing activities, they can earn rewards, i.e., cash, healthcare contributions, local incentives, or store credits. The Virgin Pulse Wellness Programs cost$147,000.00 annually. Q8: The RFP states to submit separate proposals for Plan A, B, and C however the instructions for what to include in TAB 5 list all attachments (below) for the separate products. Please advise if you would only like the Attachments corresponding to the products being quoted in each Plan included with that proposal submission. (i.e. would you like Pharmacy attachments submitted with the Medicare proposal as well?) The following attachments are required: ATTACHMENT D—CIGNA MEDICAL CLAIMS DATA-REPRICING ATTACHMENT F—CIGNA PROVIDER DISRUPTION REPORT ATTACHMENT G—MEDICAL RFP QUESTIONNAIRE ATTACHMENT I—PHARMACY (RX) SERVICES CHECKLIST ATTACHMENT J —CPT CODE LISTING ATTACHMENT K3—PBM VENDOR OFFERING WORKSHEET ATTACHMENT K4 -TOP DRUG SUBMITTALS ATTACHMENT K5—RX CLAIMS UTILIZATION ATTACHMENT K6—MAC LIST SUBMITTAL ATTACHMENT K7—SPECIALTY LIST"SAMPLE" ATTACHMENT L -GROUP MEDICARE ADVANTAGE QUESTIONNAIRE ATTACHMENT M— FEE PROPOSAL (ASO, PBM) 3 r ADDENDUM NO.2 1 REQUEST FOR PROPOSALS NO.2023.259•WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A.t\/\ I BEACI-I PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov A8: Pharmacy would be included with Medicare Advantage as a total fully insured medical/Rx plan. Only the Attachments corresponding to the products being quoted in each Plan are to be submitted for each plan that you will be responding to. Also, please refer to Revision III above. Q9: On page 17 of the RFP under the Medical Questionnaire section, it states that the Medical ASO services response should include the Traditional Health Plan and Self-funded Questionnaire worksheets. We are unable to locate these worksheets in the Attachment G document provided. Please confirm if the Traditional Health Plan and Self-funded Questionnaire worksheets are not applicable, and medical carriers are to complete the Attachment G— Medical Questionnaire that is in Microsoft Word format. A9: Only self-funded proposals are being requested. Please refer to Revision II above. 010: On page 17 of the RFP under the Medical Questionnaires section, it states to include additional information for Attachment G in hardcopy response. Please confirm that submissions are electronic and additional information can be uploaded electronically. Medical Questionnaires Please complete Attachment G — RFP Questionnaire. As part of your Medical ASO services response, the Traditional Health Plan and Self-Funded Questionnaire worksheets must be completed and submitted with your response. Please do not copy/paste lengthy, generalized answers to the questions but create responses that are specific to this RFP and to the point. If you would like to submit additional information that is not easily submitted in Attachment G, please include in your hardcopy RFP response. Attachment G must be submitted back in Excel format as part of your proposal. A10: Please refer to Revision II above. Hard copies are not required. The questionnaire is in Microsoft Word format; therefore please include your responses in Word format. The last page of the questionnaire has also been revised to allow for additional information and/or commentary. Q11: In regards to the Attachment L — Medicare Advantage Access Standards — Medical Providers Tab, please confirm what Zip Codes for the last 2 Columns. All: The first three digits of the zip codes have been updated to include 331xx and 330xx. Please refer to Attachment L, Revised Medicare Advantage Plan. Q12: In regards to the Attachment L — Medicare Advantage Access Standards — Medical Providers Tab, What parameters form the Miles from Residence Urban, Suburban and Rural columns? Al2: Attachment L has been updated to state 8 miles for urban, 15 miles for suburban, and 25 miles for rural. Please refer to Attachment L, Revised Medicare Advantage Plan. Q13: In regards to the Attachment L— Medicare Advantage Access Standards— Medical Providers Tab, For the#of Providers available—are you wanting just the#of providers available to the City or National? ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I BEACH PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov A13: The City requests the number of providers available to the City and Nationally. Please refer to Attachment L, Revised Medicare Advantage Plan. Q14: In regards to the Attachment L— Medicare Advantage, several tabs have drop-down boxes that do not appear to work correctly. Can you please provide a revised file that allows us to utilize the drop-down boxes accordingly? A14: Attachment L has been updated and includes answers in the dropdown boxes. The explanation worksheet is at the end of the file. Please refer to Attachment L, Revised Medicare Advantage Plan. Q15: Also there is a statement that if our responses are more than 400 characters, Proposers must use the Explanation worksheet. However, this tab is missing in the file. Can you please provide a revised file that has this tab? A15: The file has been updated and there is an explanation tab at the end of the Excel workbook. Please reference the tab and question number if you are to utilize this tab. Please refer to Attachment L, Revised Medicare Advantage Plan. Q16 In reviewing Attachment J — COMB Medical CPT Codes it appears that some are missing the actual DPT Codes. We can only provide this information by CPT code and not revenue or diagnostic codes. Please confirm this is the correct file the City wants their information provided for. A16. An updated CPT code file for Attachment J has been included. Please refer to Attachment J, Revised CPT Code Listing. Q17: Can we please have further clarity as to what the City is referring to as far as Stop Loss Claim Filing and Accounting? Is the City asking us to provide a stop loss proposal or make sure and all reporting shall be included in the ASO fee? A3. Specifications. The City requests responses for the following health plan services: A. ASO services proposals with the duplication of the current SBC's/SPD's (Summary of Benefits Coverage/ Summary Plan Description). The City's intent is to select one medical carrier to administer medical plan services but reserves the right to select one or more. Please quote these plan designs with the best provider network match to Cigna's existing network. Please follow the instructions carefully in the Medical ASO services section when responding to this RFP. Plan A shall include the costs for the following services (as applicable): 1. Claims Administration (claims incurred on or after October 1, 2023) 2. Utilization Review Health Information Line 3. Case Management and Precertification 4. HIPAA Administration 5. Network Fee 6. Disease Management/Predictive Modeling 5 ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I BEIF-1 PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov 7. Stop Loss Claim Filing and Accounting 8. Costs related to External Appeals as mandated by PPACA. A17: The City is requesting proposers ensure all reporting will be included in the ASO fee. With regard to #7, the vendor agrees to coordinate with the current stop-loss vendor for reporting purposes. Q18: To ensure all carriers quote consistently, can you provide the member-level census that should be used for the Medicare Advantage quote? A18: On Attachment E,tier is notated in Column J --there currently is no Medicare Advantage program in place,just a retiree plan that mirrors the active plans. Q19: What are the current funds you are receiving for these items under the ASO arrangement o Wellness Allowance o Implementation Allowance o Communication Allowance o Audit Allowance A19: The Wellness Allowance is $100,000. There is no allowance for Implementation, Communication, or Audit. Q20: The Rx checklist document that was provided (Attachment I COMB Rx Checklist) asks if our proposal includes"Pharmacy-Basic Information and Confirmations. Where is that information located? Is it the Scope of Work questionnaire that's located under Section A.4 of the RFP? A20: The required information is included in the RFP under Section A4 Scope of Pharmacy (Rx). Q21: Please confirm if the SQR report from Dun and Bradstreet must be received by the City within the bid process period or if it can be received upon request later on. Please also note the site to request the report (https://supplierportal.dnb.com) is coming up with the attached error message. Due to this please advise if proposals will still be accepted without the SQR report.? A21: Should the City request the report from proposers, it must be received directly from Dun & Bradstreet within 3 business days of the City's request. If the City requests the report, a revised link will be provided. Q22: Could you please confirm the number of lives for the pharmacy benefit, employee + dependents? Self- insured plan (2,678?)and retiree population (437)? A22: There are a total of 2,678 members and 437 retirees. Q23: Attachment D- Repricing: What defines "leased network"? Is this like PHCS/Multiplan or delegated vendors? ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I B E/\c I-I PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov A23: A leased network is similar to PHCS/ Multiplan if the zip code is not in the direct network where the carrier provides coverage for those members who reside outside of the standard coverage area. Q24: Attachment D- Repricing: Confirming: reprice non-par claims at 100% of submitted billed charges? A24: Yes, that is correct. Q25: Attachment D- Repricing: What do account types OAP and OAPIN mean? Just to confirm is OAP open access and OAPIN open access in network? A25: OAP is open access and OPAIN is the in-network only plan. Q26: Attachment D- Repricing: What is the difference between 'Non-domestic' and 'Total' in the instructions tab? A26: Please disregard non-domestic claims. Only complete lines 27-35. Q27: Attachment G- MEDICAL QUESTIONNAIRE#4. Please provide a geo-access report for each proposed network showing number of providers by specialty within 10, 15, and 20 miles for each employee zip code. Is it the City's intent that the proposers replicate the format of Attachment B Cigna GeoAccess Report? Please confirm what specific specialties & access standards by provider group are to be included. Are the access standards you are looking for: •Adult PCP-2 in 10 miles, 2 in 15 miles, and 2 in 20 miles. • Pediatricians-2 in 10 miles, 2 in 15 miles, and 2 in 20 miles. • OB/GYNs-2 in 10 miles, 2 in 15 miles, and 2 in 20 miles. •All Other Specialties-2 in 10 miles, 2 in 15 miles, and 2 in 20 miles. • Hospitals- 1 in 10 miles, 1 in 15 miles, and 1 in 20 miles. • Urgent Care Facilities- 1 in 10 miles, 1 in 15 miles, and 1 in 20 miles A27: Yes, as long as your report includes the parameters requested and are provided in pdf or excel format. Q28: RFP 2023-259-WG Section 0300 #4, TAB 3 Scope of Services Proposed states "Attachments should be included in Tab 6" however, there isn't a Tab 6 listed in the City's electronic proposal format. Should we create a TAB 6 Referenced Attachments section? Please clarify. A28: This is a scrivener's error; the attachments should be included in Tab 5, Required Attachments. Q29: RFP 2023-259-WG Section 0300 #4, regarding TAB 3 Scope of Services Proposed is the expectation that we include all of Appendix A? Please clarify. A29: Tab 3 shall include detailed information addressing how the Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix A. T 7 ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I AM I B EAC H PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach,Florida 33139 www.miamibeachfl.gov Q30: Attachment F- Disruption: Please confirm that the NPI applies only to the row on which it is listed and not subsequent lines. In other words, the NPI is not provided for all records. A30: Yes. Q31: Attachment J- Medical CPT Codes #3: What is meant by CPT Fees for IP, OP, and professional services for the top 5 zips? A31: CPT fees stand for "Current Procedural Terminology" and how providers bill the insurance company. Therefore, can you provide your standard billing fees for the zip codes provided? Q32: RFP 2023-259-WG Section A3. Scope of Work for Health Plan — Wellness: In order to determine the amount of interface and transfer fees with VirginPulse for Wellness, may we have the anticipated data that will need to be interfaced, and the frequency, in order to respond to the request for such fees in Attachment M? A32: Quarterly reporting will be required. Q33: Is the City expecting to keep RX rebates? A33: Yes. Q34: Is the submission of ATTACHMENT L - GROUP MEDICARE ADVANTAGE QUESTIONNAIRE a required form?Would non-submittal of this form consider the bidder to be non-compliant with the RFP? A34: Yes. Please refer to Attachment L, Revised Medical Advantage Plan which has been revised and simplified. Please respond to updated version. Q35: On the medical CPT codes attachment j, are we to use the zip codes as shown in columns L through P or the carriers top 5? A35: Refer to Attachment J, Revised Cpt Code Listing. Please provide the fees for the top five zip codes. Q36: RFP document-A3 -Scope of Work for Retiree Health Plan The instructions say to "Complete Attachment L - Medicare Advantage, Tab: Network Disruption". Attachment L doesn't have a tab titled "Network Disruption". Please confirm if a Network Disruption is required for the Retiree Health Plan? If so, please provide the appropriate data? A36: Please refer to Attachment L, Revised Medical Advantage Plan. Q37: Attach L-Questionnaire/ Proposal Rates Tab Please confirm the effective date for the Medicare Advantage offering. Please confirm that the quoted premium should be for 2024 and the rate guarantee should be for 2025 ADDENDUM NO.2 REQUEST FOR PROPOSALS NO.2023-259-WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I B E AC H PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov A37: The effective date for the Medicare Advantage Offering is 1/1/2024 and we would like a 2- year rate guarantee. Q38: The Rx checklist document that was provided (Attachment I COMB Rx Checklist) asks if our proposal includes "Pharmacy - Basic Information and Confirmations. Where is that information located? Is it the Scope of Work questionnaire that's located under Section A.4 of the RFP? A38: Yes, that is correct. Q39: Attach L-Questionnaire/Access Standards The instructions say"The access standards we will look for in each area are listed in the table below". There are no access standards listed. Please provide the access standards that should be applied when running the geo access report. A39: Please refer to Attachment L, Revised Medical Advantage Plan Q40: The retiree portion of the census doesn't appear to show the Medicare eligible dependents. If this is the case, please provide an updated census with the Medicare eligible dependents on a different line from the subscriber. A40: The census indicates retiree status in Column E and the date of birth is provided in Column B. Any questions regarding this Addendum should be submitted in writing to the Procurement Department to the attention of the individual named below,with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Contact: Telephone: Email: William Garviso 305-673-7000 ext. 7490 WilliamGarviso@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the"Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Sincerely, Kristy Bada Procurement Contracting Manager ADDENDUM NO.2 __ m REQUEST FOR PROPOSALS NO.2023.259•WG HEALTH,PHARMACY(Rx),AND MEDICARE ADVANTAGE PLANS M I A M I B E AC H PROCUREMENT DEPARTMENT 1755 Meridian Avenue,3rd Floor Miami Beach, Florida 33139 www.miamibeachfl.gov ADDENDUM NO. 1 REQUEST FOR PROPOSALS NO. 2023-259-WG HEALTH, PHARMACY (Rx), AND MEDICARE ADVANTAGE PLANS March 17, 2023 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only (deletions are shown by strikethrough and additions are underlined). I. ATTACHMENT: Exhibit A Pre-proposal conference Attendance Sheet II. RESPONSES TO QUESTIONS RECEIVED: Q1. Can you please provide a copy of the sign-in sheet for the pre-proposal conference held last week in connection with this RFP? A2: Please refer to Exhibit A Pre-proposal Conference Attendance Sheet. An addendum responding to questions received is forthcoming. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado@miamibeachfl.gov Contact: Telephone: Email: William Garviso 305-673-7000 ext. 7490 WilliamGarviso@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s)for not submitting a proposal. Sincerely, w I vv. c,arviso for Alex Denis Alex Denis Procurement Director ADDENDUM NO.1 REQUEST FOR QUALIFICATIONS NO.2014-142-ME FOR DESIGN CRITERIA PROFESSIONAL SERVICES FOR THE MIAMI BEACH CONVENTION CENTER RENOVATION ATTACHMENT C SUNBIZ & PROPOSAL RESPONSE TO RFP DIVISION OF CORPORATIONS AftNrsi Di mot'uf an official lair of Florida wrliairr Dgpartment of State / Division of Corporations / Search Records / Search by FEI/EIN Number / Detail by FEI/EIN Number Foreign Profit Corporation CIGNA HEALTH AND LIFE INSURANCE COMPANY Filing Information Document Number F96000002814 FEI/EIN Number 59-1031071 Date Filed 06/04/1996 State CT Status ACTIVE Last Event AMENDMENT AND NAME CHANGE Event Date Filed 03/24/2010 Event Effective Date NONE Principal Address 900 Cottage Grove Road Bloomfield, CT 06002 Changed: 06/25/2020 Mailing Address 900 Cottage Grove Road Bloomfield, CT 06002 Changed: 06/25/2020 Registered Agent Name&Address CHIEF FINANCIAL OFFICER 200 E. GAINES ST TALLAHASSEE, FL 32399-0000 Name Changed: 03/17/2003 Address Changed: 04/07/2014 Officer/Director Detail Name&Address Title Director BUCKLEY, TIMOTHY 900 Cottage Grove Road Bloomfield, CT 06002 Title DIRECTOR, President HUGGINS, JULIA 900 Cottage Grove Road Bloomfield, CT 06002 Title DIRECTOR, MEMBER OF INVESTMENT COMMITTEE, CHAIRMAN OF EXECUTIVE COMMITTEE, SENIOR VICE PRESIDENT LABONTE. TRACY 900 Cottage Grove Road Bloomfield, CT 06002 Title Director, CFO,ASSISTANT VICE PRESIDENT,ACTUARY ROTTKAMP, JOHN 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT-INVESTMENT RISK MANAGEMENT,ACTUARY, Director, MEMBER OF INVESTMENT COMMITTEE RUSSELL, DAVID 900 Cottage Grove Road Bloomfield, CT 06002 Title Director, MEMBER OF INVESTMENT COMMITTEE SNOW, CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT ABATE,ANTHONY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT ABBURI,APARNA 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY ANDERSON,TRACEY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT ARCISZEWSKI,TODD 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY ARMSTRONG, LINDSAY 900 Cottage Grove Road Bloomfield,CT 06002 Title VP AUSTIN, KAREN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP BARNES, GREGORY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP BARNETT, PETER 900 Cottage Grove Road Bloomfield, CT 06002 Title VP BERARDO, JEFF 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY BERNIER, RHIANNON 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT BLAKESLEE, ERIC 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY BORDEN, EVA 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT BOWE, CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT BRISSETT, STEPHEN 900 Cottage Grove Road Bloomfield, CT 06002 Title Secretary BROWN, GENEVA 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT BRUNDIN, KELLY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY CELMER, SUSAN 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT CETTI, WILLIAM 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT CROMPTON, MICHAEL 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT CROOKE, STEVEN 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT CULP, GARY 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY DANZIGER, LAUREN 900 Cottage Grove Road Bloomfield,CT 06002 Title ASSISTANT VICE PRESIDENT DEMONTEVERDE, MICHELLE 900 Cottage Grove Road Bloomfield,CT 06002 Title ASSISTANT VICE PRESIDENT ROSA DE , CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title VP,ASSISTANT TREASURER DILLON,TERRENCE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY SAWALLESH,ALISON EPPINGER 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT ERICKSON, KIRK 900 Cottage Grove Road Bloomfield, CT 06002 Title VP EVELYN, BONNIE 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY FARVER, KAREN 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT FITZPATRICK, JAMES 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT,ASSISTANT TREASURER FLEMING, MARK 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT FREELAND, TIMOTHY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT FUNDERBURK, KIMBERLY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY GAO, DIFEI 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT GERHARD, GLENN 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY GIRTON, MICHELLE 900 Cottage Grove Road Bloomfield, CT 06002 Title Director GORMAN, STEPHANIE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANTSECRETARY GORODETZER, KRISTEN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP GRAY, RICHARD 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT HALEY,WILLIAM 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT HAMM, KENNETH 900 Cottage Grove Road Bloomfield, CT 06002 Title VP HICKEY,JAMES 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT HOPKINS, LORI 900 Cottage Grove Road Bloomfield, CT 06002 Title VP JEFFREYS, MARC 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY JOBE, ELIZABETH 900 Cottage Grove Road Bloomfield, CT 06002 Title VP,ASSISTANT VICE PRESIDENT JOHNSON, ROBERT 900 Cottage Grove Road Bloomfield, CT 06002 Title VP JORDAL, KRISTIN 900 Cottage Grove Road Bloomfield,CT 06002 Title VP,CHIEF MEDICAL OFFICER JOSEPHS„ SCOTT, M.D. 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KANE,WILLIAM 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KENYON, MATTHEW 900 Cottage Grove Road Bloomfield,CT 06002 Title VP KHAN M.D., M.M.,ASLAM 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KOBUS, DAVID 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KOCHER, RYAN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KOWALCZYK,THOMAS 900 Cottage Grove Road Bloomfield,CT 06002 Title VP KRONBERG, DEBORAH 900 Cottage Grove Road Bloomfield, CT 06002 Title VP KRUPP,TARA 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY KU, KELLY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT MAZLISH, LEONARD 900 Cottage Grove Road Bloomfield,CT 06002 Title ASSISTANT SECRETARY METROW, SUSAN 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY MILBRANDT,TROY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP MIRABELLA, MORRIS 900 Cottage Grove Road Bloomfield, CT 06002 Title VP MONACO, PETER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT MOREAU, JENNIFER 900 Cottage Grove Road Bloomfield,CT 06002 Title ASSISTANT VICE PRESIDENT MULLINS, NANCY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT NAIK, MANISH 900 Cottage Grove Road Bloomfield, CT 06002 Title VP NEMECEK, DOUGLAS 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY OLEKSAK, KEVIN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP O'NEIL, KATHLEEN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP OUGH, BRIAN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP PARETE, NANDO 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT DIRECTOR PERROTTA, GLORIA 900 Cottage Grove Road Bloomfield, CT 06002 Title VP POTTER, CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY,ASSISTANT DIRECTOR QUENTAL,ANN 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT RAPISARDI, EUGENE 900 Cottage Grove Road Bloomfield, CT 06002 Title VP,ASSISTANT TREASURER REYNOLDS, DREW 900 Cottage Grove Road Bloomfield, CT 06002 Title VP ROBLE,JOHN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP ROOKER,TODD 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT ROSANO, JOHN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SAATHOFF, STEPHEN 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SADLER, JASON 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SANCHEZ, YESENIA 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT SCARDELLETTE, FREDERICK 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY SCATURO, JOANNE 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY SCHAEFFER, PAUL 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY SCHMEHL, SANDRA J. 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SECCHIA, RICHARD 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT SHANE, BARRY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SHEPARD, KIMBERLY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SHERIDAN,TIMOTHY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT SHERRY,WENDY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SILVAY, KENNETH 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY,VP SKRIPOL, REBECCA 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SMITH, DEBRA 900 Cottage Grove Road Bloomfield, CT 06002 Title Director SMITH,VICTORIA 900 Cottage Grove Road Bloomfield, CT 06002 Title VP SPILLANE, DANIEL 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT STACY,ADAM 900 Cottage Grove Road Bloomfield, CT 06002 Title VP STEWART, KATHLEEN 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY SWANSON, DAVID 900 Cottage Grove Road Bloomfield, CT 06002 Title VP THOMAS, LANCE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT TIMM, KATHLEEN 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY TORRES, ERIKA 900 Cottage Grove Road Bloomfield, CT 06002 Title VP TOTTERDALE , MATTHEW , II 900 Cottage Grove Road Bloomfield, CT 06002 Title VP TRIPLETT, MICHAEL , Sr. 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY UNNERSTALL, CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT UTTERBACK, CHARLES 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT VANGELI, MARIO 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT VERTEFEUILLE, MARK 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY WALKER, NATALIE 900 Cottage Grove Road Bloomfield, CT 06002 Title VP WEBB, JOHN 900 Cottage Grove Road Bloomfield, CT 06002 Title Treasurer,VP LAMBERT, SCOTT 900 Cottage Grove Road Bloomfield,CT 06002 Title ASSISTANT VICE PRESIDENT CIMINI, CRAIG 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT COLBORN , CHRISTOPHER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT FORTIN ,VALERIE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT TREASURER,VP HART, JOANNE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT HENDSEY, BRADLEY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT HINMAN , LINDY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT HOLGERSON , BRYAN 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT HOLZLI , TIMOTHY 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT IREDELL, CRAIG 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY JOHNSON , JANET 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY KAPLAN , MICHAEL 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY LEE , JENNIFER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT LESTER,TYLER 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY LEVENBACH , GARY 900 Cottage Grove Road Bloomfield, CT 06002 Title VP LEWIS, EDWARD 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY LEZON ,ALISON 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT LIPSON , GREG 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY LOUGH , LISA 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY LUKASIAK, STACIE 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT,ACTUARY MALONE , GREGORY 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT MARTINEZ , ERIC 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT MATHEWS , RANDY 900 Cottage Grove Road Bloomfield, CT 06002 Title DIRECTOR MCGOLDRICK , FRANCIS 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT OCHAL, MARK 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT OWENS , THOMAS 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY ZWICK , ROBERT 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT ZORNOSA, NICHOLAS 900 Cottage Grove Road Bloomfield, CT 06002 Title VALUATION ACTUARY,VP YABLECKI , JAMES 900 Cottage Grove Road Bloomfield, CT 06002 Title ACTUARY WORTHINGTON , MATTHEW 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY WILLIAMS , ROSINA 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT VICE PRESIDENT WELCH , PETER 900 Cottage Grove Road Bloomfield, CT 06002 Title ASSISTANT SECRETARY WEGRZYNIAK, HEATHER 900 Cottage Grove Road Bloomfield, CT 06002 Title VICE PRESIDENT- DERIVATIVES THOMAS , LISA 900 Cottage Grove Road Bloomfield, CT 06002 Annual Reports Report Year Filed Date 2023 03/11/2023 2023 04/06/2023 2023 04/10/2023 Document Images 04/10/2023—AMENDED ANNUAL REPORT View image in PDF format 04/06/2023--AMENDED ANNUAL REPORT View image in PDF format 03/11/2023—ANNUAL REPORT View image in PDF format 04/21/2022—ANNUAL REPORT View image in PDF format 04/30/2021--ANNUAL REPORT View image in PDF format 06/25/2020--ANNUAL REPORT View image in PDF format 04/20/2019—ANNUAL REPORT View image in PDF format 04/11/2018--ANNUAL REPORT View image in PDF format 04/20/2017—ANNUAL REPORT View image in PDF format 04/23/2016—ANNUAL REPORT View image in PDF format 04/15/2015--ANNUAL REPORT View image in PDF format 04/07/2014—ANNUAL REPORT View image in PDF format 04/23/2013—ANNUAL REPORT View image in PDF format 02/09/2012—ANNUAL REPORT View image in PDF format 03/08/2011--ANNUAL REPORT View image in PDF format 05/17/2010--ANNUAL REPORT View image in PDF format 03/24/2010--Amendment and Name Change View image in PDF format 07/17/2009--ANNUAL REPORT View image in PDF format 01/21/2008--ANNUAL REPORT View image in PDF format 03/13/2007--ANNUAL REPORT View image in PDF format 03/09/2006--ANNUAL REPORT View image in PDF format 01/18/2005--ANNUAL REPORT View image in PDF format 07/07/2004--ANNUAL REPORT View image in PDF format 05/05/2003--ANNUAL REPORT View image in PDF format 03/27/2002--ANNUAL REPORT View image in PDF format 02/13/2001--ANNUAL REPORT View image in PDF format 06/07/2000--ANNUAL REPORT View image in PDF format 11/23/1999--Name Change View image in PDF format 05/04/1999--ANNUAL REPORT View image in PDF format 02/19/1998--ANNUAL REPORT View image in PDF format 09/17/1997--ANNUAL REPORT View image in PDF format 06/04/1996—DOCUMENTS PRIOR TO 1997 View image in PDF format 06/04/1996--Foreign Qualification View image in PDF format City of Miami Beach RFP # 2023-259-WG Table of Contents Tab 1 - Cover Letter, Table of Contents & Minimum Qualifications Requirements 1.1 Title Page, Cover Letter, Table of Contents, Clarifications & Bid Submittal Questionnaire 1.2 Minimum Qualifications Requirements • Appendix A o Al. Minimum Eligibility Requirements • Client References • Proof of Insurance o A3. Specifications o A3. Scope of Work for Health Plan—Medical ASO Services o A4. Special Conditions Tab 2 — Experience & Qualifications 2.1 Qualifications of Proposing Firm 2.2 Qualifications of Proposer Team Tab 3 — Scope of Services Proposed Tab 4 — Approach and Methodology A. Approach and Methodology B. Implementation Calendar C. Performance Guarantees Tab 5 — Required Attachments The following attachments are required: • Attachment D - Repricing • Attachment F—Detail • Attachment F—Summary • Attachment J—CPT Codes—Top 100 • Attachment M—Fee Proposal • Attachment G—Medical Questionnaire • Questionnaire Exhibits • Trade Secret Statement Doc Cigna Cigna Benefit Solutions for: City of Miami Beach RFP # 2023-259-WG Electronic Submission April 2023 A Proposal for: Medical, Medicare, Pharmacy, and Behavioral Health Coverage Provided by: Listed below are the legal names of the companies submitting this response to the City of Miami Beach Request for Proposal. In this proposal, the name "Cigna" and other service marks, or division/trade names, may be used to refer to these companies and/or the products and services offered by them or their affiliates. All affiliated Cigna companies and operating subsidiaries are indirectly wholly owned subsidiaries of The Cigna Group, a publicly traded corporation. Cigna Health and Life Insurance Company (CHLIC) HealthSpring Life and Health Insurance Company (HSLH) cigna heals scare Confidential,unpublished property of Cigna Healthcare.Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.©2023 Cigna Healthcare Cigna healthcare,- Yesenia Sanchez Vice President of Cigna Health and Life Insurance Company April 7,2023 City of Miami Beach Mr.William Garviso Procurement Services 1755 Meridian Ave Miami Beach,FL 33139 RFP: 2023-259-WG Health, Pharmacy (Rx), and Medicare Advantage Plans Plan A—ASO and Pharmacy Services Dear Mr.Garviso: Cigna appreciates the opportunity to continue our partnership and provide The City of Miami Beach(COMB)with a proposal comprised of Medical,Behavioral Health and Pharmacy Benefit Management services as part of an integrated offering.We acknowledge and are agreeing to an understanding of the requirements of the scope of work of this solicitation and have addressed your questions. Cigna understands the unique and diverse needs of the Government sector and the challenges of providing competitive benefits in a difficult economic environment. Cigna has been providing benefits to the Government and Education sector for over fifty years. Today,we have over 1.6 million covered lives in this sector and we are very proud to also currently provide integrated benefits to many of your neighboring Government and Education Districts,including City of Miami and Miami-Dade County Public Schools. Through our long history of catering to the Government and Education segment,we have developed insights that have enabled us to build a customer centric service team that includes true 24/7/365 live customer service. Today, Cigna is the only national health services company in the industry that offers this committed level of service.With this,we are including Cigna's Smart Support Concierge service model which is a specialized customer service team exclusively designed to help local government and education members balance a healthy lifestyle with health care costs. Within this proposal,we have identified several differentiators that we believe will be beneficial to the City of Miami Beach,your members,and their families.We have outlined below the key highlights to our proposal and we look forward to the opportunity to partnering with you in the future. Plan A:ASO and Pharmacy Services offering for the City of Miami Beach highlights: ASO Fees Cigna is offering a reduced admin fee which will remain flat for 3 years thru 9/30/2026 with 2%escalators in years 4&5. ASO Fee Holidays Cigna is offering ASO Fee waivers equal to 3 months projected fees in year 1 worth $190,280&2 months projected fees in year 2 worth$126,850. Innovation Fund $100,000 Innovation Fund for years 1-5 for the City to utilize for programs, initiatives,additional wellness funds or to the City's discretion. Page 1 Cigna Wellness Fund Cigna is offering a Wellness Fund of$100,000 annually. Medical Guarantees Cigna is offering medical guarantees worth$202,000 Smart Support Customer We have included this specialized,onshore public sector Concierge Service as a part Service Model of our proposed fees Dedicated Onsite Continue to include the dedicated,Onsite Customer Service Representative Representative Improved Pharmacy Cigna is offering improved pharmacy discounts&rebates worth approximately Discounts&Rebates $590,00 Pharmacy Service Cigna is offering pharmacy guarantees worth$30,000 annually at risk Guarantees In closing,I would like to thank you for giving us the opportunity to propose services to the City of Miami Beach. We are confident in the strength of our proposal and are presenting this as an accurate and complete response to meet the needs of your organization. We are confident in the value we will bring to your organization,your employees and their families—by providing the appropriate focus and resources to drive better health outcomes,a high level of employee satisfaction and ultimately deliver long-term savings. If you have any questions regarding our proposal,please feel free to call Michelle Alperstein with any questions as well at: 860-902-5449 or myself at 404.242.7652. Sincerely, Yesenia Sanchez Vice President of Cigna Health and Life Insurance Company Page 2 Cigna healthcare City of Miami Beach Responses to RFP RFP #2023-259-WG We have provided clarifying responses to certain RFP provisions below. FORMAL SOLICITATIONS TERMS AND CONDITIONS—GOODS &SERVICES 3. ASSIGNMENT. No contract shall be assigned, transferred, conveyed, sublet or otherwise disposed, including any or all right, title or interest therein, or power to execute such contract, to any person, company or corporation, without the prior written consent of the City. Cigna agrees not to assign the contract in whole; however, while Cigna serves as the sole provider of services requested in this proposal, a number of the services under our contracts are performed by affiliates of Cigna with a particular expertise in order to help contain costs without prior written approval from clients. Every such service is supervised by Cigna. 16. FORCE MAJEURE. a. A "Force Majeure" event is an event that (i) in fact causes a delay in the performance of the Contractor or the City's obligations under the Agreement, and (ii) is beyond the reasonable control of such party unable to perform the obligation, and (iii) is not due to an intentional act, error, omission, or negligence of such party, and (iv) could not have reasonably been foreseen and prepared for by such party at any time prior to the occurrence of the event. Subject to the foregoing criteria, Force Majeure may include events such as war, civil insurrection, riot, fires, epidemics, pandemics, terrorism, sabotage, explosions, embargo restrictions, quarantine restrictions, transportation accidents, strikes, strong hurricanes or tornadoes, earthquakes, or other acts of God which prevent performance. Force Majeure shall not include technological impossibility, inclement weather, or failure to secure any of the required permits pursuant to the Agreement. Agreed; however, nothing herein shall relieve the City from its obligation to properly fund the claims bank account and to pay fees beyond the grace period. 17. INDEMNIFICATION. The bidder shall indemnify and hold harmless the City and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of the agreement by the bidder or its employees, agents, servants, partners, principals or subcontractors. The bidder shall pay all claims and losses in connection therewith, and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorney's fees which may cigna Page 1 healthcare City of Miami Beach Responses to RFP RFP #2023-259-WG be incurred thereon. The bidder expressly understands and agrees that any insurance protection required by any agreement with the City or otherwise provided by the bidder shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The above indemnification provisions shall survive the expiration or termination of this Agreement. Cigna Health and Life Insurance Company (CHLIC) does not operate as an insurance carrier in the context of administrating a self-funded benefit plan. Notwithstanding, Cigna shall use ordinary and reasonable care in the performance of its duties but shall not be liable to the City for mistakes of judgment or other actions taken in good faith (including plan benefits erroneously overpaid). Cigna will indemnify and hold the City harmless from and against all non-plan-benefit costs, damages, judgments, attorney fees, expenses, and liabilities of any kind or nature that occur as the result of Cigna's negligence concerning the administration of claims under the City's plan. 19. INSPECTOR GENERAL AUDIT RIGHTS. a. The Contractor shall make available at its office at all reasonable times the records, materials, and other evidence regarding the acquisition (bid preparation) and performance of this contract, for examination, audit, or reproduction, until three (3) years after final payment under this contract or for any longer period required by statute or by other clauses of this contract. In addition: i. If this contract is completely or partially terminated, the Contractor shall make available records relating to the work terminated until three (3) years after any resulting final termination settlement; and ii. The Contractor shall make available records relating to appeals or to litigation or the settlement of claims arising under or relating to this contract until such appeals, litigation, or claims are finally resolved. b. The provisions in this section shall apply to the Contractor, its officers, agents, employees, subcontractors, and suppliers. The Contractor shall incorporate the provisions in this section in all subcontracts and all other agreements executed by the Contractor in connection with the performance of this contract. Cigna understands, pursuant to Section 2-256 of the Code of the City of Miami Beach, the City may be audited by the Office of the Inspector General. Cigna agrees to allow the City with the opportunity to perform an independent audit for compliance with law of programs administered by Cigna for the City, subject to mutually agreed upon terms relating to, among other things, the scope, location, manner, notice rights, review rights, timing, conduct, selection of auditor, expense, and use of data as described in Section 6 of our existing ASO agreement. Our standard provision is to allow an audit up to one year after termination. Cigna Page 2 City of Miami Beach Responses to RFP RFP #2023-259-WG In addition, our subcontractors are not contractually obligated to allow audits by our customers. Cigna will remain wholly for provision of all services for which it contracts with the City. 34. PATENTS & ROYALTIES. Bidder shall indemnify and save harmless the City of Miami Beach, Florida, and its officers, employees, contractors, and/or agents, from liability of any nature or kind, including cost and expenses for, or on account of, any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the performance of the contract, including its use by the City of Miami Beach, Florida. If the Bidders uses any design, device or materials covered by letters, patent, or copyright, it is mutually understood and agreed, without exception, that the Bid prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. The parties agree and acknowledge that the relationship set forth in this contract does not contemplate the creation of intellectual property by Cigna on behalf of the City. Cigna shall indemnify and hold the City harmless against any claim arising from the actual infringement of any third-party intellectual property right by any copyrighted, patented, or unpatented invention, process, or article provided by Cigna to the City in the course of the performance of the contract. If Cigna uses any design, device, or materials covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the bid prices shall include all royalties or costs arising from the use of such design, device, or materials in any way involved in the work. 41. TERMINATION FOR DEFAULT. If the successful Bidders shall fail to fulfill in a timely manner, or otherwise violate, any of the covenants, agreements, or stipulations material to the Bid and/or the contract entered into with the City pursuant thereto, the City shall thereupon have the right to terminate the work and/or services then remaining to be performed by giving written notice to the Bidders of such termination, which shall become effective upon receipt by the Bidders of the written termination notice. In that event, the City shall compensate the successful Bidders in accordance with the term of the contract for all work and/or services satisfactorily performed by the Bidders prior to termination, net of any costs incurred by the City as a consequence of the default. Notwithstanding the above, the successful Bidders shall not be relieved of liability to the City for damages sustained by the City by virtue of any breach of the contract by the Bidders, and the City may reasonably withhold payments to the successful Bidders for the purposes of set off until such time as the exact amount of damages due the City from the successful Bidders is determined. Cigna agrees the City shall have the right to offset monies due to Cigna if Cigna fails to cigna Page 3 healthcare City of Miami Beach Responses to RFP RFP #2023-259-WG perform its services within industry standards. eigna Page 4 healthcare 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT ROUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html BID SUBMITTAL QUESTIONNAIRE SECTION 1 -BID CERTIFICATION FORM This document is a REQUIRED FORM that must be submitted fully completed and submitted. Solicitation No: Solicitation Title: RFP 2023-259-WG Health, Pharmacy and Retiree Health Plan BIDDER'S NAME (1) Cigna Health and Life Insurance Company ( LIC)' NO.OF EMPLOYEES: NO.OF YEARSIN EUElsE.SS (1) 59 years * NO.OFYEARSIN BUSINESS LOCALLY 59 71,000 OTHER NAME(S) EIDER HAS CFERAT D l MJER N THE LAST 10 WARS N/A BIDDER PRIMARYADDRESS(HEADQUPRTER ) (1)900 Cottage Grove Road * CITY: (1) Bloomfield STATE: (1)Connecticut* I ZIP CODE{ (1) 06002* TELEPHONE NO.{ 860.226.6000 1 TOLL FREE Nat Not applicable 1 FAXNO.:f Not applicable BIDDER LOCALADDRESS 1571 Sawgrass Corporate Parkway, Suite 300 crrv: Sunrise STATE:{ Florida 1 ZIP CODE, 33323 FiRMRYPCCCIATF RHiiE�ffATI.E FCR n-s ar<�,c�err. Michelle Alperstein ACCOUNT REP TELEPHON ENO 860.902.5449 ACCOUNT REP TOLLFREE NO. 561.43U.U1 19 ACCOUNTREPEMAIL MichelleAlperstein@Cigna.com FEDERALTAXIDENTIFICATIONNO. (1) 59-1 0 3 1 071 * By virtue of submitting a bid, bidder agrees:a)to complete and unconditional acceptance of the terms and conditions of this document and the solicitation, including all addendums specifications, attachments,exhibits,appendices and any other document referenced in the solicitation c) that the bidder has not divulged,discussed,or compared the proposal with other bidders and has notcolluded with any other bidder or party to any other bid; d) that bidder acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws;e) if bid is accepted, to execute an appropriate City of Miami Beach documentfor the purpose of establishing a formal contractual relationship between the bidder and the City of Miami Beach, Florida, for the performance of all requirements to which the bid pertains; and f) that all responses,data and information contained in the bid submittal are true and accurate. The individual nam ed below affirms that she: is a principal of the applicant duly authorized to execute this questionnaire, and that the contents of said document(s) are complete, true, and correct to the bestof his/her knowledge and belief. Cigna is committed to a continued partnership with the City and we look forward to meeting your needs. Should the City's preference be the development of a new agreement, Cigna agrees file:///Z:/2023 RFPs/With PM/Other Broker/City ofMiami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBM rtTAL QUESTIONNAIRE WITHO... 1/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html to work in good faith with the City to negotiate an agreement agreeable to the Parties. As the incumbent medical administrator, Cigna's preference is to continue to operate under the existing ASO agreement. Discrepancies, if any, between the terms of this RFP and the ASO agreement will be decided in the favor of the ASO agreement. Name and Title of Bidder's Authorized Signature of Bidder's Authorized Representative: Repres tati Yesenia Sanchez Vice President of CHLIC* file:///Z:/2023 RFPS/With PM/Other Broker/City of iami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WITHO.. 2/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WITHOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html SECTION 2 -ACKNOWLEDGEMENT OF ADDENDUM After issuance of solicitation, the City may release one or more addendum to the solicitation, which may provide additional information to bidders or alter solicitation requirements. The City will strive to reach every bidder having received solicitation through the City's e-procurement system. However, bidders are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the bidder has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addenda may result in proposal disqualification. Enter Initial Enter Initial Enter Initial to to Confirm to Confirm Confirm Receipt Receipt Receipt 7 YS Addendum 1 2/23/2023 Addendum 6 Addendum 11 YS Addendum 2 3,17/2023 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 r r Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required, submit under separate cover. SFrTInN 3 - C(NIFI I"T nw INTFREST All bidders must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all bidders must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the bidder entity or any of its affiliates. 1 2 3 4 5 6 SECTION 4 - FINANCIAL At time of request by the City, bidder shall request that Dun & Bradstreet submit its Supplier Qualifier Report directly to the City, with bid or within three (3) days of request. Bidder shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the City. No proposal will be considered without receipt (when requested), by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the bidder. The bidder shall file:///Z./2023 RFPs/With PM/Other Broker/City ofMiami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WITHO_. 3/14 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html request the SQR report from D&B at: https://su pplierportal.d nb.com/webapp/wcs/stores/servlet/Su pplierPortal? storeld=11696 Bidders are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each bidder review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. Cigna does not subscribe to ratings from Dun & Bradstreet.We carry ratings with three major rating agencies:AM. Best, Moody's, and Standard and Poor's, all of which are highlyregarded in the industry. Because we believe these relationships provide ample coverage of our companies,we do not seek ratings from additional agencies. Additionally, Dun & Bradstreet uses publiclyavailable data to develop ratings without any input, review, or interaction with Cigna. Without management's review of financial data used in the rating process,we cannot vouch for the re liability and/or completeness of the rating. file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WITHO. 4/14 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html SECTION 5 - REFERENCES AND PAST PERFORMANCE Project No. 2023-259-WG Project Title Health,Pharmacy and Retiree Health Plan Bidder shall submit at least three (3) references for whom the bidder has completed work similar in size and nature as the work referenced in solicitation. Bidder may submit additional references as part of its bids submittal. Reference No.1 FirmName: City of Fort Lauderdale{ Contact Individual Name and Title: Guy Hine Risk Manager Address:100 North Andres Avenue, Fort Lauderdale, FL 33301 Telephone: 954-828-5494 Contact's Email: GHine@fortlauderdale.gov Narrative on Scope of Services Provided, Project Budget, and Project Dates: Medical, Behavioral,Pharmacy, Stop Loss, EAP, Dental PPO, Dental DHMO. Group has been a client since January 1, 2012.Annual Premium including Stop Loss is$2,862,426.46 Reference No.2 FirmName: Leon Management Contact Individual Name and Title: Regina Santilli Benefits Analyst Address: 8600 NW 41 st Street, Miami, FL 33166 Telephone: 305-631-5963 Contact's Email: TarcisiaRegina.Santilli@leonmedicalcenters.corn Narrative on Scope of Services Provided, Project Budget, and Project Dates: 4 Medical, Behavioral,Stop Loss. Group has been a client since January 1, 2018.Annual Premium including Stop Loss is$2,109,653 file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WITHO... 5/14 2/24/23,3:38 PM BID SUBM ITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html City of Miami Reference Individual Name and Title: No.3 Firm Name: Contact Ann Marie Sharpe ARM-P Director of Risk Management Address: 444 SW 2nd Avenue 9th Floor Telephone: 305-416-1381 Contact's Email: Asharpe@miamigov.com Narrative on Scope of Services Provided, Project Budget, and Project Dates: Medical, Behavioral,Pharmacy, Stop Loss, EAP, Dental PPO, Dental DHMO, Vision, Medicare PDP, F.S.A. Group has been a client since January 1, 2008. Annual Premium including Stop Loss is $5,178,140.00 Medical,Behavioral, Pharmacy, Stop Loss, EAP, Dental PPO, Dental DHMO,Vision, Medicar file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WITHO... 6/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html SECTION 6-SUSPENSION, DEBARMENT, OR CONTRACT CANCELLATION Has bidder ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency? ✓1S NO If answer to above is "YES," bidder shall submit a statement detailing the reasons that led to action(s): Cigna certifies to the best of its knowle dge and belief, that neither the bidding entities, nor its principals have been debarre d, suspende d, proposed for debarme nt, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal departme nt or agency for the services conte mplate d under this proposal. Although Cigna Health and Life Insurance Company (CHLIC) and certain other operating subsidiarie s of Cigna may have been subject to regulatory actions, fines, sanctions, and/or administrative penaltie s by certain federal and state governme ntal regulatory bodie s, CHLIC's ability to fulfill its obligations under this RFP is not materially impacte d. Our busine ss operate s in a heavily regulate d industry. We are subject to numero us regular inquirie s and oversight by various state and federal authoritie s. In perhaps an overabundance of caution, we should note that effective January 21, 2016, CMS impose d interme diate sanction s on Cigna- HealthSpring citing various complian ce-related issues discov ered in the course of a 2015 audit. On June 16, 2017, Cigna received notification from CMS that the marke ting and enrollme nt sanction s impose d by CMS on January 21, 2016, had been lifted. Further, contracts terminate for a variety of reasons by both parties. Cigna does not track the cause s for such contract terminations. Additional information is restricted and cannot be shared externally. file:///Z:/2023 RFPs/With PM/OtherBroker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBM ITTAL QUESTIONNAIRE WITHO... 7/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html SECTION 7 - SMALL AND DISADVANTAGED BUSINESS CERTIFICATION Pursuant to Resolution 2020-31519, the City is tracking the Small and Disadvantaged Businesses, as certified by Miami-Dade County that have been certified as Small or Disadvantaged Business by Miami- Dade County. Does bidder possess Small or Disadvantaged Business certification by Miami-Dade County? Q YES Q NO BUSINESS ENTERPRR ''"'"' Pursuant to Resolution 2020-31342, the City is tracking the utilization of LGBT owned firms that have been certified as an LGBT Business Enterprise by the National Gay and Lesbian Chamber of Commer ce (NGLCC). Does bidder possess LGBT Business Enterprise Certification by the NGLCC? YES ✓ NO file:///Z:/2023 RFPs/With PM/Other Broker/City ofM iam i Beach(FL)M,RX,Medicare/Strategist/Wortdng/BID SUBM ITTAL QUESTIONNAIRE WITHO... 8/14 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html SECTION 9 - BYRD ANTI-LOBBYING AMENDMENT CERTIFICATION FORM APPENDIX A, 44 C.F.R. PART 18 — CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned Contractor certifies, to the best of his or her knowledge, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2 If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. a The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The undersigned Contractor certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any. By virtue of submitting bid, bidder certifies or affirms its compliance with the Byrd Anti-Lobbying Amendment Certification.IStrategist_TAGI Name and Title of Bidder's Authonzed Signature of Bidder's Authonzed Representative: Represent tive: Yesenia Sanchez Vice PresidentCHLIC J I SECTION 10 - SUSPENSION AND DEBARMENT CERTIFICATION The Contractor acknowledges that: (1) This Contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. As such the contractor is required to verify that none of the Contractor, its principals file:///Z:/2023 RFPs/With PM/Other Broker/City of M iam i Beach(FL)M,RX,Medicare/Strategist/Wortdng/BIDSUBMITTAL QUEST IONNAIRE WIT H... 10/15 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html (defined at 2 C.F.R. § 180.995), or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935). (2) The Contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. (3) This certification is a material representation of fact relied upon by the City. If it is later determined that the Contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the City, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. (4) The Contractor agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The Contractor further agrees to include a provision requiring such compliance in its lower tier covered transactions." By virtue of submitting bid, bidder certifies or affirms its compliance with the Suspension and Debarment Certification. Name and I Itle of Bidder's Authonzed Signature of Bidder's Authonzed Representative: Representative: Yesenia Sanchez Vice President of C-ILIC SECTION 11 -CONE OF SILENCE Pursuant to Section 2-486 of the City Code, all procurement solicitations once advertised and until an award recommendation has been forwarded to the City Commission by the City Manager are under the "Cone of Silence." The Cone of Silence ordinance is available at https://library.municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEOR CH2AD ARTVIISTCO DIV4PR S2-486COS1 Any communication or inquiry in reference to this solicitation with any City employee or City official is strictly prohibited with the of exception communications with the Procurement Director, or his/her administrative staff responsible for administering the procurement process for this solicitation providing said communication is limited to matters of process or procedure regarding the solicitation. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranado@miamibeachfl.gov By virtue of submitting bid, bidder certifies that it is in compliance with the Cone of Silence Ordinance, pursuant to Section 2-486 of the City Code. SECTION 12 - CODE OF BUSINESS ETHICS Pursuant to City Resolution No.2000-23789, the Bidder shall adopt a Code of Business Ethics prior to executing a contract with the City. The Code of Business Ethics shall be submitted to the Procurement Department with its response or within three (3) days of request by the City. The Code shall, at a minimum, require the Bidder, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City Code. In lieu of submitting Code of Business Ethics, bidder may indicate that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at http://www.miamibeachfl.gov/city- file:///Z:/2023 RFPsfW th PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist%World ng/BID SUBMITTAL QUESTIONNAIRE WIT H... 1 1/14 2/24/23,3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html hall/procurement/procurement-related-ordinance-and-procedures/ Bidder will submit firm's Code of Business Ethics within three (3) days of request by the City? n sirs n NO Bidder adopts the City of Miami Beach Code of Business Ethics? YES F-1N . Cigna Corporation, its subsidiaries, and its affiliates (collectively"Cigna")are committed to conducting our businesses in an ethical and law-abiding fashion. Cigna's Code of Ethics establishes the foundation for Cigna's unwavering commitment to legal compliance, integrity, and ethical conduct. Employees are trained on Cigna's code and are required to affirm that theyhave disclosed any known or suspected violation of the code of ethics and compliance as part of the annual ethics affirmation process.Cigna will abide by its code of ethics and compliance in connection with any and all services it may provide to the City. SECTION 13- LOBBYIST REGISTRATION & CAMPAIGN CONTRIBUTION REQUIREMENTS This solicitation is subject to, and all bidders are expected to be or become familiar with, all City lobbyist laws, including lobbyist registration requirements and prohibition on campaign contributions, including: • Lobbyist Registration Requirements sections 2-397 through 2-485.3 of City Code (https://library.municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEORCH2AD ARTVIISTCO DIV3L0) • Campaign Contribution Requirements sections 2-487 and 2-488 of City Code (https://library.municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEOR CH2AD ARTVIISTCO DIV5CAFIRE) By virtue of submitting bid, bidder certifies or affirms that they have read and understand the above Lobbyist Registration & Campaign Contribution Requirements. SECTION 14- NON-DISCRIMINATION The Non-Discrimination ordinance is available at: https://library.municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEOR CH2AD ARTVIPR DIV3COPR S2-375NSCCOREWA By virtue of submitting bid, bidder agrees it is and shall remain in full compliance with Section 2-375 of the City of Miami Beach City Code. SECTION 15 - FAIR CHANCE REQUIREMENT The Fair Chance Ordinance No. 2016-4012 is available at: silent.https://library.municode.com/fl/miami beach/codes/ code of ordinances ?nodeld=SPAGEOR CH62HURE ARTVFACHOR By virtue of submitting bid, bidder certifies that it has adopted policies, practices and standards consistent with the City's Fair Chance Ordinance. Bidder agrees to provide the City with supporting documentation evidencing its compliance upon request. Bidder further agrees that file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WIT H. 12/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html any breach of the representations made herein shall constitute a material breach of contract, and shall entitle the City to the immediate termination for cause of the agreement, in addition to any damages that may be available at law and in equity. SECTION 16-PUBLIC ENTITY CRIMES Please refer to Section 287.133(2)(a), Florida Statutes, available at: https://www.flsenate.gov/Laws/Statutes/2012/287.133 By virtue of submitting bid, bidder agrees with the requirements of Section 287.133, Florida Statutes,and certifies it has not been placed on convicted vendor list. SECTION 1 i - VETERAN BUSINESS ENTERPRISES PREFERENCE Pursuant to City of Miami Beach Ordinance No. 2011- 3748, https://library.municode.com/fl/miami beach/codes/code of ordinances? nodeld=SPAGEOR CH2AD ARTVIPR DIV3COPR S2- 374PRPRPRVECOGOCOSE the City shall give a preference to a responsive and responsible bidder which is a small business concern owned and controlled by a veteran(s) or which is a service-disabled veteran business enterprise, and which is within five percent (5)/0) of the lowest and best bidder, by providing such bidder an opportunity of providing said goods or contractual services for the lowest responsive bid amount. Whenever, as a result of the foregoing preference, the adjusted prices of two (2) or more bidders which are a small business concern owned and controlled by a veteran(s) or a service-disabled veteran business enterprise constitute the lowest bid pursuant to an ITB, RFP, RFQ, ITN or oral or written request for quotation, and such bids are responsive, responsible and otherwise equal with respect to quality and service, then the award shall be made to the service-disabled veteran business enterprise. Is the bidder a service-disabl ed veteran business enterprise certified by the State of Florida? YES ✓ NO Is the bidder a service-dis abled veteran business enterprise certified by the United States Federal Government? [i YES ✓; NO SECTION 18 -EQUAL BENEFITS FOR EMPLOYEES WITH SPOUSES AND EMP!_.OYFES WITH DOMESTIC PARTWFRS When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. Does bidder provide or offer access to any benefits to employees with spouses or to spouses of employees? ✓ YES NO file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WIT H. 13/14 2/24/23,3:38 PM B ID SUBM ITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.htm1 Does bidder provide or offer access to any benefits to employees with (same or opposite sex) domestic partners or to domestic partners of employees? (J) YES Li NO Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavem ent leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. Bidder Provides for Bidder Provides for Bidder does not BENEFIT Employees with Employees with Provide Benefit Spouses Domestic Partners Health x X Sick Leave x x Family Medical x x Leave bereavement X X Leave If Bidders cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Woriing/BID SUBMITTAL QUESTIONNAIRE WIT H... 14/14 2/24/23, 3:38 PM BID SUBMITTAL QUESTIONNAIRE WIT HOUT LIVING WAGE WIT H EQUAL BEN.-FINAL 10.27.html at http://Www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and- procedures/ SECTION 19 - MORATORIUM ON TRAVEL TO AND THE PURCHASE OF GOODS OR SERVICES FROM IMISSISSIPPI Pursuant to Resolution 2016-29375, the City of Miami Beach, Florida prohibits the purchase of goods or services sourced in Mississippi. Are any of the products for which the applicant is seeking to be prequalified sourced in Mississippi? YES ✓ NO If yes, explain. file:///Z:/2023 RFPs/With PM/Other Broker/City of Miami Beach(FL)M,RX,Medicare/Strategist/Working/BID SUBMITTAL QUESTIONNAIRE WIT H.. 15/14 The City of Miami Beach Florida RFP 2023-259-WG Health and Pharmacy and Retiree Health Al.Minimum Eligibility Requirements.The Minimum Eligibility Requirements for this solicitation are listed below. Bidder shall submit the required submittal(s) documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements shall be deemed non-responsive and shall not have its bid considered. 1. Required Submittals: Three (3) client references including name, contact information including address/telephone/email, length of services provided, and a detailed description of the services provided to the client. City of Fort Lauderdale Guy Hine 100 North Andrews Avenue Fort Lauderdale,FL 33301 954-828-5494/GHine(a>,fortlauderdale.gov Client since:January 1,2012 Services Provided:Medical,Behavioral,Pharmacy,Stop Loss,EAP,Dental PPO,Dental DHMO Leon Management Regina Santilli 8600 NW 41st Street,Miami,FL 33166 305-631-5963/TarcisiaRegina.Santillileonmedicalcenters.com Client since:January 1,2018 Services Provided:Medical,Behavioral,Pharmacy Stop Loss City of Miami Ann Marie Sharpe ARM-P 444 SW 2"Ave,9'Floor Miami,FL 33130 305-416-1381 /asharpe@miamigov.com Client since:January 1,2008 Services Provided: Medical,Behavioral,Pharmacy,Stop Loss,EAP,Dental PPO,Dental DHMO,Vision,Medicare PDP,F.S.A Copyright 2023 Page 1 of 1 Cigna DATE(MM/DDM'YY) ,4coRo CERTIFICATE OF LIABILITY INSURANCE 03/14/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). a) PRODUCER CONTACT 13 NAME: Aon Risk Services Central, Inc. Philadelphia PA Office (NC.No.EXt):NE (866) 283-7122 INC.FAX (800) 363-0105 NC I.) v 100 North 18th Street E-MAIL x° 15th Floor ADDRESS: Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC a INSURED INSURER A: Lexington Insurance Company 19437 Cigna Corporation Et Al INSURERS: Express scripts Holding Company 900 Cottage Grove Road INSURERC: Bloomfield CT 06002 USA - INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570098296954 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS ITR _INin_WVO IMMIDDIYYYYI IMM/DD/VYYY1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) MED EXP(My one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE <O POLICY PRO-JECT ri LOC PRODUCTS-COMP/OP AGG rn 110 OTHER'. o n AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT In (Ea accidenll ANY AUTO BODILY INJURY(Per person) •• O SCHEDULED BODILY INJURY(Per accident) Z OWNED AUTOS AUTOS ONLY PROPERTY DAMAGE HIRED AUTOS NON-OWNED A ONLY -AUTOS ONLY {Per acddern) V t d UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND I PER STATUTE I 1OTH EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mare apace Is required) See attached list of additional Named Insureds. Please see second page for Lobs and Limits. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. City of Mi ami Beach AUTHORIZED REPRESENTATIVE c/o Exigis Insurance Compliant Services Attn: William Garviso PO Box 947 /� `I'k- /l� - �Q Q li Murrieta CA 92564 USA eXl'osa Z�cY(c cJift�iaed C�ibft�siG eJssa ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10042023 LOC#: ACO ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Cigna Corporation Et Al POLICY NUMBER See Certificate Number: 570098296954 CARRIER NAIC CODE See Certificate Number: 570098296954 EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS .TR TYPE OF INSURANCE INSD WVD DATE DATE (MM/DD/YYVY) (MM/DD/YYYY) OTHER A Miscellaneous 35407109 07/01/2022 07/01/2023 HC Limit - 415,000,000 Medical Healthcare Prof Liab Claims Made Professional Liab ACORD 101(2008/01) 02 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds (1 of 2) Accredo Health Group, Inc. Cigna HealthCare of St. Louis, Inc. Accredo Health, Incorporated Cigna HealthCare of South Carolina, Inc. AHG of New York, Inc. Cigna Healthcare of Tennessee, Inc. Airport Holdings, LLC Cigna HealthCare of Texas, Inc. Allegiance Benefit Plan Management, Inc. Cigna Healthcare of Utah, Inc. Allegiance Cobra Services, Inc. Cigna Healthcare, Inc. Bravo Health Mid-Atlantic, Inc. Connecticut General Life Insurance Company Brighter Inc. CuraScript, Inc. Biopartners in Care, Inc. Diversified NY IPA, Inc. Care Continuum, Inc. Diversified Pharmaceutical Services, Inc. CareCore National Group, LLC Econdisc Contracting Solutions, LLC CareCore National Intermediate Holdings, LLC ESI Canada CareCore National, LLC ESI GP Canada ULC CareCore NJ, LLC ESI GP Holdings, Inc. CareNext Managed Care, LLC ESI GP2 Canada ULC CareNext Post-Acute, LLC ESI Mail Order Processing, Inc. Chiro Alliance Corporation ESI Mail Pharmacy Service, Inc. Cigna Corporate Services, LLC ESI Partnership Cigna Dental Health of California, Inc. ESI Resources, Inc. Cigna Dental Health of Delaware, Inc. Evernorth Behavioral Health Inc. Cigna Dental Health of Florida, Inc. f/k/a Cigna Behavioral Health, Inc. Cigna Dental Health of Kentucky, Inc. Evernorth Behavioral Health of California, Inc. Cigna Dental Health of Maryland, Inc. f/k/a Cigna Behavioral Health of California, Inc. Cigna Dental Health of Missouri Evernorth Behavioral Health of Texas, Inc. Cigna Dental Health of New Jersey, Inc. f/k/a Cigna Behavioral Health of Texas, Inc. Cigna Dental Health of North Carolina, Inc. Evernorth Care Group f/k/a Cigna Medical Group Cigna Dental Health of Ohio, Inc. Evernorth Care Solutions, Inc. Cigna Dental Health of Pennsylvania, Inc. Evernorth Direct Health, LLC Cigna Dental Health of Texas, Inc. eviCore healthcare MSI, LLC Cigna Dental Health of Virginia, Inc. Express Reinsurance Company Cigna Dental Health Plan of Arizona, Inc. Express Scripts Administrators LLC Cigna Dental Health, Inc. Express Scripts Canada Co. Cigna European Services(UK) Limited Express Scripts Canada Holding Co. Cigna Health and Life Insurance Company Express Scripts Canada Holding, LLC Cigna Health Management, Inc. Express Scripts Canada Services Cigna Healthcare of Arizona, Inc. Express Scripts Canada Wholesale Cigna Healthcare of California, Inc. Express Scripts Holding Company Cigna HealthCare of Colorado, Inc. Express Scripts Holding Company, Inc. Cigna HealthCare of Connecticut, Inc. Express Scripts, Inc. Cigna HealthCare of Florida, Inc. Express Scripts Pharmaceutical Procurement, LLC Cigna Healthcare of Georgia, Inc. Express Scripts Pharmacy Atlantic, Ltd. Cigna HealthCare of Illinois, Inc. Express Scripts Pharmacy Central, Ltd. Cigna HealthCare of Indiana, Inc. Express Scripts Pharmacy Ontario, Ltd. Cigna HealthCare of New Hampshire, Inc. Express Scripts Pharmacy West, Ltd. Cigna HealthCare of New Jersey, Inc. Express Scripts Pharmacy, Inc. Cigna Healthcare of North Carolina, Inc. Express Scripts Sales Operations, Inc. 12/01/2022 Additional Named Insureds (2 of 2) Express Scripts Senior Care Holdings, Inc. SpectraCare Health Care Ventures, Inc. Express Scripts Senior Care, Inc. SpectraCare, Inc. Express Scripts Specialty Distribution Services, Inc. Tel-Drug of Pennsylvania, L.L.C. Express Scripts Strategic Development, Inc. Tel-Drug, Inc. Express Scripts Services Co. Verity Solutions Group, Inc. Express Scripts Utilization Management Company Freco, Inc. Freedom Service Company, LLC Gulfquest, LP Healthbridge Reimbursement& Product Support, Inc. Healthbridge, Inc. HealthCare of Colorado, Inc. Healthspring Life& Health Insurance Company, Inc. Healthspring of Florida, Inc. Healthspring USA, LLC Healthspring, Inc. Home Physicians Management, LLC Innovative Product Alignment, LLC Inside RX, LLC Lynnfield Compounding Center, Inc. Lynnfield Drug, Inc. MAH Pharmacy, LLC Matrix GPO, LLC Matrix Healthcare Services, Inc. MDLIVE, Inc. Medco Containment Insurance Company of NY Medco Containment Life Insurance Company Medco Health Services, Inc. Medco Health Solutions, Inc. MedSolutions Holdings, Inc. MedSolutions of Texas, Inc. MHS Holdings, CV MSI Health Organization of Texas, Inc. MyM Technology Services, LLC myMatrixx Holdings, LLC myMatrixx-B, LLC Newquest Management Northeast, LLC Newquest Management of Alabama, LLC Newquest, LLC Palladian Health of Florida, LLC Palladian Independent Practice Association, LLC Priority Healthcare Corporation Priority Healthcare Distribution, Inc. QPID Health, LLC Quallent Pharmaceuticals Health LLC Specialty Products Acquisitions, LLC 12/01/2022 A�ORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/14/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. • If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on w this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT L AOn Risk Services Central, Inc. PHONE FAX Phi 1 adel phi a PA Office (A/C.No.Eel: (866) 283-7122 vdc.No,); (800) 363-0105 v 100 North 18th Street EMAIL SS: x 15th Floor Philadelphia PA 19103 USA INSURERS)AFFORDING COVERAGE NAIC a INSURED INSURER A: ACE American Insurance Company 22667 Cigna Corporation Et Al INSURERB: Indemnity Insurance Co of North America 43575 900 Cottage Grove Road Bloomfield CT 06002 USA INSURERC: ACE Property & casualty Insurance Co. 20699 INSURER IT Lexington Insurance Company 19437 INSURERE: American Guarantee & Liability Ins Co 26247 INSURER F: COVERAGES CERTIFICATE NUMBER: 570098292693 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, TV VC o �EFF ��c Limits shown are as requested, TV TYPE OF INSURANCE NSp WVBD POLICY NUMBER (M LIi1lOp/'/l'yY) (MMIDDVM/Y1� LIMITS TAR '�X '�COIMMERCIALGENERALLIABIILT' HDOG72482256 07/01/2022 07/01/2023 EACH OCCURRENCE 52,000,000 I CLAIMS-MADE X IOCCUR SIR applies per policy terms & conditions DAMAGE $2,000,000 l I PREMISES(Ea RENTED ce) MED EXP(Any one person) S5.000 PERSONAL&ADV INJURY 52,000,000 ,., 000 000 54, , m GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE N X POLICY PRO LOC PRODUCTS 52000000 m JECT ri , , m 0 OTHER'. a A AUTOMOBILE LIABILITY ISA H25558285 07/01/2022 07/01/2023 COMBINED SINGLE LIMIT $2,000,000 N SIR applies per policy terms & condi Lions (Ea accident) BODILY INJURY(Per person) X ANY AUTO O SCHEDULED BODILY INJURY(Per accident) Z OWNED AUTOS m AUTOS ONLY PROPERTY DAMAGE 10 HIRED AUTOS AUTOS NON-OWNEDN (Per accident) V ONLY t m C X UMBRELLA LVIB X OCCUR XEUG7258448A001 07/01/2022 07/01/2023 EACH OCCURRENCE $10,000,000 v Excludes Pol# #35407110 AGGREGATE $10,000,OOO EXCESS LIAR CLAIMS-MADE DEO RETENTION B WORKERS COMPENSATION AND WLRC68915247 07/01/2022 07/01/2023 X I PER STATUTE I04 H- EMPLOYERS'LIABILITY YIN SIR applies l es ANY PROPRIETOR I PARTNER/ pP per policy terms & conditions E.L.EACH ACCIDENT S1,000,000 EXECUTIVE OFFICER/MEMBER N N I A (Mandatory in NH) E.L.DISEASE EA EMPLOYEE S1,000,000 D describe under S1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT .111.1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mon apace is required) The Products Liability policy #35407110 evidenced on this certificate is a claims made policy. Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Umbrella "7-i Liability policies. See the attached list of additional Named Insureds. M CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Miami Beach AUTHORIZED REPRESENTATIVE c/o Exigis Insurance Compliant Services Attn: William Garviso ff-as^ PO Box 947 ` % �f_ /!� �Q p �i Murrieta CA 92564 USA .rear slbc�tid C�.osaRss6✓ ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10042023 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Cigna Corporation Et Al POLICY NUMBER See Certificate Numbe 570098292693 CARRIER NAIC CODE See Certificate Numbe 570098292693 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDI. SUBR POLICY NUMBER LIMITS I.TR TYPE OF INSURANCE EFFECTIVE EXPIRATION DATE INSD WVD DATE IMM/DD/YYYY) ..M,.m YY1/) EXCESS LIABILITY E AXF967096614 07/01/2022 07/01/2023 Aggregate $5,000,000 Each $5,000,000 occurrence OTHER p Products Liability 35407110 07/01/2022 07/01/2023 Comp/op Agg $4,000,000 Express Scripts Only ACORD 101(2008/01) ®2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds (1 of 2) Accredo Health Group, Inc. Cigna HealthCare of St. Louis, Inc. Accredo Health, Incorporated Cigna HealthCare of South Carolina, Inc. AHG of New York, Inc. Cigna Healthcare of Tennessee, Inc. Airport Holdings, LLC Cigna HealthCare of Texas, Inc. Allegiance Benefit Plan Management, Inc. Cigna Healthcare of Utah, Inc. Allegiance Cobra Services, Inc. Cigna Healthcare, Inc. Bravo Health Mid-Atlantic, Inc. Connecticut General Life Insurance Company Brighter Inc. CuraScript, Inc. Biopartners in Care, Inc. Diversified NY IPA, Inc. Care Continuum, Inc. Diversified Pharmaceutical Services, Inc. CareCore National Group, LLC Econdisc Contracting Solutions, LLC CareCore National Intermediate Holdings, LLC ESI Canada CareCore National, LLC ESI GP Canada ULC CareCore NJ, LLC ESI GP Holdings, Inc. CareNext Managed Care, LLC ESI GP2 Canada ULC CareNext Post-Acute, LLC ESI Mail Order Processing, Inc. Chiro Alliance Corporation ESI Mail Pharmacy Service, Inc. Cigna Corporate Services, LLC ESI Partnership Cigna Dental Health of California, Inc. ESI Resources, Inc. Cigna Dental Health of Delaware, Inc. Evernorth Behavioral Health Inc. Cigna Dental Health of Florida, Inc. f/k/a Cigna Behavioral Health, Inc. Cigna Dental Health of Kentucky, Inc. Evernorth Behavioral Health of California, Inc. Cigna Dental Health of Maryland, Inc. f/k/a Cigna Behavioral Health of California, Inc. Cigna Dental Health of Missouri Evernorth Behavioral Health of Texas, Inc. Cigna Dental Health of New Jersey, Inc. f/k/a Cigna Behavioral Health of Texas, Inc. Cigna Dental Health of North Carolina, Inc. Evernorth Care Group f/k/a Cigna Medical Group Cigna Dental Health of Ohio, Inc. Evernorth Care Solutions, Inc. Cigna Dental Health of Pennsylvania, Inc. Evernorth Direct Health, LLC Cigna Dental Health of Texas, Inc. eviCore healthcare MSI, LLC Cigna Dental Health of Virginia, Inc. Express Reinsurance Company Cigna Dental Health Plan of Arizona, Inc. Express Scripts Administrators LLC Cigna Dental Health, Inc. Express Scripts Canada Co. Cigna European Services(UK) Limited Express Scripts Canada Holding Co. Cigna Health and Life Insurance Company Express Scripts Canada Holding, LLC Cigna Health Management, Inc. Express Scripts Canada Services Cigna Healthcare of Arizona, Inc. Express Scripts Canada Wholesale Cigna Healthcare of California, Inc. Express Scripts Holding Company Cigna HealthCare of Colorado, Inc. Express Scripts Holding Company, Inc. Cigna HealthCare of Connecticut, Inc. Express Scripts, Inc. Cigna HealthCare of Florida, Inc. Express Scripts Pharmaceutical Procurement, LLC Cigna Healthcare of Georgia, Inc. Express Scripts Pharmacy Atlantic, Ltd. Cigna HealthCare of Illinois, Inc. Express Scripts Pharmacy Central, Ltd. Cigna HealthCare of Indiana, Inc. Express Scripts Pharmacy Ontario, Ltd. Cigna HealthCare of New Hampshire, Inc. Express Scripts Pharmacy West, Ltd. Cigna HealthCare of New Jersey, Inc. Express Scripts Pharmacy, Inc. Cigna Healthcare of North Carolina, Inc. Express Scripts Sales Operations, Inc. 12/01/2022 Additional Named Insureds (2 of 2) Express Scripts Senior Care Holdings, Inc. SpectraCare Health Care Ventures, Inc. Express Scripts Senior Care, Inc. SpectraCare, Inc. Express Scripts Specialty Distribution Services, Inc. Tel-Drug of Pennsylvania, L.L.C. Express Scripts Strategic Development, Inc. Tel-Drug, Inc. Express Scripts Services Co. Verity Solutions Group, Inc. Express Scripts Utilization Management Company Freco, Inc. Freedom Service Company, LLC Gulfquest, LP Healthbridge Reimbursement& Product Support, Inc. Healthbridge, Inc. HealthCare of Colorado, Inc. Healthspring Life& Health Insurance Company, Inc. Healthspring of Florida, Inc. Healthspring USA, LLC Healthspring, Inc. Home Physicians Management, LLC Innovative Product Alignment, LLC Inside RX, LLC Lynnfield Compounding Center, Inc. Lynnfield Drug, Inc. MAH Pharmacy, LLC Matrix GPO, LLC Matrix Healthcare Services, Inc. MDLIVE, Inc. Medco Containment Insurance Company of NY Medco Containment Life Insurance Company Medco Health Services, Inc. Medco Health Solutions, Inc. MedSolutions Holdings, Inc. MedSolutions of Texas, Inc. MHS Holdings,CV MSI Health Organization of Texas, Inc. MyM Technology Services, LLC myMatrixx Holdings, LLC myMatrixx-B, LLC Newquest Management Northeast, LLC Newquest Management of Alabama, LLC Newquest, LLC Palladian Health of Florida, LLC Palladian Independent Practice Association, LLC Priority Healthcare Corporation Priority Healthcare Distribution, Inc. QPID Health, LLC Quallent Pharmaceuticals Health LLC Specialty Products Acquisitions, LLC 12/01/2022 City of Miami Beach Scope of Work RFP # 2023-259-WG A3. Scope of Work for Health Plan — Medical ASO Services Network—Disruption Please reference the included Attachment F documents in Tab 5. Network—Alternate Options Please reference the included Attachment M document in Tab 5. Onsite Representative/Concierge Services Please reference the included Attachment M document in Tab S. Medical Repricing Please reference the included Attachment D document in Tab 5. CPT Codes Please reference the included Attachment J document in Tab 5. Current Rate Structure, Active Employee/Employer Contributions, and Plan Designs Noted. Medical Questionnaires Please reference the included Attachment G document and all associated exhibits in Tab 5. Wellness Please reference the included Attachment M document in Tab 5. Disease Management Please provide detail on the Wellness and Disease Management programs offered by your organization. Please distinguish between Standard Services (no additional fee) and Specialty Page 1 Cigna City of Miami Beach Scope of Work RFP # 2023-259-WG Services (additional fee required). Services of interest include, but are not limited to: • Disease Management including chronic/catastrophic Case Management Your Health First Our Your Health First® chronic condition coaching model takes a broad approach to helping members manage chronic health conditions. Your Health First addresses the health of the whole person, rather than focusing on a single disease that triggers participation. Supported by evidence-based medical guidelines and influential behavioral techniques,our health coaches help members manage every aspect of their personal health, including adhering to medications, understanding and managing risk factors, and maintaining up-to-date screenings. Your Health First addresses the most prevalent conditions: heart disease, coronary artery disease, angina, congestive heart failure (CHF), acute myocardial infarction, peripheral arterial disease, asthma, COPD (emphysema and bronchitis), diabetes (types 1 and 2), metabolic syndrome/weight complications, osteoarthritis, low back pain, anxiety, bipolar disorder, and depression. We include anxiety, bipolar disorder, and depression because we understand the importance of the mind-body connection when providing services to members with both medical and behavioral chronic conditions.We also support comorbid conditions through this model. Our predictive models tap into member data across our integrated plan coverage and systems to identify members with chronic conditions at risk for near-term and future high claim costs. Our models predict a likely condition- related occurrence or a worsening of an existing condition in the upcoming year, prioritize member health risk(s), and predict the optimal outreach modality (phone, email, or text) for each member based on factors such as condition,severity,progression,behavior,and modifiability.We target members identified as higher risk for phone- based coaching.We reach out to those identified as lower risk and/or to those who have an apparent preference for digital engagement by letter and/or email to encourage engagement in the program's self-guided online resources. We train Your Health First health coaches in the Cigna CARE Coaching®model that features collaborative, affirming,respectful,and empowering coaching.Cigna CARE Coaching is a foundational approach that addresses a variety of medical, behavioral,and lifestyle conditions. Before registering for the Cigna CARE Coaching training, health coaches complete two courses that address behavior coaching. Each health coach then completes a weeklong training course that incorporates features of various proven behavior change models. Using this coaching approach, health coaches assist members with setting specific, attainable goals to help them improve their health. Achievement of these goals motivates members to set new goals that will support them as they continue their journey toward better health. In addition to coaching for chronic conditions and in support of working with the whole person, Your Health First coaching for members identified with chronic conditions includes health and wellness coaching,treatment decision support,gaps-in-care coaching,and lifestyle management coaching for weight management,stress management, and tobacco cessation. In summary, our dedicated health coaches focus on each person's unique health needs, preferences, and goals. The health coach's one-on-one approach creates stronger relationships, establishes trust, and drives higher engagement. Combining clinical expertise, evidence-based practices, and extensive experience, our multidisciplinary health coaches manage health to start behavior change. Specifically,they help members • recognize worsening symptoms and know when to see a doctor; • establish questions to discuss with their doctors; • understand the importance of following doctors' orders; • develop healthy habits related to nutrition, sleep, exercise,weight, tobacco, and stress; Page 2 c�gna healthcare City of Miami Beach Scope of Work RFP # 2023-259-WG • prepare for hospital admissions or recovery after hospital stays; and • make educated decisions about treatment options. Case Management The goal of case management is to help ensure that members receive timely and appropriate medical care.Case management benefits clients by helping their employees and enrolled dependents find in-network health care providers who can provide quality care cost-effectively and focusing on helping to prevent costly hospital readmissions for the same condition. Case management benefits members by helping facilitate a member's recovery to full potential status, developing and coordinating a care plan that addresses the member's needs,and coordinating required services across both our clinical resources and the client's external resources. Our case managers provide a range of services to address short-term, complex/catastrophic, and specialty conditions, incorporating education about the condition as appropriate. Case managers work with members until their situation is stable and the required services and/or resources are in place. Case managers can also arrange access to community support services such as food, clothing, shelter, transportation, and emotional support resources. Members are considered for case management opportunities during their hospitalizations and through any other contact with a Cigna staff member. In addition, our predictive modeling tools incorporate multiple sources of information to identify members who could benefit from case management and other health advocacy services. • Online Health Screenings(Health Risk Appraisal) Our digital engagement tools,which include our Health Matters health assessment,are a significant advancement in using technology to help members improve their health.Our proprietary Health Matters health assessment offers a simple way to start a personal health journey. Available in English and Spanish, this health assessment makes it easier for members to identify health improvement opportunities and take next steps towards their personal health goals. For clients who purchase a Cigna health coaching program, responses to the health assessment feed into Health Matters Score, our single, proprietary analytic tool that integrates the relevant information we know about a member.This allows us to optimize their interactions with both Cigna health coaches and digital tools, helping us recommend the available programs and resources that align with the member's preferences and health improvement priorities. • Online Health Education(Diet,Exercises,Stress Reduction) We offer online lifestyle management programs for weight management, stress management, and tobacco cessation. For those who prefer to work independently, we offer a secure, convenient, online model. Powered by WebMD, My Health Assistant provides a personalized experience as well as an individualized online plan. Members can access the My Health Assistant online coaching programs through our member website, myCigna, or the myCigna® mobile app. Once members select the health goals they would like to address, they are provided personalized activities that serve to build habits and lay the foundation for achieving them.The interactive features in My Health Assistant offer customized experience to each participant. Health coaches also have access to view active, completed,and expired goals for members engaged in online coaching. Page 3 Cigna healthcare City of Miami Beach Scope of Work RFP # 2023-259-WG Participants regularly check in to record their progress online and add or remove goals and track activities. Individual lifestyle management programs and their components are listed below. Weight Management The My Health Assistant online weight loss program is a 28-day program during which each participant is provided activities and guidance to support their weight loss goal (not to exceed 10% of their starting weight). My Health Assistant allows participants to repeat, modify, or restart a goal and includes tips and articles along with the opportunity to connect with a live health coach. Stress Management The My Health Assistant online stress management program includes a 28-day goal and requires the participant to complete daily, weekly and one-time activities. Participants can repeat or restart a goal as desired, and they can track progress daily and weekly. The program also includes tips and articles and offers participants the opportunity to connect with a live health coach. Tobacco Cessation The My Health Assistant online tobacco cessation program is an 84-day program that includes specific activity completion goals and criteria.The program measures a participant's success in eliminating tobacco usage by their completion of daily,weekly,and one-time activities. Lifestyle management is supported by active account management, communications, and reporting. • Telephonic Health Coaching We offer phone-based lifestyle management programs for weight management, stress management, and tobacco cessation. The phone model offers one-to-one contact with a health coach who provides personalized support. These dedicated health coaches use a motivational interviewing style to help participants choose and complete actions to affect positive change.Coaching sessions,supplemental educational materials,and interactive tools support participants as they work to change old habits into new, healthier ways of life. Individual lifestyle management programs and their components are listed below. Weight Management Participants typically work with a health coach over 11 or fewer phone sessions, and they also receive an at-home tool kit. After a participant completes the program, the health coach offers follow up calls at 30 days, 6 months, and 12 months from the date of graduation. Stress Management Participants typically work with a health coach over 6 or fewer phone sessions, and they also receive an at-home tool kit. After a participant completes the program, the health coach offers follow up calls at 30 days, 6 months, and 12 months from the date of graduation. Tobacco Cessation Page 4 Cigna City of Miami Beach Scope of Work RFP # 2023-259-WG Participants typically work with a health coach over 7 or fewer phone sessions, and they also receive a workbook as well as OTC nicotine replacement therapy.After a participant completes the program,the health coach offers follow up calls at 30 days, 6 months, and 12 months from the date of graduation. Lifestyle management is supported by active account management, communications, and reporting. • Fitness Center Discounts The Cigna Healthy Rewards® program provides retail discounts to products and services that encourage and promote healthy behaviors and lifestyles.The program is easy for members to use, adding value at no additional cost. Healthy Rewards offers more choices for members, more ways to lead a healthier lifestyle, and more ways to focus on wellness and prevention.Available member discounts include • alternative medicine health care providers, including chiropractors, acupuncturists, massage therapists,and more; • discounted fitness club memberships; • virtual workout videos; • wearable fitness devices; • meal delivery service; • hearing aids and exams; • laser vision correction,vision exams, lenses, and frames; and • financial coaching services. Healthy Rewards programs are not insurance. Rather,these programs give a discount on the cost of certain goods and services.The customer must pay the entire discounted cost. Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. Participating providers are solely responsible for their goods and services. Onsite Biometric Screenings We offer clients onsite biometric screening services through two integrated suppliers: Quest Diagnostics and LifeHealth. These suppliers are two of the nation's leading onsite health screening companies. Their onsite screenings unite with our superior data integration to help us deliver proactive, population-based health management. Clients also have the option of choosing between a referred or subcontractor model. In the referred model, the City directly contracts with either integrated supplier. In the subcontractor model, the client obtains the biometric services through a contract with us, and we take on more responsibility, including contracting with the client, submitting claims for reimbursement, billing the client, paying the integrated supplier for services, conducting onsite event quality audits, and handling event questions, concerns, and communication with the integrated supplier. The onsite screening event packages available are outlined below and are available for both models. Page 5 Cigna City of Miami Beach Scope of Work RFP # 2023-259-WG The standard healthy heart screening package includes the following: • total cholesterol (HDL and coronary risk ratio) • glucose measurement(fasting suggested for 9-12 hours) • blood pressure and pulse • weight measurement • height measurement • waist circumference • BMI • health coaching The expanded healthy heart screening package includes the following: • total cholesterol (HDL, LDL,triglycerides, and coronary risk ratio) • glucose measurement(fasting suggested for 9-12 hours) • blood pressure and pulse • weight measurement • height measurement • waist circumference • BMI • results coaching Clients can customize the two standard packages by adding additional screening features such as hemoglobin A1c(HbA1c); limitations and additional fees apply.Clients can also offer other modalities(e.g., doctor fax form, retail lab location access, at-home screening kits). Additional features of our all-inclusive onsite biometric screening program include • automatic health assessment population; • participant and client reporting; and • communication/event promotion Results coaching, promotional materials, and reporting are included in per participant screening fees, unless otherwise noted.This allows clients to accurately budget for and schedule their worksite screening event(s). • Gym Membership Discounts/Senior Programs As described above,the Cigna Healthy Rewards'program provides retail discounts to products and services that encourage and promote healthy behaviors and lifestyles. The program is easy for members to use, adding value at no additional cost. Healthy Rewards offers more choices for members, more ways to lead a healthier lifestyle, and more ways to focus on wellness and prevention.Available member discounts include Page 6 Cigna City of Miami Beach Scope of Work RFP # 2023-259-WG • alternative medicine health care providers,including chiropractors,acupuncturists,massage therapists,and more; • discounted fitness club memberships; • virtual workout videos; • wearable fitness devices; • meal delivery service; • hearing aids and exams; • laser vision correction,vision exams, lenses,and frames;and • financial coaching services. Healthy Rewards programs are not insurance. Rather,these programs give a discount on the cost of certain goods and services.The customer must pay the entire discounted cost.Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. Participating providers are solely responsible for their goods and services. • Cancer Support Program Improved quality of life and reduced clinical and economic consequences are the goals of Cigna's Cancer Support Program.The program offers a variety of resources to support members impacted by this disease,taking a holistic approach to supporting members and their families in getting the information and care they need. The prevention and education component includes helpful tools and promotes lifestyle changes that reduce the risk of reoccurrence,while our included oncology case management services connect members in active treatment with a specialty RN case manager who provides information, educational materials,tools, and resources that can improve outcomes and reduce costs through case management.These nurses develop trusting relationships with members that ease the transition back home. With an emphasis on survivorship, we provide management through surveillance for members who have completed treatment, are considered cancer free from their cancer diagnoses, and have no follow-up other than routine screenings. We also provide management through maintenance for members who have completed treatment but remain on medication. We help them develop a survivorship plan, confirm treatment compliance, educate about treatment side effects, promote appropriate side effect management,and/or help them comply with follow-up tests and screenings. We also offer advanced illness care planning and an end-of-life component, focusing on supporting members and their families as they transition to palliative or hospice care. Based on the needs of the member,family members can also be actively engaged to ensure they receive any necessary support and guidance to manage the various impacts that can occur as a result of a cancer diagnosis. • Healthy Rewards and discounts As described above,the Cigna Healthy Rewards®program provides retail discounts to products and services that encourage and promote healthy behaviors and lifestyles. The program is easy for members to use, adding value at no additional cost. Healthy Rewards offers more choices for members, more ways to lead a healthier lifestyle, and more ways to focus on wellness and prevention.Available member discounts include Page 7 Cigna City of Miami Beach Scope of Work RFP # 2023-259-WG • alternative medicine health care providers, including chiropractors, acupuncturists, massage therapists,and more; • discounted fitness club memberships; • virtual workout videos; • wearable fitness devices; • meal delivery service; • hearing aids and exams; • laser vision correction,vision exams, lenses, and frames; and • financial coaching services. Healthy Rewards programs are not insurance. Rather,these programs give a discount on the cost of certain goods and services. The customer must pay the entire discounted cost.Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. Participating providers are solely responsible for their goods and services. • Lifestyle Management Programs(i.e.Weight management,tobacco cessation,stress management, etc) Cigna members receive motivational support to help them adopt healthier behaviors through our lifestyle management programs for weight management,stress management,and tobacco cessation.These programs are available by phone and online. Our phone-based health coaches use a motivational interviewing style to help participants choose and complete actions to affect positive change. One-to-one coaching sessions, supplemental educational materials, and interactive tools support participants as they work to change old habits into new, healthier ways of life. Our secure and convenient online model is for those who prefer to work independently. Powered by WebMD, My Health Assistant provides a personalized experience.Members can access the online coaching programs through the myCigna®member website or mobile app,where they select the health goals they would like to address and are provided with activities that serve to build habits and lay the foundation for achieving them. The interactive features in My Health Assistant offer additional suggestions about goals and activities based on areas of interest. Health coaches also have access to view active, completed, and expired goals for members engaged in online coaching. Page 8 Cigna healthcare City of Miami Beach Specifications RFP #2023-259-WG A3. Specifications. The City requests responses for the following health plan services: A. ASO services proposals with the duplication of the current SBC's/SPD's(Summary of Benefits Coverage/ Summary Plan Description). The City's intent is to select one medical carrier to administer medical plan services but reserves the right to select one or more. Please quote these plan designs with the best provider network match to Cigna's existing network. Please follow the instructions carefully in the Medical ASO services section when responding to this RFP. As your incumbent medical carrier there will be no changes to the current SBC's/SPD's in place unless requested by the City. Plan A shall include the costs for the following services (as applicable): 1. Claims Administration(claims incurred on or after October 1,2023) Confirmed. 2. Utilization Review Health Information Line Confirmed. 3. Case Management and Precertification Confirmed. 4. HIPAA Administration Confirmed. 5. Network Fee Confirmed. 6. Disease Management/Predictive Modeling Confirmed. 7. Stop Loss Claim Filing and Accounting Confirmed. 8. Costs related to External Appeals as mandated by PPACA. Confirmed. Page 1 Cigna City of Miami Beach A4. Special Conditions RFP #2023-259-WG 1. TERM OF CONTRACT. The term of the resulting Agreement(s) resulting from this RFP shall be for an initial term of three(3)years. 2. OPTION TO RENEW. As mutually agreed, the City, through its City Manager, will have the option to extend for two(2)additional three-year periods at the City's sole discretion.The successful contractor shall maintain,for the entirety of any renewal period,the same costs,terms, and conditions included within the originally awarded contract. Continuation of the contract beyond the initial period, and any option subsequently exercised, is a City prerogative, and not a right of the successful contractor. 3. COST ADJUSTMENTS.On or about the anniversary of each contract term,the contractor may request, and the city manager may approve, a cost adjustment based on documented cost increases for the following contract year. Typically, cost adjustments should be limited to changes in the applicable Consumer Price Index (CPI) for the local region. The Contractor's adjustment request must substantiate the requested increase.The City of Miami Beach,through its city manager, reserves the right to approve a requested adjustment or may terminate the agreement and readvertise for bids for the goods or services. 4. ADDITIONAL SERVICES. Services not specifically identified in this request may be added to,or deleted from, any resultant contract upon successful negotiations and mutual consent of the contracting parties, and approval by the City Manager. 5. INSURANCE REQUIREMENTS.The vendor shall maintain the below required insurance in effect prior to awarding the contract and for the duration of the contract. The maintenance of proper insurance coverage is a material element of the contract and failure to maintain or renew coverage may be treated as a material breach of the contract, which could result in withholding of payments or termination of the contract. A. Worker's Compensation Insurance for all employees of the vendor as required by Florida Statute 440, and Employer Liability Insurance for bodily injury or disease. Should the Vendor be exempt from this Statute, the Vendor and each employee shall hold the City harmless from any injury incurred during performance of the Contract. The exempt Vendor shall also submit (i) a written statement detailing the number of employees and that they are not required to carry Workers' Compensation insurance and do not anticipate hiring any additional employees during the term of this contract or (ii) a copy of a Certificate of Exemption. B. Commercial General Liability Insurance on an occurrence basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence,and$2,000,000 general aggregate. C. Automobile Liability Insurance covering any automobile, if vendor has no owned automobiles,then coverage for hired and non-owned automobiles,with limit no less than $1,000,000 combined per accident for bodily injury and property damage. D. Professional Liability (Errors & Omissions) Insurance appropriate to the Consultant's profession,with limit no less than $1,000,000. Page 1 Cigna City of Miami Beach A4. Special Conditions RFP #2023-259-WG Additional Insured -City of Miami Beach must be included by endorsement as an additional insured with respect to all liability policies(except Professional Liability and Workers'Compensation)arising out of work or operations performed on behalf of the contractor including materials, parts, or equipment furnished in connection with such work or operations and automobiles owned, leased,hired or borrowed in the form of an endorsement to the contractor's insurance. Notice of Cancellation-Each insurance policy required above shall provide that coverage shall not be cancelled, except with notice to the City of Miami Beach do EXIGIS Insurance Compliance Services. Cigna will provide the City with a notice of cancellation of any of our insurance programs if any insurance policies are cancelled or non-renewed and not immediately replaced by a substantially similar insurance program. Cigna's insurance premiums, on every insurance program, are paid in full at policy inception thereby eliminating any chance of policy cancellation due to non-payment of premiums; none of the insurance policies have been cancelled due to non-payment of insurance premiums. Waiver of Subrogation —Vendor agrees to obtain any endorsement that may be necessary to affect the waiver of subrogation on the coverages required. However, this provision applies regardless of whether the City has received a waiver of subrogation endorsement from the insurer. Acceptability of Insurers— Insurance must be placed with insurers with a current A.M. Best rating of A:VII or higher. If not rated, exceptions may be made for members of the Florida Insurance Funds (i.e. FWCIGA, FAJUA). Carriers may also be considered if they are licensed and authorized to do insurance business in the State of Florida. Verification of Coverage—Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Since Cigna's insurance programs are nonstandard and considered tailored (where our insurance policies are heavily manuscripted), almost all of Cigna's insurers require us to execute a confidentiality and nondisclosure statement as a precondition to obtaining preferential insurance coverage terms. Moreover, as a publicly-traded organization, disclosure of insurance policy copies may be construed as a disclosure of material, nonpublic information. Therefore,we are unable to disclose copies of insurance policies to a non-Cigna entity or a non- regulatory entity or agency. As a substitute to such requests, Cigna can provide evidence of insurance coverage(s) via the industry-standard ACORD®Certificate of Insurance form. CERTIFICATE HOLDER MUST READ: City of Miami Beach do Exigis Insurance Compliant Services P.O. Box 947 Murrieta, CA 92564 Kindly submit all certificates of insurance, endorsements, exemption letters to our servicing agent, Page 2 Cigna City of Miami Beach A4. Special Conditions RFP #2023-259-WG EXIGIS, at: Certificates-miamibeach@riskworks.com Special Risks or Circumstances - The City of Miami Beach reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. Page 3 Cigna Tab 2. Experience and Qualifications The City of Miami Beach Florida RFP 2023-259-WG Health and Pharmacy and Retiree Health 2.2 Qualifications of Propos e r Te am.Provide an organizational chart of all personnel and consultants to be used for this project if awarded,the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. Copyright 2023 Page 1 of 1 Cigna Prospect Name Dedicated Cigna Team Behind you every step of the way. • Michelle Alperstein • Nicole Watson Senior Client Manager Engagement Consultant • Trinh Keelin 0-C • Gaylene Davis • Pharmacy Clinical Consultant Client Engagement Director • Beth Smith Overall account Customer • Rick Pryce responsibility and communication Vice President,Government& Business Analytics,Senior Advisor Education financials and wellness AVBEACH • Dr. Marco Vitiello • Angela Moore Senior Medical Executive p • ` Implementation Manager • Stu Rosenthal • Micaela Bernardo AVP, Provider Network Clinical, ACO and Implementation Client Service Executive Management&ACO • Alexandra Alvarado analytics team and service • Dr. Doug Nemecek, MD Onsite Customer Service Behavioral Chief Medical Officer • Liz Gallus Behavioral Clinical Strategist Yesenia Sanchez Market Growth Leader Cigna Executive Sponsor Biography =: Cigna healthcare,- 1571 Sawgrass Corporate Parkway Suite 140 Sunrise, FL 33323 Michelle.Alperstein@jCigna.com Michelle Alperstein Client Manager Michelle Alperstein is a Senior Account Manager in Cigna's Regional Segment, where she has overall Account management responsibility for the clients in her book. In directly managing the relationships between her clients and Cigna, Michelle provides renewal strategy and negotiation, performs reporting analysis of key data,and facilitates client meetings. Michelle brings over ten years of experience in the insurance industry, having previously worked as both a manager and account executives at one of the country's largest employee benefits consultants. In those roles, Michelle provided her clients with a full suite of account management services such as financial analysis of plans, rate negotiations, benefit modifications, and employer education programs. In 2016, Michelle was nationally recognized as one of the company's top performing account executives. Having collaborated with clients to ensure their insurance needs are met for over a decade, Michelle has gained an in-depth knowledge of the health insurance industry and much insight into the handling of complex corporate accounts. Her substantial experience on the consultant side brings invaluable perspective when servicing her clients. Michelle earned a Bachelor of Science from the University of Florida, where she was on the Dean's List and a member of the Delta Phi Epsilon sorority. Michelle is a native of South Florida, and is a founding member and the past Chair of the American Heart Association's PULSE of Broward County. Biography Cigna healthcare,. Trinh Keelin,Pharm D Senior Pharmacy Clinical Account manager Pharmacy Benefit Consultant Trinh Keelin, PharmD, is a Senior Pharmacy Clinical Consultant for Regional Accounts in the Mid-Atlantic market. Trinh is responsible for providing clinical support to the Cigna Medical account management organization. She is a licensed registered pharmacist in the state of Maryland. Trinh has a Bachelor of Science degree in Biology and a Doctor of Pharmacy degree from the University of Maryland. She has 15 years of healthcare experience in the managed care industry. Prior to joining Cigna,Trinh held the role of Consultant for Hospitals and Health Systems at Pharmaceutical Strategies Group(PSG), a boutique consulting firm focused primarily on pharmacy and 340B benefits. Prior to PSG, Trinh spent several years at Catamaran,and OptumRx as a Clinical Consultant, where she worked closely with self-funded employer groups and State Government&municipalities, including the State of Maryland. Trinh also served as the Clinical Pharmacist for Johns Hopkins HealthCare,the managed-care enterprise of Johns Hopkins Hospital. %AVOW Biography Cigna healthcare,. Beth Smith Vice President of Government& Education Cigna, Florida Beth Smith currentlyserves as Vice President of Government& Education Cigna's Florida markets. In her role, she is responsible for leading all elements of the public sector growth strategy with a heightened focus on retention and business development opportunities. Beth works with the local account teamsthroughout Florida to build strategies to address the unique challenges the public sector faces on a daily basis. Before joining the Cigna team,Beth was the Corporate Manager of Community Relations for Orlando Health,a Central Florida based healthcare system, and managed the investment of charitable dollars, strategic collaborations with community and non-profit partners,and made a positive change in the community. Beth received her Bachelor of Arts and Master of Public Administration from the University of Central Florida in Orlando, FL. She is a gubernatorial appointed member to the Valencia College Board of Trustees and serves on the boards of the Leadership Florida and the Foundation for Seminole County Public Schools. Biography Cigna healthcare,. Nicole Watson Client Engagement Manager As Client Engagement Manager(CEM)Nicole will be a dedicated resource responsible for the execution and delivery of Health and Wellness strategy to ensure that both you and your employees have an outstanding customer service experience. In her role as Health and Wellness resource, Nicole will provide reporting and partner with clients throughout the year to provide insight into trends and identify health and wellness opportunities. She will support, develop, and facilitate client Health and Wellness programs,assist with coordination of events, consult on development of a communication plan, and help to promote education initiatives ensuring that employees are knowledgeable about the CIGNA Health and Wellness tools and capabilities. In addition, Nicole will assist with Open Enrollment strategy and execution,both at implementation and renewal. Nicole is dedicated to wellness strategy and execution of initiatives,as well as open enrollment and customer education. She has over seven years of experience in Human Resources(Benefits Administration), and Health& Benefits consulting. EDUCATION:Florida Atlantic University, Boca Raton, Florida Biography Cigna healthcare:. Gaylene Davis Engagement Director As an Engagement Director(ED) Gaylene Davis is aligned with the Health Engagement Team and is primarily responsible for overseeing a team of 9 Engagement Consultants in the South Florida and U.S.Virgin Island market. In her role, Gaylene works closely with her team and provides ongoing support with their book of business. Gaylene assists her team with the knowledge, tools, and resources they need to successfully support clients' health promotion strategies, wellness initiatives, and benefit education. Education: Gaylene is a graduate of DeVry University, where she received a Bachelor's Degree in Health Care Administration and is also a Certified Wellness Program Coordinator. Biography cigna healthcare,. Rick Pryce Business Analytics, Senior Advisor Rick joined the Cigna team in 1998 and began his career asa Corporate Accountant in the Healthcare division managing financial statementsfor health plans and corporate entities. His next rotation within the organization was also in Healthcare as an Accounting and Finance Manager. He was responsible for executing the accounting and finance of several corporate holding companies with a special focus on income and taxation projects. From there his career diversified with a rotation to Information Technology as part of project team supporting a start-up initiative for delivering data to external provider groups securely. His final rotation prior to joining Client Informatics was in Marketing supporting the development and promotion of Cigna websites. Rick moved to Client Informatics in 2005 as an Informatics Consultant supporting employer clients in the northeast area. In 2007 he began a role as a Team Leader managing both a staff of consultants and aligned to several key client relationships. Following that opportunity, he began a rotation as a Project Manager supporting technology and tool development within the Informatics organization. Currently he is a member of the Client Informaticsteam aligned to several premier Government and Commercial clients within the U.S. Markets region,with a concentration on south Florida locations. Rick holds a Masters Degree in Business Administration (Finance)from the University of Connecticut and a Bachelor of Science Degree in Business Administration (Management)from Bryant College. He brings 23 years of healthcare experience and 29 years of financial experience. Biography cigna healthcare,. Angela.Moore2(a�cigna.com 860-787-6502 Angela Moore Implementation Manager Angela Moore is a Implementation Manager(I M)responsible for installing new and renewing accounts on the Proclaim platform for the past 7 years. Not only does Angela come to us with 7 years of Implementation experience,she was nominated for Circle of Excellence Award by the Mid-Atlantic sales team in 2019 and was recognized in 2020. Angela's background includes the following: • Proclaim U500 Implementation Manager Mid-Atlantic Market for the past 7 years • Several roles in Proclaim spanning 11 years- Proclaim Claim Third Party Audit Coordinator, Proclaim Test,Proclaim/PMHS Claims Trainer and Proclaim claim processor Biography Cigna healthcare,. Micaela "Mickey"Bernardo ClientService Partner Micaela"Mickey"Bernardo is a Client Service Partner(CSP) based in Sunrise, Florida In this role, Mickey is a key member of your account management team with expertise in Cigna's service administration capabilities. Mickey has ownership and accountability for ongoing, end to end service delivery, ensuring your satisfaction with Cigna's products and services and delivering upon an exceptional client service experience. Mickey will be your primary Cigna contact for all operational service related to claim processing, customer service,eligibility, billing, banking and benefit structure.These primary functions include customizing service delivery to meet your needs, negotiating with internal and external partners and customers to resolve service issues and requests. Mickey will proactively trend service activities,act as a key benefit resource expert,monitor ongoing processes, develop service plans for continuous improvement and communicate with you on a regular basis regarding service strategy and service results on your account. Experience: • Mickey has over twentyyears' experience within the Health Care industry and Bi-lingual o Mickey's background includes: • Benefit Management • Service • Leadership • Medicare&Medicaid • Coordi nation of Benefits • Group Health Plans: Medical,Dental,Vision, Life Biography cigna healthcare. 1571 Sawgrass Corporate Parkway Suite 300 Sunrise,FL 33323 yesenia.sanchez@cigna.com 954.303.9804 IF .,.' - Nik Yesenia Sanchez Market Growth Leader Cigna Yesenia Sanchez is the Market Growth Leader for South Florida and Caribbean markets,where she will be responsible for managing the Select and Middle Market Segments for both new and existing sales to maximize customer and earnings growth in SFL. Prior tothat Yesenia held the role of VP,Sales 0500 for the South Florida and Caribbean. Yesenia has been with Cigna since 2005 and is responsible for customer retention and growth of the existing book of business across the entire South Florida sales office. It is her responsibility and passion to ensure that each and every client receives the level of service and support they need to meet their long term health objectives. Prior to this role,Yesenia was the Vice President for the Government and Education Segment in Florida and the Caribbean.In that role Yesenia was responsible for deploying the focus and resources needed to support the unique needs of the public sector.Yesenia worked with the local account teams throughout Florida to ensure that Cigna is delivering value added differentiated solutions to address the challenges this segment faces on a daily basis. In addition, Yesenia is involved with local associations such as ICMA, FSBA, RIMS and FERMAto stay connected with the challenges and opportunities of the government and education segment.The role brought a dedicated focus and resources to this important segment that represents 62 clients and 280,000 customers in the state of Florida alone and 1,700,000 customers nationally. Yesenia began her health services career with Neighborhood Health Partnership in 2002.She held several positions within Provider Relations area as a contractor for ancillary and hospital providers. Additionally, she is an Adjunct Professor at Florida International University in the Health Services Department. In specific as an adjunct professor she taught classes in the areas of Epidemiology and Health Service Administration. Yesenia received her Bachelor of Science Degree from the University of Miami and her Master's in Public Health from Florida International University. She is an accomplished author, publishing books in the arena of Health Service. < Y. y mi Name: Douglas (Doug) Nemecek, M.D., M.B.A Title: Chief Medical Officer—Behavioral Health Location: Bloomington, MN Dr. Doug Nemecek is the chief medical executive for behavioral health quality, integration,and clinical operations. He helps ensure network access and availability, patient safety, compliance with clinical guidelines, customer and provider satisfaction, and utilization management. Additionally, he works directly with customers and clients to mold operations and provides clinical expertise in new and existing behavioral health and integrated program development. Dr. Nemecek has helped establish workflows,protocols, and collaborative procedures to create a unified medical management team across the company. He leads clinical initiatives and provides thought leadership to key issues such as the national opioid epidemic,and loneliness. Additionally,he continues to develop unique relationships with our network providers to ensure our customers and providers achieve optimal total health outcomes. Dr. Nemecek previously served as Executive Medical Director for Allina Behavioral Health Services in Minneapolis, overseeing five outpatient clinics and four inpatient mental health units with over 80 mental health providers. He also has 10 years of clinical experience with an inpatient and outpatient psychiatric practice in Minneapolis. Dr. Nemecek received his M.D. and completed his psychiatric residency at Washington University in St.Louis. He is recognized as a Distinguished Fellow with the American Psychiatric Association,is board certified by the America Board of Quality Assurance and Utilization Review Physicians and holds an M.B.A.from the University of St. Thomas in Minneapolis. Dr. Nemecek currently serves on the Board of the Association for Behavioral Health and Wellness. He also serves on the Scientific Board for Shatterproof, a national non-profit organization dedicated to ending the devastation that addiction causes families. £VERNORTF+. EVERNORTH.COM ©2021 Ewrrirth.All rights reserved Biography cigna healthcare,. Liz Gallus, MA LPC MHSP Behavioral Clinical Strategist Liz Gallus is the Behavioral Clinical Strategist for Mid-South, Tri-South, GA/AL and South Florida markets. In her role she supports Cigna Sales teams, New Business Managers,Client Managers and market leadership as the Subject Matter Expert for Cigna's behavioral health products. This includes knowledge of clinical and operational processes necessary and partnering with Cigna Behavioral Health when needed. Liz began her Cigna career in 2010 with Cigna Behavioral Health(CBH)as a Care Manager. During her 12+years with Cigna she has held various roles with CBH and with Client Implementation and Service before becoming a Behavioral Clinical Strategist in 2021. She holds a Master's degree in Counseling Psychology from Bethel University and is a Licensed Professional Counselor. Prior to her work at Cigna Liz worked both in non-profit and private practice specializing in depression and treatment of trauma. Liz is passionate about de-stigmatizing and normalizing mental health. \•%i cI na Biography healthcare. Alexandra Alvarado Alexandra Alvarado is the enthusiastic Cigna representative for the City of Miami Beach. Alexandra began her career with Cigna in 2022. Before her tenure with Cigna,Alexandra worked for Florida Blue and held various positions in the Sales and Service Retail Center Unit. Alexandra Alvarado is available to assist with your service inquiries including questions about claims,explanations of benefits, payment policies, prescription or pharmacy, networks/contracted health care professionals, and precertification policies. Alexandra holds a Bachelor'of Psychology degree from Florida International University and a Master of Business Administration degree with a concentration in Healthcare Management from St Thomas University. City of Miami Beach Scope of Services Proposed RFP # 2023-259-WG Submit detailed information addressing how Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix A, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a full review and score the proposed scope of services.Attachments should be included in Tab 6. As a trusted partner in health care,Cigna delivers more than just a health plan,we deliver a growth plan for the City of Miami Beach business and innovative tools and support to make your plan administration easier.As a consultative growth partner,we collaborate with clients to create a customized strategy that promotes • affordability through total medical cost management; • predictability through advanced analytics and actionable data; and • simplicity through advocacy solutions that foster personalized, contextualized member interactions and digital engagement. Cigna is the right partner with expert capabilities to manage employee health and productivity across the health spectrum and guide and connect care in new ways for the best results for individuals and businesses alike. A healthier workforce translates to higher productivity, better morale,and greater employee retention—all driving factors for business growth. Cigna is a partner positioned to tackle the City's biggest health care challenges today and in the future.We believe that health care can be simple,and 0%medical cost trend is possible. We understand the challenges in today's health care delivery system,including unsustainable costs and an overwhelming complexity that leads to fragmented and inefficient care.Our unique approach puts employee health,productivity,continuity,and retention at the center of our efforts,driving better results across the board for cost,quality,and employee engagement that will drive your business performance and growth. Plan Administration We embrace the opportunity for our specialized account management team to become an extension of the City's HR team. Led by Michelle Alperstein,your account manager,the team will continue to support the City by managing the account management team and servicing the account. Michelle is responsible for City's satisfaction with the Cigna partnership. Michelle will continue to consult with the City about the financial performance of the plan,strategy,utilization,and service.The team will collaborate with the City's staff to provide coverage review, communication strategy, long-term wellness strategy,and onsite support for open enrollment meetings and wellness events as well as ongoing employee communications and education throughout the year. The account management team incorporates a global team approach to effectively support the client's HR team. We provide designated resources for customer service,accounting,and claims as well as underwriting expertise that translates to exceptional service delivery,focused on building processes and tools to best meet the client's needs.Your Onsite Customer Service Representative,Alexandra Alvarado,will also continue to provide service to your employees. Additionally,Cigna's Smart Support program provides enhanced, proactive support through designated teams across all business functions and includes a specialized public sector service team to help customers take control of their health and their health care costs. We deliver customized Cigna plans that address the specialized needs of our government and education clients.We have designed and delivered innovative services and funding for some of the largest local government plans for both active and retired employees.Through these tailored services,we have helped government employers,employees, and employees'families get the maximum value for Page 1 _ Cigna City of Miami Beach Scope of Services Proposed RFP # 2023-259-WG their health plan investment—so every dollar works harder and goes further.Our tailored health and well-being solutions are member-focused,clinically-based,and highly effective in meeting the needs of the clients we serve. To bolster the support provided by the account management team and Smart Support program,we make day-to- day plan administration simple by providing the City with access to our client portal,Cigna for Employers. Page 2 Cigna City of Miami Beach Approach and Methodology RFP # 2023-259-WG Submit detailed information on how Proposer plans to accomplish the required scope of services, including a proposed implementation timeline, performance guarantees, as applicable, and steps for ensuring the program is ready for Open Enrollment beginning October 1,2023. Cigna is pleased that we currently provide medical coverage to the City of Miami Beach, Florida. Maintaining your coverage with Cigna would not require a complex implementation process since Cigna is the City's incumbent administrator. If we are fortunate enough to add additional membership or plan changes that the City requested, we will provide detailed implementation support coordinated by your current implementation manager, Angela Moore. We will carry out any changes to the plan design with the same attention to detail as the initial implementation and provide timing for those changes within the City's implementation calendar. We make it our focus to provide an easy and efficient process when working through the implementation process, assisting clients with setting up eligibility in the system and determining the billing and banking process. We have specialized teams of designated individuals throughout the entire service experience— including implementation, client/customer service, and claims processing—to support our local government and education clients. As part of our exclusive Smart Support Program for the public sector, Angela Moore, your implementation manager, has knowledge and expertise about the needs and requirements for the City and is responsible for ensuring seamless implementation of the plan and ongoing maintenance. Our implementation managers are uniquely skilled, receiving quarterly training on the specific needs and requirements of local governments and schools and standard implementation protocol and procedure training to continuously incorporate best- in-class enhancements to the implementation process. We are committed to continue to develop our partnership with the City that allows us to provide the support they deserve. Following this response are the performance guarantees that Cigna is providing in the areas of service, implementation, account management totaling $202,000 at risk. Additionally, we have provided our implementation calendar to ensure the program is ready for Open Enrollment beginning October 1, 2023. Page 1 Cigna Performance Guarantees 0 1, • City of Miami Beach •(( Cigna Effective Start Date: October 1, 2023 IMPLEMENTATION Claim Readiness Amount At Risk Implementation Claim Readiness. Benefit Profile and eligibility information loaded on claims processing system as of the Commitment Date set forth $2,000.00 in the approved Implementation Calendar. Results measured at Account Level. Call Readiness Amount At Risk Implementation Call Readiness. Service Center(s) ready to respond to customer inquiries as of the Commitment Date set forth in the approved $2,000.00 Implementation Calendar. Results measured at Account Level. Implementation Satisfaction Amount At Risk Implementation Satisfaction. Score of no less than three (3)on the question: Overall, how satisfied were you with your most recent installation $2,000.00 experience with Cigna? in the Cigna HealthCare Implementation Survey. Results measured at Account Level. SERVICE Claim Time-to-Process Amount At Risk Medical Time to Process. Measured for the Term of the Agreement, results will meet or exceed: 92% of Claims Processed within 14 calendar $2,000.00 days. Results measured at Account Level. Claim Time-to-Process Amount At Risk Medical Time to Process. Measured for the Term of the Agreement, results will meet or exceed: 98% of Claims Processed within 30 calendar $2,000.00 days. Results measured at Account Level. Financial Accuracy Amount At Risk Medical Financial Accuracy. Measured for the Term of the Agreement, results will meet or exceed: 99% of total audited claim dollars are correctly $2,000.00 paid. Results measured at Claim Platform Level. Processing Accuracy Amount At Risk Medical Processing (Overall)Accuracy. Measured for the term of the Agreement, results will meet or exceed: 95% of total audited claims $2,000.00 correctly Processed. Results measured at Claim Platform Level. Processing Accuracy Amount At Risk Medical Procedural Accuracy. Measured for the Term of the Agreement, results will meet or exceed: 97% of total audited claims without a coding $2,000.00 error excluding any claim with a payment error. Results measured at Claim Platform Level. Payment Accuracy Amount At Risk Medical Payment Accuracy. Measured for the Term of the Agreement, results will meet or exceed: 97% of total audited claims are correctly paid. $2,000.00 Results measured at Claim Platform Level. Average Speed of Answer Amount At Risk Medical ASA. Measured for the Term of the Agreement, results will not exceed: 30 seconds to answer a Call. Results measured at Special $2,000.00 Account Queue Level. aye 08/11/2023 Performance Guarantees •`i��• • City of Miami Beach Cigna Effective Start Date: October 1, 2023 SERVICE Call Abandonment Rate Amount At Risk Medical Call Abandonment Rate. Measured for the Term of the Agreement, results will not exceed: 3% of Calls received terminated. $2,000.00 Results measured at Special Account Queue Level. First Call Resolution Amount At Risk Medical First Call Resolution. Measured for the Term of the Agreement, results will meet or exceed: 90% of Calls resolved on first Inquiry, 45 day $2,000.00 look back/forward. Results measured at Account Level. CSA Quality Amount At Risk Medical CSA Quality. Measured for the Term of the Agreement, results will meet or exceed: 95% quality standard. Results measured at Book of $2,000.00 Business Level. Automated Maintenance Eligibility Processing Amount At Risk Medical Auto Eligibility Processing. Measured for the Term of the Agreement, results will meet or exceed: 99%files processed in 2 Business $2,000.00 Days after the receipt of clean eligibility. Results measured at Account Level. Account Management Amount At Risk Medical Account Management. Composite Score (all categories)of 3.0 or better on the Account Management Report Card based on four(4) $2,000.00 quarterly scorecards. Results measured at Account Level. DISCOUNT Discount Amount At Risk One Way Medical Discount Guarantee. See Exhibit B for details. $75,744.00 PHARMACY SERVICE Mail Order Turn Around Time Amount At Risk Pharmacy Mail Order Turnaround Time. Turnaround time in 2 days, on average, requiring no intervention - Mail Order. Calculated in whole Business Days from the date a prescription order is received by $3,000.00 Administrator(PBM) (either by mail, phone, fax or internet)to the date the prescription order is shipped. Results measured at Book of Business Level. Mail Order Turn Around Time Amount At Risk Pharmacy Mail Order Turnaround Time. Pharmacy turnaround time in 4 days, on average, with administrative/clinical intervention - Mail Order. Calculated in whole Business Days from the date a prescription order is $3,000.00 received by Administrator(PBM) (either by mail, phone, fax or internet)to the date the prescription order is shipped. Results measured at Book of Business Level. Page 2 CS/ _=;2C 3 Performance Guarantees City of Miami Beach -l1 Cigna Effective Start Date: October 1, 2023 —1•� PHARMACY SERVICE Retail and Mail Order Claims Processing Accuracy(Overall Amount At Risk Accuracy), Pharmacy 99% Processing Accuracy/Mail Order and Retail. The Claims Adjudication Accuracy Rate for the Guarantee Period will be 99% or greater. Claims Adjudication Accuracy Rate means (i)the total number of point of sale claims adjudicated and paid accurately during the $3,000.00 measurement period that do not contain a material adjudication error, divided by(ii)the total number of point of sale claims adjudicated and paid during the measurement period. Results measured at Book of Business Level. Financial Accuracy - Electronic Claims Amount At Risk Pharmacy Financial Accuracy-Online/Mail Order. Measured for the Term of the Agreement, results will meet or exceed: 99.9% of total audited $3,000.00 claims are correctly paid. Results measured at Book of Business Level. Mail Order Pharmacy-Class I Dispensing Accuracy Amount At Risk Pharmacy-99.996% Class 1 Dispensing Accuracy. Calculated as the total number of conformance events divided by the total number of prescriptions dispensed. Class I error is defined by: patient name, drug $3,000.00 name, strength and directions. This includes: ESI, Accredo, and Freedom Fertility. Results measured at Book of Business Level. Average Speed of Answer Amount At Risk Pharmacy 30 Second ASA. The average speed of answer(ASA)for a Call during the Guarantee Period shall be no longer than 30 seconds. The calculation of ASA is based on all Calls received that are serviced in the $3,000.00 Special Account Queue. (Does not include Specialty). Results measured at Special Account Queue Level. Call Abandonment Rate Amount At Risk Pharmacy 3% Abandonment Rate. The percentage of Calls received resulting in the caller terminating the Call before speaking with a Customer Service Associate shall, on average, be no greater than 3%. The calculation of Abandonment Rate is based on all Calls received that are $3,000.00 serviced in the Special Account Queue. (Does not include Specialty). Results measured at Special Account Queue Level. First Call Resolution Amount At Risk Pharmacy 85% First Call Resolution. Measured for the Term of the Agreement, results will meet or exceed: 85% of Calls resolved in the first Call with a 45 calendar day look back and forward for repeat calls. First $3,000.00 Call Resolution is reported one month in arrears because of the look back/forward requirement. (Does not include Specialty). Measured at Book of Business Level. Maintenance Eligibility Processing Amount At Risk Pharmacy Auto Eligibility Processing. Measured for the Term of the Agreement, results will meet or exceed: 100% of electronic eligibility files $3,000.00 processed in 3 Business Days after the receipt of clean and accurate eligibility. Results measured at Account Level. �� ' j 08/11/2023 Performance Guarantees 61. City of Miami Beach •( C i g n a Effective Start Date: October 1, 2023 �l(� PHARMACY SERVICE Account Management Amount At Risk Pharmacy Account Management. Account Management composite score (all categories)of 3.0 or better on the Account Management Report Card $3,000.00 based on four(4)quarterly assessments. Results measured at Account Level. PHARMACY CLINICAL Pharmacy Amount At Risk Asthma: Reimburse cost of asthma-related ER visit or hospital admission. Cigna guarantees Employer that if a Qualifying Asthma Member experiences an emergency room visit or is admitted for a hospital stay due Cigna National Average U.S. to an asthma event during the Guarantee Year, then Cigna will credit cost for ER/ Hospitalization Employer the Cigna National Average Cost for such emergency room or Visits hospital admission occurring during the Guarantee Year. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Cardiovascular: 30% Cholesterol Adherence across entire population. Cigna guarantees a 30% improvement in the Adherence Rate of Qualifying Non-Adherent Cardiovascular Members in the taking of applicable cardiovascular medication by the end of the Guarantee Year when compared to the Baseline Year. If Cigna fails to improve the $0.40 PEPM Adherence Rate of Qualifying Non-Adherent Cardiovascular Members in the taking of applicable cardiovascular medication by at least 30% by the end of the Guarantee Year, then Cigna will credit Employer the amount of $0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Cardiovascular: Improve Hypertension Adherence by 25% for those not adherent. Cigna guarantees a 25% improvement in the Adherence Rate of Qualifying Non-Adherent Cardiovascular Members in the taking of applicable cardiovascular medication by the end of the Guarantee Year when compared to the Baseline Year. If Cigna fails to improve the $0.40 PEPM Adherence Rate of Qualifying Non-Adherent Cardiovascular Members in the taking of applicable cardiovascular medication by at least 25% by the end of the Guarantee Year, then Cigna will credit Employer the amount of $0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Cholesterol: Reimburse cost of cholesterol drug lowering therapy. Cigna guarantees that no Cholesterol Adherent Member will have an emergency room visit or hospitalization due to a heart attack during the Guarantee Cigna National Average cost Year. If any Cholesterol Adherent Member has an emergency room visit of cholesterol drug lowering or hospitalization due to a heart attack during the Guarantee Year, then therapy Cigna will credit Employer the Cigna National Average Cost of 12 months of cholesterol drug-lowering therapy. Performance Results measured at Client Specific Level. Page 4 'S; _:. 2: 3 Performance Guarantees City of Miami Beach •+ : Cigna Effective Start Date: October 1, 2023 � PHARMACY CLINICAL Pharmacy Amount At Risk Diabetes: 25% improvement diabetes adherence for those not adherent. Cigna guarantees a 25% improvement in the Adherence Rate of Qualifying Non-Adherent Diabetes Members in the taking of applicable diabetes medication in the Guarantee Year when compared to the Baseline Year. If Cigna fails to improve the Adherence Rate of Qualifying $0.40 PEPM Non-Adherent Diabetes Members in the taking of applicable diabetes medication by at least 25% by the end of the Guarantee Year, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Diabetes: 45% Kidney Disease Monitoring in Patients with Diabetes across entire population. Cigna guarantees a 45% improvement in the number of Qualifying Non-Monitoring Diabetes Members who will commence receiving kidney disease monitoring during the Guarantee Year. If Cigna fails to improve the number of Qualifying Non-Monitoring $0.40 PEPM Diabetes Members who commence to receive kidney disease monitoring by a rate of at least 45% during the Guarantee Year, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Diabetes: 7% Improvement in the use of statins in diabetes for those not adherent. Cigna guarantees a 7% improvement in the taking of statin medication for Diabetes Members in the Guarantee Year when compared to the Baseline Year. If Cigna fails to improve by 7% the taking of statin $0.40 PEPM medication in Diabetes Members by the end of the Guarantee Year, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Gap in Care All In Closure Rate (16%). Cigna guarantees Employers that Employer's participation in both the Well-Informed Program and the RationalMed Program will achieve no less than a 16% rate of gap closures during the Guarantee Year. If Cigna fails to achieve at least a 16% gap $0.40 PEPM closure rate from Employer's participation in both the Well-Informed and RationalMed Programs, then Cigna will credit Employer the amount of $0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk PMPM Pharmacy Savings for RationalMed ($0.25 PMPM). Cigna guarantees Employer a savings of no less than $0.25 PMPM for its participation in the RationalMed Program during the Guarantee Year. If $0.40 PEPM Cigna fails to meet this guarantee, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Performance Guarantees ;';� City of Miami Beach i1•(( Cigna Effective Start Date: October 1, 2023 PHARMACY CLINICAL Pharmacy Amount At Risk Pulmonary: 11% improve inhaled Corticosteroids use for uncontrolled asthma and COPD. Cigna guarantees 11% of Corticosteroids Users will Improve Use in the taking of corticosteroids for asthma/COPD for the Guarantee Year when compared to the Baseline Year. If Cigna fails to $0.40 PEPM Improve Use of Corticosteroids Users in the taking of corticosteroids for asthma/COPD by at least 11% in the Guarantee Year, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Pharmacy Amount At Risk Pulmonary: 30% Corticosteroids Adherence across entire population. Cigna guarantees that at least 30% of the Qualifying Pulmonary Members will remain Adherent in the taking of their inhaled corticosteroid medication during the Guarantee Year. If Cigna fails to maintain at least 30% of $0.40 PEPM Qualifying Pulmonary Members on inhaled corticosteroid medication by the end of the Guarantee Year, then Cigna will credit Employer the amount of$0.40 PEPM. Performance Results measured at Client Specific Level. Page 6 08/11/2023 Client Name:City of Miami Beach Account Number:3340006 =\ Proposed Implementation Schedule l*( Effective Date: 10/01/2023 Cigna Responsibility Task Cigna COMB TPV Start Date Target Actual Completion Date Eligibility Completion Date Notification of Sale X 7/5/2023 7/12/2023 Client signs Medicare Rate and Benefit Confirmation form X 7/5/2023 7/12/2023 Provide Structure&Administrative Summary for Client X Approval 7/5/2023 7/12/2023 Hold Customer Interface Session(CIS)(Discuss benefits,HIPAA elections,reporting,structure,billing,eligibility,pre-and post- enrollment materials,claim forms,ID cards,schedule on-going X X X 7/12/2023 7/19/2023 weekly implementation status calls) Cigna receives approval of proposed Medicare employer benefit summaries,summary of benefits and coverage,administrative X 7/12/2023 7/21/2023 summary and structure Complete a Medicare ID Verification X X 7/17/2023 7/28/2023 Create Client specific Medicare Communications X 7/24/2023 7/31/2023 Approval of Medicare communications X 7/25/2023 8/4/2023 Medicare Communication mailing list X 7/17/2023 8/4/2023 Admin Summary/Structure Approval X 7/26/2023 7/31/2023 Provide Benefit Summaries for Client approval X X 8/14/2023 8/16/2023 Client Approval: Employer Benefit Summaries _ X X _ 8/16/2023 8/18/2023 Confidential,unpublished property of Cigna. Do not duplicate or distribute.Use and distribution limited solely to authorized personnel.Copyright 2019 Cigna Provide Summary of Benefits Coverage(SBCs)for Client approval X X 8/21/2023 8/23/2023 Client Approval:Summary of Benefits Coverage(SBCs) X X 8/24/2023 8/25/2023 Conduct Enrollment meetings Open Enrollment Period- X X X TBD TBD Submit open enrollment eligibility to Cigna X X TBD TBD Load open enrollment eligibility into Cigna's eligibility system X X TBD TBD Release eligibility to ID card vendor for production/mailing X X TBD TBD All ID cards are in the mail X X TBD TBD , Call ready X 10/1/2023 10/1/2023 Pharmacy Access to Care Ready X 10/1/2023 10/1/2023 Claims System ready to Pay X 9/18/2023 9/29/2023 Claim system released X 10/25/2023 10/25/2023 Provide Medicare agreement for review and signature X X 9/18/2023 9/29/2023 Provide Benefit Description Certificates(SPDs)/Booklet Draft(s)for X X 11/15/2023 11/17/2023 Client Approval The dates included in this Implementation Project Plan are subject to change. If a change is necessary,Cigna will work with you to reach a new agreement that reflects the Confidential,unpublished property of Cigna.Do not duplicate or distribute.Use and distribution limited solely to authorized personnel.Copyright 2019 Cigna Comments Client and Broker should review rates and benefits for accuracy. Submit documents via email to broker,but can address questions during scheduling monthly call as needed. Received approved documents from client. Review communication documents and sign off that the benefits are as intended. Provide Cigna with a list of every one that eligible to join the plan. 2-.3 business days following approval of Benefit Summaries Open enrollment Confidential,unpublished property of Cigna. Do not duplicate or distribute.Use and distribution limited solely to authorized personnel.Copyright 2019 Cigna Open enrollment These are the dates that we would work with for the open enrollment file for this renewal to ensure that all products are setup and cards are in hand for your 2023 plan year We would need the file this year by 09/15 to have any cards in hand by 10/01 Based on eligibility file date Based on eligibility file date Medicare-Dates will vary pending CMS approval of eligibility. CMS requires Cigna to have ID cards sent within 10 days of acceptance or by last day of the month prior to the effective date, whichever is later. 30 days post implementation Dependent on client review/approval Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel.Copyright 2019 Cigna Providers In 10 Providers In 15 Providers In 20 Zip Code miles Radius miles Radius miles Radius 06770 432 646 3,894 07424 1,225 3,646 22,360 12435 2 122 224 15241 334 1,664 3,420 16057 14 64 337 22482 20 32 73 27214 2 931 2,031 27518 361 1,465 4,302 27855 2 15 172 28227 596 3,278 6,876 29150 391 _ 391 493 29585 45 102 261 30022 667 2,432 8,363 30028 5 415 2,362 30102 116 1,065 3,985 30228 24 555 1,880 30252 123 658 1,899 30475 35 36 44 30511 5 64 164 31019 I 0 34 125 31024 14 24 148 31030 26 106 360 31061 40 40 65 31601 109 154 176 32082 81 569 1,706 32102 1 5 116 32118 58 216 298 32129 68 254 402 32137 43 135 218 32162 287 363 980 32163 96 430 653 32174 126 174 352 32226 17 359 1,813 32303 226 406 435 32309 13 340 409 32311 179 406 430 32404 107 356 388 32433 0 11 13 32712 69 293 2,457 32720 99 229 439 32726 140 172 667 32821 226 768 2,456 32904 337 439 682 32905 340 429 619 32907 116 418 618 32909 96 344 544 32927 34 104 394 32931 52 248 613 32937 31 440 680 32940 117 274 712 132950 89 365 612 32962 _ 185 211 442 32967 170 _ 271 _ 360 32976 62 73 684 33004 440 1,717 4,790 33009 609 1,341 5,267 33010 577 3,450 5,391 33012 444 2,919 5,606 33013 494 3,158 5,620 33014 392 2,510 5,703 33015 428 1,376 _ 5,826 33016 392 1,741 5,649 33018 296 1,092 5,624 33019 489 i 1,208 4,999 33020 559 -T 1,629 5,112 33021 668 I. 1,789 5,205 133023 769 1,923 5,854 33024 715 2,076 5,264 33025 451 2,071 6,049 33026 469 1,736 5,256 _� - 33027 359 1,324 5,853 33028 473 1,267 5,536 33029 _ 82 _____+ 807 4,522 33030 113 153 895 1 33031 95 202 1,538 I 33032 91 274 2,097 _ +33033 118 190 1,479 33034 95 129 539 _ 33035 126 155 850 33037 5 6 36 - 33054 503 3,051 5,718 33055 375 1,874 6,007 33056 304 1,886 6,041 33060 411 1,364 3,293 33062 343 1,143 2,992 33063 482 1,492 3,315 33064 207 1,230 2,725 33065 432 940 3,101 _ 33066 415 1,454 3,294 33067 414 1,144 2,835 33068 602 1,613 3,472 33069 556 -T 1,625 3,315 33073 491 1,342 2,876 33082 350 1,113 _ 5,390 33114 _ 2,178 3,313 4,836 33119 404 2,001 4,756 33122 620 _ 3,339 5,185 - 33125 1,682 3,365 4,963 33126 1,268 3,344 4,953 33127 1,558 _ 3,177 5,045 33128 1,666 _ 2,961 4,951 33129 1,550 _ 3,002 4,851 33130 1,539 2,985 4,872 33131 1,605 2,828 4,866 33132 _ 1,489 2,915 4,956 33133 2,054 3,170 4,559 33134 2,203 3,378 4,876 33135 1,733 3,329 4,920 33136 1,671 2,988 4,963 33137 1,385 I 3,109 5,043 33138 1,353 I 2,784 5,481 33139 1,169 2,038 4,801 33140 315 2,139 4,939 33141 336 2,070 5,165 33142 1,578 3,328 5,045 33143 1,208 2,992 4,138 _ 33144 1,333 3,299 4,902 - 33145 1,806 3,267 4,861 33146 1,390 3,112 4,356 33147 1,312 3,333 5,584 33149 100 2,307 4,222 33150 1,387 2,868 5,558 33154 356 2,129 5,403 33155 1,521 _ 3,176 4,555 33156 902 2,490 4,029 33157 138 1,271 3,660 33158 381 1,813 3,879 33160 493 1,267 5,453 33161 378 2,617 5,637 33162 536 2,620 5,868 _ 33165 1,126 2,985 4,363 33166 558 3,367 5,279 33167 481 3,192 5,710 33168 458 2,926 5,680 33169 550 1,980 5,977 33170 29 344 2,105 33172 463 3,189 I 4,824 33173 1,092 1,995 4,097 33174 896 3,174 4,673 33175 451 1,808 4,111 33176 _ 517 1,813 3,921 33177 126 709 3,302 33178 281 2,612 5,276 33179 680 1,623 5,685 33180 600 1,305 5,596 33181 392 2,389 5,601 33182 308 2,029 4,386 33183 590 1,815 4,007 33184 343 1,925 4,347 33185 263 1,314 3,959 33186 502 1,426 3,764 33187 5 423 _ 2,131 33189 82 639 3,321 33190 92 _ 542 _ 3,187 33193 308 1,270 3,699 33194 196 1,212 4,188 33196 142 1,062 3,524 33233 2,035 3,159 4,514 33239 1,206 2,113 4,841 33261 516 2,354 5,756 33269 547 1,976 5,973 33301 401 1,533 3,654 33304 408 1,532 3,522 33305 426 1,416 3,529 33306 431 1,237 3,459 33309 487 1,602 3,488 33311 523 1,777 3,549 33312 453 1,879 3,977 33313 608 1,858 3,602 33314 _ 744 2,065 4,819 33315 _ 267 1,691 _ 3,974 33316 219 1,581 _ 3,854 33317 531 2,028 3,795 33319 570 1,591 3,513 33321 442 , 1,346 3,385 __Y 33322 573 1,909 3,637 33323 399 1,343 3,533 33324 541 1 1,769 3,716 33325 I 533 1,417 3,609 33326 207 1,101 3,422 33328 673 1,812 4,800 33330 637 1,541 4,597 33331 391 1,061 3,658 33334 395 1,525 3,476 33351 558 1,712 3,425 33407 264 574 1,298 33410 166 531 1,110 33411 195 799 1,453 33412 4 417 1,177 33417 288 905 1,453 - 33426 332 761 1,812 33435 141 f 765 1,781 33437 _ 230 841 1,984 _ 33444 341 709 2,221 33446 243 724 2,320 33449 147 634 1,615 33458 186 296 933 33463 367 875 1,646 33467 365 799 1,667 33470 9 218 1,185 33472 127 864 1,882 33478 _ 8 188 _ 959 33486 335 __+ 934 _ 2,459 33487 411 I 785 2,227 33511 _ 283 559 2,074 33543 y 181 362 1,697 33544 160 I 328 1,688 _ 33579 88 413 1,523 33604 -_ 651 --+ 1,399 2,935 33774 326 803 1,722 33837 80 169 1,051 33852 27 28 205 33880 154 237 853 33881 _ 154 4 233 881 33908 332 700 1,078 33935 y 7 t 7 46 33991 168 500 825 34105 312 495 608 34120 2 91 595 34142 11 1 11 47 34231 222 - 319 - 845 34266 33 33 46 34288 58 220 463 34432 11 97 613 34442 14 138 319 34465 65 129 268 34470 256 366 664 34476 122 433 865 34482 2 329 498 34491 142 339 911 34689 95 663 1,935 34711 174 247 908 34746 276 4 608 1,666 34772 86 i 137 876 34949 90 114 686 34951 6 295 597 34953 91 450 634 34983 233 399 631 34984 214 477 634 34986 98 389 631 34987 _ 105 281 I 626 34990 166 410 653 34997 202 248 722 36079 26 26 31 36535 78 117 255 37664 455 509 1,414 55112 530 7,761 13,224 60611 3,140 5,300 8,604 76182 230 706 2,972 81611 31 32 52 86351 _ 3 18 98 89102 _ 573 1,247 1,554 90604 142 1 1,073 5,270 95661 250 1 666 1,817 98325 0 43 218 ... .%.,4 .. ,. , • " J•.)(.........„ Cigna ® Cigna Network Analysis Cigna Open Access Plus (OAP) Created for... City of Miami Beach April 2023 Created with the Quest Analytics Suite Copyright©2003-23 Quest Analytics, LLC. Cigna Network Analysis 2 Contents Report Contents Access Summary By City(With Access) 3 Access Analysis:Medical-Breakout-Urban Access Summary By City(Without Access) 4 Access Analysis.Medical-Breakout-Urban Access Detail By Zip Code(With Access) 5 Access Analysis Medical-Breakout-Urban Access Detail By Zip Code(Without Access) 23 Access Analysis.Medical-Breakout-Urban Access Summary By City(With Access) 24 Access Analysis.Medical-Breakout-Suburban Access Summary By City(Without Access) 25 Access Analysis.Medical-Breakout-Suburban Access Detail By Zip Code(With Access) 26 Access Analysis:Medical-Breakout-Suburban Access Detail By Zip Code(Without Access) 35 Access Analysis:Medical-Breakout-Suburban Access Summary By City(With Access) 36 Access Analysis.Medical-Breakout-Rural Access Summary By City(Without Access) 37 Access Analysis.Medical-Breakout-Rural Access Detail By Zip Code(With Access) 38 Access Analysis Medical-Breakout-Rural Access Detail By Zip Code(Without Access) 50 Access Analysis:Medical-Breakout-Rural Access Detail By Zip Code(Excluded from Analysis) 51 Access Analysis:Invalid Zip Codes Cigna Network Analysis-Employees With Access 3 Access Summary By City (With Access) April 2023 Employees With Access Created for... Employee Provider With Access Counts' Average Distance City of Miami Beach Group # Group Standard # % # P 1 2 Access Analysis All Employees-Urban 1,451 Adult Primary Care Physi... 2 in 10 miles 1,451 100.0 628,036 227,301 101,503 0.6 0.7 Medical-Breakout-Urban Pediatricians 2 in 10 miles 1,451 100.0 153,429 60,348 32,008 0.9 1.0 Distance Method OB/Gyns 2 in 10 miles 1,451 100.0 122,514 35,549 24,062 1.2 1.4 Estimated Driving Distance Other Specialists 2 in 10 miles 1,451 100.0 3,462,580 906,886 220,216 0.5 0.6 Employee Group Hospitals 1 in 10 miles 1,451 100.0 10,053 6,360 8,122 2.0 3.3 All Employees-Urban Ur.ent Care Facilities 1 in 10 miles 1,451 100.0 8,689 3,500 6,940 1.8 2.5 Provider Group Adult Primary Care Physicians Key Geographic Areas Pediatricians Employee Provider With Access Average Distance OB/Gyns State Other Specialists Name City # Group Standard # % 1 2 Hospitals Florida Miami 783 Adult Primary Care Physicians 2 in 10 miles 783 100.0 0.5 0.6 Urgent Care Facilities Hospitals 1 in 10 miles 783 100.0 1.8 3.0 OB/Gyns 2 in 10 miles 783 100.0 1.3 1.5 Provider counts represent: Other Specialists 2 in 10 miles 783 100.0 0.5 0.5 #.Provider access points Pediatricians 2 in 10 miles 783 100.0 0.8 0.9 Pi Unique providers Urgent Care Facilities 1 in 10 miles 783 100.0 1.7 2.2 L:Unique provider locations Miami Beach 206 Adult Primary Care Physicians 2 in 10 miles 206 100.0 0.6 0.6 Hospitals 1 in 10 miles 206 100.0 2.7 4.8 OB/Gyns 2 in 10 miles 206 100.0 1.0 1.0 Other Specialists 2 in 10 miles 206 100.0 0.4 0.5 Pediatricians 2 in 10 miles 206 100.0 0.9 0.9 Urgent Care Facilities 1 in 10 miles 206 100.0 2.5 4.2 Hollywood 170 Adult Primary Care Physicians 2 in 10 miles 170 100.0 0.6 0.7 Hospitals 1 in 10 miles 170 100.0 1.8 2.3 OB/Gyns 2 in 10 miles 170 100.0 1.2 1.3 Other Specialists 2 in 10 miles 170 100.0 0.5 0.5 Pediatricians 2 in 10 miles 170 100.0 1.1 1.3 Urgent Care Facilities 1 in 10 miles 170 100.0 1.5 2.0 Hialeah 101 Adult Primary Care Physicians 2 in 10 miles 101 100.0 0.4 0.5 Hospitals 1 in 10 miles 101 100.0 1.6 2.2 OB/Gyns 2 in 10 miles 101 100.0 1.1 1.3 Other Specialists 2 in 10 miles 101 100.0 0.4 0.5 Pediatricians 2 in 10 miles 101 100.0 0.7 1.1 Urgent Care Facilities 1 in 10 miles 101 100.0 1.7 1.9 Fort Lauderdale 58 Adult Primary Care Physicians 2 in 10 miles 58 100.0 0.7 0.8 Hospitals 1 in 10 miles 58 100.0 2.4 3.9 OB/Gyns 2 in 10 miles 58 100.0 1.3 1.7 Other Specialists 2 in 10 miles 58 100.0 0.5 0.6 Pediatricians 2 in 10 miles 58 100.0 1.2 1.4 Urgent Care Facilities 1 in 10 miles 58 100.0 1.2 1.7 2023 Quest Analytics,LLC. Cigna Network Analysis-Employees Without Access 4 Access Summary By City (Without Access) ADri 2023 Key Geographic Areas Created for... State Employee Provider Without Access Average Distan City of Miami Beach Name City # Group Standard # % 1 2 Access Analysis No data that meets the criteria Medical-Breakout-Urban Distance Method Estimated Driving Distance Employee Group All Employees-Urban Provider Group Adult Primary Care Physicians Pediatricians OB/Gyns Other Specialists Hospitals Urgent Care Facilities 2323 Quest Analyocs.2LC. Cigna Network Analysis-Employees With Access 5 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis California Los Angeles Whittier 90604 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.5 1.0 Medical-Breakout-Urban Pediatricians 2 in 10 miles 1 100.0 0.5 0.9 Distance Method OB/Gyns 2 in 10 miles 1 100.0 0.6 2.7 Estimated Driving Distance Other Specialists 2 in 10 miles 1 100.0 1.0 1.0 Employee/Provider Groups Hospitals 1 in 10 miles 1 100.0 0.9 2.0 All Employees-Urban Urgent Care Facilities 1 in 10 miles 1 100.0 1.7 4.0 Adult Primary Care Physicians Placer Roseville 95661 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Pediatricians Pediatricians 2 in 10 miles 1 100.0 0.4 0.4 OB/Gyns OB/Gyns 2 in 10 miles 1 100.0 0.2 0.2 Other Specialists Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals Hospitals 1 in 10 miles 1 100.0 1.7 8.4 Urgent Care Facilities Urgent Care Facilities 1 in 10 miles 1 100.0 0.7 1.6 Florida Brevard Satellite Beach 32937 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.7 0.7 Pediatricians 2 in 10 miles 1 100.0 3.1 5.6 OB/Gyns 2 in 10 miles 1 100.0 5.7 6.6 Other Specialists 2 in 10 miles 1 100.0 0.6 0.7 Hospitals 1 in 10 miles 1 100.0 3.2 6.9 Urgent Care Facilities 1 in 10 miles 1 100.0 3.2 3.3 Broward Coral Springs 33065 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.2 0.2 Pediatricians 2 in 10 miles 2 100.0 0.2 0.4 OB/Gyns 2 in 10 miles 2 100.0 0.2 0.2 Other Specialists 2 in 10 miles 2 100.0 0.2 0.2 Hospitals 1 in 10 miles 2 100.0 0.9 3.2 Urgent Care Facilities 1 in 10 miles 2 100.0 0.6 0.9 Fort Lauderdale 33301 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.1 0.2 Pediatricians 2 in 10 miles 2 100.0 0.9 0.9 OB/Gyns 2 in 10 miles 2 100.0 0.3 0.3 Other Specialists 2 in 10 miles 2 100.0 0.1 0.1 Hospitals 1 in 10 miles 2 100.0 0.4 1.1 Urgent Care Facilities 1 in 10 miles 2 100.0 0.7 1.1 33304 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.6 0.6 Pediatricians 2 in 10 miles 1 100.0 1.9 2.7 OB/Gyns 2 in 10 miles 1 100.0 0.4 0.4 Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals 1 in 10 miles 1 100.0 1.7 3.0 Urgent Care Facilities 1 in 10 miles 1 100.0 2.0 2.8 33305 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.3 0.4 Pediatricians 2 in 10 miles 1 100.0 0.6 1.6 OB/Gyns 2 in 10 miles 1 100.0 1.2 1.2 Other Specialists 2 in 10 miles 1 100.0 0.3 0.3 2023 Quest Analyucs,LLC. °ontmued on next page... Cigna Network Analysis-Employees With Access 6 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance Cary of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Broward Fort Lauderdale 33305 1 Hospitals 1 in 10 miles 1 100.0 2.4 2.8 Medical-Breakout-Urban Urgent Care Facilities 1 in 10 miles 1 100.0 2.1 2.6 Distance Method 33306 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.0 0.0 Estimated Driving Distance Pediatricians 2 in 10 miles 1 100.0 0.2 0.3 Employee r Provider Groups OB/Gyns 2 in 10 miles 1 100.0 0.4 0.4 All Employees-Urban Other Specialists 2 in 10 miles 1 100.0 0.0 0.0 Adult Primary Care Physicians Hospitals 1 in 10 miles 1 100.0 1.7 2.9 Pediatricians Urgent Care Facilities 1 in 10 miles 1 100.0 1.6 1.6 OB!Gyns 33309 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.3 0.6 Other Specialists Pediatricians 2 in 10 miles 2 100.0 1.8 1.8 Hospitals Urgent Care Facilities OB/Gyns 2 in 10 miles 2 100.0 2.6 2.6 Other Specialists 2 in 10 miles 2 100.0 0.2 0.4 Hospitals 1 in 10 miles 2 100.0 0.9 3.5 Urgent Care Facilities 1 in 10 miles 2 100.0 0.8 1.2 33311 3 Adult Primary Care... 2 in 10 miles 3 100.0 0.5 0.5 Pediatricians 2 in 10 miles 3 100.0 2.2 2.6 OB/Gyns 2 in 10 miles 3 100.0 1.3 2.7 Other Specialists 2 in 10 miles 3 100.0 0.7 0.9 Hospitals 1 in 10 miles 3 100.0 3.4 4.0 Urgent Care Facilities 1 in 10 miles 3 100.0 1.6 2.0 33312 4 Adult Primary Care... 2 in 10 miles 4 100.0 1.3 1.5 Pediatricians 2 in 10 miles 4 100.0 2.1 2.3 OB/Gyns 2 in 10 miles 4 100.0 1.1 1.2 Other Specialists 2 in 10 miles 4 100.0 0.7 0.9 Hospitals 1 in 10 miles 4 100.0 2.9 3.6 Urgent Care Facilities 1 in 10 miles 4 100.0 1.4 2.3 33313 3 Adult Primary Care... 2 in 10 miles 3 100.0 0.7 0.7 Pediatricians 2 in 10 miles 3 100.0 1.1 1.7 OB/Gyns 2 in 10 miles 3 100.0 1.2 1.8 Other Specialists 2 in 10 miles 3 100.0 0.6 0.7 Hospitals 1 in 10 miles 3 100.0 1.6 4.2 Urgent Care Facilities 1 in 10 miles 3 100.0 1.2 1.6 33317 7 Adult Primary Care... 2 in 10 miles 7 100.0 1.1 1.2 Pediatricians 2 in 10 miles 7 100.0 1.6 1.8 OB/Gyns 2 in 10 miles 7 100.0 1.3 1.5 Other Specialists 2 in 10 miles 7 100.0 1.0 1.1 Hospitals 1 in 10 miles 7 100.0 2.8 3.9 Urgent Care Facilities 1 in 10 miles 7 100.0 1.1 1.8 33319 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.3 1.1 Pediatricians 2 in 10 miles 1 100.0 1.1 1.4 Continued on next page... Cigna Network Analysis-Employees With Access 7 Access Detail By Zip Code (With Access) April 20z3 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City ot Miami Beach Name County City Code # Group Standard # % 1,,,, 2 Access Analysis Florida Broward Fort Lauderdale 33319 1 OB/Gyns 2 in 10 miles 1 100.0 1.6 3.1 Medical-Breakout-Urban Other Specialists 2 in 10 miles 1 100.0 0.3 0.3 Distance Method Hospitals 1 in 10 miles 1 100.0 1.5 4.0 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 1 100.0 1.6 2.3 Employee/Provider Groups 33321 6 Adult Primary Care... 2 in 10 miles 6 100.0 0.8 0.8 All Employees-Urban Pediatricians 2 in 10 miles 6 100.0 1.6 1.8 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 6 100.0 1.2 1.7 Pediatricians Other Specialists 2 in 10 miles 6 100.0 0.5 0.6 OB/Gyns Hospitals 1 in 10 miles 6 100.0 1.8 4.9 Other Specialists Urgent Care Facilities 1 in 10 miles 6 100.0 1.0 1.5 Hospitals 33322 4 Adult Primary Care... 2 in 10 miles 4 100.0 1.1 1.2 Urgent Care Facilities Pediatricians 2 in 10 miles 4 100.0 0.9 1.0 OB/Gyns 2 in 10 miles 4 100.0 2.0 2.3 Other Specialists 2 in 10 miles 4 100.0 0.6 0.6 Hospitals 1 in 10 miles 4 100.0 4,0 4.8 Urgent Care Facilities 1 in 10 miles 4 100.0 1.2 1.4 33324 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.7 0.8 Pediatricians 2 in 10 miles 7 100.0 0.7 1.0 OB/Gyns 2 in 10 miles 7 100.0 1.3 1.4 Other Specialists 2 in 10 miles 7 100.0 0.6 0.6 Hospitals 1 in 10 miles 7 100.0 1.9 4.6 Urgent Care Facilities 1 in 10 miles 7 100.0 1.5 2.6 33326 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.7 0.8 Pediatricians 2 in 10 miles 7 100.0 1.1 1.1 OB/Gyns 2 in 10 miles 7 100.0 0.8 0.8 Other Specialists 2 in 10 miles 7 100.0 0.5 0.6 Hospitals 1 in 10 miles 7 100.0 2.2 2.6 Urgent Care Facilities 1 in 10 miles 7 100.0 1.1 1.6 33334 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.7 0.9 Pediatricians 2 in 10 miles 1 100.0 1.0 1.0 OB/Gyns 2 in 10 miles 1 100.0 1.2 1.2 Other Specialists 2 in 10 miles 1 100.0 0.5 0.6 Hospitals 1 in 10 miles 1 100.0 1.4 3.5 Urgent Care Facilities 1 in 10 miles 1 100.0 0.8 1.1 33351 8 Adult Primary Care... 2 in 10 miles 8 100.0 0.6 0.7 Pediatricians 2 in 10 miles 8 100.0 0.6 0.7 OB/Gyns 2 in 10 miles 8 100.0 2.0 2.9 Other Specialists 2 in 10 miles 8 100.0 0.3 0.3 Hospitals 1 in 10 miles 8 100.0 3.5 4.3 Urgent Care Facilities 1 in 10 miles 8 100.0 1.0 1.2 ©2023 Quest Analyecs.LLC Continued on nest page... Cigna Network Analysis-Employees With Access 8 Access Detail By Zip Code (With Access) April2023 Employees With Access Created for... Employee Provider With Access Average Distance City of Miami Beach Zip 'h .,� nx r County City Code # Group Standard # % likil. 2 Access Analysis Florida Broward Hallandale 33009 13 Adult Primary Care... 2 in 10 miles 13 100.0 0.5 0.6 Medical-Breakout-Urban Pediatricians 2 in 10 miles 13 100.0 0.9 1.1 Distance Method OB/Gyns 2 in 10 miles 13 100.0 0.5 0.8 Estimated Driving Distance Other Specialists 2 in 10 miles 13 100.0 0.4 0.4 Employee I Provider Groups Hospitals 1 in 10 miles 13 100.0 1.2 1.6 AM Employees-Urban Urgent Care Facilities 1 in 10 miles 13 100.0 0.9 1.5 Adult Primary Care Physicians Hollywood 33019 3 Adult Primary Care... 2 in 10 miles 3 100.0 1.3 1.5 Pediatricians Pediatricians 2 in 10 miles 3 100.0 2.0 2.0 OBIGyns OB/Gyns 2 in 10 miles 3 100.0 2.0 2.1 Other Specialists Other Specialists 2 in 10 miles 3 100.0 1.1 1.3 Hospitals Urgent Care Facilities Hospitals 1 in 10 miles 3 100.0 1.6 2.3 Urgent Care Facilities 1 in 10 miles 3 100.0 2.0 2.0 33020 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.4 0.5 Pediatricians 2 in 10 miles 9 100.0 1.3 1.8 OB/Gyns 2 in 10 miles 9 100.0 1.2 1.7 Other Specialists 2 in 10 miles 9 100.0 0.3 0.4 Hospitals 1 in 10 miles 9 100.0 0.9 1.9 Urgent Care Facilities 1 in 10 miles 9 100.0 1.4 2.1 33021 23 Adult Primary Care... 2 in 10 miles 23 100.0 0.4 0.4 Pediatricians 2 in 10 miles 23 100.0 0.6 0.6 OB/Gyns 2 in 10 miles 23 100.0 0.6 0.7 Other Specialists 2 in 10 miles 23 100.0 0.3 0.4 Hospitals 1 in 10 miles 23 100.0 1.2 1.3 Urgent Care Facilities 1 in 10 miles 23 100.0 1.0 1.8 33023 32 Adult Primary Care... 2 in 10 miles 32 100.0 0.7 0.8 Pediatricians 2 in 10 miles 32 100.0 1.8 2.0 OB/Gyns 2 in 10 miles 32 100.0 2.0 2.0 Other Specialists 2 in 10 miles 32 100.0 0.5 0.7 Hospitals 1 in 10 miles 32 100.0 2.5 2.8 Urgent Care Facilities 1 in 10 miles 32 100.0 2.3 2.3 33024 25 Adult Primary Care... 2 in 10 miles 25 100.0 0.5 0.5 Pediatricians 2 in 10 miles 25 100.0 0.9 1.3 OB/Gyns 2 in 10 miles 25 100.0 1.2 1.3 Other Specialists 2 in 10 miles 25 100.0 0.4 0.5 Hospitals 1 in 10 miles 25 100.0 1.4 1.8 Urgent Care Facilities 1 in 10 miles 25 100.0 1.1 1.6 33025 24 Adult Primary Care... 2 in 10 miles 24 100.0 0.6 0.8 Pediatricians 2 in 10 miles 24 100.0 0.9 1.1 OB/Gyns 2 in 10 miles 24 100.0 1.2 1.3 Other Specialists 2 in 10 miles 24 100.0 0.5 0.5 2023 Quest Acolytes,LLC Contnueu on next page Cigna Network Analysis-Employees With Access 9 Access Detail By Zip Code (With Access) nprtlzozs Employees With Access Created for... State Zip Employee Provider With Access Average Distance -City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Broward Hollywood 33025 24 Hospitals 1 in 10 miles 24 100.0 2.3 2.9 Medical-Breakout-Urban Urgent Care Facilities 1in10miles 24 100.0 1.4 1.7 Distance Method 33026 25 Adult Primary Care... 2 in 10 miles 25 100.0 0.3 0.4 Estimated Driving Distance Pediatricians 2 in 10 miles 25 100.0 0.6 0.8 Employee/Provider Groups OB/Gyns 2 in 10 miles 25 100.0 0.7 0.8 All Employees-Urban Other Specialists 2 in 10 miles 25 100.0 0.3 0.3 Adult Primary Care Physicians Hospitals 1 in 10 miles 25 100.0 1,6 1.6 Pediatricians Urgent Care Facilities 1 in 10 miles 25 100.0 1.4 2.3 OB/Gyns 33027 29 Adult Primary Care... 2 in 10 miles 29 100.0 0.8 0.8 Other Specialists Pediatricians 2 in 10 miles 29 100.0 1.4 1.6 Hospitals Urgent Care Facilities OB/Gyns 2 in 10 miles 29 100.0 1.1 1.2 Other Specialists 2 in 10 miles 29 100.0 0.7 0.7 Hospitals 1 in 10 miles 29 100.0 1.7 3.4 Urgent Care Facilities 1 in 10 miles 29 100.0 1.6 2.1 Pembroke Pines 33028 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.9 0.9 Pediatricians 2 in 10 miles 7 100.0 1.3 1.3 OB/Gyns 2 in 10 miles 7 100.0 1.2 1.4 Other Specialists 2 in 10 miles 7 100.0 0.5 0.7 Hospitals 1 in 10 miles 7 100.0 1.6 2.2 Urgent Care Facilities 1 in 10 miles 7 100.0 1.5 2.0 33082 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.7 0.7 Pediatricians 2 in 10 miles 2 100.0 1.4 1.4 OB/Gyns 2 in 10 miles 2 100.0 1.4 1.6 Other Specialists 2 in 10 miles 2 100.0 0.0 0.4 Hospitals 1 in 10 miles 2 100.0 2.0 3.5 Urgent Care Facilities 1 in 10 miles 2 100.0 0.2 1.8 Pompano Beach 33060 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.5 0.5 Pediatricians 2 in 10 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 1 100.0 0.7 0.7 Other Specialists 2 in 10 miles 1 100.0 0.4 0.5 Hospitals 1 in 10 miles 1 100.0 2.4 3.3 Urgent Care Facilities 1 in 10 miles 1 100.0 0.1 2.2 33062 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.6 0.6 Pediatricians 2 in 10 miles 1 100.0 0.5 1.1 OB/Gyns 2 in 10 miles 1 100.0 2.3 2.3 Other Specialists 2 in 10 miles 1 100.0 0.5 0.5 Hospitals 1 in 10 miles 1 100.0 3.3 3.9 Urgent Care Facilities 1 in 10 miles 1 100.0 1.7 2.8 33063 3 Adult Primary Care... 2 in 10 miles 3 100.0 0.5 1.0 Pediatricians 2 in 10 miles 3 100.0 1.1 1.2 Cigna Network Analysis-Employees With Access 10 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City or Miami Beach Name County City Code # Group Standard # % 1_ _ 2 Access Analysis Florida Broward Pompano Beach 33063 3 OB/Gyns 2 in 10 miles 3 100.0 1.3 1.4 Medical-Breakout-Urban Other Specialists 2 in 10 miles 3 100.0 0.6 0.6 Distance Method Hospitals 1 in 10 miles 3 100.0 2.2 3.2 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 3 100.0 1.4 1.7 Employee Prodder Groups 33064 3 Adult Primary Care... 2 in 10 miles 3 100.0 0.6 0.7 All Employees-Urban Pediatricians 2 in 10 miles 3 100.0 1.2 1.3 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 3 100.0 0.9 1.0 Pediatricians Other Specialists 2 in 10 miles 3 100.0 0.5 0.5 OB/Gyns Hospitals 1 in 10 miles 3 100.0 1.4 2.6 Other Specialists Urgent Care Facilities 1 in 10 miles 3 100.0 1.4 2.7 Hospitals 33066 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.4 0.4 Urgent Care Facilities Pediatricians 2 in 10 miles 1 100.0 1.6 2.2 OB/Gyns 2 in 10 miles 1 100.0 0.5 1.6 Other Specialists 2 in 10 miles 1 100.0 0.4 0.4 Hospitals 1 in 10 miles 1 100.0 2.6 3.5 Urgent Care Facilities 1 in 10 miles 1 100.0 2.6 3.0 33068 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.4 1.2 Pediatricians 2 in 10 miles 1 100.0 2.3 2.3 OB/Gyns 2 in 10 miles 1 100.0 1.6 1.6 Other Specialists 2 in 10 miles 1 100.0 1.0 1.0 Hospitals 1 in 10 miles 1 100.0 2.1 3.4 Urgent Care Facilities 1 in 10 miles 1 100.0 2.3 2.4 33073 3 Adult Primary Care... 2 in 10 miles 3 100.0 0.2 0.2 Pediatricians 2 in 10 miles 3 100.0 0.8 0.8 OB/Gyns 2 in 10 miles 3 100.0 1.3 1.5 Other Specialists 2 in 10 miles 3 100.0 0.2 0.2 Hospitals 1 in 10 miles 3 100.0 3.5 4,2 Urgent Care Facilities 1 in 10 miles 3 100.0 1.9 3.0 Hillsborough Brandon 33511 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.5 Pediatricians 2 in 10 miles 1 100.0 0.5 1,2 OB/Gyns 2 in 10 miles 1 100.0 1.1 1.1 Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals 1 in 10 miles 1 100.0 1.2 1.6 Urgent Care Facilities 1 in 10 miles 1 100.0 0.3 0.3 Tampa 33604 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.8 0.8 Pediatricians 2 in 10 miles 1 100.0 0.8 2.1 OB/Gyns 2 in 10 miles 1 100.0 2.2 2.2 Other Specialists 2 in 10 miles 1 100.0 0.6 0.6 Hospitals 1 in 10 miles 1 100.0 3.1 3.5 Urgent Care Facilities 1 in 10 miles 1 100.0 2.5 4.2 Continued on next page_. Cigna Network Analysis-Employees With Access 11 Access Detail By Zip Code (With Access) ApM2ozB Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # Io 1 2 Access Analysis Florida Miami-Dade Coral Gables 33114 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Medical-Breakout-Urban Pediatricians 2 in 10 miles 1 100.0 0.2 0.4 Distance Method OB/Gyns 2 in 10 miles 1 100.0 0.4 0.4 Estimated Driving Distance Other Specialists 2 in 10 miles 1 100.0 0.1 0.1 Employee/Provider Groups Hospitals 1 in 10 miles 1 100.0 0.6 2.3 All Employees-Urban Urgent Care Facilities 1 in 10 miles 1 100.0 0.6 0.6 Adult Primary Care Physicians Hialeah 33010 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.4 0.5 Pediatricians Pediatricians 2 in 10 miles 9 100.0 0.9 1.4 OB/Gyns OB/Gyns 2 in 10 miles 9 100.0 0.8 1.0 Other Specialists Other Specialists 2 in 10 miles 9 100.0 0.4 0.4 Hospitals Urgent Care Facilities Hospitals 1 in 10 miles 9 100.0 1.6 3.7 Urgent Care Facilities 1 in 10 miles 9 100.0 3.3 3.6 33012 25 Adult Primary Care... 2 in 10 miles 25 100.0 0.3 0.5 Pediatricians 2 in 10 miles 25 100.0 0.6 0.8 OB/Gyns 2 in 10 miles 25 100.0 1.1 1.5 Other Specialists 2 in 10 miles 25 100.0 0.3 0.4 Hospitals 1 in 10 miles 25 100.0 1.1 1.4 Urgent Care Facilities 1 in 10 miles 25 100.0 1.2 1.3 33013 10 Adult Primary Care... 2 in 10 miles 10 100.0 0.4 0.4 Pediatricians 2 in 10 miles 10 100.0 0.4 0.5 OB/Gyns 2 in 10 miles 10 100.0 0.6 0.9 Other Specialists 2 in 10 miles 10 100.0 0.3 0.4 Hospitals 1 in 10 miles 10 100.0 0.9 3.1 Urgent Care Facilities 1 in 10 miles 10 100.0 3,0 3.1 33014 22 Adult Primary Care... 2 in 10 miles 22 100.0 0.3 0.4 Pediatricians 2 in 10 miles 22 100,0 0.7 0.8 OB/Gyns 2 in 10 miles 22 100.0 0.8 0.9 Other Specialists 2 in 10 miles 22 100.0 0.4 0.4 Hospitals 1 in 10 miles 22 100.0 1.4 1.6 Urgent Care Facilities 1 in 10 miles 22 100.0 1.2 1.5 33015 26 Adult Primary Care... 2 in 10 miles 26 100.0 0.6 0.6 Pediatricians 2 in 10 miles 26 100.0 0.9 1.8 OB/Gyns 2 in 10 miles 26 100.0 1.9 2.0 Other Specialists 2 in 10 miles 26 100.0 0.5 0.8 Hospitals 1 in 10 miles 26 100.0 2.7 3.1 Urgent Care Facilities 1 in 10 miles 26 100.0 1.3 1.9 33016 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.4 0.5 Pediatricians 2 in 10 miles 9 100.0 0.8 0.9 OB/Gyns 2 in 10 miles 9 100.0 0.7 0.9 Other Specialists 2 in 10 miles 9 100.0 0.4 0.4 - - - Continued on next page... Cigna Network Analysis-Employees With Access 12 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zi Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Hialeah 33016 9 Hospitals 1 in 10 miles 9 100.0 0.9 1.1 Medical-Breakout-Urban Urgent Care Facilities 1 in 10 miles 9 100.0 1.7 1.8 Distance Method Miami 33125 18 Adult Primary Care... 2 in 10 miles 18 100.0 0.3 0.4 Estimated Driving Distance Pediatricians 2 in 10 miles 18 100.0 0.7 1.0 Employee I Provider Groups OB/Gyns 2 in 10 miles 18 100.0 1.2 1.3 All Employees-Urban Other Specialists 2 in 10 miles 18 100.0 0.3 0.4 Adult Primary Care Physicians Hospitals 1 in 10 miles 18 100.0 1.4 1.5 Pediatricians Urgent Care Facilities 1 in 10 miles 18 100.0 2.2 2.6 OB/Gyns 33126 12 Adult Primary Care... 2 in 10 miles 12 100.0 0.3 0.4 Other Specialists Pediatricians 2 in 10 miles 12 100.0 0.4 0.5 Hospitals OB/Gyns 2 in 10 miles 12 100.0 1.0 1.0 Urgent Care Facilities Other Specialists 2 in 10 miles 12 100.0 0.3 0.3 Hospitals 1 in 10 miles 12 100.0 1.1 2.1 Urgent Care Facilities 1 in 10 miles 12 100.0 1.2 1.8 33127 22 Adult Primary Care... 2 in 10 miles 22 100.0 0.5 0.6 Pediatricians 2 in 10 miles 22 100.0 0.7 0.9 OB/Gyns 2 in 10 miles 22 100.0 1.0 1.2 Other Specialists 2 in 10 miles 22 100.0 0.5 0.5 Hospitals 1 in 10 miles 22 100.0 1.3 1.9 Urgent Care Facilities 1 in 10 miles 22 100.0 1.3 1.6 33128 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.2 0.3 Pediatricians 2 in 10 miles 7 100.0 0.7 0.8 OB/Gyns 2 in 10 miles 7 100.0 0.3 0.5 Other Specialists 2 in 10 miles 7 100.0 0.2 0.2 Hospitals 1 in 10 miles 7 100.0 0.5 1.4 Urgent Care Facilities 1 in 10 miles 7 100.0 1.7 2.1 33129 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.4 0.4 Pediatricians 2 in 10 miles 7 100.0 0.3 0.6 OB/Gyns 2 in 10 miles 7 100.0 1.3 1.6 Other Specialists 2 in 10 miles 7 100.0 0.3 0.3 Hospitals 1 in 10 miles 7 100.0 0.9 1.7 Urgent Care Facilities 1 in 10 miles 7 100.0 0.6 1.0 33130 5 Adult Primary Care... '2 in 10 miles 5 100.0 0.3 0.3 Pediatricians 2 in 10 miles 5 100.0 0.6 0.8 OB/Gyns 2 in 10 miles 5 100.0 0.5 0.8 Other Specialists 2 in 10 miles 5 100.0 0.3 0.3 Hospitals 1 in 10 miles 5 100.0 0.9 1.5 Urgent Care Facilities 1 in 10 miles 5 100.0 1.2 1.5 33131 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.4 0.5 Pediatricians 2 in 10 miles 2 100.0 1.4 1.7 Centinued on next page. Cigna Network Analysis-Employees With Access 13 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # /s 1 2 Access Analysis Florida Miami-Dade Miami 33131 2 OB/Gyns 2 in 10 miles 2 100.0 1.5 2.0 Medical-Breakout-Urban Other Specialists 2 in 10 miles 2 100.0 0.2 0.3 Distance Method Hospitals 1 in 10 miles 2 100.0 2.1 2.4 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 2 100.0 0.8 2.3 Employee/Provider Groups 33132 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.3 0.6 All Employees-Urban Pediatricians 2 in 10 miles 9 100.0 0.8 1.2 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 9 100.0 1.4 1.6 Pediatricians Other Specialists 2 in 10 miles 9 100.0 0.2 0.3 OBlGyns Hospitals 1 in 10 miles 9 100.0 1.6 1.9 Other Specialists Urgent Care Facilities 1 in 10 miles 9 100.0 1.1 1.7 Hospitals Urgent Care Facilities 33133 8 Adult Primary Care... 2 in 10 miles 8 100.0 0.6 0.7 Pediatricians 2 in 10 miles 8 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 8 100.0 0.7 0.7 Other Specialists 2 in 10 miles 8 100.0 0.5 0.7 Hospitals 1 in 10 miles 8 100.0 1.4 2.1 Urgent Care Facilities 1 in 10 miles 8 100.0 1.5 2.1 33134 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.4 0.4 Pediatricians 2 in 10 miles 9 100.0 0.6 0.7 OB/Gyns 2 in 10 miles 9 100.0 0.9 1.1 Other Specialists 2 in 10 miles 9 100.0 0.3 0.4 Hospitals 1 in 10 miles 9 100.0 0.9 1.9 Urgent Care Facilities 1 in 10 miles 9 100.0 0.9 0.9 33135 14 Adult Primary Care... 2 in 10 miles 14 100.0 0.2 0.3 Pediatricians 2 in 10 miles 14 100.0 0.6 0.6 OB/Gyns 2 in 10 miles 14 100.0 1.1 1.4 Other Specialists 2 in 10 miles 14 100.0 0.2 0.3 Hospitals 1 in 10 miles 14 100.0 1.5 1.9 Urgent Care Facilities 1 in 10 miles 14 100.0 1.3 1.7 33136 6 Adult Primary Care... 2 in 10 miles 6 100.0 0.3 0.3 Pediatricians 2 in 10 miles 6 100.0 0.4 0.4 OB/Gyns 2 in 10 miles 6 100.0 0.6 0.6 Other Specialists 2 in 10 miles 6 100.0 0.1 0.2 Hospitals 1 in 10 miles 6 100.0 0.7 0.7 Urgent Care Facilities 1 in 10 miles 6 100.0 1.9 2.3 33137 11 Adult Primary Care... 2 in 10 miles 11 100.0 0.3 0.4 Pediatricians 2 in 10 miles 11 100.0 0.7 0.8 OB/Gyns 2 in 10 miles 11 100.0 0.7 0.9 Other Specialists 2 in 10 miles 11 100.0 0.3 0.3 Hospitals 1 in 10 miles 11 100.0 0.8 3.0 Urgent Care Facilities 1 in 10 miles 11 100.0 0.8 0.8 0 2023 Quest Analytics,LLC. Continued on next page_. Cigna Network Analysis-Employees With Access 14 Access Detail By Zip Code (With Access) April2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami 33138 29 Adult Primary Care... 2 in 10 miles 29 100.0 0.4 0.5 Medical-Breakout-Urban Pediatricians 2 in 10 miles 29 100.0 0.8 0.8 Distance Method OB/Gyns 2 in 10 miles 29 100.0 1.0 1.8 Estimated Driving Distance Other Specialists 2 in 10 miles 29 100.0 0.3 0.4 Employee I Provider Groups Hospitals 1 in 10 miles 29 100.0 2.1 3.0 All Employees-Urban Urgent Care Facilities 1 in 10 miles 29 100.0 1.4 1.4 Adult Primary Care Physicians 33142 39 Adult Primary Care... 2 in 10 miles 39 100.0 0.5 0.6 Pediatricians Pediatricians 2 in 10 miles 39 100.0 0.8 0.8 OBIGyns OB/Gyns 2 in 10 miles 39 100.0 2.1 2.3 Other Specialists Other Specialists 2 in 10 miles 39 100.0 0.6 0.6 Hospitals Urgent Care Facilities Hospitals 1 in 10 miles 39 100.0 2.5 2.9 Urgent Care Facilities 1 in 10 miles 39 100.0 3.1 3.4 33143 11 Adult Primary Care... 2 in 10 miles 11 100.0 0.6 0.6 Pediatricians 2 in 10 miles 11 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 11 100.0 0.8 0.9 Other Specialists 2 in 10 miles 11 100.0 0.5 0.5 Hospitals 1 in 10 miles 11 100.0 1.1 1.4 Urgent Care Facilities 1 in 10 miles 11 100.0 1.3 2.2 33144 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.2 0.2 Pediatricians 2 in 10 miles 9 100.0 0.5 0.6 OB/Gyns 2 in 10 miles 9 100.0 0.9 1.3 Other Specialists 2 in 10 miles 9 100.0 0.2 0.3 Hospitals 1 in 10 miles 9 100.0 1.4 2.0 Urgent Care Facilities 1 in 10 miles 9 100.0 1.8 2.0 33145 17 Adult Primary Care... 2 in 10 miles 17 100.0 0.2 0.3 Pediatricians 2 in 10 miles 17 100.0 0.5 0.7 OB/Gyns 2 in 10 miles 17 100.0 1.2 1.2 Other Specialists 2 in 10 miles 17 100.0 0.2 0.3 Hospitals 1 in 10 miles 17 100.0 1.3 1.9 Urgent Care Facilities 1 in 10 miles 17 100.0 0.5 1.0 33146 4 Adult Primary Care... 2 in 10 miles 4 100.0 0.3 0.5 Pediatricians 2 in 10 miles 4 100.0 0.8 0.9 OB/Gyns 2 in 10 miles 4 100.0 0.7 1.1 Other Specialists 2 in 10 miles 4 100.0 0.3 0.3 Hospitals 1 in 10 miles 4 100.0 0.7 0.8 Urgent Care Facilities 1 in 10 miles 4 100.0 1.0 2.4 33147 53 Adult Primary Care... 2 in 10 miles 53 100.0 0.7 0.8 Pediatricians 2 in 10 miles 53 100.0 0.9 1.0 OB/Gyns 2 in 10 miles 53 100.0 1.4 1.8 Other Specialists 2 in 10 miles 53 100.0 0.7 0.8 'J 2023 Quest Analytics,LLC Continued on nevi page. Cigna Network Analysis-Employees With Access 15 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami 33147 53 Hospitals 1 in 10 miles 53 100.0 1.9 3.1 Medical-Breakout-Urban Urgent Care Facilities 1 in 10 miles 53 100.0 3.6 3.6 Distance Method 33150 23 Adult Primary Care... 2 in 10 miles 23 100.0 0.5 0.6 Estimated Driving Distance Pediatricians 2 in 10 miles 23 100.0 0.6 0.7 Employee/Provider Groups OB/Gyns 2 in 10 miles 23 100.0 0.7 1.1 All Employees-Urban Other Specialists 2 in 10 miles 23 100.0 0.4 0.4 Adult Primary Care Physicians Hospitals 1 in 10 miles 23 100.0 1.5 3.3 Pediatricians Urgent Care Facilities 1 in 10 miles 23 100.0 1.7 1.7 OB/Gyns 33155 32 Adult Primary Care... 2 in 10 miles 32 100.0 0.4 0.4 Other Specialists Hospitals Pediatricians 2 in 10 miles 32 100.0 0.6 0.7 Urgent Care Facilities OB/Gyns 2 in 10 miles 32 100.0 1.4 1.5 Other Specialists 2 in 10 miles 32 100.0 0.3 0.4 Hospitals 1 in 10 miles 32 100.0 1.2 2.0 Urgent Care Facilities 1 in 10 miles 32 100.0 0.9 1.3 33157 12 Adult Primary Care... 2 in 10 miles 12 100.0 0.7 0.8 Pediatricians 2 in 10 miles 12 100.0 1.0 1.2 OB/Gyns 2 in 10 miles 12 100.0 1.4 1.4 Other Specialists 2 in 10 miles 12 100.0 0.6 0.6 Hospitals 1 in 10 miles 12 100.0 1.5 2.8 Urgent Care Facilities 1 in 10 miles 12 100.0 1.1 1.2 33161 49 Adult Primary Care... 2 in 10 miles 49 100.0 0.6 0.7 Pediatricians 2 in 10 miles 49 100.0 0.6 0.7 OB/Gyns 2 in 10 miles 49 100.0 0.9 0.9 Other Specialists 2 in 10 miles 49 100.0 0.5 0.5 Hospitals 1 in 10 miles 49 100.0 1.2 3.4 Urgent Care Facilities 1 in 10 miles 49 100.0 1.5 1.8 33162 32 Adult Primary Care... 2 in 10 miles 32 100.0 0.6 0.6 Pediatricians 2 in 10 miles 32 100.0 0.6 0.6 OB/Gyns 2 in 10 miles 32 100.0 0.9 1.1 Other Specialists 2 in 10 miles 32 100.0 0.4 0.5 Hospitals 1 in 10 miles 32 100.0 1.7 3.2 Urgent Care Facilities 1 in 10 miles 32 100.0 1.2 2.4 33165 26 Adult Primary Care... 2 in 10 miles 26 100.0 0.4 0.5 Pediatricians 2 in 10 miles 26 100.0 0.6 0.7 OB/Gyns 2 in 10 miles 26 100.0 1.4 1.5 Other Specialists 2 in 10 miles 26 100.0 0.4 0.5 Hospitals 1 in 10 miles 26 100.0 1.8 3.8 Urgent Care Facilities 1 in 10 miles 26 100.0 1.2 1.7 33167 14 Adult Primary Care... 2 in 10 miles 14 100.0 0.8 0.8 Pediatricians 2 in 10 miles 14 100.0 0.9 0.9 2023 Quest Analytics,LLC Continued on next page. Cigna Network Analysis-Employees With Access 16 Access Detail By Zip Code (With Access) Aprd2023 Employees With Access Created tor... State Zip Employee Provider With Access Average Distance City of Miami Beach s Name __v s._m County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami 33167 14 OBlGyns 2 in 10 miles 14 100.0 2.3 2.3 Medical-Breakout-Urban Other Specialists 2 in 10 miles 14 100.0 0.8 0.8 Distance Method Hospitals 1 in 10 miles 14 100.0 2.5 3.6 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 14 100.0 3.1 3.7 Employee/Provider Groups 33168 21 Adult Primary Care... 2 in 10 miles 21 100.0 0.6 0.9 All Employees-Urban Pediatricians 2 in 10 miles 21 100.0 1.1 1.1 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 21 100.0 1.7 1.7 Pediatricians Other Specialists 2 in 10 miles 21 100.0 0.5 0.5 OB/Gyns Hospitals 1 in 10 miles 21 100.0 2.0 2.8 Other Specialists Urgent Care Facilities 1 in 10 miles 21 100.0 2.7 2.8 Hospitals 33169 47 Adult Primary Care... 2 in 10 miles 47 100.0 0.6 0.8 Urgent Care Facilities Pediatricians 2 in 10 miles 47 100.0 0.8 1.1 OB/Gyns 2 in 10 miles 47 100.0 1.1 1.9 Other Specialists 2 in 10 miles 47 100.0 0.5 0.7 Hospitals 1 in 10 miles 47 100.0 2.0 4.9 Urgent Care Facilities 1 in 10 miles 47 100.0 2.3 3.0 33172 16 Adult Primary Care... 2 in 10 miles 16 100.0 0.5 0.7 Pediatricians 2 in 10 miles 16 100.0 0.8 1.0 OB/Gyns 2 in 10 miles 16 100.0 1.4 1.8 Other Specialists 2 in 10 miles 16 100.0 0.4 0.5 Hospitals 1 in 10 miles 16 100.0 2.0 2.7 Urgent Care Facilities 1 in 10 miles 16 100.0 1.0 1.5 33173 19 Adult Primary Care... 2 in 10 miles 19 100.0 0.5 0.5 Pediatricians 2 in 10 miles 19 100.0 0.6 0.6 OB/Gyns 2 in 10 miles 19 100.0 0.9 1.0 Other Specialists 2 in 10 miles 19 100.0 0.4 0.5 Hospitals 1 in 10 miles 19 100.0 1.9 3.6 Urgent Care Facilities 1 in 10 miles 19 100.0 2.3 2.8 33174 12 Adult Primary Care... 2 in 10 miles 12 100.0 0.2 0.3 Pediatricians 2 in 10 miles 12 100.0 0.5 0.6 OBIGyns 2 in 10 miles 12 100.0 0.7 0.8 Other Specialists 2 in 10 miles 12 100.0 0.3 0.3 Hospitals 1 in 10 miles 12 100.0 2.9 3.4 Urgent Care Facilities 1 in 10 miles 12 100.0 1.2 2.4 33175 23 Adult Primary Care... 2 in 10 miles 23 100.0 0.5 0.6 Pediatricians 2 in 10 miles 23 100.0 0.7 0.9 OB/Gyns 2 in 10 miles 23 100.0 2.3 2.4 Other Specialists 2 in 10 miles 23 100.0 0.6 0.6 Hospitals 1 in 10 miles 23 100.0 2.1 3.6 Urgent Care Facilities 1 in 10 miles 23 100.0 1.5 2.2 2023 Quest Analytics,LLC c tca_ Cigna Network Analysis-Employees With Access 17 Access Detail By Zip Code (With Access) April zoza Employees With Access Created for... State Zi Employee Provider With Access Average Distance City of Miami Beach p y_m„ Name _Gounty City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami 33176 20 Adult Primary Care... 2 in 10 miles 20 100.0 0.7 1.0 Medical-Breakout-Urban Pediatricians 2 in 10 miles 20 100.0 1.4 1.4 Distance Method OB/Gyns 2 in 10 miles 20 100.0 1.4 1.4 Estimated Driving Distance Other Specialists 2 in 10 miles 20 100.0 0.8 0.9 Employee/Provider Groups Hospitals 1 in 10 miles 20 100.0 2.0 3.0 All Employees-Urban Urgent Care Facilities 1 in 10 miles 20 100.0 2.2 2.4 Adult Primary Care Physicians 33177 14 Adult Primary Care... 2 in 10 miles 14 100.0 1.5 1.6 Pediatricians Pediatricians 2 in 10 miles 14 100.0 1.8 2.5 OB/Gyns OB/Gyns 2 in 10 miles 14 100.0 2.9 2.9 Other specialists Other Specialists 2 in 10 miles 14 100.0 1.1 1.4 Hospitals Hospitals 1 in 10 miles 14 100.0 4.3 5.3 Urgent Care Facilities Urgent Care Facilities 1 in 10 miles 14 100.0 2.7 3.4 33179 19 Adult Primary Care... 2 in 10 miles 19 100.0 0.7 0.7 Pediatricians 2 in 10 miles 19 100.0 1.2 1.5 OB/Gyns 2 in 10 miles 19 100.0 1.6 1.8 Other Specialists 2 in 10 miles 19 100.0 0.6 0.6 Hospitals 1 in 10 miles 19 100.0 2.2 3.1 Urgent Care Facilities 1 in 10 miles 19 100.0 1.9 2.3 33180 22 Adult Primary Care... 2 in 10 miles 22 100.0 0.6 0.6 Pediatricians 2 in 10 miles 22 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 22 100.0 0.7 0.7 Other Specialists 2 in 10 miles 22 100.0 0.3 0.5 Hospitals 1 in 10 miles 22 100.0 0.8 1.2 Urgent Care Facilities 1 in 10 miles 22 100.0 0.8 1.0 33181 18 Adult Primary Care... 2 in 10 miles 18 100.0 0.4 0.5 Pediatricians 2 in 10 miles 18 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 18 100.0 0.7 0.8 Other Specialists 2 in 10 miles 18 100.0 0.4 0.4 Hospitals 1 in 10 miles 18 100.0 1.8 4.7 Urgent Care Facilities 1 in 10 miles 18 100.0 0.7 1.0 33183 10 Adult Primary Care... 2 in 10 miles 10 100.0 0.7 0.8 Pediatricians 2 in 10 miles 10 100.0 0.9 1.0 OB/Gyns 2 in 10 miles 10 100.0 1.6 1.6 Other Specialists 2 in 10 miles 10 100.0 0.7 0.7 Hospitals 1 in 10 miles 10 100.0 2.9 3.6 Urgent Care Facilities 1 in 10 miles 10 100.0 1.1 1.6 33184 7 Adult Primary Care... 2 in 10 miles 7 100.0 0.5 0.8 Pediatricians 2 in 10 miles 7 100.0 0.9 1.5 OB/Gyns 2 in 10 miles 7 100.0 2.2 2.6 Other Specialists 2 in 10 miles 7 100.0 0.5 0.6 Continued on next page... Cigna Network Analysis-Employees With Access 18 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distan City of Miami Beach Name County City Code # Group Standard # % 1 Access Analysis Florida Miami-Dade Miami 33184 7 Hospitals 1 in 10 miles 7 100.0 1.6 3.3 Medical-Breakout-Urban Urgent Care Facilities 1 in 10 miles 7 100.0 1.6 2.8 Distance Method 33186 25 Adult Primary Care... 2 in 10 miles 25 100.0 0.7 0.8 Estimated Driving Distance Pediatricians 2 in 10 miles 25 100.0 0.8 1.0 Employee/Provider Groups OB/Gyns 2 in 10 miles 25 100.0 1.3 1.3 All Employees-Urban Other Specialists 2 in 10 miles 25 100.0 0.6 0.6 Adult Primary Care Physicians Hospitals 1 in 10 miles 25 100.0 1.7 2.7 Pediatricians Urgent Care Facilities 1 in 10 miles 25 100.0 1.1 1.6 OB/Gyns 33189 9 Adult Primary Care... 2 in 10 miles 9 100.0 0.6 1.0 Other Specialists Pediatricians 2 in 10 miles 9 100.0 1.2 1.5 Hospitals OB/Gyns 2 in 10 miles 9 100.0 1.7 1.7 Urgent Care Facilities Other Specialists 2 in 10 miles 9 100.0 0.5 0.6 Hospitals 1 in 10 miles 9 100.0 3.2 4.6 Urgent Care Facilities 1 in 10 miles 9 100.0 2.4 2.5 33190 4 Adult Primary Care... 2 in 10 miles 4 100.0 1.0 1.1 Pediatricians 2 in 10 miles 4 100.0 1.1 1.1 OB/Gyns 2 in 10 miles 4 100.0 1.1 1.1 Other Specialists 2 in 10 miles 4 100.0 1.0 1.0 Hospitals 1 in 10 miles 4 100.0 3.7 5.4 Urgent Care Facilities 1 in 10 miles 4 100.0 2.8 2.8 33193 13 Adult Primary Care... 2 in 10 miles 13 100.0 1.2 1.3 Pediatricians 2 in 10 miles 13 100.0 0.7 1.1 OB/Gyns 2 in 10 miles 13 100.0 2.0 2.0 Other Specialists 2 in 10 miles 13 100.0 0.5 0.8 Hospitals 1 in 10 miles 13 100.0 3.0 4.5 Urgent Care Facilities 1 in 10 miles 13 100.0 1.7 2.3 33233 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.7 0.7 Pediatricians 2 in 10 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 1 100.0 0.7 0.7 Other Specialists 2 in 10 miles 1 100.0 0.2 0.7 Hospitals 1 in 10 miles 1 100.0 1.7 2.0 Urgent Care Facilities 1 in 10 miles 1 100.0 1.9 2.2 33261 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.7 1.0 Pediatricians 2 in 10 miles 2 100.0 1.1 1.4 OB/Gyns 2 in 10 miles 2 100.0 1.4 1.4 Other Specialists 2 in 10 miles 2 100.0 0.0 0.2 Hospitals 1 in 10 miles 2 100.0 2.4 4.3 Urgent Care Facilities 1 in 10 miles 2 100.0 1.1 1.4 33269 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.1 0.2 Pediatricians 2 in 10 miles 1 100.0 0.2 0.4 J 2023 Quest Analytics,LLC. Coninued on next page.. Cigna Network Analysis-Employees With Access 19 Access Detail By Zip Code (With Access) Ap<azo2s Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name a _ County City Code # Group Standard # % 1 2 Access Analysis Florida �+ Miami-Dade Miami 33269 1 OB/Gyns 2 in 10 miles 1 100.0 0.7 1.2 Medical-Breakout-Urban Other Specialists 2 in 10 miles 1 100.0 0.0 0.1 Distance Method Hospitals 1 in 10 miles 1 100.0 1.2 5.1 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 1 100.0 1.9 2.5 Employee/Provider Groups Miami Beach 33119 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.6 0.6 All Employees-Urban Pediatricians 2 in 10 miles 1 100.0 1.0 1.0 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 1 100.0 1.0 1,0 Pediatricians Other Specialists 2 in 10 miles 1 100.0 0.4 0.5 OBIGyns Hospitals 1 in 10 miles 1 100.0 2.5 5.3 Other Specialists Urgent Care Facilities 1 in 10 miles 1 100.0 2.2 4.5 Hospitals 33139 65 Adult Primary Care... 2 in 10 miles 65 100.0 0.5 0.5 Urgent Care Facilities Pediatricians 2 in 10 miles 65 100.0 0.8 0.8 OB/Gyns 2 in 10 miles 65 100.0 0.9 0.9 Other Specialists 2 in 10 miles 65 100.0 0.3 0.4 Hospitals 1 in 10 miles 65 100.0 2.6 4.8 Urgent Care Facilities 1 in 10 miles 65 100.0 2.4 4.2 33140 47 Adult Primary Care... 2 in 10 miles 47 100.0 0.5 0.6 Pediatricians 2 in 10 miles 47 100.0 0.8 1.0 OB/Gyns 2 in 10 miles 47 100.0 0.8 0.9 Other Specialists 2 in 10 miles 47 100.0 0.5 0.5 Hospitals 1 in 10 miles 47 100.0 1.3 4.3 Urgent Care Facilities 1 in 10 miles 47 100.0 1.1 4.2 33141 76 Adult Primary Care... 2 in 10 miles 76 100.0 0.8 0.8 Pediatricians 2 in 10 miles 76 100.0 1.0 1.0 OB/Gyns 2 in 10 miles 76 100.0 1.0 1.0 Other Specialists 2 in 10 miles 76 100.0 0.6 0.8 Hospitals 1 in 10 miles 76 100.0 3.6 5.1 Urgent Care Facilities 1 in 10 miles 76 100.0 3.5 4.3 33154 16 Adult Primary Care... 2 in 10 miles 16 100.0 0.5 0.6 Pediatricians 2 in 10 miles 16 100.0 0.6 0.6 OB/Gyns 2 in 10 miles 16 100.0 2.1 2.2 Other Specialists 2 in 10 miles 16 100.0 0.3 0.4 Hospitals 1 in 10 miles 16 100.0 3.5 5.3 Urgent Care Facilities 1 in 10 miles 16 100.0 2.7 3.0 33239 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Pediatricians 2 in 10 miles 1 100.0 1.1 1.1 OB/Gyns 2 in 10 miles 1 100.0 1.1 1,1 Other Specialists 2 in 10 miles 1 100.0 0.1 0.1 Hospitals 1 in 10 miles 1 100.0 1.9 4.3 Urgent Care Facilities 1 in 10 miles 1 100.0 2.1 3.5 . . -,��; Cigna Network Analysis-Employees With Access 20 Access Detail By Zip Code (With Access) Apnl2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance Cityot Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami Gardens 33056 37 Aduft Primary Care... 2 in 10 miles 37 100.0 0.8 1.0 Medical-Breakout-Urban Pediatricians 2 in 10 miles 37 100.0 0.9 1.2 Distance Method OB/Gyns 2 in 10 miles 37 100.0 1.2 2.0 Estimated Driving Distance Other Specialists 2 in 10 miles 37 100.0 0.7 0.7 Employee/Provider Groups Hospitals tin 10 miles 37 100.0 3.8 5.5 Au Employees-Urban Urgent Care Facilities 1 in 10 miles 37 100.0 2.0 3.6 Adult Primary Care Physicians North Miami B... 33160 5 Adult Primary Care... 2 in 10 miles 5 100.0 0.4 0.4 Pediatricians Pediatricians 2 in 10 miles 5 100.0 2.2 2.3 OBiGyns OB/Gyns 2 in 10 miles 5 100.0 0.7 0.7 Other Specialists Other Specialists 2 in 10 miles 5 100.0 0.3 0.3 Hospitals Hospitals 1 in 10 miles 5 100.0 3.0 3.6 Urgent Care Facilities Urgent Care Facilities 1 in 10 miles 5 100.0 3.0 3.2 Opa Locka 33054 19 Adult Primary Care... 2 in 10 miles 19 100.0 0.8 0.8 Pediatricians 2 in 10 miles 19 100.0 1.4 1.9 OB/Gyns 2 in 10 miles 19 100.0 1.5 1.5 Other Specialists 2 in 10 miles 19 100.0 1.2 1.2 Hospitals 1 in 10 miles 19 100.0 3.7 4.8 Urgent Care Facilities 1 in 10 miles 19 100.0 1.5 4.0 33055 12 Adult Primary Care... 2 in 10 miles 12 100.0 0.6 0.7 Pediatricians 2 in 10 miles 12 100.0 1.0 1.5 OB/Gyns 2 in 10 miles 12 100.0 1.7 2.5 Other Specialists 2 in 10 miles 12 100.0 0.7 0.8 Hospitals 1 in 10 miles 12 100.0 4.0 5.0 Urgent Care Facilities 1 in 10 miles 12 100.0 2.1 2.9 Palm Beach Boca Raton 33486 2 Adult Primary Care... 2 in 10 miles 2 100.0 1.3 1.3 Pediatricians 2 in 10 miles 2 100.0 1.4 1.5 OB/Gyns 2 in 10 miles 2 100.0 1.1 1.3 Other Specialists 2 in 10 miles 2 100.0 0.4 0.4 Hospitals 1 in 10 miles 2 100.0 1.5 3.8 Urgent Care Facilities 1 in 10 miles 2 100.0 2.6 2.8 Boynton Beach 33426 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.6 0.7 Pediatricians 2 in 10 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 1 100.0 1.3 1.3 Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals 1 in 10 miles 1 100.0 2.5 5.0 Urgent Care Facilities 1 in 10 miles 1 100.0 1.6 1.9 33435 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.3 0.3 Pediatricians 2 in 10 miles 1 100.0 1.4 1.8 OB/Gyns 2 in 10 miles 1 100.0 0.3 0.3 Other Specialists 2 in 10 miles 1 100.0 0.3 0.3 2023 Quest Analytics,LLC. Continued on next page_. Cigna Network Analysis-Employees With Access 21 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Palm Beach Boynton Beach 33435 1 Hospitals 1 in 10 miles 1 100.0 1.8 5.9 Medical-Breakout-Urban Urgent Care Facilities 1 in 10 miles 1 100.0 0.9 3.1 Distance Method 33437 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.7 0.7 Estimated Driving Distance Pediatricians 2 in 10 miles 2 100.0 1.0 1.0 Employee/Provider Groups OB/Gyns 2 in 10 miles 2 100.0 1.9 1.9 All Employees-Urban Other Specialists 2 in 10 miles 2 100.0 0.4 0.7 Adult Primary Care Physicians Hospitals 1 in 10 miles 2 100.0 0.8 4.4 Pediatricians Urgent Care Facilities 1 in 10 miles 2 100.0 1.4 1.8 OB/Gyns Delray Beach 33444 1 Adult Primary Care... 2 in 10 miles 1 100.0 1.0 1.0 Other Specialists Pediatricians 2 in 10 miles 1 100.0 1.0 1.0 Hospitals Urgent Care Facilities OB/Gyns 2 in 10 miles 1 100.0 1.0 1.0 Other Specialists 2 in 10 miles 1 100.0 0.6 0.6 Hospitals 1 in 10 miles 1 100.0 3.9 4.2 Urgent Care Facilities 1 in 10 miles 1 100.0 1.0 1.6 Lake Worth 33463 1 Adult Primary Care... 2 in 10 miles 1 100.0 1.2 1.3 Pediatricians 2 in 10 miles 1 100.0 0.9 1.3 OB/Gyns 2 in 10 miles 1 100.0 1.5 1.5 Other Specialists 2 in 10 miles 1 100.0 0.7 0.7 Hospitals 1 in 10 miles 1 100.0 2.6 3.3 Urgent Care Facilities 1 in 10 miles 1 100.0 2.1 2.1 West Palm Be... 33417 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Pediatricians 2 in 10 miles 1 100.0 1.0 1.0 OB/Gyns 2 in 10 miles 1 100.0 1.7 1.7 Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals 1 in 10 miles 1 100.0 5.0 5.1 Urgent Care Facilities 1 in 10 miles 1 100.0 1.2 1.2 Pinellas Largo 33774 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Pediatricians 2 in 10 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 10 miles 1 100.0 1.5 3.0 Other Specialists 2 in 10 miles 1 100.0 0.2 0.2 Hospitals 1 in 10 miles 1 100.0 1.2 3.6 Urgent Care Facilities 1 in 10 miles 1 100.0 0.3 2.5 Sarasota Sarasota 34231 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.3 0.6 Pediatricians 2 in 10 miles 1 100.0 2.7 2.9 OB/Gyns 2 in 10 miles 1 100.0 2.9 2.9 Other Specialists 2 in 10 miles 1 100.0 0.5 0.5 Hospitals 1 in 10 miles 1 100.0 3.5 5.8 Urgent Care Facilities 1 in 10 miles 1 100.0 4.0 4.0 Sumter The Villages 32163 1 Adult Primary Care... 2 in 10 miles 1 100.0 1.5 1.5 Pediatricians 2 in 10 miles 1 100.0 8.7 8.7 2023 Quest Analyncs.LLC. Continued on next page... Cigna Network Analysis-Employees With Access 22 Access Detail By Zip Code (With Access) April2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Sumter The Villages 32163 1 OB/Gyns 2 in 10 miles 1 100.0 1.9 5.5 Medical-Breakout-Urban Other Specialists 2 in 10 miles 1 100.0 1.5 1.5 Distance Method Hospitals 1 in 10 miles 1 100.0 6.1 9.1 Estimated Driving Distance Urgent Care Facilities 1 in 10 miles 1 100.0 3.9 7.4 Employee Provider Groups Illinois Cook Chicago 60611 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.0 0.0 All Employees-Urban Pediatricians 2 in 10 miles 1 100.0 0.0 0.0 Adult Primary Care Physicians OB/Gyns 2 in 10 miles 1 100.0 0.0 0.0 Pediatricians Other Specialists 2 in 10 miles 1 100.0 0.0 0.0 OB/Gyns Hospitals 1 in 10 miles 1 100.0 0.1 0.2 Other Specialists Urgent Care Facilities 1 in 10 miles 1 100.0 0.4 0.8 Hospitals Nevada Clark Las Vegas 89102 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.2 0.2 Urgent Care Facilities Pediatricians 2 in 10 miles 1 100.0 1.0 1.1 OB/Gyns 2 in 10 miles 1 100.0 1.1 1.2 Other Specialists 2 in 10 miles 1 100.0 0.1 0.1 Hospitals 1 in 10 miles 1 100.0 1.3 1.3 Urgent Care Facilities 1 in 10 miles 1 100.0 0.8 1.4 New Jersey Passaic Little Falls 07424 2 Adult Primary Care... 2 in 10 miles 2 100.0 0.3 0.3 Pediatricians 2 in 10 miles 2 100.0 0.5 0.5 OB/Gyns 2 in 10 miles 2 100.0 0.4 0.4 Other Specialists 2 in 10 miles 2 100.0 0.2 0.3 Hospitals 1 in 10 miles 2 100.0 2.9 4.2 Urgent Care Facilities 1 in 10 miles 2 100.0 1.5 1.5 Texas Tarrant North Richlan... 76182 1 Adult Primary Care... 2 in 10 miles 1 100.0 0.6 1.4 Pediatricians 2 in 10 miles 1 100.0 0.6 1.6 OB/Gyns 2 in 10 miles 1 100.0 2.7 3.9 Other Specialists 2 in 10 miles 1 100.0 0.4 0.4 Hospitals 1 in 10 miles 1 100.0 2.5 2.7 Urgent Care Facilities 1 in 10 miles 1 100.0 2.4 2.4 Grand Totals 1,451 Adult Primary Care... 2 in 10 miles 1,451 100.0 0.6 0.7 Pediatricians 2 in 10 miles 1,451 100.0 0.9 1.0 OB/Gyns 2 in 10 miles 1,451 100.0 1.2 1.4 Other Specialists 2 in 10 miles 1,451 100.0 0.5 0.6 Hospitals 1 in 10 miles 1,451 100.0 2.0 3.3 Urgent Care Facilities 1 in 10 miles 1,451 100.0 1.8 2.5 U 2023 Quest Analytics,LLC Cigna Network Analysis-Employees Without Access 23 Access Detail By Zip Code (Without Access) April 2023 Employees Without Access Created for... State Zip Employee Provider Without Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis No data that meets the criteria Medical-Breakout-Urban Distance Method Estimated Driving Distance Employee/Provider Groups All Employees-Urban Adult Primary Care Physicians Pediatricians OB/Gyns Other Specialists Hospitals Urgent Care Facilities V Q� • 1� co O d Ql C V CO CO CD N .- .- N. CT/ 0 N V N 03 O N OD CO CO e- cn M 0, C.- CO 0 01 N (� r' .- N O R C7 6)• O L") N O ., N ,- C) N O .- N . N N O N C) r- Ln O N - V .- C) C N 63 N. 0 ) O o 4 0 O V 0) f• r. N G) 0) C"') t- CO N N O 0 0 CO CO I-- 0) 0) CD C) N I- NJ n- C) CN- .7 cO M CO CO O C' c0 Q) •- O CV N l0) O N N O N — N N O — O — N O .- N c- N - O — — — C - '-) .- . C) n Q CJ c0 N CO N O O O 0 O 0 0 0 0 O O O O O O 0 O O 0 O O O O O 0 0 0 0 0 0 0 �? 0 O N CO In o O OO OO OO O OO OO O OO O OO O OO 0 0 0O 0O 0O 0 0O 0 0 0 0O 0 0O 0O 0O 0O 0 • N 7 o ao CO C) O N N N i j N • I.) 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L) E c w c = .� m t c > O1 . y U y w E < o G n O O r 6 is a .� U a a O n w o _ Cigna Network Analysis-Employees Without Access 25 Access Summary By City (Without Access) Aprilzoz9 Key Geographic Areas Created for... State Employee Provider Without Access Average Distance City of Miami Beach Name City # Group Standard # / 1 2 Access Analysis No data that meets the criteria Medical-Breakout-Suburban Distance Method Estimated Driving Distance Employee Group All Employees-Suburban Provider Group Adult Primary Care Physicians Pediatricians OBIGyns Other Specialists Hospitals Urgent Care Facilities Cigna Network Analysis-Employees With Access 26 Access Detail By Zip Code (With Access) Apnt202B 77 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Connecticut New Haven Naugatuck 06770 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.3 0.3 Medical-Breakout-Suburban Pediatricians 2 in 15 miles 1 100.0 0.6 0.6 Distance Method OB/Gyns 2 in 15 miles 1 100.0 0.6 3.9 Estimated Driving Distance Other Specialists 2 in 15 miles 1 100.0 0.3 0.3 Employee/Provider Groups Hospitals 1 in 15 miles 1 100.0 0.3 4.5 All Employees-Suburban Urgent Care Facilities 1 in 15 miles 1 100.0 0.3 0.3 Adult Primary Care Physicians Florida Brevard Cocoa 32927 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.4 1.3 Pediatricians Pediatricians 2 in 15 miles 1 100.0 1.3 1.3 OB/Gyns OB/Gyns 2 in 15 miles 1 100.0 2.0 2.0 Other Specialists Other Specialists 2 in 15 miles 1 100.0 1.3 1.3 Hospitals Hospitals 1 in 15 miles 1 100.0 12.1 12.1 Urgent Care Facilities Urgent Care Facilities 1 in 15 miles 1 100.0 2.0 8.2 Cocoa Beach 32931 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.9 0.9 Pediatricians 2 in 15 miles 1 100.0 1.2 2.7 OB/Gyns 2 in 15 miles 1 100.0 2.7 2.7 Other Specialists 2 in 15 miles 1 100.0 0.3 0.4 Hospitals 1 in 15 miles 1 100.0 2.7 7.1 Urgent Care Facilities 1 in 15 miles 1 100.0 0.9 0.9 Melbourne 32940 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.1 0.1 Pediatricians 2 in 15 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 15 miles 1 100.0 0.1 0.1 Other Specialists 2 in 15 miles 1 100.0 0.0 0.0 Hospitals 1 in 15 miles 1 100.0 1.5 7.1 Urgent Care Facilities 1 in 15 miles 1 100.0 0.2 2.1 Palm Bay 32905 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.8 1.5 Pediatricians 2 in 15 miles 1 100.0 0.4 0.6 OB/Gyns 2 in 15 miles 1 100.0 2.2 2.3 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 2.4 4.3 Urgent Care Facilities 1 in 15 miles 1 100.0 2.2 2.2 32907 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.7 0.7 Pediatricians 2 in 15 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 15 miles 1 100.0 5.1 5.3 Other Specialists 2 in 15 miles 1 100.0 0.7 0.7 Hospitals 1 in 15 miles 1 100.0 5.0 7.2 Urgent Care Facilities 1 in 15 miles 1 100.0 2.6 3.0 Broward Dania 33004 4 Adult Primary Care... 2 in 15 miles 4 100.0 0,4 0.4 Pediatricians 2 in 15 miles 4 100.0 2.9 2.9 OB/Gyns 2 in 15 miles 4 100.0 1.9 2.7 Other Specialists 2 in 15 miles 4 100,0 0.4 0.5 2023 Quest Analytcs,LLC. Continued on next page... Cigna Network Analysis-Employees With Access 27 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Employee Provider With Access Average Distance City of Miami Beach zip 9 Name County City Code # Group Standard # % 1 2 Access Analysis Florida Broward Dania 33004 4 Hospitals 1 in 15 miles 4 100.0 1.8 2.7 Medical-Breakout-Suburban Urgent Care Facilities 1 in 15 miles 4 100.0 0.8 1.5 Distance Method Fort Lauderdale 33314 5 Adult Primary Care... 2 in 15 miles 5 100.0 0.3 0.3 Estimated Driving Distance Pediatricians 2 in 15 miles 5 100.0 1.6 2.0 Employee/Provider Groups OB/Gyns 2 in 15 miles 5 100.0 1.5 1.6 All Employees-Suburban Other Specialists 2 in 15 miles 5 100.0 0.6 0.6 Adult Primary Care Physicians Hospitals 1 in 15 miles 5 100.0 1.6 2.0 Pediatricians Urgent Care Facilities 1 in 15 miles 5 100.0 1.7 2.5 OB/Gyns 33315 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.2 1.2 Other Specialists Pediatricians 2 in 15 miles 1 100.0 1.4 1.4 Hospitals Urgent Care Facilities OB/Gyns 2 in 15 miles 1 100.0 1.4 1.4 Other Specialists 2 in 15 miles 1 100.0 1.0 1.0 Hospitals 1 in 15 miles 1 100.0 1.4 2.2 Urgent Care Facilities 1 in 15 miles 1 100.0 1.1 1.1 33316 2 Adult Primary Care... 2 in 15 miles 2 100.0 0.8 1.2 Pediatricians 2 in 15 miles 2 100.0 0.8 1.3 OB/Gyns 2 in 15 miles 2 100.0 1.3 1.3 Other Specialists 2 in 15 miles 2 100.0 0.6 0.7 Hospitals 1 in 15 miles 2 100.0 1.5 1.6 Urgent Care Facilities 1 in 15 miles 2 100.0 1.3 1.4 33323 3 Adult Primary Care... 2 in 15 miles 3 100.0 1.6 1.6 Pediatricians 2 in 15 miles 3 100.0 1.3 1.3 OB/Gyns 2 in 15 miles 3 100.0 2.2 2.9 Other Specialists 2 in 15 miles 3 100.0 0.7 0.8 Hospitals 1 in 15 miles 3 100.0 5.8 6.5 Urgent Care Facilities 1 in 15 miles 3 100.0 2.4 2.4 33325 1 Adult Primary Care... 2 in 15 miles 1 100.0 2.0 2.4 Pediatricians 2 in 15 miles 1 100.0 2.4 2.7 OB/Gyns 2 in 15 miles 1 100.0 2.1 2.8 Other Specialists 2 in 15 miles 1 100.0 0.6 0.9 Hospitals 1 in 15 miles 1 100.0 4.2 4.9 Urgent Care Facilities 1 in 15 miles 1 100.0 3.3 3.3 33328 11 Adult Primary Care... 2 in 15 miles 11 100.0 1.2 1.3 Pediatricians 2 in 15 miles 11 100.0 1.6 1.7 OB/Gyns 2 in 15 miles 11 100.0 1.7 1.7 Other Specialists 2 in 15 miles 11 100.0 0.6 0.8 Hospitals 1 in 15 miles 11 100.0 1.9 2.7 Urgent Care Facilities 1 in 15 miles 11 100.0 1.6 2.5 33330 4 Adult Primary Care... 2 in 15 miles 4 100.0 0.9 1.1 Pediatricians 2 in 15 miles 4 100.0 1.5 2.6 c 2023 Quest Analylics,LLC Continued on next page... Cigna Network Analysis-Employees With Access 28 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Accessnnatysis Florida Broward Fort Lauderdale 33330 4 OB/Gyns 2 in 15 miles 4 100.0 2.8 2.9 Medical-Breakout-Suburban Other Specialists 2 in 15 miles 4 100.0 0.3 0.5 Distance Method Hospitals 1 in 15 miles 4 100.0 3.2 3.5 Estimated Driving Distance Urgent Care Facilities 1 in 15 miles 4 100.0 1.7 2.9 Employee/Provider Groups 33331 4 Adult Primary Care... 2 in 15 miles 4 100.0 1.0 1.3 All Employees-Suburban Pediatricians 2 in 15 miles 4 100.0 1.9 2.6 Adult Primary Care Physicians OB/Gyns 2 in 15 miles 4 100.0 2.8 3.0 Pediatricians Other Specialists 2 in 15 miles 4 100.0 0.8 0.9 OB/Gyns Hospitals 1 in 15 miles 4 100.0 2.9 3.2 Other Specialists Urgent Care Facilities 1 in 15 miles 4 100.0 1.7 2.5 Hospitals Hollywood 33029 23 Adult Primary Care... 2 in 15 miles 23 100.0 1.2 1.2 Urgent Care Facilities Pediatricians 2 in 15 miles 23 100.0 1.1 1.1 OB/Gyns 2 in 15 miles 23 100.0 1.3 1.3 Other Specialists 2 in 15 miles 23 100.0 0.7 0.8 Hospitals 1 in 15 miles 23 100.0 2.7 5.6 Urgent Care Facilities 1 in 15 miles 23 100.0 1.6 2.9 Pompano Beach 33067 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.4 1.5 Pediatricians 2 in 15 miles 1 100.0 2.5 2.5 OB/Gyns 2 in 15 miles 1 100.0 1.4 2.1 Other Specialists 2 in 15 miles 1 100.0 0.6 1.2 Hospitals 1 in 15 miles 1 100.0 3.6 4.2 Urgent Care Facilities 1 in 15 miles 1 100.0 2.2 2.8 33069 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.2 0.3 Pediatricians 2 in 15 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 15 miles 1 100.0 0.4 0.4 Other Specialists 2 in 15 miles 1 100.0 0.1 0.3 Hospitals 1 in 15 miles 1 100.0 2.6 4.8 Urgent Care Facilities 1 in 15 miles 1 100.0 2.6 2.6 Collier Naples 34105 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.1 Pediatricians 2 in 15 miles 1 100.0 1.0 1.0 OB/Gyns 2 in 15 miles 1 100.0 2.2 2.9 Other Specialists 2 in 15 miles 1 100.0 0.6 0.8 Hospitals 1 in 15 miles 1 100.0 3.0 5.4 Urgent Care Facilities 1 in 15 miles 1 100.0 2.8 5.5 Hillsborough Riverview 33579 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.8 2.4 Pediatricians 2 in 15 miles 1 100.0 1.8 2.4 OB/Gyns 2 in 15 miles 1 100.0 2.5 2.5 Other Specialists 2 in 15 miles 1 100.0 1.8 1.8 Hospitals 1 in 15 miles 1 100.0 3.9 8.1 Urgent Care Facilities 1 in 15 miles 1 100.0 2.8 2.9 - - Continued on next page.. Cigna Network Analysis-Employees With Access 29 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for.., State zipEmployee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Indian River Vero Beach 32962 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.0 Medical-Breakout-Suburban Pediatricians 2 in 15 miles 1 100.0 1.0 1.0 Distance Method OB/Gyns 2 in 15 miles 1 100.0 1.0 2.8 Estimated Driving Distance Other Specialists 2 in 15 miles 1 100.0 0.6 0.6 Employee/Provider Groups Hospitals 1 in 15 miles 1 100.0 5.1 12.8 All Employees-Suburban Urgent Care Facilities 1 in 15 miles 1 100.0 2.3 2.3 Adult Primary Care Physicians Lee Cape Coral 33991 2 Adult Primary Care... 2 in 15 miles 2 100.0 0.9 2.0 Pediatricians Pediatricians 2 in 15 miles 2 100.0 4.3 4.3 oB Gyns OB/Gyns 2 in 15 miles 2 100.0 4.0 4.3 Other Specialists Other Specialists 2 in 15 miles 2 100.0 1.1 1.4 Hospitals Hospitals 1 in 15 miles 2 100.0 4.8 8.4 Urgent Care Facilities Urgent Care Facilities 1 in 15 miles 2 100.0 3.0 3.3 Leon Tallahassee 32303 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.4 0.4 Pediatricians 2 in 15 miles 1 100.0 3.9 4.7 OB/Gyns 2 in 15 miles 1 100.0 4.5 5.3 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 5.6 5.8 Urgent Care Facilities 1 in 15 miles 1 100.0 5.7 30.9 Marion Ocala 34470 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.4 0.4 Pediatricians 2 in 15 miles 1 100.0 1.1 1.1 OB/Gyns 2 in 15 miles 1 100.0 1.1 2.5 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 4.2 4.2 Urgent Care Facilities 1 in 15 miles 1 100.0 0.4 3.9 Miami-Dade Hialeah 33018 29 Adult Primary Care... 2 in 15 miles 29 100.0 0.9 1,2 Pediatricians 2 in 15 miles 29 100.0 1.2 2.0 OB/Gyns 2 in 15 miles 29 100.0 2.0 2.2 Other Specialists 2 in 15 miles 29 100.0 0.9 0.9 Hospitals 1 in 15 miles 29 100.0 1.9 2.4 Urgent Care Facilities 1 in 15 miles 29 100.0 2.7 3.1 Homestead 33030 3 Adult Primary Care... 2 in 15 miles 3 100.0 1.1 1.2 Pediatricians 2 in 15 miles 3 100.0 1.2 1.2 OB/Gyns 2 in 15 miles 3 100.0 1.2 1.2 Other Specialists 2 in 15 miles 3 100.0 1.2 1.2 Hospitals 1 in 15 miles 3 100.0 3.7 4.7 Urgent Care Facilities 1 in 15 miles 3 100.0 2.5 3.4 33032 9 Adult Primary Care... 2 in 15 miles 9 100.0 1.7 1,8 Pediatricians 2 in 15 miles 9 100.0 1.8 2.0 OB/Gyns 2 in 15 miles 9 100.0 2.0 2.0 Other Specialists 2 in 15 miles 9 100.0 1.3 1.7 - ' - Continued on nest page... Cigna Network Analysis-Employees With Access 30 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Homestead 33032 9 Hospitals 1 in 15 miles 9 100.0 5.6 6.9 Medical-Breakout-Suburban Urgent Care Facilities 1 in 15 miles 9 100.0 5.3 5.5 Distance Method 33033 6 Adult Primary Care... 2 in 15 miles 6 100.0 0.7 0.8 Estimated Driving Distance Pediatricians 2 in 15 miles 6 100.0 1.0 1.1 Employee/Provider Groups OB/Gyns 2 in 15 miles 6 100.0 1.3 1.3 All Employees-Suburban Other Specialists 2 in 15 miles 6 100.0 0.6 0.6 Adult Primary Care Physicians Hospitals 1 in 15 miles 6 100.0 1.3 2.2 Pediatricians Urgent Care Facilities 1 in 15 miles 6 100.0 1.7 1.8 OB/Gyns Key Biscayne 33149 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.6 0.6 Other Specialists Pediatricians 2 in 15 miles 1 100.0 0.0 0.6 Hospitals OB/Gyns 2 in 15 miles 1 100.0 6.5 6.5 Urgent Care Facilities Other Specialists 2 in 15 miles 1 100.0 0.0 0.5 Hospitals 1 in 15 miles 1 100.0 6.2 6.5 Urgent Care Facilities 1 in 15 miles 1 100.0 6.2 6.3 Miami 33156 8 Adult Primary Care... 2 in 15 miles 8 100.0 1.2 1.4 Pediatricians 2 in 15 miles 8 100.0 1.5 1.5 OB/Gyns 2 in 15 miles 8 100.0 2.1 2.2 Other Specialists 2 in 15 miles 8 100.0 0.6 0.8 Hospitals 1 in 15 miles 8 100.0 1.6 3.1 Urgent Care Facilities 1 in 15 miles 8 100.0 1.4 1.7 33158 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.3 1.3 Pediatricians 2 in 15 miles 1 100.0 1.9 1.9 OB/Gyns 2 in 15 miles 1 100.0 1.3 2.3 Other Specialists 2 in 15 miles 1 100.0 1.3 1.3 Hospitals 1 in 15 miles 1 100.0 2.4 2.5 Urgent Care Facilities 1 in 15 miles 1 100.0 1.3 1.5 33166 27 Adult Primary Care... 2 in 15 miles 27 100.0 0.6 0.6 Pediatricians 2 in 15 miles 27 100.0 1.0 1.4 OB/Gyns 2 in 15 miles 27 100.0 1.1 1.4 Other Specialists 2 in 15 miles 27 100.0 0.6 0.6 Hospitals 1 in 15 miles 27 100.0 2.3 2.8 Urgent Care Facilities 1 in 15 miles 27 100.0 2.8 3.0 33182 3 Adult Primary Care.., 2 in 15 miles 3 100.0 1.1 1.4 Pediatricians 2 in 15 miles 3 100.0 1.4 2.2 OB/Gyns 2 in 15 miles 3 100.0 3.1 3.3 Other Specialists 2 in 15 miles 3 100.0 0.9 0.9 Hospitals 1 in 15 miles 3 100.0 2.6 4.1 Urgent Care Facilities 1 in 15 miles 3 100.0 2.4 3.4 33185 14 Adult Primary Care... 2 in 15 miles 14 100.0 1.2 1.3 Pediatricians 2 in 15 miles 14 100.0 1.2 1.7 . , -, Continued on next page... Cigna Network Analysis-Employees With Access 31 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Florida Miami-Dade Miami 33185 14 OBlGyns 2 in 15 miles 14 100.0 3.7 3.8 Medical-Breakout-Suburban Other Specialists 2 in 15 miles 14 100.0 0.5 0.9 Distance Method Hospitals 1 in 15 miles 14 100.0 2.9 4.3 Estimated Driving Distance Urgent Care Facilities 1 in 15 miles 14 100.0 1.7 3.2 Employee/Provider Groups 33194 2 Adult Primary Care... 2 in 15 miles 2 100.0 0.3 0.3 All Employees-Suburban Pediatricians 2 in 15 miles 2 100.0 1.0 1.5 Adult Primary Care Physicians OB/Gyns 2 in 15 miles 2 100.0 4.7 5.1 Pediatricians Other Specialists 2 in 15 miles 2 100.0 0.8 1.0 OB/Gyns Hospitals 1 in 15 miles 2 100.0 1.1 5.3 Other Specialists Urgent Care Facilities 1 in 15 miles 2 100.0 1.1 3.7 Hospitals Orange Orlando 32821 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.8 1.8 Urgent Care Facilities Pediatricians 2 in 15 miles 1 100.0 3.3 3.3 OB/Gyns 2 in 15 miles 1 100.0 2.9 2.9 Other Specialists 2 in 15 miles 1 100.0 1.7 1.8 Hospitals 1 in 15 miles 1 100.0 2.8 2.9 Urgent Care Facilities 1 in 15 miles 1 100.0 2.1 3.2 Palm Beach Boca Raton 33487 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.3 1.4 Pediatricians 2 in 15 miles 1 100.0 2.1 2.5 OB/Gyns 2 in 15 miles 1 100.0 2.1 2.1 Other Specialists 2 in 15 miles 1 100.0 0.7 0.9 Hospitals 1 in 15 miles 1 100.0 4.4 4.7 Urgent Care Facilities 1 in 15 miles 1 100.0 2.5 2.6 Boynton Beach 33472 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.3 Pediatricians 2 in 15 miles 1 100.0 1.3 1.6 OB/Gyns 2 in 15 miles 1 100.0 1.3 1,3 Other Specialists 2 in 15 miles 1 100.0 0.9 0.9 Hospitals 1 in 15 miles 1 100.0 3.1 3.5 Urgent Care Facilities 1 in 15 miles 1 100.0 1.3 1.7 Delray Beach 33446 2 Adult Primary Care... 2 in 15 miles 2 100.0 1.0 1.0 Pediatricians 2 in 15 miles 2 100.0 2.4 2.4 OB/Gyns 2 in 15 miles 2 100.0 1.0 1.0 Other Specialists 2 in 15 miles 2 100.0 0.7 0.7 Hospitals 1 in 15 miles 2 100.0 2.5 5.3 Urgent Care Facilities 1 in 15 miles 2 100.0 1.1 2.3 Jupiter 33458 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.8 0.8 Pediatricians 2 in 15 miles 1 100.0 0.9 0.9 OB/Gyns 2 in 15 miles 1 100.0 1.1 1.1 Other Specialists 2 in 15 miles 1 100.0 0.8 0.8 Hospitals 1 in 15 miles 1 100.0 1.4 6.0 Urgent Care Facilities 1 in 15 miles 1 100.0 1.1 1.1 - Continued on next page. Cigna Network Analysis-Employees With Access 32 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distan., City of Mianu Beach Name County City Code # Group Standard # % Access analysis Florida Palm Beach Lake Worth 33467 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.8 0.9 Medical-Breakout-Suburban Pediatricians 2 in 15 miles 1 100.0 1.0 1.0 Distance Method OB/Gyns 2 in 15 miles 1 100.0 1.0 1.0 Estimated Driving Distance Other Specialists 2 in 15 miles 1 100.0 0.8 0.8 Employee!Provider Groups Hospitals 1 in 15 miles 1 100.0 3.5 5.0 All Employees-Suburban Urgent Care Facilities 1 in 15 miles 1 100.0 2.8 2.8 Adult Primary Care Physicians Palm Beach G... 33410 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.3 0.3 Pediatricians Pediatricians 2 in 15 miles 1 100.0 0.2 0.2 OBiGyns OB/Gyns 2 in 15 miles 1 100.0 0.4 0.4 Other Specialists Other Specialists 2 in 15 miles 1 100.0 0.1 0.2 Hospitals Hospitals 1 in 15 miles 1 100.0 0.2 1.1 Urgent Care Facilities Urgent Care Facilities 1 in 15 miles 1 100.0 0.2 0.2 West Palm Be... 33407 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.3 0.4 Pediatricians 2 in 15 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 15 miles 1 100.0 0.4 0.4 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 0.9 1.5 Urgent Care Facilities 1 in 15 miles 1 100.0 3.6 3.6 33411 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.8 Pediatricians 2 in 15 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 15 miles 1 100.0 1.8 2.4 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 4.2 4.9 Urgent Care Facilities 1 in 15 miles 1 100.0 0.4 2.4 Pinellas Tarpon Springs 34689 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.6 0.9 Pediatricians 2 in 15 miles 1 100.0 0.9 0.9 OB/Gyns 2 in 15 miles 1 100.0 0.9 0.9 Other Specialists 2 in 15 miles 1 100.0 0.1 0.1 Hospitals 1 in 15 miles 1 100.0 1.1 7.9 Urgent Care Facilities 1 in 15 miles 1 100.0 1.4 1.4 St.Lucie Port Saint Lucie 34953 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.4 2.5 Pediatricians 2 in 15 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 15 miles 1 100.0 0.4 0.4 Other Specialists 2 in 15 miles 1 100.0 0.4 0.4 Hospitals 1 in 15 miles 1 100.0 0.7 4.2 Urgent Care Facilities 1 in 15 miles 1 100.0 4.2 5.4 34983 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.0 Pediatricians 2 in 15 miles 1 100.0 0.9 0.9 OB/Gyns 2 in 15 miles 1 100.0 2.4 3.4 Other Specialists 2 in 15 miles 1 100.0 1.0 1.0 s 2023 Quest Analytics,LLC Continued on next page. Cigna Network Analysis-Employees With Access 33 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # °Is 1 2 Access Analysis Florida St.Lucie Port Saint Lucie 34983 1 Hospitals 1 in 15 miles 1 100.0 4.9 5.6 Medical-Breakout-Suburban Urgent Care Facilities 1 in 15 miles 1 100.0 1.7 2.6 Distance Method 34984 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.0 Estimated Driving Distance Pediatricians 2 in 15 miles 1 100.0 0.6 0.6 Employee I Provider Groups OB/Gyns 2 in 15 miles 1 100.0 1.2 1.2 All Employees-Suburban Other Specialists 2 in 15 miles 1 100.0 0.6 0.6 Adult Primary Care Physicians Hospitals 1 in 15 miles 1 100.0 2.9 4.7 Pediatricians Urgent Care Facilities 1 in 15 miles 1 100.0 0.6 3.5 OBIGyns 34986 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.9 0.9 Other Specialists Pediatricians 2 in 15 miles 1 100.0 1.3 1.3 Hospitals Urgent Care Facilities OB/Gyns 2 in 15 miles 1 100.0 1.3 1.4 Other Specialists 2 in 15 miles 1 100.0 0.9 0.9 Hospitals 1 in 15 miles 1 100.0 6.6 6.6 Urgent Care Facilities 1 in 15 miles 1 100.0 1.8 1.8 Sumter The Villages 32162 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.0 1.0 Pediatricians 2 in 15 miles 1 100.0 4.7 4.7 OB/Gyns 2 in 15 miles 1 100.0 2.1 2.1 Other Specialists 2 in 15 miles 1 100.0 1.0 1.0 Hospitals 1 in 15 miles 1 100.0 2.0 4.5 Urgent Care Facilities 1 in 15 miles 1 100.0 3.4 3.4 Volusia Daytona Beach 32118 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.5 1.9 Pediatricians 2 in 15 miles 1 100.0 3.5 3.5 OB/Gyns 2 in 15 miles 1 100.0 3.5 3.6 Other Specialists 2 in 15 miles 1 100.0 1.0 1.1 Hospitals 1 in 15 miles 1 100.0 8.5 8.5 Urgent Care Facilities 1 in 15 miles 1 100.0 2.9 4.4 Port Orange 32129 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.2 1.3 Pediatricians 2 in 15 miles 1 100.0 1.4 1.4 OB/Gyns 2 in 15 miles 1 100.0 3.3 6.3 Other Specialists 2 in 15 miles 1 100.0 0.4 1.0 Hospitals 1 in 15 miles 1 100.0 3.3 3.3 Urgent Care Facilities 1 in 15 miles 1 100.0 1.4 1.5 Georgia Cherokee Acworth 30102 1 Adult Primary Care... 2 in 15 miles 1 100.0 2.6 2.6 Pediatricians 2 in 15 miles 1 100.0 4.2 4.3 OB/Gyns 2 in 15 miles 1 100.0 5.4 5.4 Other Specialists 2 in 15 miles 1 100.0 2.2 2.5 Hospitals 1 in 15 miles 1 100.0 3.7 5.5 Urgent Care Facilities 1 in 15 miles 1 100.0 4.0 4.3 Fulton Alpharetta 30022 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.7 0.7 Pediatricians 2 in 15 miles 1 100.0 1.1 2.4 - - . Continued on next page. Cigna Network Analysis-Employees With Access 34 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for.. State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Georgia Fulton Alpharetta 30022 1 OB/Gyns 2 in 15 miles 1 100.0 2.5 2.9 Medical-Breakout-Suburban Other Specialists 2 in 15 miles 1 100.0 0.7 0.7 Distance Method Hospitals 1 in 15 miles 1 100.0 2.6 3.2 Estimated Driving Distance Urgent Care Facilities 1 in 15 miles 1 100.0 2.6 2.6 Employee/Provider Groups Minnesota Ramsey Saint Paul 55112 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.5 0.5 All Employees-Suburban Pediatricians 2 in 15 miles 1 100.0 0.8 0.8 Adult Primary Care Physicians OB/Gyns 2 in 15 miles 1 100.0 0.5 0.8 Pediatricians Other Specialists 2 in 15 miles 1 100.0 0.5 0.5 OB/Gyns Hospitals 1 in 15 miles 1 100.0 1.2 1.2 Other Specialists Urgent Care Facilities 1 in 15 miles 1 100.0 0.8 2.9 Hospitals North Carolina Mecklenburg Charlotte 28227 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.2 1.5 Urgent Care Facilities Pediatricians 2 in 15 miles 1 100.0 1.2 1.6 OB/Gyns 2 in 15 miles 1 100.0 1.5 1.6 Other Specialists 2 in 15 miles 1 100.0 1.2 1.2 Hospitals 1 in 15 miles 1 100.0 4.4 4.4 Urgent Care Facilities 1 in 15 miles 1 100.0 4.3 4.5 Wake Cary 27518 1 Adult Primary Care... 2 in 15 miles 1 100.0 0.2 0.2 Pediatricians 2 in 15 miles 1 100.0 0.2 0.2 OB/Gyns 2 in 15 miles 1 100.0 0.4 0.5 Other Specialists 2 in 15 miles 1 100.0 0.2 0.2 Hospitals 1 in 15 miles 1 100.0 0.8 0.8 Urgent Care Facilities 1 in 15 miles 1 100.0 1.0 1.0 Pennsylvania Allegheny Pittsburgh 15241 1 Adult Primary Care... 2 in 15 miles 1 100.0 1.8 1.8 Pediatricians 2 in 15 miles 1 100.0 0.7 0.7 OB/Gyns 2 in 15 miles 1 100.0 2.1 2.1 Other Specialists 2 in 15 miles 1 100.0 0.2 0.7 Hospitals 1 in 15 miles 1 100.0 2.1 2.1 Urgent Care Facilities 1 in 15 miles 1 100.0 2.2 2.7 Grand Totals 200 Adult Primary Care... 2 in 15 miles 200 100.0 1.0 1.1 Pediatricians 2 in 15 miles 200 100.0 1.4 1.7 OB/Gyns 2 in 15 miles 200 100.0 1.9 2.1 Other Specialists 2 in 15 miles 200 100.0 0.7 0.8 Hospitals 1 in 15 miles 200 100.0 2.7 4.0 Urgent Care Facilities 1 in 15 miles 200 100.0 2.2 3.1 s)2023 Quest Acolytes,LLC Cigna Network Analysis-Employees Without Access 35 Access Detail By Zip Code (Without Access) April 2023 Employees Without Access Created for... State Zip Employee Provider Without Access Average Dista City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis No data that meets the criteria Medical-Breakout-Suburban Distance Method Estimated Driving Distance Employee I Provider Groups All Employees-Suburban Adult Primary Care Physicians Pediatricians OB/Gyns Other Specialists Hospitals Urgent Care Facilities 2023 Quest Analybcs,LLC. Cigna Network Analysis-Employees With Access 36 Access Summary By City (With Access) April 2023 Employees With Access Created for... Employee Provider With Access Counts' Average Distance City of Miami Beach Group # Group Standard # % # P L 1; __, 2 Access Analysis All Employees-Rural 110 Adult Primary Care Physi... 2 in 20 miles 110 100.0 628,036 227,301 101,503 2.0 2.5 Medical-Breakout-Rural Pediatricians 2 in 20 miles 108 98.2 153,429 60,348 32,008 3.2 3.6 Distance Method OB/Gyns 2 in 20 miles 108 98.2 122,514 35,549 24,062 3.7 4.3 Estimated Driving Distance Other Specialists 2 in 20 miles 110 100.0 3,462580 906,886 220,216 1.9 2.0 Employee Group Hospitals 1 in 20 miles 106 96.4 10,053 6,360 8,122 4.9 9.2 All Employees-Rural Ur.ent Care Facilities 1 in 20 miles 95 86.4 8,689 3,500 6,940 4.3 7.6 Provider Group Adult Primary Care Physicians Key Geographic Areas Pediatricians Employee Provider With Access Average Distance OB/Gyns State % Other Specialists Name City # Group Standard # 1 2 Hospitals Florida Miami 31 Adult Primary Care Physicians 2 in 20 miles 31 100.0' 1.2 1.7 Urgent Care Facilities Hospitals 1 in 20 miles 31 100.0 3.0 3.9 OB/Gyns 2 in 20 miles 31 100.0 2.0 2.2 Provider counts represent: Other Specialists 2 in 20 miles 31 100.0 1.2 1.4 #.Provider access points Pediatricians 2 in 20 miles 31 100.0 1.6 2.0 P:Unique providers Urgent Care Facilities 1 in 20 miles 31 100.0 2.5 3.3 Unique provider locations Homestead 3 Adult Primary Care Physicians 2 in 20 miles 3 100.0 2.2 2.5 Ocala 3 Adult Primary Care Physicians 2 in 20 miles 3 100.0 5.2 5.4 Homestead 3 Hospitals 1 in 20 miles 3 100.0 4.7 5.4 Ocala 3 Hospitals 1 in 20 miles 3 100.0 8.5 8.5 Homestead 3 OB/Gyns 2 in 20 miles 3 100.0 2.2 2.6 Ocala 3 OB/Gyps 2 in 20 miles 3 100.0 6.8 8.2 Homestead 3 Other Specialists 2 in 20 miles 3 100.0 2.1 2.1 Ocala 3 Other Specialists 2 in 20 miles 3 100.0 5.3 5.3 Homestead 3 Pediatricians 2 in 20 miles 3 100.0 2.0 2.6 Ocala 3 Pediatricians 2 in 20 miles 3 100.0 6.4 6.4 Homestead 3 Urgent Care Facilities 1 in 20 miles 3 100.0 3.6 4.5 Ocala 3 Urgent Care Facilities 1 in 20 miles 3 100.0 8.4 8.5 Alabama Troy 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 6.3 6.6 Florida Fort Pierce 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 2.8 3.7 Immokalee 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 0.6 0.6 Palm City 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 0.5 0.5 Palm Coast 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 2.1 2.1 Tallahassee 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 3.6 4.3 Wesley Chapel 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 1.1 1.1 Winter Haven 2 Adult Primary Care Physicians 2 in 20 miles 2 100.0 1.4 1.4 Alabama Troy 2 Hospitals 1 in 20 miles 2 100.0 7.3 21.5 Florida Fort Pierce 2 Hospitals 1 in 20 miles 2 100.0 7.8 11.9 Palm City 2 Hospitals 1 in 20 miles 2 100.0 4.6 4.7 Palm Coast 2 Hospitals 1 in 20 miles 2 100.0 8.9 22.9 2 2023 guest Analytics,LLC Cigna Network Analysis-Employees Without Access 37 Access Summary By City (Without Access) April 2023 Employees Without Access Created for... Employee Provider Without Access Counts' Average Distance City of Miami Beach Group # Group Standard # % # P L 1 2 Access Analysis All Employees-Rural 110 Pediatricians 2 in 20 miles 2 1.8 153,429 60,348 32,008 10.3 21.2 Medical-Breakout-Rural OB/Gyns 2 in 20 miles 2 1.8 122,514 35,549 24,062 5.5 20.9 Distance Method Hospitals 1 in 20 miles 4 3.6 10,053 6,360 8,122 22.5 26.9 Estimated Driving Distance Ur.ent Care Facilities 1 in 20 miles 15 13.6 8,689 3,500 6,940 28.5 31.5 Employee Group .,......, __--,....®,. All Employees-Rural Key Geographic AreasI Provider Group State Employee Provider Without Access Average Distance Adult Primary Care Physicians Name City # Group Standard # % 1 2 Pediatricians OB/Gyns Florida Immokalee 2 Hospitals 1 in 20 miles 2 100.0 23.0 24.3 Other Specialists Urgent Care Facilities 1 in 20 miles 2 100.0 24.1 25.8 Hospitals Astor 1 Hospitals 1 in 20 miles 1 100.0 20.2 27.8 Urgent Care Facilities Defuniak Springs 1 Hospitals 1 in 20 miles 1 100.0 23.9 31.1 Astor 1 OB/Gyns 2 in 20 miles 1 100.0 10.0 20.1 1 Provider counts represent. Labelle 1 OB/Gyns 2 in 20 miles 1 100.0 0.9 21.7 #:Provider access points Astor 1 Pediatricians 2 in 20 miles 1 100.0 20.1 20.1 P:Unique providers Labelle 1 Pediatricians 2 in 20 miles 1 100.0 0.4 22.2 L Unique provider locations Colorado Aspen 1 Urgent Care Facilities 1 in 20 miles 1 100.0 33.1 39.5 Florida Arcadia 1 Urgent Care Facilities 1 in 20 miles 1 100.0 27.5 27.5 Astor 1 Urgent Care Facilities 1 in 20 miles 1 100.0 20.3 20.3 Defuniak Springs 1 Urgent Care Facilities 1 in 20 miles 1 100.0 24.1 33.2 Labelle 1 Urgent Care Facilities 1 in 20 miles 1 100.0 22.2 22.2 Panama City 1 Urgent Care Facilities 1 in 20 miles 1 100.0 30.1 53.3 Georgia Dexter 1 Urgent Care Facilities 1 in 20 miles 1 100.0 35.1 36.3 Eatonton 1 Urgent Care Facilities 1 in 20 miles 1 100.0 22.5 22.6 Milledgeville 1 Urgent Care Facilities 1 in 20 miles 1 100.0 39.1 40.0 Vidalia 1 Urgent Care Facilities 1 in 20 miles 1 100.0 43.9 43.9 North Carolina Murfreesboro 1 Urgent Care Facilities 1 in 20 miles 1 100.0 30.5 30.9 Virginia Kilmarnock 1 Urgent Care Facilities 1 in 20 miles 1 100.0 29.8 30.3 Washington Chimacum 1 Urgent Care Facilities 1 in 20 miles 1 100.0 20.8 20.8 Cigna Network Analysis-Employees With Access 38 Access Detail By Zip Code (With Access) April2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # .- Group Standard # % 1 2 Access Analysis Alabama Baldwin Foley 36535 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.8 0.8 Medical-Breakout-Rural Pediatricians 2 in 20 miles 1 100.0 1.1 1.1 Distance Method OB/Gyns 2 in 20 miles 1 100.0 1.9 2.3 Estimated Driving Distance Other Specialists 2 in 20 miles 1 100.0 0.8 0.8 Employee I Provider Groups Hospitals 1 in 20 miles 1 100.0 2,6 18.9 All Employees-Rural Urgent Care Facilities 1 in 20 miles 1 100.0 1,2 19.9 Adult Primary Care Physicians Pike Troy 36079 2 Adult Primary Care... 2 in 20 miles 2 100.0 6.3 6.6 Pediatricians Pediatricians 2 in 20 miles 2 100.0 7.1 7.1 OB/Gyns OB/Gyns 2 in 20 miles 2 100.0 6.8 7.0 Other Specialists Other Specialists 2 in 20 miles 2 100.0 2.9 2.9 Hospitals Hospitals 1 in 20 miles 2 100.0 7.3 21.5 Urgent Care Facilities Urgent Care Facilities 1 in 20 miles 2 100.0 6.9 36.4 Arizona Yavapai Sedona 86351 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.4 0.4 Pediatricians 2 in 20 miles 1 100.0 16.6 16.6 OB/Gyns 2 in 20 miles 1 100.0 16.6 17.2 Other Specialists 2 in 20 miles 1 100.0 0.2 0.2 Hospitals 1 in 20 miles 1 100.0 8.3 17.3 Urgent Care Facilities 1 in 20 miles 1 100.0 7.7 16.5 Colorado Pitkin Aspen 81611 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.6 0.6 Pediatricians 2 in 20 miles 1 100.0 0.6 0.6 OB/Gyns 2 in 20 miles 1 100.0 0.4 0.5 Other Specialists 2 in 20 miles 1 100.0 0.4 0.5 Hospitals 1 in 20 miles 1 100.0 0.6 0.6 Florida Bay Panama City 32404 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.5 1.5 Pediatricians 2 in 20 miles 1 100.0 5.0 5.0 OB/Gyns 2 in 20 miles 1 100.0 4.8 4.8 Other Specialists 2 in 20 miles 1 100.0 1.5 1.5 Hospitals 1 in 20 miles 1 100.0 4.8 4.8 Brevard Malabar 32950 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.4 2.4 Pediatricians 2 in 20 miles 1 100.0 2.4 2.4 OB/Gyns 2 in 20 miles 1 100.0 2.5 5.8 Other Specialists 2 in 20 miles 1 100.0 2.4 2.4 Hospitals 1 in 20 miles 1 100.0 2,7 8.7 Urgent Care Facilities 1 in 20 miles 1 100.0 2.5 2.5 Melbourne 32904 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.6 0.8 Pediatricians 2 in 20 miles 1 100.0 1.0 1.0 OB/Gyns 2 in 20 miles 1 100.0 2.4 2.4 Other Specialists 2 in 20 miles 1 100.0 0.0 0.8 Hospitals 1 in 20 miles 1 100.0 2.8 3.9 Urgent Care Facilities 1 in 20 miles 1 100.0 2.1 2.4 s 2023 Quest Analytics,LLC. 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Cigna Network Analysis-Employees With Access 39 Access Detail By Zip Code (With Access) Apolsozs Employees With Access Created for... r- • zipEmployee Provider With Access Average Distance City of Miami Beach City Code # Group Standard # % 1 2 Access Analysis Florida Brevard Palm Bay 32909 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.2 1.2 Medical-Breakout-Rural Pediatricians 2 in 20 miles 1 100.0 4.3 4.3 Distance Method OB/Gyns 2 in 20 miles 1 100.0 1.0 1.3 Estimated Driving Distance Other Specialists 2 in 20 miles 1 100.0 1.0 1.0 Employee/Provider Groups Hospitals 1 in 20 miles 1 100.0 5.4 10.4 All Employees-Rural Urgent Care Facilities 1 in 20 miles 1 100.0 1.2 3.9 Adult Primary Care Physicians Sebastian 32976 1 Adult Primary Care.., 2 in 20 miles 1 100.0 0.7 0.7 Pediatricians Pediatricians 2 in 20 miles 1 100.0 3.4 3.6 OB/Gyns OB/Gyns 2 in 20 miles 1 100.0 4.2 5.1 Other Specialists Other Specialists 2 in 20 miles 1 100.0 0.7 0.7 Hospitals Hospitals 1 in 20 miles 1 100.0 3.8 13.9 Urgent Care Facilities Urgent Care Facilities 1 in 20 miles 1 100.0 3.6 5.1 Citrus Beverly Hills 34465 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.5 1.5 Pediatricians 2 in 20 miles 1 100.0 1.5 3.3 OB/Gyns 2 in 20 miles 1 100.0 4.9 6.6 Other Specialists 2 in 20 miles 1 100.0 0.6 1.4 Hospitals 1 in 20 miles 1 100.0 4.4 9.9 Urgent Care Facilities 1 in 20 miles 1 100.0 1.4 8.3 Hernando 34442 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.3 4.1 Pediatricians 2 in 20 miles 1 100.0 5.7 6.0 OB/Gyns 2 in 20 miles 1 100.0 4.3 9.1 Other Specialists 2 in 20 miles 1 100.0 1.0 4.3 Hospitals 1 in 20 miles 1 100.0 9.3 9.4 Urgent Care Facilities 1 in 20 miles 1 100.0 4.8 7.9 Collier Immokalee 34142 2 Adult Primary Care... 2 in 20 miles 2 100.0 0.6 0.6 Pediatricians 2 in 20 miles 2 100.0 2.9 2.9 OB/Gyns 2 in 20 miles 2 100.0 2.9 3.0 Other Specialists 2 in 20 miles 2 100.0 1.3 1.3 Naples 34120 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.8 3.8 Pediatricians 2 in 20 miles 1 100.0 6.1 10.6 OB/Gyns 2 in 20 miles 1 100.0 6.1 6.2 Other Specialists 2 in 20 miles 1 100.0 4.6 4.6 Hospitals 1 in 20 miles 1 100.0 12.3 12.4 Urgent Care Facilities 1 in 20 miles 1 100.0 6.1 10.0 DeSoto Arcadia 34266 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.2 2.5 Pediatricians 2 in 20 miles 1 100.0 2.2 2.2 OB/Gyns 2 in 20 miles 1 100.0 3.0 3.0 Other Specialists 2 in 20 miles 1 100.0 0.8 0.8 Hospitals 1 in 20 miles 1 100.0 3.0 25.1 Duval Jacksonville 32226 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.8 1.8 2023 Quest Analytics,LLC. 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Cigna Network Analysis-Employees With Access 42 Access Detail By Zip Code (With Access) April2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code it Group Standard # % 1, 2 Access Analysis Florida Marion Summerfield 34491 1 Hospitals 1 in 20 miles 1 100.0 1.3 1.3 Medical-Breakout-Rural Urgent Care Facilities 1 in 20 miles 1 100.0 5.9 9.2 Distance Method Martin Palm City 34990 2 Adult Primary Care... 2 in 20 miles 2 100.0 0.5 0.5 Estimated Driving Distance Pediatricians 2 in 20 miles 2 100.0 0.2 1.3 Employee I Provider Groups OB/Gyns 2 in 20 miles 2 100.0 2.7 2.7 All Employees-Rural Other Specialists 2 in 20 miles 2 100.0 0.2 0.2 Adult Primary Care Physicians Hospitals 1 in 20 miles 2 100.0 4.6 4.7 Pediatricians Urgent Care Facilities 1 in 20 miles 2 100.0 1.6 3.0 OBIGyns Stuart 34997 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.5 0.5 Other Specialists Pediatricians 2 in 20 miles 1 100.0 0.8 0.8 Hospitals OB/Gyns 2 in 20 miles 1 100.0 0.8 0.8 Urgent Care Facilities Other Specialists 2 in 20 miles 1 100.0 0.1 0.5 Hospitals 1 in 20 miles 1 100.0 0.8 6.2 Urgent Care Facilities 1 in 20 miles 1 100.0 2.5 3.9 Miami-Dade Homestead 33031 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.4 3.8 Pediatricians 2 in 20 miles 1 100.0 2.8 3.8 OB/Gyns 2 in 20 miles 1 100.0 2.8 3.9 Other Specialists 2 in 20 miles 1 100.0 3.8 3.8 Hospitals 1 in 20 miles 1 100.0 6.2 7.1 Urgent Care Facilities 1 in 20 miles 1 100.0 5.4 5.9 33034 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.4 1.8 Pediatricians 2 in 20 miles 1 100.0 1.2 1.8 OB/Gyns 2 in 20 miles 1 100.0 1.8 1.8 Other Specialists 2 in 20 miles 1 100.0 1.1 1.1 Hospitals 1 in 20 miles 1 100.0 5.7 6.9 Urgent Care Facilities 1 in 20 miles 1 100.0 3.0 5.4 33035 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.9 1.9 Pediatricians 2 in 20 miles 1 100.0 1.9 2.1 OB/Gyns 2 in 20 miles 1 100.0 2,1 2.1 Other Specialists 2 in 20 miles 1 100.0 1.3 1.3 Hospitals 1 in 20 miles 1 100.0 2.3 2.3 Urgent Care Facilities 1 in 20 miles 1 100.0 2.3 2.3 Miami 33122 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.4 0.4 Pediatricians 2 in 20 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 20 miles 1 100.0 0.4 0.4 Other Specialists 2 in 20 miles 1 100.0 0.2 0.2 Hospitals 1 in 20 miles 1 100.0 0.4 3.1 Urgent Care Facilities 1 in 20 miles 1 100.0 1.2 1.9 33170 5 Adult Primary Care... 2 in 20 miles 5 100.0 2.1 2.1 Pediatricians 2 in 20 miles 5 100.0 2.1 2.5 'J 2023 Quest Analytics,LLC ::ondnued on next page. a6e0 pau uo panupuo3 Oil so,Neuy lsan0 ezoz: Z'9 87 0"OOl t RILL OZ ul 1 sagpioed are°lua6in L'9 Z 9 0'001. l sap OZ ul 1 sletidsoH Z Z Z l 0'0N l saliw 0Z w Z stsgeioadS Ja4l0 4'4 4"4 0"001. l sapw 0Z ul Z suA0/80 9"Z £Z 0"001. l saliw OZ w Z suelouteipad £'Z 9"1, 0'001. t sap OZ u1 Z ._.aJe0 tiewud 11nPV l 97Lb£ aawwlss!N eloaoso 6 9 19 0"001. l sap OZ ul t sapped aJe01ua6ifl L S L'9 0•00l l sap 0Z ul L sle11dsoH 0 Z 0'Z 0 001. l saw OZ ui Z stslleloads J0410 97 9'Z 0"00t l sap OZ u!Z sw(O/80 9 Z l'Z 0"001. l sap OZ ul Z sueioutelpad £'Z 07 0"001. l sapw 0Z w Z ...aJe0 tiewud 11fPV l Z1LZ£ midody a6ueJO £'4Z 0 S Mt l sapw OZ w 1 sa9lIPed aie01ua6i11 6'£Z L'91. 0"001. l sap OZ w 1 sIe11dsoH l"l VI. 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State Zip Employee Provider With Access Average Distan City of Miami Beach Name County City Code # Group Standard # % 1 Access Analysis Florida Osceola Saint Cloud 34772 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.0 2.0 Medical-Breakout-Rural Pediatricians 2 in 20 miles 1 100.0 2.7 3.2 Distance Method OB/Gyns 2 in 20 miles 1 100.0 3.5 3.5 Estimated Driving Distance Other Specialists 2 in 20 miles 1 100.0 1.8 1.8 Employee/Provider Groups Hospitals 1 in 20 miles 1 100.0 4.1 11.6 All Employees-Rural Urgent Care Facilities 1 in 20 miles 1 100.0 6.4 9.4 Adult Primary Care Physicians Palm Beach Jupiter 33478 1 Adult Primary Care... 2 in 20 miles 1 100.0 5.4 5.4 Pediatricians Pediatricians 2 in 20 miles 1 100.0 5.6 5.6 OB/Gyns OB/Gyns 2 in 20 miles 1 100.0 7.8 7.8 Other Specialists Other Specialists 2 in 20 miles 1 100.0 2.5 3.4 Hospitals Hospitals 1 in 20 miles 1 100.0 8.5 13.3 Urgent Care Facilities Urgent Care Facilities 1 in 20 miles 1 100.0 6.3 6.6 Lake Worth 33449 1 Adult Primary Care.., 2 in 20 miles 1 100.0 1.6 1.9 Pediatricians 2 in 20 miles 1 100.0 2.9 2.9 OB/Gyns 2 in 20 miles 1 100.0 3.4 5.0 Other Specialists 2 in 20 miles 1 100.0 1.6 1.6 Hospitals 1 in 20 miles 1 100.0 3.4 5.1 Urgent Care Facilities 1 in 20 miles 1 100.0 3.4 3.4 Loxahatchee 33470 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.2 3.2 Pediatricians 2 in 20 miles 1 100.0 7.4 7.4 OB/Gyns 2 in 20 miles 1 100.0 7.5 7.9 Other Specialists 2 in 20 miles 1 100.0 0.5 0.5 Hospitals 1 in 20 miles 1 100.0 0.4 7.9 Urgent Care Facilities 1 in 20 miles 1 100.0 5.3 9.3 West Palm Be... 33412 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.2 5.3 Pediatricians 2 in 20 miles 1 100.0 6.3 6.3 OB/Gyns 2 in 20 miles 1 100.0 6.4 7.6 Other Specialists 2 in 20 miles 1 100.0 0.9 0.9 Hospitals 1 in 20 miles 1 100.0 7.9 8.0 Urgent Care Facilities 1 in 20 miles 1 100.0 7.7 8.0 Pasco Wesley Chapel 33543 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.4 1.4 Pediatricians 2 in 20 miles 1 100.0 1.4 1.4 OB/Gyns 2 in 20 miles 1 100.0 1.4 1.4 Other Specialists 2 in 20 miles 1 100.0 1.4 1.4 Hospitals 1 in 20 miles 1 100.0 1.4 1.4 Urgent Care Facilities 1 in 20 miles 1 100.0 4.4 4.9 33544 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.7 0.7 Pediatricians 2 in 20 miles 1 100.0 1.2 1.2 OB/Gyns 2 in 20 miles 1 100.0 3.0 3.1 Other Specialists 2 in 20 miles 1 100.0 0.7 0.7 ©2023 Quest Analytics,LLC. Continued on next page.. Cigna Network Analysis-Employees With Access 45 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach - , Name County City Code # Group Standard # % 1 2 Access Analysis Florida Pasco Wesley Chapel 33544 1 Hospitals 1 in 20 miles 1 100.0 1.8 3.4 Medical-Breakout-Rural Urgent Care Facilities 1 in 20 miles 1 100.0 0.8 0.8 Distance Method Polk Davenport 33837 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.7 1.5 Estimated Driving Distance Pediatricians 2 in 20 miles 1 100.0 1.7 1.7 Employee/Provider Groups OB/Gyns 2 in 20 miles 1 100.0 2.4 2.4 All Employees-Rural Other Specialists 2 in 20 miles 1 100.0 0.7 1.5 Adult Primary Care Physicians Hospitals 1 in 20 miles 1 100.0 1.8 11.2 Pediatricians Urgent Care Facilities 1 in 20 miles 1 100.0 2.4 5.3 OB/Gyns Winter Haven 33880 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.7 1.8 Other Specialists Pediatricians 2 in 20 miles 1 100.0 1.8 1.8 Hospitals Urgent Care Facilities OB/Gyns 2 in 20 miles 1 100.0 1.3 1.7 Other Specialists 2 in 20 miles 1 100.0 0.5 0.5 Hospitals 1 in 20 miles 1 100.0 3.2 11.5 Urgent Care Facilities 1 in 20 miles 1 100.0 2.5 3.0 33881 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.0 1.0 Pediatricians 2 in 20 miles 1 100.0 1.0 1.0 OB/Gyns 2 in 20 miles 1 100.0 1.0 1.0 Other Specialists 2 in 20 miles 1 100.0 0.9 0.9 Hospitals 1 in 20 miles 1 100.0 1.6 13.6 Urgent Care Facilities 1 in 20 miles 1 100.0 1.7 1.7 Sarasota North Port 34288 1 Adult Primary Care.., 2 in 20 miles 1 100.0 1.9 3.2 Pediatricians 2 in 20 miles 1 100.0 2.1 2.1 OB/Gyns 2 in 20 miles 1 100.0 1.8 1.8 Other Specialists 2 in 20 miles 1 100.0 1.8 1.8 Hospitals 1 in 20 miles 1 100.0 1.8 6.8 Urgent Care Facilities 1 in 20 miles 1 100.0 4.4 4.4 St.Johns Ponte Vedra B... 32082 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.3 0.3 Pediatricians 2 in 20 miles 1 100.0 0.4 0.4 OB/Gyns 2 in 20 miles 1 100.0 4.8 4.8 Other Specialists 2 in 20 miles 1 100.0 0.1 0.4 Hospitals 1 in 20 miles 1 100.0 6.4 8.0 Urgent Care Facilities 1 in 20 miles 1 100.0 0.4 7.7 St.Lucie Fort Pierce 34949 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.6 3.4 Pediatricians 2 in 20 miles 1 100.0 3.8 3.8 OB/Gyns 2 in 20 miles 1 100.0 4.3 5.3 Other Specialists 2 in 20 miles 1 100.0 3.6 3.8 Hospitals 1 in 20 miles 1 100.0 6.5 13.7 Urgent Care Facilities 1 in 20 miles 1 100.0 8.9 8.9 34951 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.9 3.9 Pediatricians 2 in 20 miles 1 100.0 3.9 3.9 2023 Quest Analytics,LLC Continued on next page... Cigna Network Analysis-Employees With Access 46 Access Detail By Zip Code (With Access) APril3 Employees With Access Created for... State Zip Employee Provider With Access Average Distan.- City of Miami Beach Name County City Code # Group Standard # Is 1 2 . Access Analysis Florida St.Lucie Fort Pierce 34951 1 OB/Gyns 2 in 20 miles 1 100.0 3.9 7.4 Medical-Breakout-Rural Other Specialists 2 in 20 miles 1 100.0 1.1 1.7 Distance Method Hospitals 1 in 20 miles 1 100.0 9.0 10.1 Estimated Driving Distance Urgent Care Facilities 1 in 20 miles 1 100.0 6.9 6.9 Employee I Provider Groups Port Saint Lucie 34987 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.5 2.5 All Employees-Rural Pediatricians 2 in 20 miles 1 100.0 1.9 1.9 Adult Primary Care Physicians OB/Gyns 2 in 20 miles 1 100.0 1.8 1.8 Pediatricians Other Specialists 2 in 20 miles 1 100.0 0.5 1.6 OB/Gyns Hospitals 1 in 20 miles 1 100.0 2.5 2.5 Other Specialists Urgent Care Facilities 1 in 20 miles 1 100.0 4.9 4.9 Hospitals Volusia Deland 32720 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.4 2.4 Urgent Care Facilities Pediatricians 2 in 20 miles 1 100.0 2.8 2.8 OB/Gyns 2 in 20 miles 1 100.0 2.8 2.9 Other Specialists 2 in 20 miles 1 100.0 1.6 2.4 Hospitals 1 in 20 miles 1 100.0 3.0 10.6 Urgent Care Facilities 1 in 20 miles 1 100.0 4.3 4.3 Ormond Beach 32174 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.6 1.7 Pediatricians 2 in 20 miles 1 100.0 2.4 2.4 OB/Gyns 2 in 20 miles 1 100.0 4.3 4.3 Other Specialists 2 in 20 miles 1 100.0 1.2 1.2 Hospitals 1 in 20 miles 1 100.0 2.1 4.3 Urgent Care Facilities 1 in 20 miles 1 100.0 2.1 2.1 Walton Defuniak Spri... 32433 1 Adult Primary Care... 2 in 20 miles 1 100.0 7.9 8.8 Pediatricians 2 in 20 miles 1 100.0 9.7 10.1 OB/Gyns 2 in 20 miles 1 100.0 9.7 18.7 Other Specialists 2 in 20 miles 1 100.0 7.2 7.2 Georgia Baldwin Milledgeville 31061 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.1 0.3 Pediatricians 2 in 20 miles 1 100.0 0.8 0.9 OB/Gyns 2 in 20 miles 1 100.0 0.8 0.8 Other Specialists 2 in 20 miles 1 100.0 0.1 0.1 Hospitals 1 in 20 miles 1 100.0 0.8 22.3 Banks Baldwin 30511 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.5 3.8 Pediatricians 2 in 20 miles 1 100.0 4.7 4.7 OB/Gyns 2 in 20 miles 1 100.0 4.7 4.7 Other Specialists 2 in 20 miles 1 100.0 3.8 4.7 Hospitals 1 in 20 miles 1 100.0 9.4 17.4 Urgent Care Facilities 1 in 20 miles 1 100.0 7.0 7.0 Forsyth Cumming 30028 1 Adult Primary Care.., 2 in 20 miles 1 100.0 6.3 6.4 Pediatricians 2 in 20 miles 1 100.0 5.6 5.6 OB/Gyns 2 in 20 miles 1 100.0 6.4 6.4 ... Continued or,next page Cigna Network Analysis-Employees With Access 47 Access Detail By Zip Code (With Access) April 2023 Employees With Access Created for... State Zip Employee Provider With Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Georgia Forsyth Cumming 30028 1 Other Specialists 2 in 20 miles 1 100.0 4.7 4.9 Medical-Breakout-Rural Hospitals 1 in 20 miles 1 100.0 8.7 9.8 Distance Method Urgent Care Facilities 1 in 20 miles 1 100.0 8.4 8.4 Estimated Driving Distance Henry Hampton 30228 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.9 1.9 Employee/Provider Groups Pediatricians 2 in 20 miles 1 100.0 2.2 2.2 All Employees-Rural OB/Gyns 2 in 20 miles 1 100.0 2.6 2.6 Adult Primary Care Physicians Other Specialists 2 in 20 miles 1 100.0 1.9 1.9 Pediatricians Hospitals 1 in 20 miles 1 100.0 8.6 10.6 oB/Gyns Urgent Care Facilities 1 in 20 miles 1 100.0 8.6 8.6 Other Specialists McDonough 30252 1 Adult Primary Care... 2 in 20 miles 1 100.0 3.7 4.2 Hospitals Urgent Care Facilities Pediatricians 2 in 20 miles 1 100.0 4.2 4.8 08/Gyns 2 in 20 miles 1 100.0 5.7 8.0 Other Specialists 2 in 20 miles 1 100.0 2.4 4.2 Hospitals 1 in 20 miles 1 100.0 8.0 11.3 Urgent Care Facilities 1 in 20 miles 1 100.0 5.1 8.0 Laurens Dexter 31019 1 Adult Primary Care... 2 in 20 miles 1 100.0 12.3 12.3 Pediatricians 2 in 20 miles 1 100.0 12.5 12.5 OB/Gyns 2 in 20 miles 1 100.0 12.4 12.4 Other Specialists 2 in 20 miles 1 100.0 10.1 10.1 Hospitals 1 in 20 miles 1 100.0 12.7 19.0 Lowndes Valdosta 31601 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.0 3.1 Pediatricians 2 in 20 miles 1 100.0 4.1 4.1 OBIGyns 2 in 20 miles 1 100.0 4.3 4.3 Other Specialists 2 in 20 miles 1 100.0 1.0 1.0 Hospitals 1 in 20 miles 1 100.0 4.6 8.7 Urgent Care Facilities 1 in 20 miles 1 100.0 4.0 5.3 Peach Fort Valley 31030 1 Adult Primary Care... 2 in 20 miles 1 100.0 0.6 0.6 Pediatricians 2 in 20 miles 1 100.0 0.8 0.8 OB/Gyns 2 in 20 miles 1 100.0 0.8 0.8 Other Specialists 2 in 20 miles 1 100.0 0.6 0.6 Hospitals 1 in 20 miles 1 100.0 9.8 15.8 Urgent Care Facilities 1 in 20 miles 1 100.0 11.1 13.6 Putnam Eatonton 31024 1 Adult Primary Care... 2 in 20 miles 1 100.0 2.2 2.2 Pediatricians 2 in 20 miles 1 100.0 2.2 10.8 OB/Gyns 2 in 20 miles 1 100.0 2.3 10.7 Other Specialists 2 in 20 miles 1 100.0 2.2 2.2 Hospitals 1 in 20 miles 1 100.0 2.3 15.8 Toombs Vidalia 30475 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.9 1.9 Pediatricians 2 in 20 miles 1 100.0 0.3 0.3 OB/Gyns 2 in 20 miles 1 100.0 1.9 1.9 0 2023 Quest Analytics,LLC. 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I sapw 0Z u!Z ''aJe3 AJewud 11nPV L S£4Zl )IJed Plague@JO Jalslll )1J0A MaN moil nuoisi j 9 4Z S'Z 0'00L I sapw OZ w L slel!dsoH Tema-Jno>IeaJe-IeoiPaW £.0 Z'0 O'OOl L sapw 0Z u!Z sls!le!oedS J01110 l SL40£ e!lep!A sgwool e!6Joa0 sisAleuV ssaooy Z L % # paepuels dnojg # apo0 A;!0 'Auno0 aweN pen iweylJoAJO aoue;s!aa6eJany ssaooyy;!M Jlap!noud aai(oldw3 d!Z a;e;g JoipaieaJO ssaOOV LU!M saaAoidw3 ezoz oJdy (ssaooy y;!M) apo3 dIZ A8 Iie;aO ssaooy 8V ssaooy pM sea/Co/dug-spfleud)IaoM,IaN euBQ Cigna Network Analysis-Employees With Access 49 Access Detail By Zip Code (With Access) Apr Employees With Access Created for._ Zi Employee Provider With Access Average Distance City of Miami Beach • p City Code # Group Standard # % 1 2 Access Analysis Tennessee Sullivan Kingsport 37664 1 Other Specialists 2 in 20 miles 1 100.0 0.9 0.9 Medical-Breakout-Rural Hospitals 1 in 20 miles 1 100.0 2.4 4.6 Distance Method Urgent Care Facilities 1 in 20 miles 1 100.0 17.5 28.0 Estimated Driving Distance Virginia Northumberland Kilmarnock 22482 1 Adult Primary Care... 2 in 20 miles 1 100.0 1.8 1.8 Employee I Provider Groups Pediatricians 2 in 20 miles 1 100.0 1.8 1.8 All Employees-Rural OB/Gyns 2 in 20 miles 1 100.0 3.4 3.4 Adult Primary Care Physicians Other Specialists 2 in 20 miles 1 100.0 1.8 1.8 Pediatricians Hospitals 1 in 20 miles 1 100.0 3.3 28.1 OB/Gyns Washington Jefferson Chimacum 98325 1 Adult Primary Care... 2 in 20 miles 1 100.0 7.2 7.2 Other Specialists Pediatricians 2 in 20 miles 1 100.0 12.9 12.9 Hospitals Urgent Care Facilities OB/Gyns 2 in 20 miles 1 100.0 9.2 9.2 Other Specialists 2 in 20 miles 1 100.0 3.8 3.8 Hospitals 1 in 20 miles 1 100.0 9.2 18.6 Grand Totals 110 Adult Primary Care... 2 in 20 miles 110 100.0 2.0 2.5 108 Pediatricians 2 in 20 miles 108 100.0 3.2 3.6 OB/Gyns 2 in 20 miles 108 100.0 3.7 4.3 110 Other Specialists 2 in 20 miles 110 100.0 1.9 2.0 106 Hospitals 1 in 20 miles 106 100.0 4.9 9.2 95 Urgent Care Facilities 1 in 20 miles 95 100.0 4.3 7.6 .0;2023 Quest Analytics,LLC Cigna Network Analysis-Employees Without Access 50 Access Detail By Zip Code (Without Access) April 2023 Employees Without Access Created for... State Zip Employee Provider Without Access Average Distance City of Miami Beach Name County City Code # Group Standard # % 1 2 Access Analysis Colorado Pitkin Aspen 81611 1 Urgent Care Facilities 1 in 20 miles 1 100.0 33.1 39.5 Medical-Breakout-Rural Florida Bay Panama City 32404 1 Urgent Care Facilities 1 in 20 miles 1 100.0 30.1 53.3 Distance Method Collier Immokalee 34142 2 Hospitals 1 in 20 miles 2 100.0 23.0 24.3 Estimated Driving Distance Urgent Care Facilities 1 in 20 miles 2 100.0 24.1 25.8 Employee i Provider Groups DeSoto Arcadia 34266 1 Urgent Care Facilities 1 in 20 miles 1 100.0 27.5 27.5 All Employees-Rural Hendry Labelle 33935 1 Pediatricians 2 in 20 miles 1 100.0 0.4 22.2 Adult Primary Care Physicians OB/Gyns 2 in 20 miles 1 100.0 0.9 21.7 Pediatricians Urgent Care Facilities 1 in 20 miles 1 100.0 22.2 22.2 OB/Gyns Lake Astor 32102 1 Pediatricians 2 in 20 miles 1 100.0 20.1 20.1 Other Specialists OB/Gyns 2 in 20 miles 1 100.0 10.0 20.1 Hospitals Hospitals 1 in 20 miles 1 100.0 20.2 27.8 Urgent Care Facilities Urgent Care Facilities 1 in 20 miles 1 100.0 20.3 20.3 Walton Defuniak Spri... 32433 1 Hospitals 1 in 20 miles 1 100.0 23.9 31.1 Urgent Care Facilities 1 in 20 miles 1 100.0 24.1 33.2 Georgia Baldwin Milledgeville 31061 1 Urgent Care Facilities 1 in 20 miles 1 100.0 39.1 40.0 Laurens Dexter 31019 1 Urgent Care Facilities 1 in 20 miles 1 100.0 35.1 36.3 Putnam Eatonton 31024 1 Urgent Care Facilities 1 in 20 miles 1 100.0 22.5 22.6 Toombs Vidalia 30475 1 Urgent Care Facilities 1 in 20 miles 1 100.0 43.9 43.9 North Carolina Hertford Murfreesboro 27855 1 Urgent Care Facilities 1 in 20 miles 1 100.0 30.5 30.9 Virginia Northumberland Kilmarnock 22482 1 Urgent Care Facilities 1 in 20 miles 1 100.0 29.8 30.3 Washington Jefferson Chimacum 98325 1 Urgent Care Facilities 1 in 20 miles 1 100.0 20.8 20.8 Grand Totals 15 Urgent Care Facilities 1 in 20 miles 15 100.0 28.5 31.5 4 Hospitals 1 in 20 miles 4 100.0 22.5 26.9 2 Pediatricians 2 in 20 miles 2 100.0 10.3 21.2 OB/Gyns 2 in 20 miles 2 100.0 5.5 20.9 ©2023 Quest Analytics,LLC. Cigna Network Analysis-Employees Excluded from Analysis 51 Access Detail By Zip Code (Excluded from Analysis) Aprilzoz3 Employees Excluded from Analysis Created for... City of Miami Beach Zip Employee Code # Access Analysis "00000 1 Invalid Zip Codes Distance Method Grand Totals 1 Estimated Driving Distance Employee/Facility Groups All Employees Hospitals These records have been excluded from the analysis because of invalid zip codes.