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SERVICE AGREEMENT
Between
CITY OF MIAMI BEACH
and
HUMANA MEDICAL PLAN, INC., and
HUMANA HEALTH INSURANCE COMPANY
OF FLORIDA, INC.
for
HEALTH INSURANCE COVERAGE AND BENEFITS
INSURING CITY OF MIAMI BEACH EMPLOYEES
for
OCTOBER 1, 2004 - SEPTEMBER 31,2005
1A
This Agreement made and entered into as of this 1!iday of f}fR. I L , 2005, and is
intended to be effective retroactively as of the first day of October, 2004, by and between CITY
OF MIAMI BEACH, a political subdivision of the State of Florida, herein referred to as "City"
and
HUMANA MEDICAL PLAN, INC., and HUMANA HEALTH INSURANCE COMPANY
OF FLORIDA, INC., and each of their successors and assigns, hereinafter collectively referred
to as "HUMANA".
WITNESSETH, in consideration of the mutual terms, conditions, promises, covenants and
payments hereinafter set forth, City and HUMANA agree as follows:
ARTICLE 1
DEFINITIONS AND IDENTIFICATIONS
For the purposes of this Agreement and the various covenants, conditions, term and provisions
which follow, the definitions and identifications set forth below are assumed to be true and
correct and are agreed upon by the parties.
1.1 AFFILIATE: AFFILIATE means (a) a predecessor or successor ofa PERSON; or
(b) an entity under the control of any natural person who is active in the
management of the entity. The term "AFFILIATE" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents
who are active in the management of an AFFILIATE. The ownership HUMANA
by one PERSON of shares constituting a controlling interest in another PERSON,
or a pooling of equipment or income among PERSONS when not for fair market
value under an arm's length agreement, shall be a prima facie case that one
PERSON controls another PERSON. A PERSON who knowingly enters into a
joint venture with another PERSON who has been convicted of a PUBLIC
ENTITY CRIME in Florida during the preceding 36 months shall be considered
an AFFILIATE of such other PERSON.
1.2 CONTRACT ADMINISTRATOR: CONTRACT ADMINISTRATOR means
the City of Miami Beach Human Resources Director or such Director's designee.
In the administration of this Agreement, as contrasted with matters of policy, all
parties may rely upon instructions or determinations made by the CONTRACT
ADMINISTRATOR.
1.3 DEPARTMENT: DEPARTMENT means the Florida Department of
Management Services.
1.4 EMPLOYEES: EMPLOYEE shall mean the employees of the City of Miami
Beach and their covered dependents.
1.5 GROUP CONTRACTS: Group Contracts shall mean the contracts containing all
of the benefits available to an insured, which contracts are filed by HUMANA
with the Florida Department of Insurance.
1.6 HUMANA: HUMANA means (a) HUMANA MEDICAL PLAN, INC., and (b)
HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC., in each
case selected to provide health insurance benefits and coverage pursuant to the
terms of this Agreement, the RLI and the OFFER.
1.7 HMO PLAN: HMO PLAN means the HUMANA Health Maintenance
Organization "HMO" health msurance policy as set forth in the OFFER
submitted by HUMANA.
1.8 HUMANA Representative: HUMANA Representative means James Murdakes,
Account Executive and Vanessa Johnson-Cook, Group Services Representative,
at Humana Medical Plan Inc., or another individual designated by HUMANA.
1.9 MEMBERS: MEMBERS shall mean the EMPLOYEES who are members of one
of the PLANS.
1.10 OFFER: OFFER means the offer to provide health insurance benefits and
coverage to the EMPLOYEES that was prepared by HUMANA for the City of
Miami Beach.
1.11 PERSON: PERSON means any natural person or any entity organized under the
laws of any state or of the United States with the legal power to enter into a
binding contract and which bids or applies to bid on contracts let by a PUBLIC
ENTITY, or which otherwise transacts or applies to transact business with a
PUBLIC ENTITY. The term PERSON includes those officers, directors,
executives, partners, shareholders, employees, members, and agents who are
active in management of an entity.
1.12 PLANS: PLANS mean the HMO PLAN, the POS PLAN, the PPO PLAN and
any other plans for the payment of healthcare related services offered by
HUMANA to or for the benefit ofthe City of Miami Beach or the EMPLOYEES.
1.13 POS PLAN: POS PLAN means the HUMANA Point of Service health plan set
forth in the OFFER.
1.14 PPO PLAN: PPO PLAN means the HUMANA high and low options PPO Plan
set forth in the OFFER.
1.15 PRIMARY CARE PHYSICIAN: PRIMARY CARE PHYSICIAN means a
licensed practitioner of medicine under the HMO PLAN and POS PLAN.
1.16 PROVIDER: PROVIDER means a physician or facility providing health related
services pursuant to the terms of this Agreement, the RLI, and the OFFER.
1.17 PUBLIC ENTITY: PUBLIC ENTITY means the State of Florida, any of its
departments or agencies, or any political subdivision thereof.
1.18 PUBLIC ENTITY CRIME: PUBLIC ENTITY CRIME means a violation of
any state or federal law by a PERSON with respect to and directly related to the
transaction of business with any PUBLIC ENTITY or with an agency or political
subdivision of any other state or with the United States, including, but not limited
to, any bid or contract for goods or services, any lease for real property, or any
contract for the construction or repair of a public building or public work,
involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or
material misrepresentation.
1.19 RETIREE: means a former EMPLOYEE who has retired from the City of Miami
Beach, or with a full disability that has been accepted by the CITY, and is
drawing a benefit, and who has elected to participate in a HUMANA group plan.
ARTICLE 2
BACKGROUND
2.1 In order to establish the background, context and frame of reference for this
Agreement and to generally express the objectives and intentions ofthe respective
parties herein, the following statements, representations, and explanations shall be
accepted as predicates for the undertakings and commitments included within the
provisions which follow and may be relied upon by the parties as essential
elements of the mutual considerations upon which the Agreement is based, to wit:
Negotiations pertaining to the health insurance coverage and benefits to be
provided by HUMANA were undertaken between HUMANA and the City of
Miami Beach.
ARTICLE 3
TERM OF AGREEMENT
3.1 This Agreement shall commence on October 1, 2004 and shall terminate on
September 30, 2005 unless terminated sooner as provided herein.
ARTICLE 4
SELECTED POLICIES AND BENEFITS
4.1 HUMANA shall, in accordance with the General Provisions contained in Article
5 hereof, provide group health insurance benefits to the EMPLOYEES under the
following 3 types of insurance plans.
HMO PLAN PREMIUM RATES (HIGH)
Employee
Family
HMO PLAN PREMIUM RATES (LOW)
Employee
Family
PPO PLAN PREMIUM RATES (HIGH)
Employee
Family
PPO PLAN PREMIUM RATES (LOW)
Employee
Family
POS PLAN PREMIUM RATES
Employee
Family
$350.85
$869.63
$310.32
$769.15
$714.51
$1,753.01
$606.51
$1,488.06
$431.76
$1,071.01
4.2 (a) HUMANA agrees that the premium rates set forth in Section 4.1 are the
guaranteed maximum rates for the 12-month period of this Agreement, commencing
October 1, 2004
ARTICLE 5
GENERAL PROVISIONS
5.1. Open EnrollmentlEducational Sessions
The CITY will schedule the annual Open Enrollment sessions at various locations and times.
The CITY will provide HUMANA a complete list of Open Enrollment session locations and
times at least 30 days prior to the commencement of the first session HUMANA will provide
a representative to conduct benefit presentations at these sessions.
5.2. HMO. POS and PPO Plans Packets
HUMANA shall deliver complete enrollment packages (including an updated provider
directory) for each PLAN to the CONTRACT ADMINISTRATOR at least 30 days prior to
the start of open enrollment. Updates to the provider directories are available at the
employee's request through customer service. Employees may also obtain current provider
information through HUMANA'S web site (www.humana.com.)
5.3. Identification Cards - Following enrollment, the CITY shall provide batch-processed
enrollment forms. HUMANA shall, within 10 business days (plus 5 days mailing time)
send identification cards to EMPLOYEES. The CONTRACT ADMINISTRATOR must
notify HUMANA in writing of any EMPLOYEES who do not receive the identification
cards issued as a result of the initial enrollment process.
Upon HUMANA's receipt of such notice from the CONTRACT ADMINISTRATOR,
HUMANA shall, within 10 business days (plus 5 days mailing time) send the identification
cards to EMPLOYEES.
5.4 Claims Processing
HUMANA will "process" 90% of claims within 14 days of receipt. Receipt date is
measured from the date a clean claim is received to the date it is "Processed", meaning
paid or denied without requiring additional information from an external source.
5.5 Claim Quality:
(a) Financial Accuracy: HUMANA will pay all clean claims made by
MEMBERS under the PLANS in a manner that will assure that 99% of all
such claims are paid in the amounts required under the PLANS
("Financial Accuracy").
(b) Procedural Accuracy: HUMANA will pay all clean claims made by
MEMBERS under the PLANS using procedures that will assure that 97%
of all such claims are paid in accordance with the procedures required
under the PLANS ("Procedural Accuracy").
5.6 Telephone Responsiveness:
(a). HUMANA will be responsive to each and every telephone call received from an
EMPLOYEE on the customer service line established for the CITY. In
connection therewith, HUMANA agrees that: (i) 80% of all such telephone calls
will be answered by HUMANA ready to assist such EMPLOYEE within 20
seconds (average of all calls made) of the time such call is placed by such
EMPLOYEE (the "Timing Requirement"); and (ii) HUMANA's abandonment
rate on all such calls will be less than 3% (the "Abandonment Rate").
(b). To assure HUMANA is attaining the requirements set forth in Subsection (a)
above, HUMANA will deliver to the CITY, within 10 days of the end of each
quarter, specific reports and other measurements made by HUMANA to
demonstrate HUMANA compliance with the Timing Requirement and the
Abandonment Rate.
ARTICLE 6
TERM OF AGREEMENT
6.1 This Agreement shall commence on October 1, 2004 and terminate on September 30,
2005. The CITY administration and HUMANA have the option to renew this Agreement
annually upon mutual consent.
ARTICLE 7
PENALTIES
7.1 HUMANA agrees to meet the performance standards as described in Article V above
(the "Performance Standards") in providing administrative services to the CITY.
HUMANA shall place a total of 5% of the annual administration fees less commissions
at risk for failure to meet the Performance Standards. Performance results will be
reported annually to the CONTRACT ADMINISTRA TOR based upon service center
results, not client specific results, and payment of any penalties due to client will be made
following the end of the Plan year (which is the same as the term ofthe Agreement).
7.2 With respect to Financial Accuracy and Procedural Accuracy, data shall be obtained
through ongoing random audits based on a statistically valid sampling of all claims
presented for payment. For purposes of this Agreement all claims shall mean all claims
received by HUMANA'S service centers by members or providers. HUMANA shall not
be responsible for Performance Standards or any penalty described herein if during
implementation of the PLANS the CITY requests significant changes to the PLANS, or
in the event a benefit change notification is not received from the CITY on a timely
basis.
ARTICLE 8
NOTICES
8.1 Any notices or other communications required or permitted to be given or delivered
under this Agreement shall be in writing (unless otherwise specifically provided herein)
and shall be deemed to be duly given if delivered personally, by commercial overnight
courier or ifby certified or registered mail, postage prepaid, return receipt requested and
addressed as follows:
For HUMANA:
James Murdakes
Account Executive
3501 SW 160 Avenue, Building A, 2nd Floor
Miramar, FL 33027
305-626-5231
For CITY OF MIAMI BEACH:
Mayra D. Buttacavoli
Director of Human Resources & Risk Management
1700 Convention Center Dr
Miami Beach, Fl. 33139
305-673-7524
ARTICLE 9
PUBLIC ENTITY CRIMES ACT
9.1 In accordance with Section 287.133, Florida Statutes, HUMANA represents by means of
Exhibit B, attached hereto and made a part thereof, that it is not listed on the convicted
vendors list maintained by the state of Florida Department of General Services.
ARTICLE 10
ENTIRE AGREEMENT
10.1 The CITY and HUMANA recognize that in order to comply with applicable State laws,
HUMANA must file a document with the state of Florida Department of Financial
Services setting forth the benefits and coverage to be provided by HUMANA under the
terms of this Agreement, and this Agreement is subject to the Department of Financial
Services approval.
10.2 This Agreement incorporates and includes all prior negotiations, correspondence,
conversations, agreements, or understandings applicable to the matters contained herein;
and the parties agree that there are no commitments, agreements or understandings
concerning the subject matter of this Agreement that are not contained in this document.
Accordingly, the parties agree that no deviation from the terms hereof shall be predicated
upon any prior representations or agreements whether oral or written.
10.3 No modifications, amendments or alterations in the terms or conditions contained herein
shall be effective unless contained in a written document executed with the same
formality and of equal dignity herewith.
10.4 In the event that a conflict arises between this Agreement and the Group Health Plan
Policy, this Agreement shall be controlling.
10.5 Each of Humana Medical Plan, Inc. and Humana Health Insurance Company of Florida,
Inc. agree that each is jointly and severally liable for all obligations of HUMANA under
this Agreement.
ARTICLE 11
MODIFICATIONS AND AMENDMENTS
11.1 No modification, amendment, supplement to or waiver of this Agreement or any of its
provisions shall be binding upon the parties hereto unless made in writing and duly
signed by both parties.
11.2 A failure or delay of either party to this Agreement to enforce at any time any of
the provisions of this Agreement, or to exercise any option which is herein provided, or
to require at any time performance of any of the provisions hereof, shall in no way be
construed to be a waiver of such provision of this Agreement or shall not excuse the other
party's performance of such, nor affect any rights at a later time to enforce the provision.
ARTICLE 12
AMERICANS WITH DISABILITIES ACT
12.1 HUMANA warrants that its coverage exclusions and limitations on coverage are based
on underwriting criteria and risks, in conformance with the Americans with Disabilities
Act of 1991 (ADA), 42 D.S.C.S. 12101 et seq., and no attempt has been made to
circumvent the provisions of the ADA. HUMANA will administer the PLANS,
uniformly apply all coverage exclusions and limitations, and otherwise perform its
obligations under the Agreement in a manner consistent with the ADA.
ARTICLE 13
GOVERNING LA WI JURISDICTION
13.1 By entering into this Agreement, the City of Miami Beach and HUMANA
expressly waive any rights either party may have to a trial by jury of any civil
litigation related to, or rising out ofthis agreement.
13.2 The validity, construction and performance of this Agreement and the legal
relations among the parties to this Agreement shall be governed by and
construed in accordance with the laws ofthe State of Florida, without giving
effect to its conflict of law principles. The parties agree that the federal or
state courts sitting in Miami-Dade County, Florida, shall be the exclusive
courts of jurisdiction and venue for any litigation, special proceeding or other
proceeding as between the parties that may be brought, or arise out of, or in
connection with, or by reason ofthis Agreement.
Signed and agreed this /3?.Jb day of ft f R-I L- , 2005.
Humana Medical Plan, Inc. and
Humana Health Insurance Co. of Florida, Inc.
(collective HUM
Mayor
Attest:
Attest: (
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APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
AAJU(J~~ ?-y)7:J1)
I~ Date
RESOLUTION NO. 2004-25596
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ENTER INTO NEGOTIATIONS, AND IF
SUCCESSFUL, FURTHER AUTHORIZING RENEWAL WITH
HUMANA, THE CITY'S CURRENT PROVIDER OF GROUP
MEDICAL INSURANCE FOR EMPLOYEES, WITH A 4.44%
INCREASE FOR THE HIGH HMO & HIGH PPO AND NO
INCREASE FOR THE POS, LOW HMO AND LOW PPO PLANS,
FOR A ONE-YEAR PERIOD, EFFECTIVE ON OCTOBER 1, 2004,
FOR AN ESTIMATED ANNUAL AMOUNT NOT TO EXCEED
$14,000,000, WITH THE CITY'S OPTION TO RENEW FOR ONE
ADDITIONAL YEAR IF THE ANNUAL COMBINED INCREASE IS
LESS THAN 5%; AUTHORIZING THE ADMINISTRATION TO
RENEW WITH COMPBENEFITS, THE CITY'S CURRENT GROUP
DENTAL PROVIDER FOR EMPLOYEES, FOR A ONE-YEAR
PERIOD, EFFECTIVE ON OCTOBER 1, 2004, WITH NO
PREMIUM INCREASE AND AN ESTIMATED ANNUAL AMOUNT
NOT TO EXCEED $600,000, WITH THE CITY'S OPTION TO
RENEW FOR ONE ADDITIONAL YEAR IF THE ANNUAL
COMBINED INCREASE IS LESS THAN 3%; AUTHORIZING THE
ADMINISTRATION TO RENEW FOR THE YEAR 2004-05 WITH
FRINGE BENEFITS MANAGEMENT COMPANY TO
ADMINISTER THE CITY'S FLEXIBLE SPENDING PROGRAM
AND FOR TWO SUBSEQUENT ONE YEAR PERIODS AT THE
SAME PER-EMPLOYEE MONTHLY ADMINISTRATIVE FEE OF
$4.50, AS PROVIDED IN THE CITY'S CONTRACT WITH FRINGE
BENEFITS MANAGEMENT COMPANY OF OCTOBER 1, 2003;
AUTHORIZING THE ADMINISTRATION TO RENEW FOR THE
YEAR 2004-05 WITH THE COMPREHENSIVE COMPANIES, INC.
TO ADMINISTER THE CITY'S VOLUNTARY BENEFITS
PROGRAM FOR THOSE PLANS OFFERED TO EMPLOYEES AT
NO COST TO THE CITY, AND FOR SUBSEQUENT
CONSECUTIVE ONE YEAR RENEWAL TERMS, UNLESS
OTHERWISE TERMINATED AS PROVIDED IN THE CITY'S
CONTRACT WITH THE COMPREHENSIVE COMPANIES, INC.
OF OCTOBER 1, 2003.
WHEREAS, Hwnana, the City's current medical plan provider, has offered the City
renewal rates, effective on October 1, 2004, for a one-year period, which are a 4.4% increase for
the high option PPO and POS plans, and no increase for the POS plan and the low option HMO
and PPO plans; and
WHEREAS, CompBenefits, the City's current dental plan provider, has offered renewal
rates, effective on October I, 2004, for a one-year period, at no increase over the premiums
charged for 2003-2004; and
WHEREAS, Fringe Benefits Management Company, the City's current provider for
flexible spending programs, provided a two-year rate guarantee at the time its contract with the
City was executed in October 2003, and for two subsequent one year periods, at the same per-
employee monthly administrative fee of $4.50 ; and
WHEREAS, The Comprehensive Companies, Inc., the City's current broker for other
voluntary benefit plans that ,have no cost to the City, was renewed for 2003-2004, with
subsequent one year renewal tenns unless otherwise terminated; and
WHEREAS, the Administration recommends that the Mayor and City Commission
authorize the Administration to enter into negotiations and, if successful, authorize renewal with
Humana to provide Group Medical Insurance for employees and retirees, for a one-year perio~
effective on October 1, 2004, with the option to renew for one additional year if the combined
renewal increase is less than 5%; authorize renewal with CompBenefits to provide Group Dental
Insurance for employees and retirees, for a one-year period, effective October 1, 2004, at no
increase over the premiums for 2003-2004, with the option to renew for one additional year if the
combined renewal increase is less than 3%; authorize the renewal of the current contract with
Fringe Benefits Management Company, dated October 1, 2003, to provide flexible spending
programs for City employees for a second year, effective October I, 2004, and for two
subsequent one year periods, as provided in the contract; and authorize the renewal ofthe current
contract with The Comprehensive Companies, dated October 1, 2003, to provide volWltary
benefit plans, as selected by the City for a second year, effective October 1, 2004, and for
subsequent one year periods unless otherwise terminated; and
WHEREAS, these recommendations were presented to the Group Insurance Board on
J Wle 1, 2004 with the Board agreeing with the recommendations of the Administration.
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 authorize the Administration to enter into negotiations, and, if successful, further
authorize renewal with Humana, the City's current provider of Group Medical Insurance for
employees and retirees, with a 4.44% increase for the High HMO & High PPO and no increase
for the POS, Low HMO and Low PPO plans, for a one-year period, effective on October 1,
2004, for an estimated annual amount not to exceed $14,000,000, with the City's option to renew
for one additional year if the annual combined increase is less than 5%; authorize the
Administration to renew with CompBenefits, the City's current Group Dental provider for
employees and retirees, for a one-year period, effective on October 1, 2004, with no premiwn
increase and an estimated annual amount not to exceed $600,000, with the City's option to renew
for one additional year if the annual combined increase is less than 3%; authorize the
Administration to renew for the year 2004-05 with Fringe Benefits Management Company to
administer the City's flexible spending program, and for two subsequent one year periods at the
same per-employee monthly administrative fee of $4.50, as provided in the City's contract with
the Fringe Benefits Management Company of October 1, 2003; and authorize the Administration
to renew for the year 2004-05 with the Comprehensive Companies, Inc. to administer the City's
, ,
Voluntary Benefits program for those plans offered to employees at no cost to the City, and for
subsequent consecutive one-year renewal tenns, unless otherwise terminated, as provided in the
City's contract with The Comprehensive Companies, Inc. of October 1,2003.
PASSED AND ADOPTED this
9th
day of June
, 2004
ATTEST:
~\S~
t CITY CLERK
APPROVEDM 10
FORM & LANGUAGE
a FOR EXECUTION
'_I$.rocotoAl.IlESlGp ~_ _.cIoc
CITY OF MIAMI BEACH
COMMISSION' ITEM SUMMARY
~
.,.,..
Condensed Title:
Group Employee Benefits (medical. dental, flexible spending accounts and voluntary benefits) for plan
year beginning October 1, 2004.
Issue:
Should the City renew with Humana for group medical, CompBenefits for group dental, renew the
contract with Fringe Benefits Management Co, for the flexible spending program and renew the
contract with The Comprehensive Companies for voluntary benefits for City employees?
Item Summarv/Recommendatlon:
The City Administration recommends that the Commission accept the recommendations of the
Gallagher Benefits Services, the City's consultant for group health care for employees, and renew
with Humana for medical coverage with a 4.44% increase to the high option PPO and HMO and no
increase for the POS and low option PPO and HMO plans; renew with CompBenefits for dental
coverage with no increase in premium; renew the contract that was executed October 2003 with
Fringe Benefits Management for flexible spending programs for a second year with no increase to the
administrative fee; and renew the contract that was executed October 2003 with the Comprehensive
Companies to provide voluntary benefit programs to employees at no cost to the City.
Advlsorv Board Recommendation:
The Group Insurance Board agrees with the recommendations of the Administration and Gallagher
Benefit Services.
Financial Information:
Source of , .. Atridunt: ~ .. " " ;{ '~Ac'cO'unt~ . . i APproved
.
Funds: .f 7,000,000,00 Medical
, '.,
IF~J. , ::~; 300,000.00 Dental
; ;
,......~~ .~., 8,000.00 Flex. Spending
:', ::4:
;~o~,; 7,308,000.00
,. -
City Clerk's Office Legislative Tracking:
I Mayra Diaz Buttacavoli
51 n-efts:
~partm.ntplr.ctor'i
Assistant :cit)t'.anage,';
City Ma"ager .,i
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AGENDA ITEM
DATE
R7D
'Jf~'{
CITY OF MIAMI BEACH
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139
www.miamibeachll.gov
To:
From:
Subject:
COMMISSION MEMORANDUM
Mayor David Denner and
Members of the City Commission
Jorge M. Gonzalez \ . /'
City Manager a ~
Date: 6/09/04
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY
OF MIAMI BEACH, FLORIDA, AUTHORIZING THE ADMINISTRATION TO
ENTER INTO NEGOTIATIONS, AND IF SUCCESSFUL, FURTHER
AUTHORIZING RENEWAL WITH HUMANA, THE CITY'S CURRENT
PROVIDER OF GROUP MEDICAL INSURANCE FOR EMPLOYEES, WITH
A 4.44% INCREASE FOR THE HIGH HMO & HIGH PPO AND NO
INCREASE FOR THE POS, LOW HMO AND LOW PPO PLANS, FOR A
ONE-YEAR PERIOD, EFFECTIVF ON OCTOBER 1, 2004, FOR AN
ESTIMATED ANNUAL AMOUNT NOT TO EXCEED $14,000,000, WITH
THE CITY'S OPTION TO RENEW FOR ONE ADDITIONAL YEAR IF THE
ANNUAL COMBINED INCREASE IS LESS THAN 5%; AUTHORIZING THE
ADMINISTRATION TO RENEW WITH COMPBENEFITS, THE CITY'S
CURRENT GROUP DENTAL PROVIDER FOR EMPLOYEES, FOR A ONE-
YEAR PERIOD, EFFECTIVE ON OCTOBER 1, 2004, WITH NO PREMIUM
INCREASE AND AN ESTIMATED ANNUAL AMOUNT NOT TO EXCEED
$600,000, WITH THE CITY'S OPTION TO RENEW FOR ONE ADDITIONAL
YEAR IF THE ANNUAL COMBINED INCREASE IS LESS THAN 3%;
AUTHORIZING THE ADMINISTRATION TO RENEW FOR THE YEAR 2004-
05 WITH FRINGE BENEFITS MANAGEMENT COMPANY TO ADMINISTER
THE CITY'S FLEXIBLE SPENDING PROGRAM AND FOR TWO
SUBSEQUENT ONE YEAR PERIODS AT THE SAME PER-EMPLOYEE
MONTHLY ADMINISTRATIVE FEE OF $4.50, AS PROVIDED IN THE
CITY'S CONTRACT WITH THE FRINGE BENEFITS MANAGEMENT
COMPANY OF OCTOBER 1, 2003; AUTHORIZING THE
ADMINISTRATION TO RENEW FOR THE YEAR 2004-05 WITH THE
COMPREHENSIVE COMPANIES, INC. TO ADMINISTER THE CITY'S
VOLUNTARY BENEFITS PROGRAM FOR THOSE PLANS OFFERED TO
EMPLOYEES AT NO COST TO THE CITY, AND FOR SUBSEQUENT
CONSECUTIVE ONE YEAR RENEWAL TERMS, UNLESS OTHERWISE
TERMINATED AS PROVIDED IN THE CITY'S CONTRACT WITH THE
COMPREHENSIVE COMPANIES, INC. OF OCTOBER 1, 2003.
ADMINISTRATION RECOMMENDATION:
Adopt the Resolution.
ANALYSIS:
MEDICAL:
Humana, the City's current provider of Group Medical Insurance for its employees and
retirees, has offered renewal rates of 4.44% for the High Option HMO and PPO and no
increase for the POS and Low Option HMO and PPO, resulting in a straight line
percentage increase of 1.78%. This is a minimal increase in light of the upward trends that
continue to affect health insurance, with the nationwide averages being between 10 and
14%. The Administration recommends accepting the renewal rates offered and continuing
with the plan options and contribution percentages established and approved by
Commission for the plan year effective October 1, 2003. The High Option plans are
available at a contribution rate by the City of 50%. The Low Option plans are available to
Unclassified, Others, and GSA at a contribution level of 75% for employee coverage and
60% for family coverage. Participation in the Low plans by members of C.W.A. and
A.F.S.C.M.E. are subject to negotiation. When the new HMO and PPO low option plans
were introduced for the October 1,2002 plan year, C.W.A. and A.F.S.C.M.E. declined to
offer these plans to their members. The attached chart (Attachment A) indicates the new
monthly premiums for employees covered under the City's medical plan.
The City estimates that it will contribute an additional $ 553,000.00 to the Fraternal Order
of Police Health Trust for fiscal year 2004-05 and approximately $370,000.00 to the Florida
Fire Fighters Insurance Trust Fund as a result of this years successful negotiation with the
F.D.P. and the I.A.F.F.
DENTAL:
CompBenefits, the City's current provider of Group Dental Plans for its employees and
retirees, has offered renewal rates at no increase over the premiums established in the
contract effective October 1, 2003. The Administration recommends renewal with
CompBenefrts.
The City offers a Dental HMO and a Dental PPO, contributing 50% towards the premium.
Last year the City added a third plan - the Elite 400 - that is another PPO and available to
the groups Unclassified, Others and GSA. Members of the Fraternal Order of Police will
have the option of enrolling in the Elite plan this year (IAFF members have their own
coverage as part of their Trust). This plan provides higher benefits to employees, at a
higher cost. The City contributes 50% of the premium of the base PPO and employees
"buy up" if they wish to participate in this plan. Participation in the Elite 400 by members
of C.W .A. and A.F.S.C.M.E. is subject to negotiation. The attached chart (Attachment A)
indicates the monthly premiums.
FLEXIBLE SPENDING PROGRAM:
The City currently has a flexible spending program for members of the groups Unclassified
and Others. This program offers a medical spending account andlor a dependant care
account that allows employees to set aside pre-tax dollars, on a fiscal year basis, to assist
with healthcare expenses not covered under their health insurance and dependant care
related expenses as defined by the IRS. As a result of successful bargaining with F.O.P.,
I.A.F.F. and G.S.A., this program will be offered to these groups.
October 1 , 2003 a contract was established with Fringe Benefits Management Company to
administer the plans for a monthly per individual fee of $4.50 and for two subsequent one
year periods at the same per-employee monthly administrative fee. For the last two years,
and again this year, the City will pay this monthly administrative fee. The Administration
recommends continuing the current contract with Fringe Benefits Management Co.
VOLUNTARY BENEFITS:
The City currently offers several voluntary benefit plans to employees. These plans are
fully paid for by the employee; however the City allows the premiums to be payroll
deducted.
October 1, 2003 a contract was established with The Comprehensive Companies, Inc. to
administer the City's voluntary benefit program for the year, allowing subsequent
consecutive one year terms unless otherwise terminated as provided in the contract. The
City will continue to review various voluntary benefits and offer those that it feels are
valuable to its employees. The Administration recommends continuing the contract with
The Comprehensive Companies.
SUMMARY:
The City Administration recommends that the Commission accept the recommendations of
the Gallagher Benefits Services, the City's consultant for group health care for employees,
the recommendation of the Group Insurance Board, and renew with Humana for medical
coverage with a 4.44% increase to the high option PPO and HMO and no increase for the
POS and low option PPO and HMO plans; renew with CompBenefits for dental coverage
with no increase in premium; continue the contract that was executed October 2003 with
Fringe Benefits Management for flexible spending programs for a second year with no
administrative fee increase; and continue the contract that was executed October 2003
with the Comprehensive Companies to provide voluntary benefit programs to employees at
no cost to the City
JMG:MDB:ph
,_~E""""""_OI_-
MONTHLY RATES FOR GROUP EMPLOYEE MEDICAL AND DENTAL INSURANCE
OCTOBER 1, 2004
EMPLDftE IIONTHl Y RATES FOf! MElllCAL 1NSlH'lAHCE- - ..
CURRENT RAYEI NEW RATE
(THRU ~, EFFECTIVE 111t11114
MONTHLY MONTHLY
HIGH ~T1ON HMO HIGH OPTION HMO aTY COST TOTAL PREMIUM
EMPLOYEE (~, "67.111 EMPLOYEE (5O'Ilo) $115.<42 5 115.43 5 350 8$
FAMILY (50'lIo) 5416.33 FAMIl.Y(5O'Ilo) 5434.81 '. 5 434.12 5 86963
I
POI I'OS
EMPLOYEE (~) 5215.. EMPLOYEE (5O'Ilo) S2lS.. . 5 215.81 . 431.16
FAMILY (5O'Ilo) 153565 FAMlI. Y 150"1 $535.65 5 535.. . 1.011.31
IIOH OPTION ,PO HIGH OI'TION PI'O
EMPLOYEE (5O'Ilo) 1342.08 EMPLOYEE (5O'Ilo) 5367.25 5 357.2lS 5 714.51
FAMlLY(5O'Ilo) $138.24 FAMIlY (5O'Ilo) 1818.50 $ 818.51 $ 1.75301
LOW CPTION HIIO LOW 0I'Tl0H HMO
EMPLOYEE (35") $77.51 EMPLOYEE (21") $77.58 5 232.14 . 31032
FAM" Y (5O'Ilo) 1301.00 FAMLY (40\6) 5301.00 . 462.15 S 769.15
LOW OPTION ,PO LOW OPTION ,PO
EMPLOYEE (35") $151.63 aPLOYEE (2ft) 115U3 I 454.18 I 806.51
FAM" Y (5O'Ilo) 1692.40 FAMILY (40\6) S692.<<l 5 895.116 I l.olIll.06
IIONTHL Y RATES FOR DENTAL INSURANCE
CURRENT RATE -- ..
1C1i1l111D3-W3lMM 1CIID11D4.f13O/111
DMO(5O'Ilo) 0M0(5O'Ilo)
Empl~ 15.05 EmpIoy- $5.06 S 508 5 10.16
EmplOye. + 1 59.41 EmpI_ + 1 58.48 S 8.41 . 18.116
Flmily "2.33 Fnily $1233 I 12.33 S 24.1l6
PPO(5O'Ilo) PPO (50")
E~oyH 11135 e~ 11135 . I 11.35 I 22.70
E~'+1 52U8 e........,. + 1 S21. I 2UII I 43.78
FI!llIly 533.55 F...., 533.55 I 33.55 $ 87.10
PPO ELITE 400 PPO ELITE o4OCl(bu)' up Iran PPO Mi.)
E~ $18.23 Emp...,.. 111.23 I 11.35 I 29.51
E~+1 $35.15 Empl_ + 1 $35.15 I 21.89 I 57.04
F_ly 153.81 FMiIy 153.87 I 33.55 I 87.42
ATTACHMENT A
F:\HUMA\$all\GROUPINS\OPEN-ENR\OPEN -04\MONTHL Y MED-DENT for 04-05 reso.xls
. .
~."."..'
...
Gallagher Benefit Services, Jne.
A Subsidiary of Arthur J. Gallagher Ii: Co.
April 20, 2004
Ms. Pat Hipple, Human Resources Administrator
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
Re: Medical, Dental & Flex Plan Renewals
Dear Pat,
Gallager Benefit Services recommends the City renew with Humana effective October 1,
2004, maintaining the existing five plans with an increase of 4.44% applied to the High
Option plans and no change in rates to the Low Option Plans. The addition of alternate
plans and the inclusion of drug formularies continue to reflect in improved experience in
a time of medical and drug inflation in the mid to high teens.
CompBenefits, the City's dental carrier has agreed to continue the current three dental
offerings at current rates and we recommend renewal. The inclusion of a third plan
during the last renewal, prohibited CompBenefits from offering a multi-year rate
guarantee. With six months of experience now available, we will continue to negotiate a
multi year contract.
The Flexible Spending Account manager, Fringe Benefit is renewing the second year of a
two year rate guarantee.
We appreciate the opportunity to work with the City and it's staff and we wit be happy to
answer any questions that ay arise.
One Boca Place
2255 Glades Road, Suite 400 E
Boca Raton. Fl 33431
561.995.6706
Fax 561.995.6708
www.ajg.com
K HUMANA.
, "
..;
Renewal Underwriting Decision
Marketing Exhibit
Case Name: City of Miami Beach
Affllia~onlCustomer Number: 80156.80638.60355.64298.604637.65311.98346, N1323
ProduClS: HMO. PPO & POS
Market: South Florida
Effective Oate: 10/112004
Mar1leting Representative: Brian Garrison
Broker: Gallagher. Richards. Shell
Plan Summary and Rate.
Group number: 91341,64137,80131, 801M
Plan option: High HMO . Plan 02130..
Employee Only
Employee + Family
Tol.1 Employees;
Total Members:
Currenl Rates
$ 335.93
$ 832.66
Group number: 8015&
Plan option: Low HMO - Pliln 02127
Employee Only
Employee. Famify
Total Employees:
Total Members:
Currenl Rates
$ 310.32
$ 769.15
Group number: 10355
Plan option: POS . Plan 141431
Employee Only
Employee + Family
. Total Employees:.
Total Members:
Current R.tes
S 431.78
S 1.071.31
Group number: 15311,14291
Plan option: High PPO . Plan 061712
Employee Only
Employ.e . Family
Total Employees:.
Total Members:
Current R.tes
S 884.13
S 1.878.49
Group number: N1323
Plen option: Low PPO . Plan 181783
Employee Only
Employee. FamHy
Total Employees:.
I olal MemOirs:
Current Rates
S 806.51
S 1.468.06
~
428
>>2
808
1742
D!W2!.!1
78
29
107
183
~
25
11
58
119
~
305
ill
499
773
~
44
i!
68
101
Renewal Ac1lon
4.44%
Renewal Rates
$ 350.15
$ 8&9.&3
Re"ewal Action
0.00%
Renewal R.tls
$ 310.32
S 7&9.15
Renewel Action
0.00%
Re~al Rates
S 431.7&
S 1,071.31
Ren-.I Action
".44%
Renewal Rales
S 714.51
S 1,753.01
Renewal Action
0.00%
ReIllWI' Rates
S 60&.51
S 1,488.06
. A portion of tne singleffamily population above qualifies for Medicare ClIVe-out rales as provided below:
2/1212004