2000-23901 RESO
RESOLUTION NO. 2000-23901
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ISSUE A REQUEST FOR PROPOSALS
(RFP) FOR GROUP MEDICAL INSURANCE FOR THE CITY OF
MIAMI BEACH EMPLOYEES' BENEFIT PLAN, FOR A
ONE- YEAR PERIOD, WITH THREE (3), ONE-YEAR RENEWAL
OPTIONS.
WHEREAS, the City of Miami Beach Employees' Benefit Plan provides for Group Medical
Managed Care Insurance for eligible employees and retirees; and
WHEREAS, on January 26, 2000, the City obtained the services of Siver Insurance Consultants
to analyze the current Group Medical Insurance for the City of Miami Beach Employee's Plan; and
WHEREAS, Siver Insurance Consultants believes that Humana's rate increases for Fiscal Year
2000-2001 will be substantial; and
WHEREAS, Siver Insurance Consultants encourages the City to market the Group Medical Plan
this year looking at both fully-insured and self-insured financial arrangements; and
WHEREAS, the Administration, with the approval of the Group Insurance Board and the Health
Advisory Committee, has drafted a Request for Proposals (RFP) for providing said services.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND THE CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission
hereby authorize the Administration to issue a Request for Proposals (RFP) for Group Medical Insurance
for the City of Miami Beach Employees' Benefit Plan, for a one-year period, with three (3), one-year
renewal options.
ADOPTED this 10th day of May
,2000.
!Jf!
Mayor
ATTEST:
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City Clerk
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APPROVED AS TO
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CITY OF MIAMI BEACH
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139
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COMMISSION MEMORANDUM NO. 3~~ -0'0
TO:
Mayor Neisen o. Kasdin and
Members of the City Commission
Lawrence A. Levy W-
City Manager ~
DATE: May 10,2000
FROM:
SUBJECT:
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE
CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ISSUE A REQUEST FOR PROPOSALS (RFP) FOR
GROUP MEDICAL INSURANCE FOR THE CITY OF MIAMI BEACH
EMPLOYEES' BENEFIT PLAN, FOR A ONE-YEAR PERIOD, WITH
THREE (3), ONE- YEAR RENEWAL OPTIONS.
ADMINISTRATION RECOMMENDATION:
Adopt the Resolution.
BACKGROUND:
The City of Miami Beach Employees' Benefit Plan provides Group Medical insurance benefits to
eligible employees and retirees. The City currently contracts with Humana for the Group Medical
Insurance.
For the contract year October 1999-00, Humana increased premium rates by 18.31 % for the PPO,
and POS, and 21.7% for the HMO. As a result of this increase in Group Medical Rates, on January
26, 2000, the City obtained the services of Siver Insurance Consultants to review the current Group
Medical Plan to determine the feasibility of self insurance and to assist the Administration with the
preparation of an RFP for Fiscal Year 2000-2001.
Siver Insurance Consultants has completed their initial analysis of the current Group Medical Plan.
The analysis indicates that Humana's rate increases for Fiscal Year 2000-2001 will be substantial and
very possibly higher than previous years. It is estimated that the increase for the HMO will be 24%
and 33% for the PPO. Siver encourages the City to market the Group Medical Plan this year,
looking at both fully-insured and self-funded financial agreements.
The issuance of an RFP will allow the City to move forward with the selection of an insurance
AGENDA ITEM L' U
DATE 5-lG - OD
planes) that will provide Group Managed Medical Care Insurance under the City of Miami Beach
Employees' Benefit Plan. The Administration has met with the Group Insurance Board and Health
Advisory Committee and has their concurrence.
CONCLUSION:
The City Administration recommends that the City Commission authorize the Administration to
issue a Request for Proposals for Group Medical Insurance for the City of Miami Beach Employees'
Benefit Plan, for a one-year period, with three (3), one-year renewal options.
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CITY OF MIAMI BEACH
RFP NO. 97-99/00
REQUEST FOR PROPOSALS FOR
GROUP MEDICAL INSURANCE
PRE-PROPOSAL CONFERENCE
FRIDAY, JUNE 9, 2000 AT 10:00 AM
FIRST FLOOR CONFERENCE ROOM
CITY HALL, 1700 CONVENTION CENTER DRIVE, MIAMI BEACH, FLORIDA
PROPOSALS ARE DUE AT THE ADDRESS SHOWN BELOW
NO LATER THAN JULY 7. 2000 AT 3:00 PM
CITY OF MIAMI BEACH
PROCUREMENT DIVISION
1700 CONVENTION CENTER DRIVE, THIRD FLOOR
MIAMI BEACH, FLORIDA 33139
PHONE: (305) 673-7490
FAX: (305) 673-7851
RFP NO.: 97-99/00
DATE: OS/25/00
1
CITY OF MIAMI BEACH
CITY OF MAMI
BEACH
1700 CONVENTION CENTER DRIVE, MIAMI BEACH, FLORIDA 33139
http:\\ci.miami-beach.fI.us
PROCUREMENT DIVISION
Telephone (305) 673-7490
facsimile (305) 673-7851
CITY OF MIAMI BEACH
RFP NO. 97-99/00
Sealed proposals will be received by the City of Miami Beach Procurement Director, 1700 Convention Center Drive,
Miami Beach, Florida, 33139, until 3:00 P.M. on July 7, 2000 for the following:
GROUP MEDICAL INSURANCE
Scope of Services: To provide coverage and services for the Group Medical Plan, Flex Plan Administration and to offer
Voluntary Products for its employees on either a pre-tax or post-tax payroll deduction basis depending on IRS Section
125 rules for the employees and retirees of the City of Miami Beach. Additionally, the City desires a separate proposal
that offers the Group Medical Benefit to Domestic Partners.
Any proposal received after the time and date specified will be returned to the proposer unopened. The responsibility
for sumitting a bid/proposal before the stated time and date is solely strictly the responsibility of the proposer. The city
is not responsible for delays caused by mail, courier service, including U.S. Mail, or any other occurrence.
An OPTIONAL Pre-Proposal Conference is scheduled for 10:00 a.m. on June 9, 2000, at City Hall, First Floor
Conference Room, 1700 Convention Center Drive, Miami Beach, Florida.
Package request fonns are available by calling City of Miami Beach Procurement Division's DemandStar.com system
at (407) 975-3227 and requesting Document #973. Many packages can be downloaded from the Internet. Check the
City's site at http://www.cLmiami-beach.f1.us for download availability and any applicable fees. Vendors registered with
DemandStar.com can download packages at no cost from their website - http://www.demandstar.com.
You are hereby advised that this RFP is subject to the "Cone of Silence," in accordance with Ordinance No. 99-3164.
The City of Miami Beach, may at its sole and absolute discretion, reject any and all, or parts of any and all, responses;
re-advertise this RFP; postpone or cancel, at any time, this RFP process; or waive any irregularities in this RFP or in
the responses received as a result of this RFP, as deemed to be in the best interest of the City of Miami Beach.
~-7 ---'
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Gus Lopez, CPPO
Pro~urement Director
RFP NO.: 97-99/00
DATE: OS/25/00
2
CITY OF MIAMI BEACH
CITY OF MIAMI BEACH
1700 CONVENTION CENTER DRIVE, MIAMI BEACH, FLORIDA 33139
http:\\ci.miaml-beach.f1.us
PROCUREMENT DIVISION
Telephone (305) 673-7490
Facsimile (305) 673-7851
I NOTICE TO PROSPECTIVE BIDDERS
GROUP MEDICAL INSURANCE
RFP # 97-99/00
NO BID
If not submitting a bid at this time, please detach this sheet from the bid documents,
complete the information requested, and return to the address listed above.
NO BID SUBMITTED FOR REASON(S) CHECKED AND/OR INDICATED:
D Our company does not handle this type of product/service.
D We cannot meet the specifications nor provide an alternate equal product.
D Our company is simply not interested in bidding at this time.
D Due to prior commitments, I was unable to attend pre-proposal meeting.
D OTHER. (Please specify)
We do D do not D want to be retained on your mailing list for future bids for the type or
product and/or service.
Signature:
Title:
Company:
Note: Failure to respond, either by submitting a bid or this completed form, may result in your
company being removed from the City's bid list.
RFP NO.: 97-99/00
DATE: OS/25/00
3
CITY OF MIAMI BEACH
TABLE OF CONTENTS
SECTION
PAGE NO.
I. INTRODUCTION
A. Background
B. Term of Contract
C. Definitions
D. Separation and Distribution
E. Role of Consultant
F. Diskette
6
6
6-7
7
7
7
II. OVERVIEW AND PROPOSAL PROCEDURES
A. RFP Timetable
B. Proposal Submission
C. Pre-Proposal Conference
D. Contacts/Additional Information/Addenda
E. Modification/Withdrawal of Proposals
F. RFP Postponement/Cancellation/Rejection
G. Cost Incurred by Proposers
H. Vendor Application
I. Exceptions to RFP
J. Sunshine Law
K. Negotiations
L. Protest Procedure
M. Rules: Regulations: Licensing Requirements
N. Default
O. Conflict of Interest
P. Proposer's Responsibility
Q. Relation of City
R. Public Entity Crime
8
8
9
9
9
9
10
10
10
10
10-11
11
11
11
11
12
12
12
III. SCOPE OF SERVICES
A. Scope
B. Medical Proposals
C. Alternative 1 & 2
D. Participant Eligibility
E. Domestic Partners
F. Plan Contributions
13
13
13
14
15
15-16
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DATE: OS/25/00
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CITY OF MIAMI BEACH
IV. PROPOSAL FORMAT
A. Contents of Proposal
B. Minimum Qualifications
17
18
V. EVALUATION/SELECTION PROCESS; CRITERIA FOR EVALUATION 19-20
VI. GENERAL PROVISIONS
A. Assignment
B. Indemnification
C. Termination for Default
D. Termination of Convenience of the City
21
21
21
22
VII. ATTACHMENTS
23
A. Plan Summaries
B. Premiums
C. Cone of Silence, Ordinance No. 99-3164
D. Employee Census (diskette)
E. Claim Loss Experience
F. Model Program for Claims Administration Service for Self-Insured Plan and
Flexible Spending Account
G. Model Program for Stop-Loss Insurance
H. Model Program for Group Medical for Fully-Insured Plan
I. Proposal Forms for Claims Administrative Services for Self-Insured Plan and
Administrative Services for Flexible Spending Account
J. Proposal Forms for Stop-Loss Insurance
K. Proposal Forms for Group Medical for Fully-Insured Plan
L. Debarment, Ordinance No. 2000-3234
M. Regulating Granting of Annual Leave, Ordinance No. 1335
N. Granting and Computation of Annual Leave, Ordinance No. 1613
VIII. ADDITIONAL DOCUMENTS TO BE COMPLETED
A. Acknowledgment of Addenda
B. Declaration
C. Questionnaire
RFP NO.: 97-99/00
DATE: OS/25/00
5
CITY OF MIAMI BEACH
ACTION I - INTRODUCTION
A. BACKGROUND
The City of Miami Beach (hereinafter referred to as "th~ City") employs approximately 1,700
employees, the majority of which live in Dade County and Broward County. The City has
approximately 1,300 retired employees, of which about half live in the South Florida area and the
majority of the other half live in other areas of Florida. However, there is a small population of
retirees living in other areas of the United States.
The City currently contracts with Humana for the Group Managed Medical Care. The plan is fully
insured and experience rated. The City has contracted with Humana for the Group Managed Medical
Care since November 1, 1987. The current contract is in effect through September 30,2000.
The City currently offers Managed Care Medical (PPO), Point of Service (POS), HMO and
Medicare Supplement Plans. The PPO, POS and HMO Plans are available to all full-time eligible
employees; all four plans are available to retirees. There are two exceptions:
1. Effective October 1, 1986, approximately 200 employees (all members of the fire fighters'
bargaining unit, and some unclassified fire management employees), have had medical insurance
coverage provided by the Florida Fire Fighters Health Insurance Trust Plan; and
2. Effective January 1, 1991, approximately 300 employees (all members of the police officers'
bargaining unit, and some unclassified police management employees) have had medical
insurance coverage provided by the Miami Beach Fraternal Order of Police Health Trust.
Presently, the City has 193 in the Fire Fighters Health Insurance Trust plan and 275 members
in the Miami Beach Fraternal Order of Police Health Trust plan.
The current effective date of October 1 coincides with the City's fiscal year. The fiscal year budget
process requires insurance rates for the next plan year is received no later than March 2000.
B. TERM OF CONTRACT:
The contract term requested in connection with this RFP will be from October 1, 2000 to September
30,2001 (12 months) with three one-year options to renew.
C. DEFINITIONS AS USED IN THIS RFP
"Administrative Services Only (ASO)" means medical benefits provided by the City on an
uninsured basis, with Administrative Services provided on a fee basis. The administrator provides
services including, but not limited to, actuarial, claim payment, claim control, plan description, etc.
but has no insurance risk/liability for the program.
6
RFP NO.: 97-99/00 CITY OF MIAMI BEACH
DATE: OS/25/00
"Claims Administrative Services" refers to claims adjudication and associated services performed
by an insurer or third party administrator (TP A).
"Excess Stop-loss Insurance" means that an im:urer accepts all or part of the risk of loss above a
certain limit. Specific stop-loss is the negotiated percentage of the excess on every claim above a
certain amount. Aggregate stop-loss is calculated after a certain amount has been paid on all claims,
in a policy year, the insurer would pay a negotiated percentage of the remaining claims.
"Fully-Insured Plan" means a group health care plan funding arrangement in which the group
policyholder makes monthly premium payments to the organization that provides the health care
coverage, and the insurer bears all risks.
"Self-funded" means the Plan assumes direct and ultimate responsibility for providing plan benefits
with specific stop-loss and aggregate coverage to limit the Plan's exposure.
D. SEPARATION AND DISTRIBUTION
This RFP has been designed for transmittal as a complete document to interested parties. It is
recommended that it not be separated, but that it is reproduced in its entirety as additional
distribution might dictate.
E. ROLE OF CONSULTANT
The City retains Siver Insurance Management Consultants as independent risk and insurance
management consultants. Siver acts solely in its capacity as consultant. The consultant does not
participate in commissions from any insurance company, agent or broker, nor does it accept any
income from other than its clients.
This does not preclude payment of commissions to an agent. However, commissions should be
limited to a maximum of 15% of fixed costs or 5% of aggregate premiums, whichever is less, and
the amount of commissions should be clearly stated in the proposal response.
F. DISKETTE
A diskette containing the census in Microsoft Excel format is included for your convenience.
RFP NO.: 97-99/00
DATE: OS/25/00
7
CITY OF MIAMI BEACH
SECTION II - OVERVIEW AND PROPOSAL PROCEDURES
A. RFP TIMET ABLE
The anticipated schedule for this RFP and contract approval is as follows. All dates listed below are
tentative and subject to change.
RFP issued:
May 23, 2000
Deadline for receipt of questions
June 23, 2000
Pre-Proposal Conference
June 9, 2000 at 10:00 am
Deadline for receipt of proposals:
July 7,2000 at 3:00 PM
Evaluation committee meeting
Week of August 7, 2000
Commission approval and authorization
of negotiations
September 13, 2000
Contract negotiations
September 20, 2000
Projected award date
September 27, 2000
Projected contract start date:
October 1,2000
B. PROPOSAL SUBMISSION
An original and ten (10) copies of complete proposal must be received by July 7, 2000 at 3:00 PM
and will be opened on that day at that time. The original and all copies must be submitted to the
Procurement Division in a sealed envelope or container stating on the outside the proposer's name,
address, telephone number, RFP number and title, and proposal due date.
The responsibility for submitting a response to this RFP to the Procurement Division on or before
the stated time and date will be solely and strictly that of the proposer. The City will in no way be
responsible for delays caused by the U.S. Post Office or caused by any other entity or by any
occurrence. Proposals received after the proposal due date and time will not be accepted and will
not be considered.
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DATE: OS/25/00
8
CITY OF MIAMI BEACH
C. PRE-PROPOSAL CONFERENCE
A pre-proposal conference will be held on June 9, 2000 at 10:00 A.M., in the First Floor
Conference Room of City Hall, 1700 Convention Center Drive, Miami Beach, Florida.
D. CONTACT PERSON/ADDITIONAL INFORMATION/ADDENDA
The contact person for this RFP is the Procurement Director at (305) 673-7490. Proposers are
advised that from the date of release of this RFP until award of the contract, no contact with City
personnel related to this RFP is permitted, except as authorized by the contact person. Any such
unauthorized contact may result in the disqualification of the proposer's submittal.
Requests for additional information or clarifications must be made in writing to the Procurement
Director no later than the date specified in the RFP timetable. Facsimiles will be accepted at (305)
673-7851.
The City will issue replies to inquiries and any other corrections or amendments it deems necessary
in written addenda issued prior to the deadline for responding to the RFP. Proposers should not rely
on representations, statements, or explanations other than those made in this RFP or in any
addendum to this RFP. Proposers are required to acknowledge the number of addenda received as
part of their proposals. The proposer should verify with the Procurement Division prior to
submitting a proposal that all addenda have been received.
E. MODIFICA TIONIWITHDRA W ALS OF PROPOSALS
A proposer may submit a modified proposal to replace all or any portion of a previously submitted
proposal up until the proposal due date and time. Modifications received after the proposal due date
and time will not be considered.
Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the proposal
due date or after expiration of one-hundred-twenty (120) calendar days from the opening of
proposals without a contract award. Letters of withdrawal received after the proposal due date and
before said expiration date and letters of withdrawal received after contract award will not be
considered.
F. RFP POSTPONEMENT/CANCELLATION/REJECTION
The City may, at its sole and absolute discretion, reject any and all, or parts of any and all, proposals;
fe-advertise this RFP; postpone or cancel, at any time, this RFP process; or waive any irregularities
in this RFP or in any proposals received as a result of this RFP.
RFP NO.: 97-99/00
DATE: OS/25/00
9
CITY OF MIAMI BEACH
G. COST INCURRED BY PROPOSERS
All expenses involved with the preparation and submission of proposals to the City, or any work
performed in connection therewith, shall be the sole responsibility of the proposer(s) and not be
reimbursed by the City.
H. VENDOR APPLICATION
Prospective proposers should register with the DemandStar.com (the City's Vendor Database
Management firm); this will facilitate the receipt of future notices of solicitations when they are
issued. Potential proposers may contact DemandStar.com at (800) 711-1712 or register on-line at
www.demandstar.com.
It is the responsibility of the proposer to inform DemandStar.com concerning any changes, such as
new address, telephone number, or commodities.
I. EXCEPTIONS TO RFP
Proposers must clearly indicate any exceptions they wish to take to any of the terms in this RFP, and
outline what alternative is being offered. The City, after completing evaluations, may accept or
reject the exceptions. In cases in which exceptions are rejected, the City may require the proposer
to furnish the services or goods originally described, or negotiate an alternative acceptable to the
City.
J. SUNSHINE LAW
Proposers are hereby notified that all information submitted as part of a response to this RFP will
be available for public inspection after opening of proposals, in compliance with Chapter 286,
Florida Statutes, known as the "Government in the Sunshine Law".
K. NEGOTIATIONS
The City may award a contract on the basis of initial offers received, without discussion, or may
require proposers to give oral presentations based on their proposals. The City reserves the right to
enter into negotiations with the selected proposer, and if the City and the selected proposer cannot
negotiate a mutually acceptable contract, the City may terminate the negotiations and begin
negotiations with the next selected proposer. This process may continue until a contract has been
executed or all proposals have been rejected. No proposer shall have any rights in the subject project
RFP NO.: 97-99/00
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CITY OF MIAMI BEACH
or property or against the City arising from such negotiations.
L. PROTEST PROCEDURE
Proposers that are not selected may protest any recommendations for contract award by sending a
formal protest letter to the Procurement Director, which letter must be received no later than 5
calendar days after award by the City Commission. The Procurement Director will notify the
protester of the cost and time necessary for a written reply, and all costs accruing to an award
challenge shall be assumed by the protester. Any protests received after 5 calendar days from
contract award by the City Commission will not be considered, and the basis or bases for said protest
shall be deemed to have been waived by the protester.
M. RULES; REGULATIONS; LICENSING REQUIREMENTS
Proposers are expected to be familiar with and comply with all Federal, State and local laws,
ordinances, codes, and regulations that may in any way affect the services offered, including the
Americans with Disabilities Act, Title VII of the Civil Rights Act, the EEOC Uniform Guidelines,
and all EEOC regulations and guidelines. Ignorance on the part of the proposer will in no way
relieve it from responsibility for compliance.
N. DEF AUL T
Failure or refusal of a proposer to execute a contract upon award by the City Commission, or
untimely withdrawal of a proposal before such award is made and approved, may result in forfeiture
of that portion of any proposal surety required as liquidated damages to the City; where surety is
not required, such failure may result in a claim for damages by the City and may be grounds for
removing the proposer from the City's vendor list.
O. CONFLICT OF INTEREST
All proposers must disclose with their proposal the name(s) of any officer, director, agent, or
immediate family member (spouse, parent, sibling, child) who is also an employee of the City of
Miami Beach. Further, all proposers must disclose the name of any City employee who owns,
either directly or indirectly, an interest often (10%) percent or more in the proposer or any of its
affiliates.
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DATE: OS/25/00
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CITY OF MIAMI BEACH
P. PROPOSER'S RESPONSIBILITY
Before submitting a proposal, each proposer shall make all investigations and examinations
necessary to ascertain all conditions and requirements affecting the full performance of the contract.
Ignorance of such conditions and requirements resulting from failure to make such investigations
and examinations will not relieve the successful proposer from any obligation to comply with every
detail and with all provisions and requirements of the contract documents, or will be accepted as a
basis for any claim whatsoever for any monetary consideration on the part of the proposer.
Q. RELATION OF CITY
It is the intent of the parties hereto that the successful proposer be legally considered to be an
independent contractor and that neither the proposer nor the proposer's employees and agents shall,
under any circumstances, be considered employees or agents of the City.
R. PUBLIC ENTITY CRIME (PEC)
A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crimes may not submit a bid on a contract to provide any goods or services to a public
entity, may not submit a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real property to public entity, may
not be awarded or perform work as a contractor, supplier, sub-contractor, or consultant under a
contract with a public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Sec. 287.017, for CATEGORY TWO for a period of36 months from
the date of being placed on the convicted vendor list.
RFP NO.: 97-99/00
DATE: OS/25/00
12
CITY OF MIAMI BEACH
SECTION III - SCOPE OF SERVICES
A. SCOPE OF SERVICES
This Request for Proposals (hereinafter RFP) is prepared to solicit proposals to provide coverage and
services for the Group Medical Plan, Flex Plan Administration and to offer Voluntary Products for
its employees on either a pre-tax or post-tax payroll deduction basis depending on IRS Section 125
rules for the employees and retirees of the City of Miami Beach (hereinafter the City). It is the
intention of the City to select one or more vendors of benefits and specific insurance products from
the selected vendor's portfolio for solicitation to its employees and retirees.
Carve-out programs for management of Prescriptions Drugs and or Mental Health and Substance
Abuse will also be considered. Services and/or coverage proposed must be available on a
standalone basis. The City requires self-billing of premiums and/or fees.
The City is looking at a plan year beginning October 1,2000 and ending September 30, 2001. The
City may consider changing the contract dates due to time constraints. The City desires a one year
contract with the option to renew for three additional one-year periods. Additional consideration will
be given to those proposals, which include a full time on-site representative. Any costs associated
with the provision of the on-site representative should be clearly stated in the cost of the proposal
This RFP solicits proposals for a Group Medical Plan on both a fully-insured basis, and self-funded
basis to include specific and aggregate stop-loss insurance for medical claims.
Medical proposals should be submitted based on one or more of the following alternatives.
Proposers are not limited to the number of proposals submitted, as long as they are within the
specified parameters. The City's current Group Medical Plan is delivered through a PPO, POS and
HMO managed care arrangement. The City desires to offer similar type plans to the employees and
retirees. The City will consider the following funding alternatives:
Alternative No.1: A bundled Administrative Services Only (ASO)ffhird Party Administrator
(TP A) self-insurance program including specific and aggregate excess insurance, claims
administration, utilization review, medical case management, managed drug program, managed
mental health and substance abuse program, wellness program and network access. Attachments F
& G describe the required services. Complete the Proposal Forms under Attachments I & J.
Alternative No.2: A fully-insured program including network access, utilization review, medical
case management, managed drug program, managed mental health and substance abuse program and
wellness program. Attachment H describes the required services. Complete the Proposal Forms
under Attachment K.
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DATE: OS/25/00
13
CITY OF MIAMI BEACH
Those providing proposals for Stop Loss Insurance only: Refer to required services
underAttachment G and complete the Proposal Forms provided under Attachment J.
Those providing proposals for TP A Services only:
Those providing proposals for Flex Administration
Participant Eligibility
Classified:
This category includes all civil service employees, who are all bargaining unit
(union) employees and some non-bargaining unit (t10thers") employees. An
employee must be full-time (work 30 or more hours per week) and be Original
Probationary or Regular Status.
Eligibility for coverage begins after 90 consecutive days of employment. For
classified employees rehired with civil service rights (within one year of previous
resignation or layoff), employees are eligible for coverage on the date of hire.
Those classified employees whose positions are bargained by the International
Association of Fire Fighters (IAFF) and the Fraternal Order of Police (FOP) are not
eligible for Group Managed Care Medical Plan, Point of Service Plan, or HMO Plan
coverage sponsored by the City.
Unclassified: This category includes all non-civil service employees, including professional and
management. The mayor and commissioners are also included. An employee must
be full-time (work 30 or more hours per week) and be Unclassified Status and is
eligible for coverage upon date of hire.
Those non-bargaining unit management employees who elected medical coverage
with the Florida Fire Fighters Health Insurance Trust Plan and the Fraternal Order
of Police (FOP) are not eligible for Group Managed Care Medical (PPO) Plan,
Point of Service (PaS) Plan, or HMO coverage sponsored by the City.
Retirees:
This category includes all retirees currently receiving a pension benefit from one of
the City's defined benefit or defined contribution pension plans, except those who
retired from positions bargained for by the IAFF, the FOP and who were covered
by the Florida Fire Fighters Health Insurance Trust Plan or the Miami Beach
Fraternal Order of Police Health Trust as employees.
The surviving dependent(s) ofa deceased covered retiree or employee is eligible if:
(1) will be receiving a pension benefit, and (2) was covered as a dependent by the
retiree or employee.
RFP NO.: 97-99/00
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CITY OF MIAMI BEACH
Retirees may elect coverage for themselves and their dependent(s) on or after the
effective date of pension benefit commencement. Retirees are required to enroll in
Medicare Part B and, if eligible, Part A. There are some retirees and widows of
retirees who are of Medicare eligibility age, but do not participate in Medicare Part
A (hospitalization). They are ineligible for Part A because they have never
participated in the Social Security system. Less than 20 retirees are in this situation.
Pension Bd
Employees:
The City also has two Pension Boards and offers medical coverage to their office
employees upon date of hire with the City and employee sharing the cost 50%/50%,
for both employee only coverage and for family [employees and eligible
dependent( s)].
Their claims experience is pooled together with the employees' and retirees' claim
experience. Their premium costs and benefits shall be the same as the employees
and retirees.
We need a separate group number to be issued for the Pension Board office
employees.
Presently, there are 6 employees working for the Pension Boards.
Domestic Partners (Optional Quote)
The City desires a separate proposal that offers the Group Medical Benefit to Domestic
Partners. Domestic Partners is defined in Ordinance No. 1335.
We need a separate group number to be issued for Domestic Partners. It is estimated that
there will be less than 75 participants.
Plan Contributions
Medical coverage is optional for all eligible retirees and eligible surviving dependents of
deceased employees and retirees, except those covered by the Florida Fire Fighters Health
Insurance Trust Fund or the Miami Beach Fraternal Order of Police Health Trust.
The City and the employee/retiree share the cost 50%/50%, for both employee/retiree only
coverage and for family (employee/retiree and eligible dependents) coverage. "Dependent"
includes spouse, and child(ren) from birth to 19th birthday (or to 25th birthday if a full-time
RFP NO.: 97-99/00
DATE: OS/25/00
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CITY OF MIAMI BEACH
student in college or trade school). However, under the PPO and POS plan a dependent child
can continue coverage to the end of the calendar year in which the child reaches age 25.
Premium costs are the same for employees and non-Medicare eligible retirees. Deductions are
withheld from 24 of the 26 paychecks per year for the employees. Effective October 1, 1988,
employees can elect Section 125 Cafeteria Plan to pre-tax employee payroll deductions.
Deductions are withheld from the participating retirees' and survivors' pension benefit checks
each month. The City provides the Medicare covered retirees credit each month for one-half of
the Medicare Part B premium for the retiree and, if applicable, the covered spouse.
Employees' and retirees' claims experience is pooled together for the Group Managed Care
Medical Plan (PPO) and Point of Service (POS), per Florida state statute. Employees' and pre-
Medicare retirees' claims experience is pooled together for the HMO Plan, per Florida State
statute. Medicare retirees in the HMO Plan are currently covered by the Humana Gold Plus
Plan, Humana's Medicare risk contract.
Plan Summaries: *Please refer to plan summaries for Group Medical in the ~ttachment.
section of this RFP.
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DATE: OS/25/00
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CITY OF MIAMI BEACH
SECTION IV - PROPOSAL FORMAT
Proposals must contain the following documents, each fully completed and signed as required.
Proposals which do not include all required documentation or are not submitted in the required
fonnat, or which do not have the appropriate signatures on each document, may be deemed to be
non-responsive. Once determined to be non-responsive, proposals will receive no further
consideration.
A. CONTENTS OF PROPOSAL
1. Table of Contents
Outline in sequential order the major areas of the proposal, including enclosures. All pages
must be consecutively numbered and correspond to the table of contents.
2. Proposal Points to Address:
Proposer must respond to all mIrumum requirements listed below, and provide
documentation, which demonstrates the ability to satisfy all of the minimum qualification
requirements. Proposals, which do not contain such documentation, may be deemed non-
responSIve.
3. Price Proposal
Proposer must include the price, which will be charged to the City.
3. Acknowledgment of Addenda and Proposer Information forms (See fonns required,
Attachments, Section VI)
4. Anv other document required by this RFP. such as a Ouestionnaire or Proposal Guaranty (See
forms required, Additional Documents, Section VII)
Note: Responses to required items in Section VI and/or Section VII must be completed on the
proposals forms. These forms must not be altered in any way. Additional pages may be
included as required to complete responses and should be so noted. Responses should be
provided in hard copy within each copy of the proposal response.
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CITY OF MIAMI BEACH
B. MINIMUM REQUIREMENTS / QUALIFICATIONS:
In order to be considered, a Proposer must, as of the Proposal Submission Date specified in this
RFP and throughout the duration of its program, meet the following applicable minimum
qualifications:
1. Fullv-Insured Plans and Stop-Loss Coverage:
a. Licensed by the State of Florida Department of Insurance to provide the
goods and services requested in the RFP; and
b. Hold an A. M. Best Letter Rating of "A-" or better and a Financial Size
Category of "Y" or higher.
2. Claims Administrative Services:
a.
Licensed or authorized by the State of Florida Department of Insurance, to
provide the goods and services requested in the RFP; and either
b.
Hold an A. M. Best Letter Rating of "A-" or better and a Financial Size
Category of "Y" or higher; or if a non-rated third party administrator, provide
financial statements for the last two full fiscal years.
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CITY OF MIAMI BEACH
SECTION V - EVALUATION/SELECTION PROCESS: CRITERIA FOR EVALUATION
The procedure for proposal evaluation and selection is as follows:
1. Request for Proposals issued.
2. Receipt of proposals.
3. Opening and listing of all proposals received.
4. Review and evaluation of proposals by Siver Insurance Consultants. Siver will report their
findings to an Evaluation Committee, appointed by the City Manager.
5. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each
proposal in accordance with the requirements of this RFP. If further information is desired,
proposers may be requested to make additional written submissions or oral presentations to
the Evaluation Committee.
6. The Evaluation Committee shall review their fmdings with the Health Advisory Committee
and, then, recommend the City Manager accept the proposal or proposals which the
Evaluation Committee deems to be in the best interest of the City. The Evaluation
Committee shall base its recommendations on the following criteria:
Cost - Price including rates, rate guarantees, premium and other costs of the
proposed coverage and/or services;
Benefits Provided -Plans offered (HMO, POS, PPO) including co-payments,
reimbursement levels, and limitations of coverage;
Qualifications - Competency of firm including experience with clients of similar
size and type, availability of qualified personnel, references, financial
responsibility, current workload;
Technical - Responsiveness to RFP requirements, completion of RFP Proposal
Forms and inclusion of any appropriate supplemental data.
Client References - Responses by references provided will be considered in the
evaluation of each proposal.
Network Capability - Accessibility to appropriate care by physicians and
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CITY OF MIAMI BEACH
facilities. A site match comparing network access to employee home zip codes
is required for the Group Medical Plan.
7. After considering the recommendation(s) of the Evaluation Committee, the City Manager
shall recommend the City Commission accept the proposal or proposals, which the City
Manager deems to be in the best interest of the City.
8. The City Commission shall consider the City Manager's recommendation(s) in light of the
recommendation(s) and evaluation of the Evaluation Committee and, if appropriate, approve
the City Manager's recommendation(s). The City Commission may reject the City
Manager's recommendation(s) and select another proposal or proposals. In any case, the City
Commission shall select the proposal or PlOPOSalS, which the City Commission deems to be
in the best interest of the City. The City Commission may also reject all proposals.
9. Negotiations between the selected proposer and the City Manager will take place to arrive
at a contract. If the City Commission has so directed, the City Manager may proceed to
negotiate a contract with a proposer other than the top-ranked proposer if the negotiations
with the top-ranked proposer fail to produce a mutually acceptable contract within a
reasonable period of time.
10. The proposed contract or contracts will be presented to the City Commission for approval,
modification and approval, or rejection.
11. If and when a contract or contracts acceptable to the respective parties is approved by the
City Commission, the Mayor and City Clerk will sign the contract(s) after the selected
proposer(s) has (or have) done so.
Important Note:
By submitting a proposal, all proposers shall be deemed to understand and agree that no
property interest or legal right of any kind shall be created at any point during the aforesaid
evaluation/selection process until and unless a contract has been agreed to and signed by both
parties.
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CITY OF MIAMI BEACH
SECTION VI - GENERAL PROVISIONS
A. ASSIGNMENT
The successful proposer shall not enter into any sub-contract, retain consultants, or
assign, transfer, convey, sublet, or otherwise dispose of this contract, or of any or all
of its right, title, or interest therein, or its power to execute such contract to any
person, firm, or corporation without prior written consent of the City. Any
unauthorized assignment shall constitute a default by the successful proposer.
B. INDEMNIFICATION
The successful proposer shall be required to agree to indemnify and hold harmless
the City of Miami Beach and its officers, employees, and agents, from and against
any and all actions, claims, liabilities, losses and expenses, including but not limited
to attorneys' fees, for personal, economic or bodily injury, wrongful death, loss of or
damage to property, in law or in equity, which may arise or be alleged to have arisen
from the negligent acts or omissions or other wrongful conduct of the successful
proposer, its employees, or agents in connection with the performance of service
pursuant to the resultant Contract; the successful proposer shall pay all such claims
and losses and shall pay all such costs and judgments which may issue from any
lawsuit arising from such claims and losses, and shall pay all costs expended by the
City in the defense of such claims and losses, including appeals.
C. TERMINATION FOR DEF AUL T
If through any cause within the reasonable control of the successful proposer, it shall
fail to fulfill in a timely manner, or otherwise violate any of the covenants,
agreement~, or stipulations material to the Agreement, the City shall thereupon have
the right to terminate the services then remaining to be performed by giving written
notice to the successful proposer of such termination which shall become effective
upon receipt by the successful proposer of the written termination notice.
In that event, the City shall compensate the successful proposer in accordance with
the Agreement for all services performed by the proposer prior to termination, net of
any costs incurred by the City as a consequence of the default.
Notwithstanding the above, the successful proposer shall not be relieved of liability
to the City for damages sustained by the City by virtue of any breach of the
Agreement by the proposer, and the City may reasonably withhold payments to the
successful proposer for the purposes of set off until such time as the exact amount of
damages due the City from the successful proposer is determined.
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CITY OF MIAMI BEACH
D. TERMINATION FOR CONVENIENCE OF CITY
The City may, for its convenience, terminate the services then remaining to be
performed at any time without cause by giving written notice to successful proposer
of such termination, which shall become effective thirty (30) days following receipt
by proposer of such notice. In that event, all fInished or unfInished documents and
other materials shall be properly delivered to the City. If the Agreement is
terminated by the City as provided in this section, the City shall compensate the
successful proposer in accordance with the Agreement for all services actually
performed by the successful proposer and reasonable direct costs of the successful
proposer for assembling and delivering to the City all documents. No compensation
shall be due to the successful proposer for any profits that the successful proposer
expected to earn on the balanced of the Agreement. Such payments shall be the total
extent of the City's liability to the successful proposer upon a termination as provided
for in this section.
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CITY OF MIAMI BEACH
SECTION VII - A TT ACHMENTS
A. Plan Summaries
B. Premiums
C. Cone of Silence, Ordinance No. 99-3164
D. Employee Census (diskette)
E. Claim Loss Experience
F. Model Program for Claims Administration Service for Self-Insured Plan and
Flexible Spending Account
G. Model Program for Stop-Loss Insurance
H. Model Program for Group Medical for Fully-Insured Plan
I. Proposal Forms for Claims Administrative Services for Self-Insured Plan and
Administrative Services for Flexible Spending Account
J. Proposal Forms for Stop-Loss Insurance
K. Proposal Forms for Group Medical for Fully-Insured Plan
L. Debarment, Ordinance No. 2000-3234
M. Regulating, Granting of Annual Leave, Ordinance No. 1335
N. Granting and Computation of Annual Leave, Ordinance No. 1613
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DATE: OS/25/00
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CITY OF MIAMI BEACH
SECTION VIII - ADDITIONAL DOCUMENTS TO BE COMPLETED
A. Acknowledgement of Addenda
B. Declaration
C. Questionnaire
PROPOSER INFORMATION
Submitted by:
Proposer (Entity):
Signature:
Name (Typed):
Address:
City/State:
Telephone:
Fax:
It is understood and agreed by proposer that the City reserves the right to reject any and all
proposals, to make awards on all items or any items according to the best interest of the City,
and to waive any irregularities in the RFP or in the proposals received as a result of tht RFP.
It is also understood and agreed by the proposer that by submitting a proposal, proposer shall
be deemed to understand and agree than no property interest or legal right of any kind shall
be created at any point during the aforesaid evaluation/selection process until and unless a
contract has been agreed to and signed by both parties.
(Authorized Signature)
(Date)
(printed Name)
REQUEST FOR PROPOSALS NO. 97-99/00
ACKNOWLEDGMENT OF ADDENDA
Directions: Complete Part I or Part II, whichever applies.
Part I: Listed below are the dates of issue for each Addendum received in connection with
this RFP:
Addendum No.1, Dated
Addendum No.2, Dated
Addendum No.3, Dated
Addendum No.4, Dated
Addendum No.5, Dated
Part II:
No addendum was received in connection with this RFP.
Verified with Procurement staff
Name of Staff
Date
Proposer - Name
Date
(Signature)
DECLARATION
TO: Lawrence A. Levy
City Manager
City of Miami Beach, Florida
Submitted this
day of
,2000.
The undersigned, as proposer, declares that the only persons interested in this proposal are named
herein; that no other person has any interest in this proposal or in the Contract to which this proposal
pertains; that this proposal is made without connection or arrangement with any other person; and
that this proposal is in every respect fair and made in good faith, without collusion or fraud.
The proposer agrees if this proposal is accepted, to execute an appropriate City of Miami Beach
document for the purpose of establishing a formal contractual relationship between the proposer and
the City of Miami Beach, Florida, for the performance of all requirements to which the proposal
pertains.
The proposer states that the proposal is based upon the documents identified by the following
number: RFP No. 97-99/00.
SIGNATURE
PRINTED NAME
TITLE