HomeMy Public PortalAbout21-9897 AvMed and Metlife employee insurance renewalSponsored by: City Manager
RESOLUTION NO. 21-9897
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF OPA-LOCKA, FLORIDA, AUTHORIZING THE
CITY MANAGER TO ENTER INTO RENEWAL
INSURANCE CONTRACTS WITH AVMED, INC. AND
METLIFE FOR MEDICAL, DENTAL, AND VISION
INSURANCE FOR CITY EMPLOYEES; PROVIDING FOR
INCORPORATION OF RECITALS; PROVIDING FOR AN
EFFECTIVE DATE.
WHEREAS, there is a continued need for municipal health insurance
coverage for City of Opa-Locka ("City") employees; and
WHEREAS, the I Iuman Resources Department has worked with the
City's Agent of Records firm to assess the existing group insurance policies
and proposed premium rates from other carriers (Policy Quote Presentation
attached hereto as Exhibit "A"). Staff has recommended to renew coverage
with the current carriers; and
WHEREAS, the City desires to renew its current AvMed, Inc. and
Metlife policies for medical, dental, and vision insurance for City employees
and their dependents; and
WHEREAS, it is in the best interest of the City to renew the contracts
with AvMed and Metlife as the City's benefits providers.
NOW THEREFORE, BE RESOLVED BY THE COMMISSION OF THE
CITY OF OPA-LOCKA, FLORIDA:
Section 1. The recitals to the preamble herein are incorporated by
reference.
Section 2. The City Commission of the City of Opa-Locka, Florida
hereby authorizes the City Manager to enter into Renewal Contracts, between
the City of Opa-Locka, AvMed, Inc ., and Metlife for medical, dental, and vision
insurance coverage for City employees and dependents.
Resolution No. 21-9897
Section 3. The City Manager and other proper City Officials are hereby
authorized to execute any required documents in order to implement the
intent of this resolution.
Section 4. Sections of this Resolution may be renumbered or re -lettered
and corrections of typographical errors which do not affect the intent may
be authorized by the City Manager or the City Manager's designee, without the
need ofa public hearing, by filing a corrected copy of same with the City Clerk.
Section 5. This Resolution shall take effect immediately upon adoption and is
subject to the approval of the Governor or his designee.
PASSED AND ADOPTED this 18th day of August, 2021.
Matthew A. Pigatt, Mayor
ATTEST:
APPROVED AS TO FORM AND
LEGAL SUFFICIENCY:
144/
Burnadette NorrisL
City Attorney
2
Resolution No. 21-9897
Moved by: Commissioner Taylor
Seconded by: Commissioner Davis
VOTE: 4-0
Commissioner Taylor YES
Commissioner Davis YES
Vice -Mayor Williams YES
Mayor Pigatt YES
3
City of Opa-Locka
Agenda Cover Memo
Department
Director:
Kierra Ward, MBA
Department
Director
Signature:
City
Manager:
John E. Pate
CM Signature:
Commission
Meeting
Date:
8/18/2021
Item Type:
(EnterXin box)
Resolution
Or n.
Other
X
Fiscal
Impact:
(EnterXin box)
Yes
No
Ordinance Reading.
(Enter X in box)
ist Reading
2nd Reading
X
Public Hearing:
(EnterXin box)
Yes
No
Yes
No
X
X
Funding
Source:
Account# :
(Enter Fund & Dept)
Ex:
Advertising Requirement:
(EnterXin box)
Yes
No
X
Contract/P.O.
Required:
(Enter X in box)
Yes
No
RFP/RFQ/Bid#:
X
Strategic
Plan Related
(EnterXin box)
Yes
No
Strategic Plan Priority Area:
Enhance Organizational IN
Bus. & Economic Dev MI
Public Safety •
Quality of Education •
Qual. of Life & City Image - 1
Communication •
Strategic Plan Obj./Strategy:
(list the specific objective/strategy this
item will address)
Sponsor
Name
City Manager
Department:
Human Resources
City Manager
Short Title:
A resolution authorizing the City Manager to enter into an agreement with AvMed, and Metlife, for the City
Employee health, vision and dental plans.
Staff Summary:
The Human Resources Department has worked diligently with the City's Agent of Record, Sapoznik Insurance
and Associates, Inc. to assess the existing group insurance policies and proposed premium rated from other
carriers. Staff is recommending to renew with the current carriers. It is in the best interest of the City to renew
the contract with the AvMed, and Metlife Insurance Companies. This approval is based on staff's analysis of
the proposed services, providers, and costs,
Staff has analyzed the results of the competitive Bid Process for Insurance Carriers facilitated by the City's
current Agent of Records Sapoznik Insurance and Associates. It has been determined that it would be in the
City's best interest to renew the contract with the current carriers.
Sapoznik has successfully negotiated the initial renewal of 5.63 % increase with AvMed to a rate pass for the
current plan. Due to concerns expressed by employees that participate in the health plan, management decided
to invest the anticipated amount budgeted for an increase into enriching the current plan to allow less out of
pocket expenses to the employees. The current AvMed Plan will present a 5.24% increase to the budget.
Metlife provided a rate pass for the renewal of the dental and vision insurance with no increase.
The packet attached documents provide additional quotes and plans received and formal declination letters
from carriers that declined to provide a quote.
Financial Impact - The cost of this plan represents a 5% increase in rates compared to the FY 21 plan. The
proposed FY 22 Budget had provided for a 7% increase. The lower rate will result in a $21,700 savings spread
over the General, Water -Sewer and Stormwater Funds.
Proposed Action:
Staff recommends approval.
Attachment:
Renewal Quote.
"
A W O R L D C O M P A N Y
A V M E D - C U R R E N T / R E N E W A L
C I T Y O F O P A - L O C K A
O C T O B E R 2 0 2 1
C a r r i e r N a m e
A v M e d
A v M e d
P l a n N a m e
N e t w o r k A c c e s s
D e d u c t i b l e
D e d u c t i b l e
M e m b e r C o - I n s u r a n c e
M a x B e n e f i t s
O u t o f P o c k e t M a x i m u m
L i f e t i m e m a x
P h y s i c i a n O f f i c e S e r v i c e s
P h y s i c i a n
S p e c i a l i s t
P r e v e n t i v e C a r e
D i a g n o s t i c S e r v i c e s
I n d e p e n d e n t C l i n i c a l L a b
D i a g n o s t i c T e s t i n g F a c i l i t y
M R 1 , M R A , C T & P E T S c a n s
E R a n d U r g e n t C a r e
E m e r g e n c y R o o m
U r g e n t C a r e
O u t p a t i e n t & I n p a t i e n t S e r v i c e s
O u t p a t i e n t S u r g e r y
A m b u l a t o r y S u r g i c a l
I n p a t i e n t H o s p i t a l
P r o v i d e r S e r v i c e s I n p a t i e n t
H o s p i t a l
P h a r m a c y S e r v i c e s
P r e s c r i p t i o n
P r e m i u m B r e a k d o w n
E m p l o y e e
E m p l o y e e / S p o u s e
E m p l o y e e / C h i l d ( r e n )
E m p l o y e e / F a m i l y
H M O O A 7 4 2 2
R e n e w a l : H M O O A 7 5 6 0
I n N e t w o r k O n l y
$ 5 0 0 0 / $ 1 0 0 0 0
2 0 %
$ 6 8 5 0 / $ 1 3 7 0 0
U n l i m i t e d
$ 2 5
$ 5 0
C o v e r e d 1 0 0 %
P a r t i c : C o v e r e d 1 0 0 %
A l l O t h e r s : $ 2 5
I n d p : $ 2 5 0 / A l l O t h e r s : $ 5 0 0 A f t e r D e d
R e n e w a l : I n d p : $ 2 5 0 1 A l l O t h e r s : $ 5 0 0
$ 5 0 0
$ 7 5 / $ 2 5
2 0 % A f t e r D e d
2 0 % A f t e r D e d
2 0 % A f t e r D e d
$ 1 0 / 3 5 / 7 5 ; 3 0 % / 3 0 % A f t e r D e d
/ R e n e w a l : $ 1 0 / 3 5 / 7 5 ; . 3 0 % / 3 0 % A f t e r $ 2 5 0 / $ 5 0 0 D e d
. C u r r e n t
7 4
$ 4 3 1 . 5 3
C h o i c e 7 4 7 0
R e n e w a l : C h o i c e 7 6 2 8
I n N e t w o r k
P H C S
O u t o f N e t w o r k
$ 2 5 0 0 1 $ 5 0 0 0
$ 7 5 0 0 1 $ 1 5 0 0 0
1 0 %
4 0 %
$ 6 5 0 0 1 $ 1 3 0 0 0
$ 1 9 5 0 0 / $ 3 9 0 0 0
U n l i m i t e d
$ 2 5
4 0 % A f t e r b e d
$ 5 0
4 0 % A f t e r D e d
C o v e r e d 1 0 0 %
4 0 % A f t e r D e d
P a r t i c : C o v e r e d 1 0 0 %
A l l O t h e r s : $ 5 0
4 0 % A f t e r D e d
I n d : $ 2 0 0
A l l O t h e r s : $ 4 0 0 A f t e r D e d
4 0 % A f t e r D e d
$ 3 5 0
$ 7 5 1 $ 2 5
4 0 % A f t e r D e d
1 0 % A f t e r D e d
4 0 % A f t e r D e d
1 0 % A f t e r D e d
4 0 % A f t e r D e d
1 0 % A f t e r D e d
4 0 % A f t e r D e d
R e n e w a l N e g o t i a t e d �%
$ 4 5 5 . 8 3
$ 4 3 1 . 5 3
1
$ 1 0 1 2 5 1 5 0 / 1 0 0 ; 3 0 %
A f t e r $ 5 0 0 / $ 1 0 0 0 D e d
C t i i r e n t
$ 5 2 5 . 7 6
N C
R e n e w a l
$ 5 5 8 . 7 8
N e g o t i a t e d
$ 5 2 5 . 7 6
1 1
$ 8 6 3 . 0 6
$ 9 1 1 . 7 1
$ 8 6 3 . 0 6
0
$ 1 , 0 5 1 . 5 2 -
$ 9 9 8 . 9 5
$ 1 , 1 1 7 . 5 6
$ 1 , 0 6 1 . 6 8
$ 1 , 7 3 2 . 2 2
$ 1 , 0 5 1 . 5 2
C o m m e n t s
1 6
$ 8 1 9 . 9 1
$ 8 6 6 . 1 2
$ 8 1 9 . 9 1
1
$ 9 9 8 . 9 5
7
1 $ 1 , 3 3 7 . 7 4
$ 1 , 4 1 3 . 1 5
$ 1 , 3 3 7 . 7 4
3
$ 1 , 6 2 9 . 8 6
$ 1 , 6 2 9 . 8 6
1 0 8
C u r r e n t
5 . 6 3 %
0 . 0 0 %
5
C u r r e n t
6 . 2 8 %
0 . 0 0 %
M o n t h l y T o t a l
$ 6 3 , 9 0 9 . 6 2
$ 6 7 , 5 1 0 . 2 0
$ 6 3 , 9 0 9 . 6 2
$ 6 , 4 1 4 . 2 9
$ 6 , 8 1 7 . 1 2
$ 6 , 4 1 4 . 2 9
Q u o t e s a r e b a s e d o n t h e c e n s u s r e c e i v e d . R a t e s c o u l d b e a d j u s t e d b a s e d o n f i n a l e n r o l l m e n t .
T h i s d a t a i s p r o v i d e d f o r i n f o r m a t i o n p u r p o s e s o n l y . I t I s n o t i n t e n d e d t o r e p r e s e n t a b i n d i n g o b l i g a t i o n . T h e g o v e r n i n g d o c u m e n t f o r t h l a p u r p o s e w o u l d b e t h e C O C i s s u e d b y t h e c a r r i e r . P l e a s e s e e d e t a i l e d b e n e f i t s u m m a r y .
8 : 4 5 A M I n f o r m a t o n p r o v i d e d i s p r o p r i e t a r y . I t m a y n o t b e c o p i e d , e m u l a t e d o r d i s t r i b u t e d w i t h o u t e x p r e s s p e r m i s s i o n . 7 / 2 1 / 2 0 2 1
St:
■ i i
AWORLD COMPANY
Plan Name
Network Access
Dedu ctible
Deductible
Member Co -Insurance
Ma x Be ne fits
Out of Po cke t Maximum
Lifetime max
Physician O ffice Servic es
Physic ian
Specialist
Preventive Care
Diagnostic Serv ice s
Independent Clinical Lab
Diagnostic Testing Facility
M RI, MRA, CT & PET Scans
ER and Urgen t Care
Emergency Roo m
Urgent Care
Outpatient & Inpa tient Se rvices
Outpatient Surgery
Ambulatory Surgical
Inpatient Hospital
Provider Services Inpatient
Hospital
Pharma cy Se rv ice s
Prescription
Premium Breakdo wn
Employee
Employee/Spo use
Employee/Child(ren)
Emplo yee/Family
Comments
74
HMO OA 7422
Renewal: HMO OA 7560
AV MED - ALTERNATES
HMO OA 7559
H MO OA 7550
In Network Only
In Network Only
In Network Only
$50001$10000
550001$10000
53500/$7000
20%
20%
20%
$6850/813700
$6350/$12700
$6350/$12700
Unlimited
Unlimited
Unlimited
$25
$25
$25
$50
$50
$50
Covered 100%
Covered 100%
Covered 100%
Partic: Co vered 100%
All Others: $25
Partic: Covered 100%
All Other . $25
Partic: Covered 100%
All Other: $100
Indp: $2501 At Others: $500 After Ded
Re ne wal: Indp: 5250 / Ail Others: 5500
Indp: $250
All Others $500
Indp: $100
All Others: $200
$500
$200
$200
$75/$25
540/525
540/$25
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% Aft er Ded
20% Afte r Ded
20% After Ded
20% After Ded
$1`0/35/75; 30% /30% After Ded $15/25/40/80; 50% After Ded
Renewal: $10/35/75; 30%/30% After $250/$500 Ded
Corr zI t Negotiate d
$431453
$863 06
S819;s1
$431.53
8863.06
$20/30/501100/50%
$443.74
$454.15
1
CITY OF OPA-LOCKA
OCTOBER 2021
Choice 7470
Renewal: Choic e 7628
In Network
PHCS
O ut of Network
$2500/$5000
$7500/$15000
10%
40%
$6500/513000
$19500/$39000
Unlimited
$25
40 % After Ded
$50
40% After Ded
Covered 100%
40% After Ded
Partic: Covered 100%
All Others: $50
40 % After Ded
Ind: $200
All Others: $400 After Ded
40 % Aft er Ded
$350
575/825
40 % After Ded
10% After Dad
40 % After Ded
10% After Ded
40 % Aft er Ded
10% After Ded
40% Aft er Ded
$10/25/50/100; 30%
After $500/$1000 Ded
C urrent
$525.76
NC
N eg otiat ed
8525 .76
11
$887.49
5908.31
$862.89
0
$1,051 .52
$998.95
$1,051 .52
$998.95
16
7
51,337.74
$819. 91
$1,337.74
5843.11
$1,375.60
51,407 .88
1
3
51,629.86
$1,629.86
108
Curren t
0.00%
2. 83%
5.24%
b
Current
0.00%
Mo nthly Total
883,909.62
563,909.62
$65,718.11
567, 269.91
$6, 414.29
$6,414 .29
Quotes ate based on the census rec eived. Rates co uld be adlueted based on find enrollment.
8:45 AM
This data lo pro vide dl.for informatio n purposes only. It Is not Intended to represent a banding obllgatlo n. The governing document for this purpo se would be the 000Iss ed by the carri er. Please see dagped be nent summ ary .
Information provided Is proprietary. It may not be copied, emulated or distributed without express permission .
7/21/2021
CITY OF OPA-LOCKA
AWORLD CaMPANY
Plan N ame
Network Acces s
Dedu ctible
Deductible
Member Co -Insurance
Max Be ne fits
Out of Pocket Maximum
Lifetime max
Physician O ffice Se rvice s
Physician
Specia list
Preventive Care
D iagno stic Services
In dependen t Clinical Lab
Diagnostic Testin g Facility
MRI, MRA, CT & PET Scans
ER an d Urgen t C are
Emergency Roo m
Urgent Care
Ou tpatient & In patient Services
Outpatient Surgery
Ambulatory Surgical
Inpatient Hospital
Provider Services Inpatient
Ho spital
Pharmacy Services
Prescription
Premiu m Brea kdown
Employee
Emplo yee/Spouse
Employee /Child(ren)
Employee/Family
Co mments
Mon thly Total
H MO OA 7422
R enewal: HM O OA 7580
In Network Only
OCTOBER 2021
FLORIDABLUE
BlueCare 71 Ch oice 7470 BlueOptions 05904
R enew al: Choice 7628
In N etwork Only
$5000/$10000
85000/$10000
20%
20%
$6850/813700
$7900/$15800
Unlimited
Unlimited
$25
$10
$50
$100
Covered 100%
Cov ered 100%
P rtic: Covered 100%
I All Others: $25
Indp: $2501/ AR O thers: $500 After Ded
Renewal: indp: 8250 / All Others: $500
Cov er ed 100%
20 % Aft er Ded
8500
1 $75/$25
$250 + 20 % After Ded
$75
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% Afte r Ded
110/35/75; 30%/30% After Ded
Renewal: $10/35175. 30%130% After 6250/6500 D ed
$431. 53
$431. 53
$670.90
74
11
16
7
108
$863.06
8819.91
$1,337.74
Current
$83,809.82.
$863. 06
$819.91
$1,337. 74
0.00%
$63,909.62
$10/601100
$1,596. 74
$1,208.13
$2,146. 88
60.93%
$102,848.98
0
1
3
5
In Network
PI -I CS
Out of Network
In Netw ork I Out of Network
$2500/85000
10%
$7500/$15000
40%
$2500/87500 85000/$15000
40%
20%
$6500/$13000
819500/$39000
$6000/$12000 1 $8000/$20000
Unlimited
Unlimited
$25
$50
Covered 100%
40% Aft er Ded
40 % After Ded
40% After Ded
$35 40% After Ded
$65 40 % Aft er Ded
Covered 100% 40%
Partic: Covered 100%
All Oth ers: $50
40% After Ded
Ind: $200
All Others: $400 After D ed
40 % After D ed
Co vered 100% 40% Aft er Dad
$450 40 % After D ed
$350
20% Aft er Ded
$75/$25
40 % After Ded
$70 $70 Aft er Ded
10% After Ded
40% After Ded
10% After Ded
40% After Ded
20% After Ded 1 40% After Ded
20% After Ded 40% After Ded
10% After Ded
40% After Ded
20% After In Network Ded
$10/25/50/100; 30% .
After $500/$1000 Ded
$525.76
$838 .58
$525 .76
$1,051.52
$998.95
$1,629 .86
Current
66,414 .29
NC
$1,051.52
8998.95
$1,629.88
0.00%
86,414.29
$10/60/100
$1,995.76
$1,610 .03
$2,683 .38
63 .68%
$10,498.73
50%
Quotes are based on the census received. Rates could be adjusted based on final enrolbnent .
This data la pmvided for Inform Lion purposes only. It is not intended t repre sen t a binding o bligation. The go verning document for this purpose would he the CCC Is sued by the carrier. Pleas e see detailed benefit summary.
8:45 AM
Information provided is proprietary. It may n ot be copied, emulate d or distribute d without express permissi on.
7/21/2021
A WORLD CO MP ANY HUMANA - MT. SINAI NOT AVAILABLE
I H MO OA 7422
Plan Name Ren al: HMO 0A 7580 OA HMO 16
Network Access
De ductible
Deductible
Member Co-insurance
Ma x Bene fits
Out of Pocket M aximum
Lifetime max
Physician Office Se rvices
Physician
Specialist
Preventive Care
Diagnostic Services
Independent Clinical Lab
Diagnostic Tes ting Facility
MRI, M RA, CT & PET Scans
ER and Urge nt Care
Eme rgency Room
Urgent Care
Ou tpatient & Inpa tient Se rvices
Outpatient Surge ry
Ambula to ry Surgical
In patient Hospital
Provider Services Inpatient
Hospital
Pha rma cy Se rvic es
Prescription
Employee
Employee/Spouse
Employee/Chlld(ren)
Employee/Family
Comments
Monthly To tal
74
11
•
In Network Only
In Network Only
$5000/$10000
$5000/$10000
20%
20%
$6850/$13700
$6500/$13000
Unlimited
Unlimited
$25
$25
$50
$50
Covered 100%
Covered 100%
Partic Covered 100%
AJI Others: $25
Indp: $25011 All Others : $500 After Ded
Renewal: Irtdp: $250 /All Others: $500
Covered 100%
$300
$500
6500
$75/$25
$75
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% After Ded
20% After Ded
Renewal: $10/35/75; 30% /30% After $250/6500 De d $10/40/70/25%/35%125%
16
7
$10/35/75; 30%/30% After Ded
$431. 53
$863. 06
$819.91 1
108
$1, 337.741
$431. 53
$863.06
$819.91
$1,337.74
0.00%
$541.40
$1,082. 79
81,028.65
81,678.33
25.46%
1
0
1
3
5
Avis rd
Choice 7470
Renewal: Ch oice 7628
CITY OF OPA-LOCKA
OCTOBER 2021
j1i�1i:F1=f.;
NPOS 16
In Network
PH CS
O ut of Network
In Netw ork
Out of N etwork
82500/$5000
$7500/$15000
$2500/$5000 $7500/$15000
10%
40 %
10%
40%
$6500/$13000 1 819500/$39000
$6500/$13000
$19500/$39000
Unlimited
Unlimit ed
$25 40% After Ded
$25
40% After D ed
$50
40% After D ed
$50
40% After Ded
Cov ered 100% 40% After Ded
Covered 100%
40% After Ded
Partic: Co vered 100%
All Others: $50
40% After Ded
C overed 100%
40% After D ed
Ind: $200
All Others: $400 Aft er Ded
40 % After Ded
$300
40% After Ded
$350
$350
$75/$25 40% After Ded
$75
40% After Ded
10% After Ded 40% Aft er Ded
10% After Ded
40 % After Ded
10% After Ded
40% After Ded
10% After Ded
40% Aft er Ded
10% After Ded 40% After Ded
10 % After Ded
40 % After D ed
$10/25/50/100; 30%
After $500/$1000 Ded
$525 .76
$1,051 .52
$998.95
$1,629.88
Current
NC
$525.76
$1,051.52
$998.95
$1,629.86
0.00%
$10/25/50/25%/35%/25% 30% After $10/25/50/25 %;
Current
$63,909.6 $80,181. 00
Humana Rs Tlerstrudure - Tier 1: Lowest Cost G eneric and Brand, Tier 2: High Coat Generic and Wend, Tier 3: Go ne de and Band Higher Cwt than Tier 2, Tier 4: High Co st Drugs Tier 5: Specialty DrugiPreferred Sp eci alty Drug
$63,909. 62
$6,414.29
$6,414.29
$667.34
$1,334.68
$1,267 .94
$2,068.75
50%
26.93%
$8,141 .53
Quot a ere base d on Iha census received. Rates could b0 adjusted based on final enrollment.
8:45 AM
This des Is provided for informa tion purpo ses o nly. It Is not intended to represent a binding a bllgatlun . The go verning document fo r this purpose would be the CDC issued by the carder . Pl ease sae Petalled benefit summary.
Informa tion provided is proprietary. It may not be copied, emulated or distributed without express permission. 7/21/2021
151 Farmington Avenue, F265,
Hartford CT 06156
inetnam
Confirmation of Request for Group Health Coverage
Aetna has recently completed a review of CITY OF OPA LOCKA's request for a quote of group health coverage (the "Request") and determined that we
are not currently positioned to provide a competitive proposal.
However, as an entity that offers health coverage and consistent with direction provided under Section 2702 of the Patient Protection and Affordable
Care Act, we will provide a response to your Request and proceed with an insured quote should CITY OF OPA LOCKA continue to be interested in the
information.
If it is still CITY OF OPA LOCKA's position to have Aetna provide a quote for group health coverage, please
a) Furnish the information indicated below that has not already been provided (where available), and
b) Sign and return this notification to Aetna as indicated below.
In order for Aetna to provide you the quote, a signed request La ong with —all requested dada ems is required no IaMrthan 30 -days puorto the-requeste
quote effective date.
REQUIRED DATA:
• Please provide a detailed summary of the plan design(s) requested.
• Please provide the contribution strategy for the current and proposed plans.
• Please provide the following historical information:
o Monthly claims and corresponding enrollment counts for a recent 12 months minimum, up to a 24 month period.
• Please identify the basis for the claim information (i.e., paid vs. incurred and if incurred if a completion factor has been applied) and
provide the information broken down for each unique plan offering.
• Please identify if any of the plans are capitated and if so, whether capitations are included/excluded from the claim information.
• Large claim information for individual claims in excess of $25,000 based on the same time period as the claims data provided.
■ For Hospital or Health Systems only: Claims need to be split by domestic and non -domestic. Also please provide home/host/domestic
payment arrangement (i.e. discount off billed charges, fee schedules, etc.)
■ Individual Medical Questionnaires (IMQ) (Where allowed by state) — will be required if/when monthly claim data is not available
o Plan designs: A description of the plans which were in place during the experience period along with a description of any plan changes that
occurred during this period and the date the change went into effect
• Current and/or Renewal Rates
• Please provide a complete census file including the following for all eligible employees: Age/DOB, Gender, Dependent Tier Status, COBRA
Participant indicator, Waiver indicator, Retiree indicator, Home Zip Code, and Current Medical Plan Election.
Additional Requested Data:
• Current Medical Management programs in place
• 5 year carrier history
• Large Claim Data: including diagnosis and claimant status information and should identify if amounts in excess of any pooling threshold have
been included/excluded from the claim experience provided.
• Current commission level
• A recent utilization report from the current carrier to include historical achieved discount and trend information as well as utilization information
relative to the use of inpatient hospital, outpatient hospital, and physician/other services as well as identification of the top utilized facilities
• Please provide information/reason on any required data noted as not available
CITY OF OPA LOCKA Certification:
I understand Aetna's position on its product offerings' alignment with our Request, but CITY OF OPA LOCKA requests a quote from Aetna as allowed
under Section 2702 of the Patient Protection and Affordable Care Act.
Signature
Title Date
Please send this form back c/o Mark Wilson via email wilsonml@aetria.com or at via fax.
Health Insurance plans are offered, underwritten or administered by Aetna Life Insurance Company and its affiliates (Aetna). Health Information programs provide general health information and
are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however it is subject to change. For
more information about Aetna Plans, refer to www.aetna.com.
Proprietary
From:
To:
Subject
Date:
iiishoo Primo
Linda Jamen
Response To Your Inquiry - Qty of Opa-Lod<a
Monday, June 28, 2021 9:27:33 AM
Ricardo Villena
NBM
Sunrise, FL 33323
June 28, 2021
Linda Jamen
Sapoznik Insurance & Associates
1100 NE 163 Street 2nd Floor
North Miami Beach, FL33162
RE: City of Opa-Locka
Thank you for considering Cigna HealthCare for City of Opa-Locka.
Based upon our evaluation of the information provided with your request
for proposal, we do not believe that we can offer a competitive proposal.
Therefore, we respectfully decline to offer a quote at this time.
We appreciate being given the opportunity to review your request for a
proposal and we look forward to working with you on future prospects.
Please do not hesitate to contact me if you have any questions.
Sincerely,
Ricardo Villena
NBM
(954) 514-6895
Attention California Agents/Brokers: A copy of this letter must immediately
be forwarded to the client in order to comply with California law, SB 1163
(2010).
Unitedllealthcare
A UnitedHealth Group Company
3100 SW 145th Ave, rd Floor
Miramar, Florida 33027
Brian Murray
Account Executive
UnitedHealthcare
3100 SW 145th Avenue
Miramar, FL 33027
Tel 954-378-0565
Uncompetitive Quote Notification
Date: 07/14/21
Requested Effective Date: 10/01/2021
Dear Ana,
Thank you for your recent proposal request on City Of Opa-Locka. After a thorough evaluation
of the information provided, our decision is to decline to quote this request at this time. The
reason for this declination is as follows:
■ We are unable to provide a competitive quote
We appreciate being given the opportunity to review this request and we look forward to
working with your office on future prospects. If you have any questions or need assistance
please contact me.
Again, thank you for considering UnitedHealthcare.
Sincerely,
Brian Murray Key Accounts
Account Executive Office -
954-378-0565
brian t murray®uhc.com
Carrier Name
DHMO
CITY 0
OPA-LOCKA
OCT OBER 2021
DPP O
M en .if e MetLife
Plan Name
Network Access
De ductible
Ded waived for Preventive
Prev entive
Basic
Major
Periodontics / Endodontic s
Annu al Maximu m Be nefit
Out of Netwo rk Reimbursement
Lev el
Ortho dontic
Ortho don tic Eligibility
O rthodontic Maximu m
Rate Guarantee
Met290
In Network Only
No Ded
$5 Office Visits
None
Some procedures
Co vered 100%
Co -Pays Apply
Co -Pays Apply
Co -Pays Apply
None
In Network Only
Co -Pays Apply
Adult & Child
None
Ne xt Renewal:10/01/2022
DPPO
In Network
Out of Netw ork
$50/$150
$501$150
Yes
No
100%
90%
90%
70%
60%
40%
Major
Simple Extractions: Basic
$3,000
$1,500
Fee
Fee
50%
Child(ilen) to age 19
$1,000
Next Renewal: 10/01/2022
Pre mium Bre akdown
Curre nt
■
C urr ent
Employee
34
$11. 86
32
$40 .42
Employee/Spouse
6
$20. 75
6
$80 .83
Employee/Child(ren)
9
$24. 90
8
$97 .48
Employee/Family
4
$34. 99
9
$145.48
Co mments
53
Under Rate Guarante e
55
Under Rate Guarantee
Monthly Total
$891.80
$3,867.58
quotes are based on the ce nsus rece ived. Rate s co uld be adjuste d bas ed on final enro llment.
This data is prov ided fo r info rmation purposes only. It Is n ot inte nded to represent a binding obligation. The gov erning document for this purpo se wo uld be the COC issued by the farri er. Please see detailed benefit summery.
8:45 AM Informa tion provided is pro prietary. It may not be copied, emulated or distributed without express
rmission . 7/21/2021
AN+VORLD COMPANY
,Lor„,
CITY OF OPA-LOCKA
OCTOBER 2021
VISION
Carrier Name MetLife
Plan Name
Network Access
Eye Care Co -pay
Eye Exam
Frequency
Materials Co -pay
Lenses
Single
M130D-10/10
Bifocal
Trifocal
Lenticular
Frequency
Frames
Frames
Frequency
Contact Lens Co -pay
Elective
Medically Necessary
Frequency
Rate Guarantee
Premium Breakdown
Employee
Ir-Network
Allowance
Out of Network
Reimbursement
$10
Up to $45
12 Months
$10
N/A
$0 After Co -pay Up to $30
$0 After Co -pay Up to $50
$0 After Co -pay
Up to $65
$0 After Co -pay Up to $100
12 Months
Up to $130+
20% off Balance
Up to $70
24 Months
In lieu of any other eyewear benefits
$0
Up to $130 f Up to $105
After Co pay Up to $210
12 Months
■
45
Next Renewal: 10/01/2022
Current
$6.80
Employee/Spouse
13
$13.62
Employee/Child(ren)
10
$14.02
Employee/Family
11
$21.79
Comments
79
Under Rate Guarantee
Total Monthly
8862.95
Quotes are based on the census received. Rates could be adjusted based on final enrollment.
This data is provided for information purposes only. It is not intended to represent a binding obligation. The governing document for this
purpose would be the COC Issued by the carrier. Please see detailed benefit summary.
8:4tifMldhation provided is proprietary. It may not be copied, emulated or distributed without express perrr 1 021