HomeMy WebLinkAbout2005 06 27 Regular Item 512- Issues with Health Insurance
062705_ COMM _Add_On _Regular _ 512_ Health _Insurance
Page 1 on
COMMISSION AGENDA
ADD-ON
ITEM 512
Consent
Informational
Public Hearing
Regular X
June 27, 2005
Regular Meeting
Mgr. f2/ / Dept.
Authorization
REQUEST: The City Manager is requesting the City Commission decide issues related to Health
Insurance coverage.
PURPOSE: To have the City Commission decide issues related to employee health insurance as
follows.
1. Health Insurance Plan Type
2. Employee Contribution to Employee's Coverage
3. Monetary Incentive to Employees Who Opt out of Plan
4. Dependent Care Subsidy
CONSIDERATIONS:
We sent requests to eight carriers. We received and reviewed proposals from five
carriers listed on attachment "A". The preferred carrier was chosen based upon similarity
of coverage and network to the current plan, and price. Attachment "B" provides a
comparison of the two best proposals from CIGNA and Av-Med as compared to the
current United Health Care Plan. Of the 25 plans reviewed, CIGNA presented the best
proposal. As shown on Attachment "C" the current plan and the CIGNA Plan are very
similar.
As shown below, there are two alternative implementation structures with the CIGNA Plan.
062705_ COMM _Add_On _Regular _ 512 _Health_Insurance
Page 2 of 3
Alternative 1: Offer Three SIGNA Plans
Average
HMO Select Plan
City Pays Employee/Shared Family
Primary Physician
Smaller Network
5.56 % City Reduction
5.56% Employee Reduction
HMO
City Pays Employee/Share Family
Open Access/Full Network
2.62 % City Increase
2.62% Employee Increase
pas Buy-Up
Employee Pays Additional Cost
Open Access/Full Network
Out of Network Option 70/30
10.84% Employee Increase
HMO Select Plan
Coverage Type Annual $ Decrease Annual % Decrease
Employee $189.24 City 5.66% City
Employee & Spouse $486.96 City and Employee 5.66% City and Employee
Employee & Child $486.96 City and Employee 5.66% City and Employee
Family $534.00 City and Employee 5.68% City and Employee
HMO Regular Plan
Coverage Type Annual $ Increase Annual % Increase
Employee $105.48 City 2.62% City
Employee & Spouse $217.32 City and Employee 2.62% City and Employee
Employee & Child $217.32 City and Employee 2.62% City and Employee
F amil y $235.08 City and Employee 2.62% City and Employee
Alternative 2: Offer Two CIGNA Plans
HMO
City Pays Employee/Shared Family
Open Access/Full Network
2.62% City Increase
2.62 Employee Increase
pas Buy Up
Employee Pay Additional Cost
Open Access/Full Network
Out of Network Option 70/30
10.84% Employee Increase
HMO Regular Plan
Coverage Type Annual $ Increase Annual % Increase
Employee $105.48 City 2.62% City
Employee & Spouse $217.32 City and Employee 2.62% City and Employee
Employee & Child $217.32 City and Employee 2.62% City and Employee
Family $235.08 City and Employee 2.62% City and Employee
062705 _ COMM _Add_On _Regular _512 _Health_Insurance
Page 3 of 3
As shown in attachments "D" and "E", and "F", the broker fees have been and continue to be 4%.
FUNDING:
Funding for the recommendations (listed as items 1 through 4 above) are included in the City Manager's
Tentative Fiscal Year 2005-2006 Budget proposal.
RECOMMENDATION:
The City Manager recommends the City Commission approves the following:
1. Approve the plan options provided by CIGNA.
2. Approve CIGNA Implementation Structure the Commission deems appropriate.
3. Continue to charge employee $5 per month (or $60 per year) in order to continue
Opting Out Provision.
ATTACHMENTS:
1. Health Insurance Plan Comparisons "A", "B" and "C".
2. Fees "D", "E", and "F".
COMMISSION ACTION:
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City of Winter Springs
Attachment C
UHC Plan 44 *~Igna
Benefits Description
$OOed $ 0 Oed
$0 Oed Fam $ 0 Oed Fam
100 % Coins 100 % Coins
$1 OOOP / $2000P Fam $1500P / $3000P Fam
Physician's Office Visit
. Preventive Care $20 $20 / $30
. Office Visit-PCP
. Office Visit-Specialist
Inpatient Hospital Services $250 $250
Outpatient Surgery No Copay No Co pay
Outpatient Diagnostic / Therapeutic No Copay No Co pay
Treatments
Emergency Health Services $100 $100
Emergency Ambulance Services No CODav No CODav
Urgent Care Services $50 $50
Routine Vision Exam thru Vision $20 $20
Network Provider 1 X 24 months 1 X 12 months
Rehabilitation Services-Outpatient Therapy $20 $20 / 20 Visits
20 Physical therapy Physical therapy
20 Occupational Occupational
20 Speech Speech
20 Pulmonary Pulmonary
36 Cardiac
Home Health Services-Max 60 CY Visits No Copay No Copay'
DME/Prosthetic Devices No Copay No Co pay / $3500 OME
$2,500 $200/ $1000 Prosthetics
Outpatient Hospice Services No Copay No Copay
Lifetime 360 no time frame
Skilled Nursing Services No Copay No Copay
90 davs 60 davs'
Professional Fees for Surgical and Medical No Copay No Copay
Services received in a facility
Transplantation Services $250 $250
Spinal Treatment $20 $20
24 visits 20 visits'
Prescription Drugs- $101 $20 / $50 $1 5 / $30 / $50
Mail Order
2.5 X 90 days 2 X for 90 days
$25/ $50 / $125 $30/ $60 / $100
IncludinCl Lifestvle druCls
Mental Health/Substance Abuse Services
. Inpatient-Max 30 CY days combined $250 $75 per day, 20 max'
MH/SA
. Outpatient-Max 30 CY visits combined $20 individual $15 1 - 2 visits'
MH/SA $15 group $35 3 - 20 visits'
$1540 groups visits
'combined days
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ATTACHMENT "0"
From:
Sent:
To:
Subject:
Dawn V Keller [dawn v keller@uhc.com]
Monday, June 27, 2005 10:36 AM
fbellus@aol.com
City of Winter Springs- commissions
Hi Fluffy.
This email is to confirm that you are receiving 4% commissions for the City of Winter Springs. You are
not receiving any types of overrides, bonuses or contingencies.
Thank you.
Dawn
This e-mail, including attachments, may include confidential and/or
proprietary information, and may be used only by the person or entity to
which it is addressed. If the reader of this e-mail is not the intended
recipient or his or her authorized agent, the reader is hereby notified that
any dissemination, distribution or copying of this e-mail is prohibited. If
you have received this e-mail in error, please notify the sender by
replying to this message and delete this e-mail immediately.
Subj:
City of Winter Springs
ATTACHMENT "E"
Date: 07/0212003 12:26:55 PM Eastern Daylight Time
From. william b abrahamsAuhc.com
To: fbellus@ aol.co_m
Sent from the Internet Details)
Fluffy,
With regards to the most recent set of rates and benefits being offered by United
Healthcare to the City of Winter Springs, please let it be known that this is our best
offer. Since our first issue of our proposal we have lowered our fates twice: Once
by a straight underwriting concession -which also included a lowering of
commission from 5 to 4% by your request - and a second time which incorporated
the up-to-date experience you provided.
Per your information, the City is focusing on our HMO 399T and POS 499T plans as a
dual option. The rates for the HMO 399T are now set exactly at the current in-force
rates. We are not prepared to offer the HMO - which is at on overall richer benefit level
- LESS than the current premiums under any circumstance. If a further request for a
reduction in Comission is requested, we will do so, but it will NOT lower the rates. The
United program being offered is the richest plan in our portfolio. Combine that with the
distinct advantages United offers - Open Access, Care Coordination, Employer
eServices, myuhc.com and Care24 - and a case can be made that our rates are more
than fair.
Please understand that we definitely want to earn the City's business. We feel
that our offer stands on its own merits and needs no further modification.
Please let me know if you have any questions.
Thanks!
Bill Abrahams
Account Executive - Key Accounts
UnitedHealthcare
This e-mail, including attachments, may include confidential and/or
proprietary information, and may be used only by the person or entity to
which it is addressed. If the reader of this e-mail is not the intended
recipient or his or her authorized agent, the reader is hereby notified that
any dissemination, distribution or copying of this e-mail is prohibited. If
you have received this e-mail in error, please notify the sender by replying
to this message and delete this e-mail immediately.
Sub): City of Winter Springs ATTACHMENT "F"
Date: 07/01/20033:12:50 PM Eastern Daylight Time
From: william Q abraharns@uhc.com
To: fbellus@aol.com
5 ent from the Internet (DetaiiJ!
Fluffy,
With regards to your existing groups written with UnitedHealthcare Key Accounts
(Large Groups over 50 eligible employees), you are receiving regular commissions
only. You are not being paid a bonus.
Please let me know if you have any questions.
Thanks!
Bill Abrahams
Account Executive - Key Accounts
UnitedHealthcare
495 N. Keller Road, S. 200
Maitland, FL 32751
407 -659-6964
This e-mail, including attachments, may include confidential and/or
proprietary information, and may be used only by the person or entity to
which it is addressed. If the reader of this e-mail is not the intended
recipient or his or her authorized agent, the reader is hereby notified that
any dissemination, distribution or copying of this e-mail is prohibited. If
you have received this e-mail in error, please notify the sender by replying
to this message and delete this e-mail immediately.
Jan Palladino
From:
Sent:
To:
Subject:
Reabe, Kelly A 30T [Kelly.Reabe@CIGNAcom]
Sunday, June 26, 2005 8: 11 PM
fbellus@aol.com
Commission Information for City of Winter Springs
To: Mr. Ron McLemore
Mrs. Fluffy Bellus
Subject: Commission Information for City of Winter Springs
This email is to confirm that Mrs. Fluffy Bellus will receive standard commission at 4% and does not
qualify for any other monies.
I trust you will find everything in order. Should you have any additional questions, please do not
hesitate to call me @ 407-833-3134.
Sincerely,
Kelly A. Reabe
Senior Account Executive
CIGNA HealthCare
255 Primera Blvd. St. 264
Lake Mary, FL 32746
ph. 407-833-3134
fax 407-833-3159
kelly.reabe@cigna.com
CONFIDENTIALITY NOTICE: If you have received this email in error, please immediately notify the
sender bye-mail at the address shown. This email transmission may contain confidential
information. This information is intended only for the use of the individual(s) or entity to whom it is
intended even if addressed incorrectly. Please delete it from your files if you are not the intended
recipient. Thank you for your compliance. Copyright 2005 CIGNA
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