R10-094
II I
1 RESOLUTION NO. RlO- 0 q '-I
2
3
4
5 A RESOLUTION OF THE CITY COMMISSION OF
6 BOYNTON BEACH, FLORIDA, AWARDING A
7 PROVIDER AGREEMENT FOR RFP #046-1610-10/CJD
8 "GROUP BENEFITS: MEDICAL CLAIMS
9 ADMINISTRATION (TP A) SERVICES AND/OR FULLY
10 INSURED PLANS" WITH CIGNA CORPORATION, FOR
11 MEDICAL INSURANCE FROM OCTOBER 1, 2010
12 THROUGH SEPTEMBER 30,2011; AUTHORIZING THE
13 CITY MANAGER AND CITY CLERK TO EXECUTE
14 THE PROVIDER AGREEMENT AND PROVIDING AN
15 EFFECTIVE DATE.
16
17
18 WHEREAS, on June 2, 2010, Procurement Services received and opened five (5)
19 proposals which were ranked by the review committee and sent to the City's Consultant,
2 Willis of Florida for technical expertise; and
21 WHEREAS, the City Commission of the City of Boynton Beach, upon
22 recommendation of staff, deems it to be in the best interests of the residents and citizens of the
23 City of Boynton Beach to award a Provider Agreement with CIGNA Corporation for the
2 medical insurance plan for a one year term commencing October I, 2010 for all city
25 employees.
2 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
2 THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
2 Section I. The foregoing "Whereas" clauses are hereby ratified and confirmed
2 as being true and correct and are hereby made a specific part of this Resolution upon adoption
3 hereof.
31 Section 2. The City Commission of the City of Boynton Beach, Florida does
S:ICA lRESOIAgreementslReso - Cigna Health Benefits 20 I O-II.doc
-I-
i
Ii
II
I hereby award a Provider Agreement to CIGNA Corporation for the medical insurance plan for
2 a one year term commencing October I, 2010, for all city employees, a copy of which is
3 attached hereto as Exhibit "A".
4 Section 3. The City Manager and City Clerk are authorized to execute the
5 Provider Agreement with CIGNA Corporation.
6 Section 4. That this Resolution shall become effective immediately upon passage.
-+h
7 PASSED AND ADOPTED this ~D day of July, 2010.
8
CITY OF BOYNTON BEACH, FLORIDA
1
II
P
13
I -
15
I
I
I
I
2
21
2
2
2 Commissioner . S ev
2
ATTEST:
1n. p~
J et M. Prainito, MMC
City Clerk
entslReso - Cigna Health Benefits 20 I O-II.doc
- 2-
RID-09Y
PROVIDER AGREEMENT FOR
"GROUP BENEFITS: MEDICAL CLAIMES ADMINISTRATOR (TP A)
SERVICES AND/OR FULLY INSURED PLAN
THIS AGREEMENT is entered into between the City of Boynton Beach, hereinafter referred to
as "the City", and CIGNA HealthCare , hereinafter referred to as "the
Provider", in consideration of the mutual benefits, terms, and conditions hereinafter specified.
\. PROJECT DESIGNATION. The Provider is retained by the City to perform PROVIDER
services in connection with the project designated.
2. SCOPE OF SERVICES. Provider agrees to perform the services, identified on Exhibit "A"
attached hereto and incorporated herein by reference, including the provision of all labor,
materials, equipment and supplies. No modifications will be made to the original scope of
work without the written approval of the City Manager or his designee.
3. TIME FOR PERFORMANCE. Work under this agreement shall commence upon the giving
of written notice by the City to the Provider to proceed. Provider shall perform all services
and provide all work product required pursuant to this agreement.
4. TERM: October I, 2010 through September 30, 201 I with three (3) additional one (I) year
renewals.
5. PAYMENT. The Consultant shall be paid by the Provider/City for completed work and for
services rendered under this agreement as follows:
Monthly basis per eligible employee and dependent for medical coverage invoiced by
Provider.
6. OWNERSHIP AND USE OF DOCUMENTS. All documents, drawings, specifications and
other materials produced by the Provider in connection with the services rendered under this
Agreement shall be the property of the City whether the project for which they are made is
executed or not. The Provider shall be permitted to retain copies, including reproducible
copies, of drawings and specifications for information, reference and use in connection with
Provider's endeavors.
7. COMPLIANCE WITH LAWS. Provider shall, in performing the services contemplated by
this Agreement, faithfully observe and comply with all federal, state and local laws,
ordinances and regulations that are applicable to the services to be rendered under this
agreement.
8. INDEMNIFICATION. Provider shall indemnify, defend and hold harmless the City, its
offices, agents and employees, from and against any and all claims, losses or liability, or any
portion thereof, including attorneys fees and costs. arising from injury or death to persons,
including injuries, sickness, disease or death to Provider's own employees, or damage to
property occasioned by a negligent act, omission or failure of the Provider.
PA-I
9. INSURANCE. The Provider shall secure and maintain in force throughout the duration of
this contract comprehensive general liability insurance with a minimum coverage of
$1,000,000 per occurrence and $1,000,000 aggregate for personal injury; and $1,000,000 per
occurrence/aggregate for property damage, and professional liability insurance in the amount
of $1 ,000,000 per occurrence to 2 million aggregate with defense costs in addition to limits.
Said general liability policy shall name the City of Boynton Beach as an additional named
insured and shall include a provision prohibiting cancellation of said policy except upon
thirty (30) days prior written notice to the City. Certificates of coverage as required by this
section shall be delivered to the City within fifteen (15) days of execution of this agreement.
10. INDEPENDENT CONTRACTOR. The Provider and the City agree that the Provider is an
independent contractor with respect to the services provided pursuant to this agreement.
Nothing in this agreement shall be considered to create the relationship of employer and
employee between the parties hereto. Neither Provider nor any employee of Provider shall
be entitled to any benefits accorded City employees by virtue of the services provided under
this agreement. The City shall not be responsible for withholding or otherwise deducting
federal income tax or social security or for contributing to the state industrial insurance
program, otherwise assuming the duties of an employer with respect to Provider, or any
employee of Provider.
II. COVENANT AGAINST CONTINGENT FEES. The Provider warrants that he has not
employed or retained any company or person, other than a bonafide employee working solely
for the Provider, to solicit or secure this contract, and that he has not paid or agreed to pay
any company or person, other than a bonafide employee working solely for the Provider, any
fee, commission, percentage, brokerage fee, gifts, or any other consideration contingent upon
or resulting from the award or making of this contract.
For breach or violation of this warranty, the City shall have the right to annul this contract
without liability or, in its discretion to deduct from the contract price or consideration, or
otherwise recover, the full amount of such fee, commission, percentage, brokerage fee, gift,
or contingent fee.
12. DISCRIMINATION PROHIBITED. The Provider, with regard to the work performed by it
under this agreement, will not discriminate on the grounds of race, color, national origin,
religion, creed, age, sex or the presence of any physical or sensory handicap in the selection
and retention of employees or procurement of materials or supplies.
13 ASSIGNMENT. The Provider shall not sublet or assign any of the services covered by this
Agreement without the express consent of the City.
14. NON-WAIVER. Waiver by the City of any provision of this Agreement or any time
limitation provided for in this Agreement shall not constitute a waiver of any other provision.
PA-2
15. TERMINATION.
a. The City reserves the right to terminate this Agreement at any time by giving ten
(10) days written notice to the Provider.
b..In the event of the death of a member, partner or officer of the Provider, or any of its
supervisory personnel assigned to the project, the surviving members of the Provider
hereby agree to complete the work under the terms of this Agreement, if requested to do
so by the City. This section shall not be a bar to renegotiations of this Agreement
between surviving members of the Provider and the City, if the City so chooses.
16. DISPUTES. Any disputes that arise between the parties with respect to the performance
of this Agreement, which cannot be resolved through negotiations, shall be submitted to
a court of competent jurisdiction in Palm Beach County, Florida. This Agreement shall
be construed under Florida Law.
17. NOTICES. Notices to the City of Boynton Beach shall be sent to the following address:
City of Boynton Beach
P.O. Box 310
Boynton Beach, FL 33425-0310
Notices to Provider shall be sent to the following address:
CIGNA HealthCare
1571 Sawgrass Corporate Parkway
Suite 140
Sunrise, FL 33323
A TTN: Scott Evelyn
18. INTEGRA TED AGREEMENT. This agreement, together with attachments or addenda,
represents the entire and integrated agreement between the City and the Provider and
supersedes all prior negotiations, representations, or agreements written or oral. This
agreement may be amended only by written instrument signed by both City and Provider.
DA TED this :-to _ day of -:s '^- "" e.- ,20~.
CITY OF BOYNTON BEACH
~ot~
City Manager Scott Evelyn
PA-3
Attest/Authenticated: Vice President, CGLIC _
Title
~Yn. ~<"1b Seal)
City lerk
Approved as to Form: Attest/Authenticated:
~~
C' r~l )(L..' (\
ffice of ~e .' y o~~) Secretary
Rev 1/22/91
PA-4
"EXHIBIT A"
SCOPE OF SERVICES
PA-5
110
CIGNA RID-oG}Y
CIGNA HealthCare Group Benefits
Account Name: City of Boynton Beach
100 E. Boynton Beach Boulevard,
Boynton Bcach, FL 33425
SIC Code: 9111
Total Eligible Employees: 950 Participating Subscribers: 946
Employer Contributions - Employee: 100% Employer Contributions.. Dependent: 0%
Waiting Period: 30 Days
Eligibility Definition: Active Employees working 36 hrs
Note: The Quoted rates are subject to tinal Underwriting approval and, as noted below, are subject to change in the event of
changes in benefits selected or changes in the risk factors upon which the Quoted Rates are based. In addition, state law may require
regulalory approval of rates. If required regulatory approval has not been obtained on the proposed effective date, the heallhplan
shall use rates that are consistent with its theo eurreotly approved rating methodoiogy and the quoted rates shall be eITective
immediately on the date for which they are approved for use. The Quoted Rates are guaranteed while the Group Service Agreement
remains in effeel until the next anniversary date, unless enrollment changes by 10% in which ca..e the CIGNA Companies may
change the Quoted Rate.
SiF # 20704 Page I of II 0613012010
110
CIGNA
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/0112010
Category Description In Network Out of Network
Medleal Benents Open Aeeess Plus Copay
Modular Medical Management Program PHS+
Omce Visit Copay NA
Primary Care Copay $15
Specialty Care Copay (Tier lmer 2) $251$30
Coinsurance 80% 60%
Hospital!P Copay - Per Admit NA
Hospital 11' Deductible - Per Admit NA
Hospital 11' Copay Per Day NA
Hospital 11' Dcduetiblc - Per Day NA
Maximum Reimbursable Charge Option 2 - 110% Incl
NSP & Bill Negotiation
Collective Deduetible/OOP Admin Option NO NO
Combined MedicallPharmacy Deductible/OOP Admin NO NO
Option
Annual Individual Plan Deductible $0 $500
Annual Family Plan Deductible $0 $1,500
Deduct Accumulator Standard: One Way Standard: One Way
Accumulation Accumulation
OOP - Individual Maximum Amount $2,500 $5,000
001' - Family Maximum Amount $5,000 $10,000
OOP Max - Accumulator Standard: One Way Standard: One Way
Accumulation Accumulation
OOP Max Oed Includes Ded Includes Ded
001' Max Copays Includes Copays Includes Copays
Lifetime Maximum Amount Unlimited
Lifetime Maximum" Annual Reinstatement Amount NA
Outpatient Facility Copay $100
Outpatient Paeility Deductible $375
Emergency Room Copay $\00
Emergency Room Deductible $100
Urgent Carc Copay $50
Urgent Care Deductihle $50
Other Health Care Facility IP Maximum Days 60
Lab/Radiclogy Standard Coverage Freestanding fac 100% Freestanding Fac 100%
MRI, CT PET Scans Copay $50 $100
LablRadiology Mid-Point Coins Option Coinsurance NA NA
Home Health Care Maximum Days 60
Durable Medical Equipment Included Cvrd-DedlCoins
SIF # 20704 Page 2 of II 06/3012010
II~
OGNA
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10101/2010
Category Destription In Network Out of Network
Medical De.en.. Open Access Plus Cop.y
Durable Medioal Equipment Maximum Amount Unlimited
External Prosthetic Appliances Included Cvrd-Ded/Coins
External Proslhetic Appliances Deductible $0
External Prosthetic Applianecs Maximum Amount Unlimited
Short Term Rehab and Chiro Combined Maximum Days 60
Short Term Rehab Maximum Day, NA
Chiropractie Care Maximum Amount NA
Chiropractic Care Maximum Days NA
Infertility Treatment Standard Coverage Not Covered Not Covered
Infertility Optl - DiaSnoses/Correetive procedures Excluded
Infertility Opt I _ Diagnoses/Corrective procedure Not Covered
Infertility Opt 2 - Opt! plus Invitro, GIFT, ZIFT, etc. Excludcd
Inferlility Opt 2 - Opt 1 plus Invilro, GlFT, ZWf Not Covered
Infertility Opt 2 - Lifetime Maximum Amoun\ NA
Bariatric Services Excluded
Bariatrie Surgery - Lifetime Maximum Amount NA
Preventive Care - Children thru Age 2 Included Not Covered
Preventive Care Opt 2 - Annual Physicals Age 3+ Included Not Covered
Preventive Care Opt 2 . Immuni""tions Included
Preventive Care Opt 2 - Calendar Year Benefit Maximum Unlimited
Amount
Organ Transplant Included Cvrd-OedlCoins
Health Advisor Health Advisor (Core I!r.
Behavioral Coaching)
Routine Foot Care Buy-up Inciuded Cvrd-DedJCoins
Routine foot Care Separate Buy-up Coinsurance NA
Rouline FoOl Care - Cal Yr Buy-up Oenetit Maximum $1.000 NA
Amount
Non-Surgical TMJ Included Included
PCL Included Included
P AC/CSR - Standard lp Admit/Case Management UR Included
Program
P AC/CSR Ip Non Compliance Penalty Amount $750
P AC/CSR IP Non Complianoe Penalty Percent 50%
Medicare COB: Retirees >~65 Admin Option NA
Medicare COO Type None
Percent of Medicare Eligible NA
SIF # 20704 Page 3 of J I 06/30/20 J 0
110
CIGNA
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10101/2010
Category Description In Network Out of Network
Medleal Benents Opcn Ae.es. Plus Copay
Well Aware Program (Diabetes) Included
Well Aware Program (Cardiac) Included
Wcll Aware Program (Aslhmn) Included
Well Aware Program (Low Back Pain) Included
Well Aware Program (COPD) Included
Well Aware Program (Weight Complications) Included
Well Aware Program (Targeted Conditions) Included
Well Aware Program (DeprcSsion Management) Included
Incentive Points Program Excluded
24NIL Included
Heallhy Rewards Included
LifeSourcc Organ Transplant Network Transplant Included
Program
Language Line Ineludcd
Transition of Care Included
Case Management Included
Provider Channeling Included
A way From Home Care Included
Drugstore.Com Included
Pharmacy Benefits CIGNA PharmacyPlus ,}- Tier Copay
Plan Buy Up Option Coinsurance NA
Retail - Generic Copay $10
Retail - Brand Copay $25
Retail - Non Preferred Copay $40
Mail Order - Generic Copay $20
Mail Order - Brand Copay $50
Mail Order Copay - Non-preferred $80
Retail - Individual Buy Up Option Deductible NA
Retail - Family Buy Up Option Deductible NA
Retail - Individual Deduetible NA
Retail - Family Deductible NA
OOP - Individual Maximum NA NA
OOP - Family Maximum NA NA
Standard Preventive Drugs Exeludcd from Deductible NO
Oed & OOP Max Apply to MOD Do Not Apply to MOD
MOD Program No Mandatory
Maintenance Drug List NA
SIF # 20704 Page40fll 06130120 I 0
R~
CIGNA
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/20]0
Category Description In Network Out of Network
Pharmacy Benefits CICNA PharmaeyPlus 3-Tlcr Copay
Oral Contraceptives/Devices Covered
Lifestyle Drugs Not Covered
Oral Fertility Drugs Not Covered
Self"Administered Injcctables Covered
Optionallnjectables Buy-Up NOI Covered
Insulin Covered
Insulin Needles & Syringes Covered
Glucose TeSI Strips Covered
Lancets Covered
Prenatal Vitamins Covered
Step Therapy Program Included
Clinical Management Program Enhanced
Enh. - Benefit Exclusion Selected
Enh. . Intensive Appropriateness of Use Selected
Enh. - Utilization and Unit Cost Management Selected
Generic Push Included
Formulary Incentive
Prescriber Panel Open
MH/SA Benefits OA Plus MHSA Sep'l'lIte
CIGNA Behavioral Health In 8< Outpatient Mgmt. CAP
MH HospitallP Coinsuranee 80% 60%
MH HospitallP - Per Admit Copay NA NA
MH HospitallP" Per Day Copay NA NA
MH Hospital IP Maximum Days 365
SA HospitallP Coinsurance 80% 60%
SA Hospital IP - Per Admit Copay NA NA
SA Hospilal IP - Per Day Copay NA NA
SA Hospital IP Maximum Days NA
MH Outpatient Copay $20
MH Outpatient Coinsurance NA 60%
MH or & Group Therapy Combined Maximum Visits 365
MH lnlensive Outpatient Copay S50 $50
MH Intensive Outpatient Coinsurance 50% 50%
S ^ Outpatient Copay S20
SA Outpatient Coinsurance NA 60%
SA Outpatient Maximum Visits NA
SA Intensive Outpatient Copay $50 $50
SIF # 20704 Page 5 of II 06/30/20 I 0
.~
CIGNA
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 1010112010
Category Description In Network Out of Network
MUlSA Benefits OA Plus MHSA Separate
SA Intensive Outpatient Coinsurance 50% 50%
MH Grp Therapy Copay $20
MH Grp Therapy Coinsurance NA 60%
MI" OP Tiered Copay Option Excluded
MH OP Tier I Copay NA
MH OP Tier I Visits (I to _ ) Maximum NA
MH OP Tier 2 Copay NA
MH 01' Tier 2 VisilS (Tier I max to _ ) Maximum NA
MH 01' Tier 3 Copay NA
MH 01' Tier 3 Visits (Tier 2 max to _ ) Maximum NA
SA OP Tiered Copay Option Excluded
SA 01' Tier I Copay NA
SA 01' 1'Ier 1 Visits (1 to _) Maximum NA
SA 01' Tier 2 Copay NA
SA 01' Tier 2 Visits (Tier 1 max to _ ) Maximum NA
SA OP Tier 3 Copay NA
SA 01' Tier 3 Visits (Tier 2 max to _ ) Maximum NA
Standard lP Review/Case Mgmt UR Program Included
01' Review/Case Mgmtl3uy Up 1 UR Program Excluded
OP Review/Cas. Mgmt Buy Up 2 UR Program Excluded
Transition of Care (90 day period) Included
SIF # 20704 Page 6 of II 06/30/20 to
lie
CIGNA
Display Group Name: CG OAP Agg (C0300A, FL305B, FL305C, FL305E, FL30SI, FL30SJ, FL305K,
FLJ05L, FL305V, GA300A, GA300B,
Ti~,. Sub5Ctibtn: Pl'OpOitd Rate Montbly Prtml~m
Employee 653.00 1175.11 1371,174.36
limp + Spouse 70,00 11,111.80 178,101.98
Emp + Child(ren) 66.00 51.031.28 168,328.62
Emp'" I:umily 157.00 11,282.$9 1201.367.30
'rut.t !'46.uu 171',376,17
SIF # 20704 Page 7 of I 1 06/30/2010
110
CIGNA
Medical History Information
For
City of Boynton Beach
I. Have there been claims over $10,000 in the last 12 months?
2. Nas any employee missed more than 10 consecutive days in the last 12
months due to i1Incss or injury?
3. Arc there any employees with ongoing disabilities?
4. Have any individuals been diagnosed, received treatment, or arc currently
recei....ing treatment from the following condition:;; in the pa...-.t three years: AlcohOl I
Drug abuse, Cancer, Diabetes. Heart Conditions, Immune System Disorder,
Kidney Ailments, Liver Diseases, Lung Conditions, Obesily, Organ Transplants?
SIF # 20704 Page ~ of II 06/30/2010
110
CIGNA.
Underwriting Contingencies
For
City of Boynton Beach
A. General Terms of this Proposal
CIGNA HealthCare is pleased to present this Proposal for a Guaranteed Cost group medical and pharmacy benefit plan
(the "Plan") sponsored by City of Boynton Beach. This proposal is valid for 90 days from its original date of release,
06/30/2010, Any revisions or updates to this proposal will not renew this valid timeframe unless expressly
communicated by CIGNA HealthCare,
Procosal Caveats
CIGNA may revise or withdraw this Proposal if:
1 there is a change to the effective date of the quote.
2 the policy period length is differentlhan 12 months.
3 the policy will not be siNsed in fL.
4 the Plan benefits are different than shown in the RFP or benefit moditications arc requcsted.
5 the ccnsuS or experience provided by Willis of J'Iorida, Inc. is deemed inaccurate.
6 there is a change in any law, regulation, or required assessment or tax that ehanges CTGNA HealthCare's costs in offering the
plan.
7 enrollment increases or decreases by 10% or more, by product or for the total account, from the enrollment assumptions used in
establishing the rates and/or fees sel forth herein.
8 the final enrollment deviates from the quoted enrollment such that it results in a needed change in premium rates, Rales are
based on Jinal enrollment factors, including total number of enrollees, their age, sex, demogT'8phics, loeation and the distrihution
of enrollees by product or membership tier.
9 participation is below 70%. This will be based On thc total eligible employees, identified as 950.
10 any of the information upon which these rates or benetits were based (including Medieal History Infonnalion) changes or is
inaccurate.
11 it is not the exclusive provider of Medical/ Phannacy or like products for all of City of Boynton Beach's employees in all
worksites.
12 the employer contributes less than 50% toward the total cost of the plan.
13 the employer changes its eontribution to the plan rates (either the percentage or amount).
14 either one or more of the quoted sites withdraws prior to the elTeetive date or terminates during the contract term, or at any time
following enrollment.
15 the current waiting period i. different than 30 D days.
16 it is requested to change the following additional Programs included in the rates and/or fees as listed here: 11ealth Advisor.
17 current product is not sold as a single option. If placed beside another product in II dual option position. rates will be loaded
based on the number of products placed alongside each other.
18 there is any reimbursement arrangement ("gap" cards, etc.) that subsidizes or reduces the out-oC-pocket obligation of covered
persons under the policy.
SIF # 20704 Page 9 of I I 06/30/2010
110
CIGNA
Underwriting Contingencies
For
City of Boynton Beach
8, Scope and Application ofthis Proposal
Unless otherwise indicated, this Proposal:
1 supersedes and renders null and void any prior CIGNA HealthCare offer or proposal with respect to the Plan.
2 or policy may be canceled "'_ ofany Premium Due Date if the number of insured Employ... fails to meet the minimum
required per group participation rules; or for failure to comply with any othcr material plan provision relating to Employer
contributions or group participation rules.
3 require, a sep8J'llte bene lit option due to state regulations. if you have purch",_ed OAPIPPO with CIGNA HealthCare
Behavioral Advantage and you have mcm~rs residing in NC or CA.
4 does not apply to part..time or seasonal employees for any plan.
5 does not apply to Medicare eligible retirees for any plan.
6 includes the Network Savings Program (NSP) and other bill negotiation.
7 excludes charges for converting a qualitied member of a group plan to an individual plan,
8 includes a maximum reimbursable charge for out-of-network eovcrage cqualto 110% ofa fee schedule developed by CIONA
HcallhCare bascd upon a melhodology similar to that used by Medicare to detemline the allowable ree ror similar services in
the geographic market. OR 80th percentile of charges made by providers of such service or supply in the geographic area
where the service is received.
9 assumes all employees are loeated in the network area, and that all employecs are only eligible for lhe CIGNA HealthCare or
any other affiliated company product orrerings specitied.
10 requires you notify us within 30 days if any information set forth in this form changes at any time while coverage is provided to
you by CIGNA HealthCare.
11 may require regulatory approval ofmtes, If, as of their proposed effective date, regulatory approval is not obtained, the
hcallhplan shall use rates consistent with its then currently approved raleS and the foregoing rates shall be effeetive
automatically. If a product is new and has never had approved ratesl the effective date of coverage will be postponed until
regulatory approval is received.
12 allows cavcats and conditions set forth in this document to survive cxecution of any final contract and/or issuance by CIGNA
HealthCare of any policy and/or Group Service Agreement.
13 is a high-level summary of the proposed coverage, It docs not idenlify al1the categories ofheal1h care expenses that are
covered or excluded.
14 may inolude state required continuation rates which will ma.tch the rates for the underlying plan. For Nebra.l!:Oka and New York
Over Age Dependents the rates will match the employee rate for the underlying plan.
SIF # 20704 Page JO or I I 06/30/2010
110
CIGNA
Underwriting Contingencies
For
City of Boynton Beach
The CIGNA HeaUhCare Companies rcscrve the right to change the Quoted Rates and/or Quoted Benefits or to decline
to offer eoverage if any of the foregoing information is inaccurate or changes prior to the proposed EITeclive Date
indicated above, or if the quoted rates and/or fees are not agreed to within 60 days of receipt of this summary
infonllation form. If any of the information idenlified above changes either prior to the proposed Effective Date or
while covcragc is in effect, you agree to notify us promptly of such change.
The "Underwriting Contingencies" set forth above shall survive execution of any insurance policy, applicalion, elc.,
issued by Connecticut General Ufe Insurance Company or any other CIGNA HeaUhCare company, and shall further
~urvive lhe effective date of any such policies.
Tbe beneftls displayed In Ibis sumlnary are, for tbe mosl part, modular benelit packages used to develop tbe
rates. Please review tbe Benefit Summary and its attachments for infurmation about the benefits available in
your sites.
"CIGNA Healthcarc" refers to various operating subsidiaries of CIGNA Corporation. Products and services arc
provided by these subsidiaries ilnd not by CIONA Corporation. These subsidiaries include Connecticut General Life
Insurance Company, Tel-Drug, Inc. and its affiliates, C1GNA Behavioral Health, Inc., Intracorp, and HMO or service
company subsidiaries ofCIGNA Health Corporation and CtGNA Dental Health, Inc.
I UNDERSTAND AND AGREE ON BEHALF OF CONTRACTHOLDER THAT CIGNA HEALTHCARE MA Y,
NOTWITHSTANDING THE TERMS OF THE INSURANCE POLICY OR SERVICE AGREEMENT, REVISE
ANY PREMIUM RATES OR PREPAYMENTS FEES AT ANY TIME IF THE ENROLLMENT OR EMPLOYER
CONTRIBUTION LEVEL IS DIFFERENT THAN ASSUMED BY CIGNA HEAL THCARE IN UNDERWRITlNG
THE CONTRACT OR IF CIGNA IS Ci) REQUIRED TO PAY ANY ASSESSMENT, OR (iI) INCUR
ADDITIONAL COSTS IN ADMINISTERING THE CONTRACT AS A RESULT OF THE PATIENT
PROTECTION AND AffORDABLE CARE ACT AND THE RECULA nONS PROMULGATED
THEREUNDER.
Client Signature Date
Client Name Title
SIF II 20704 Page II ofl1 06/30/20 I 0
The Cibj ol BoljDtOD Beach
City Clerk's Office
100 E BOYNTON BEACH BLVD
BOYNTON BEACH FL 33435
(561) 742-6060
FAX: (561) 742-6090
e-mail: prainitoj@bbfl.us
www.boynton-beach.org
July 22, 2010
Mr. Scott Evelyn
CIGNA HealthCare
1571 Sawgrass Corporate Parkway
Suite 140
Sunrise, FL 33323
Re: Resolution # Rl0-094 Provider Agreement for Group Benefits: Medical Claims and
Administrator (TPA) Services and! or Fully Insured Plan
Dear Mr. Evelyn:
Attached for your handling is the original agreement and a copy of the Resolution mentioned above.
Once the agreement has been signed, please return the original to the City Clerk's Office for further
processing.
If you have any questions, please do not hesitate to contact me.
Very truly yours,
CITY OF BOYNTON BEACH
~Y{).~
J net M. Prainito, MMC
City Clerk
Attachments
(agreement & resolution)
tis
s: \ cc \ WP\AFTER COMMISSION\ Other Transmittal Letters After Commission \20 10 \R1O-094 ClGNA HealthCare.doc
America's Gateway to the Gulfstream
The City of Boynton Beach
City Clerk's Office
100 E BOYNTON BEACH BLVD
BOYNTON BEACH FL 33435
(561) 742-6060
FAX: (561) 742-6090
e-mail: prainitoj@bbfl.us
www.boynton-beach.org
July 6, 2011
Ms. Terri Gosling
Cigna Corporation
Suite 140
1571 Sawgrass Corporate Parkway
Sunrise, FI 3323-2807
Re: Rl0-094 Provider Agreement for GrouD Benefits Medical Claims
Administrator Services and/or Fully Insured Plan
Dear Ms. Gosling:
Attached for your information and files is a fully executed copy of the agreement and
the resolution mentioned above.
If I can be of any additional service, please do not hesitate to contact me.
Very truly yours,
CITY OF BOYNTON BEACH
~m.~
J et M. Prainito, MMC
City Clerk
Attachments
tis
S:\CC\WP\AFTER COMMISSION\Other Transmittal Letters After Commission\2011 \Rl0-094 Provider Agreement for Group Benefist Medical Claims.doc
America's Gateway to the Gulfttream