R11-072RESOLUTION NO. R11 -01 ,2 `
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A RESOLUTION OF THE CITY COMMISSION OF
BOYNTON BEACH, FLORIDA, AWARDING A
PROVIDER AGREEMENT FOR RFP 4046 - 1610- 10 /CJD
"GROUP BENEFITS: MEDICAL CLAIMS
ADMINISTRATION (TPA) SERVICES AND /OR FULLY
INSURED PLANS" WITH CIGNA CORPORATION, FOR
MEDICAL INSURANCE FROM OCTOBER 1, 2010
THROUGH SEPTEMBER 30, 2011; AUTHORIZING THE
INTERIM CITY MANAGER AND CITY CLERK TO
EXECUTE THE PROVIDER AGREEMENT AND
PROVIDING AN EFFECTIVE DATE.
WHEREAS, on July 20, 2010, the City Commission of the City of Boynton Beach
14 approved the award of a Provider Agreement to CIGNA Healthcare for Group Benefits
20 Medical Claims Administration Services and /or Fully Insured Plan for the one year term from
2 ) October 1, 2010 to September 30, 2011; and
2 : WHEREAS, the Provider Agreement had the option to extend the Agreement for
2_ three additional one -year periods; and
2z WHEREAS, the City Commission of the City of Boynton Beach, upon
2_ recommendation of staff, deems it to be in the best interests of the residents and citizens of the
26 City of Boynton Beach to approve the one year extension of a Provider Agreement with
2" CIGNA HealthCare for the medical insurance plan for a term commencing October 1, 2011 to
2t September 30, 2012, for all city employees.
24 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
Y THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
31 Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed
S: \CA \RESO\Agreements \Reso - Cigna Health Benefits 201 1- 12.doc
j as being true and correct and are hereby made a specific part of this Resolution upon adoption
hereof.
Section 2. The City Commission of the City of Boynton Beach, Florida does
hereby approve a one year extension of the Provider Agreement to CIGNA HealthCare for the
medical insurance plan for a one year term commencing October 1, 2011 to September 30,
(0 2012, for all city employees, a copy of which is attached hereto as Exhibit "A ".
Section 3. The Interim City Manager and City Clerk are authorized to execute the
Provider Agreement with CIGNA Healthcare.
Section 4. That this Resolution shall become effective immediately upon passage.
t( PASSED AND ADOPTED this day of July, 2011.
CITY OF BOYNTON BEACH,L(QRIDA
M'
Vice Mlyi — Willia Orl ove
Comm' ner Woodrow Ha
Commissions. St o
Commissioner — Marlene Ross
ATTEST:
31 'M • (�
3_ Jai n MMC
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- Cigna Health Benefits 201 1- 12.doc
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PROVIDER AGREEMENT FOR
"GROUP BENEFITS: MEDICAL COVERAGE 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.
1. 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. Also to incorporate changes outlined in June 3, 2011
letter included in Exhibit "A ". No additional modifications other than those described in the
June 3, 2011 letter 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 1, 2011 through September 30, 2012 with two (2) additional one (1) 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.
VNIVI
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.
11. 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
ATTN: Dina D'Angelo
18. INTEGRATED 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.
DATED this day of 20
CITY OF BOYNTON BEACH
City Manager
Provider
Vail
Attest /Authenticated:
Title
(Corporate Seal)
City Clerk
Approved as to Form: Attest/Authenticated:
Office of the City Attorney Secretary
Rev 1/22/91
FEE,
"EXHIBIT A"
SCOPE OF SERVICES
,
Dina D'Angelo
Sr. Client Manager
June 3, 2011
City of Boynton Beach
100 E. Boynton Beach Blvd.
Boynton Beach, FL 33425
ealthCare
1571 Sawgrass Corp Pkwy
Suite 140
Sunrise, Florida 33323
Telephone 954 -514 -6877
dina.dangelok�cigna.com
CIGNA is pleased to provide a renewal offer with no change to your
current rates for the upcoming policy year October 1, 2011 through
September 30, 2012. The following benefit changes would apply:
Benefit Changes:
Increase in- network deductible from $0 x 3 Family to
$300 x 3 Family
Increase PCP copay from $15 to $20
Increase CCN Specialist/ Non CCN Specialist copay from
$25/$30 to $30/$35
Increase ER copay to $125 from $100
Increase UC copay to $75 from $50
Increase Rx Retail non - preferred brand copay to $50 from
$40
E
Renewal Rates:
Increase Rx MOD non - preferred brand copay to $100 from
Tier
Subscribers
Current
Renewal
Monthly
Change
EMP
648
$575.15
$575.15
$372,697.20
0%
EMP + Spouse
064
$1,115.80
$1,115.80
$71,411.84
0%
EMP + Child(ren)
058
$1,035.28
$1,035.28
$60,046.82
0%
EMP +Family
116
$1,282.59
$1,282.59
$148,781.60
0`Yo
We value our partnership with you and look forward to continuing to
serve you.
Sincerely,
Dina D'Angelo
Dina D'Angeio
Proud National Sponsor of the March of Dimes walkAmerical.. the Walk that Saves Babies
"CIGNA" or "CIGNA HealthCare" are registered service marks and refer to various operating subsidiaries of CIGNA Corporation.
Products and services are piovided by these operating subsidiaries and not by CIGNA Corporation. These operating eubeldiaries
include Connecticut General Life Insurance Company, Tel -Drug, Inc_ and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and
HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO Plans are offered by
CIGNA HealthCare of Arizona, Inc. In California, HMO plans are of Eered by CIGNA HealthCare of California, Inc. in Virginia, HMO
Plans are offered by CIGNA Healthcare of virginia, Inc. and CIGNA HealthCare Hid - Atlantic, Inc. In North Carolina, HMO plans are
offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by
Connecticut General Life Insurance Company.
June 3, 2011
Page 2
Sr. Client Manager
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Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2010
Category Description To Network Out of Network
Medical Benefits Open Access Plus CoPttr
Modular Medical Management Program
PHS+
Of ice VWtCopsy
NA
Primary Carc Copay
$1 S
Specialty Caro Copay (Tier 1 PI'Ior 2)
$25/$30
Coinsurance
BO%
60%
Hospital tP Copay - Per Admit
NA
Hospital 1P Deductible - Per Admit
NA
Hospital IP Copay Pcf Day
NA
Hospital IP Deductible - Pcr Day
NA
Maximum Rcimbursablc Charge
Option 2. 110% Intl
NSP k Bill Negotiation
Collective Dcduetible/OOP Admin Option
NO
NO
Combined Medical/Pharmacy DeductibicfOOP Admin
NO
NO
Option
Annual Individual Plan Deductible
50
53110
Annual Family Plan Deductible
SO
$ 1,500
Deduct Accumulator
Standard: One Way
Standard: One Way
Aomimulation
Accumulation
OOP - Individual Maximum Amount
$2,500
$5,000
OOP - Family Maximum Amount
$5,000
$10,000
OOP Max - Accumulator
Standard: One Way
Standard: One Way
Accumulation
Accumulation
OOP Max Ded
includes Ded
Includes Ded
OOP Max Copays
Includes Copays
Includes Copays
Lifetime Maximum Amount
Unlimited
Lifetime Maximum - Annual Reinstatement Amount
NA
Outpati=t Facility Copay
S100
Outpatient Facility Deductible
$375
Emergency Room Copay
SIOO
Emergency Room Deductible
s 100
Urgent Carc Copay
$50
Urgent Care Dcductibtc
$50
Other Health Care Facility IP Maximum Days
60
l.ab/Radiology Standard Coverage
Freestanding Fac 1009
Freestanding Fac WO%
MRI, CT PET Scans Copay
$50
$100
Lob/Radiology Mid -Point Coins Option Coinsurance
NA
NA
Mome Health Care Maximum Days
60
Durable Medical Equipment
included
Cvrd- Ded/Coins
SI F 0 20704 Page 2 of 11
06!30/2010
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Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2010
Category Description In Network Out of Network
Medical Beueflts Open Access Plus Copay
Durable Medical Equipmmeut Maximum Amount Unlimited
External Prosthetic Appliances Included Cvrd- Ded/Coins
External Prosthetic Appliances Deductible S0
lxtemal Prosthetic Appliances Maximum Amount Unlimited
Short Term Rehab and Chiro Combined Maximum Days 60
Short Term Rehab Maximum Days
NA
Chiropractic Care Maximum Amount
NA
Chiropractic Cars Maximum Days
NA
Infertilhy' routmem Standard Coverage
Not Covered
Not Covered
Infertility Opt 1- Diagnoses/Corrective procedures
excluded
infertility Opt 1 - Diagnoses/Corrective procedure
Not Covered
Infertility Opt 2 - Opt l plus Invitro, GIFT, ZIFT, etc.
Excluded
Infertility Opt 2 - Opt 1 plus Invitro, CIFr, ZIF r
Not Covered
Infertility Opt 2 - Lifetime Maximum Amount
NA
Barlatric Services
Excluded
Barintric 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 - Immuniudons
Included
Preventive Care Opt 2 - Calendar Year Benefit Maximum Unlimited
Amount
Organ Transplant
Included
Cvrd- Ded/Coins
Health Advisor
Health Advisor (Core &
Behavioral Coaching)
Routine Foot Care Huy -up
Included
Cvrd- Do&Coins
Routine Foot Care Separate Buy -up Coinsurance
NA
Routine Foot Care - Cal Yr Buy -up Benefit Maximum
S1,000
NA
Amount
Non - Surgical 7`MJ
included
included
PCL
included
Included
PAC /CSR - Standard IP Admit/Case Management UR
Included
Program
PAC /CSR iP Non Compliance Penalty Amount
$950
PACICSR IP Non Compliance Penalty Percent
50%
Medicare COB. Retinas »65 Admin Option
NA
Medicare COB type
None
Pcrcant of Medicare eligible
NA
SIF 0 20704 Page 3 or i 1
06130/2010
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Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10101/2010
Category Description [a Network Out of Network
Medkal Benefits Open Access Plus Copay
Well Aware Program (Diabetes)
Included
Well Aware Program (Cardiac)
Included
WeII Aware Program (Asthma)
Included
Well Aware Program (Low [tack Pain)
Included
Well Aware Program (COPD)
Included
Well Aware Program (Weight Complications)
Included
Wall Award Program (Targeted Conditions)
Included
Well Award Program (Depression Management)
Included
Incentive Points Program
Excluded
24HIL
included
healthy Rewards
Included
LifcSourcc Organ Transplant Network Transplant
Included
Program
Language Lino
Included
Transition of Care
Included
Case Management
Included
Provider Channeling
Included
Away From Home Care
Included
Drugstore.Com
Included
Pharmacy Benefits CIGNA PtiarmaeyFlus 3 -Tier Copay
Plan guy Up Option Coinsurance
NA
Retail - Generic Copay
$10
Retail - Brand Copay
$25
Retail - Non Prcfcncd Copay
$40
Mail Order - Generic Copay
$20
Mail Order - Brand Copay
$50
Mail Order Copay - Non - preferred
$30
Retail - Individual Buy Up Option Deductible
NA
Retail - Family Buy Up Option Deductible
NA
Retail - Individual Deductible
NA
Retail - Family Deductible
NA
OOP - Individual Maximum
NA
NA
OOP - Family Maximum
NA
NA
Standard Preventive Drugs Excluded from Deductible
NO
Ded & OOP Max Apply to MOD
Do Not Apply to MOD
MOD Program
No Mandatory
Maintenance Drug List
NA
SIF 0 20704 Page 4 of I I
06/30/2010
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Proposed Benefits
Product: Open Access Plus
Situs State: PL
Effective Date: 10/01/2010
Category
Description
In Network
Out or Netwetrk
Pharmacy Benefits
CIGNA PttarmaeyPtus 3-Tler Copsy
Oral Contraceptives/Uevices
Covered
Lifestylc Drugs
Not Covered
Oral Fertility Drugs
Not Covered
Self- Administered Injoetables
Covered
Optional Injectables Huy -Up
Not Covered
Insulin
Covered
insulin Needles & Syringes
Covered
Glucose Text Strips
Covered
Lancets
Covered
Prenatal Vitamins
Covered
Step Therapy Program
included
Clinical MwuW=ent PTgram
Enhanced
Enh. - Benefit Exclusion
Sciected
Hnh, - intensive Appropriateness of Use
$elected
Enh. - Uti lizedon and Unit Cost Management
Selected
Generic Push
Tncluded
formulary
lnmdve
Preseribcr Pancl
Open
MH /SA Benefits
OA Plus MHSA Separate
CIGNA Behavioral Health
in & Outpatient Mgmt, CAP
MH Hospital IP Coinsurance
80%
60%
MH Hospital IP - Per Admit Copay
NA
NA
MH Hospital IP - Per Gay Copay
NA
NA
MH Hospital IP Maximum Days
365
SA Hospital IP Colnsurrncc
80%
60 0 /6
SA Hospital IP - Per Admit Copay
NA
NA
SA Hospital IF - Per Day Copay
NA
NA
SA Hospital IP Maximum Days
NA
MH Outpatient Copay
$20
M14 Outpatient Coinsurance
NA
60 0 /6
MH OP do Group Therapy Combinod Maximum visits
365
MH Intensive Outpatient Copay
$30
$50
MH Tnicnsive Outpatient Coinsurance
50%
50%
SA Outpatient Copay
S20
SA Outpatient Coinsurance
NA
60%
SA Outpatient Maximum Visits
NA
SA intensive Outpatient Copay
$50
$50
SIP # 20704
Pages of If
06/3012010
At - i,
Proposed Benefits
Product: Open Access Plus
Sites State: FL Effective Date: 10/01 /2010
Category Description In Network
MWSA Benefits OA Pius MHSA Separate
SA Intensive Outpatient Coinsunmcc
50%
MH Grp Therapy Copay
$20
MH Grp Therapy Coinsurance
NA
MH OP Tiered Copay Option
Excluded
MH OF Tier 1 Copay
NA
MH OP Tier l Visits (1 to_) Maximum
NA
MH OF Tier 2 Copay
NA
MH OP Tier 2 Visits (Tier 1 max to _) Maximum
NA
MH OP Tier 3 Copay
NA
MH OP Tier 3 Visits (Ticr 2 max to _) Maximum
NA
SA OF Tiered Copay Option
Excluded
SA OF Tier I Copay
NA
SA OF Tier 1 Visits (1 to Maximum
NA
SA OP 'tier 2 Copay
NA
SA OF Tier 2 V tsiu (Tier 1 max to _) Maximum
NA
SA OP Tler 3 Copay
NA
SA OP Tier 3 Visits (7 ier 2 max to _) Maximum
NA
Standard iP Review/Case Mgmt UR Program
Included
OF Review/Cut M&Mt guy Up 1 UR Program
Excluded
OP Revi"ICase Mgmt Buy Up 2 UR Program
Excluded
Transition of Care (90 day period)
Included
Out of Network
50%
60%
SIF * 20704 Page 6 of I I 06130120t0
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
MEMORANDUM
TO: Tim Howard
Deputy Director of Finance
FROM: Janet M. Prainito, MMC
City Clerk
DATE: July 6, 2011
SUBJECT: RII -072 Provider Agreement for Group Benefits Medical
Coverage Fully Insured Plan
Attached for your handling is the original agreement mentioned above and a copy of
the Resolution. Once the document has been executed, please return the original to
the City Clerk's Office for further processing.
Please contact me if there are any questions. Thank you.
Attachments (2)
(1 Agreement & Resolution)
C: Central File
S: \CC \WP\AFTER COMMISSION\Departmental Transmittals\2011 \Tim HoNvard R11 -072 Provider Agreement for Group
Benefits Medical Covarge Fully leisured Plan.doc
America 's Gateiva to the Gillfstreant
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
TO: Tim Howard
Deputy Director of Finance
FROM: Janet M. Prainito, MMC
City Clerk
DATE: July 6, 2011
SUBJECT: Rll-072 Provider Agreement for Group Benefits Medical
Coverage Fully Insured Plan
Attached for your information and file is an executed copy of the agreement mentioned
above. Since the document has been fully executed, I have retained the original for
Central File.
Please contact me if there are any questions. Thank you.
UNWI• IN =_1
C: Central File
S:\CC\WP\AFTER COMMISSIOMDepartmental Transmittals1201 ffim Howard R11 -072 Executed.doc,
America's Gateway to the Gu fsti-eam