R13-078 1
1 RESOLUTION NO. R13 -078
2
3
ifl A RESOLUTION OF THE CITY COMMISSION OF
BOYNTON BEACH, FLORIDA, APPROVING A ONE
.1 YEAR EXTENSION OF A PROVIDER AGREEMENT
FOR RFP #046- 1610- 10 /CJD "GROUP BENEFITS:
:I MEDICAL CLAIMS ADMINISTRATION (TPA)
■ SERVICES AND /OR FULLY INSURED PLANS" WITH
11 CIGNA CORPORATION, FOR MEDICAL INSURANCE
11 FROM OCTOBER 1, 2013 THROUGH SEPTEMBER 30,
1 ' 2014; AUTHORIZING THE CITY MANAGER AND CITY
1 CLERK TO EXECUTE THE PROVIDER AGREEMENT
1 AND PROVIDING AN EFFECTIVE DATE.
1.
1.
1 WHEREAS, on July 20, 2010, the City Commission of the City of Boynton Beach
1: approved the award of a Provider Agreement to CIGNA HealthCare for Group Benefits
it Medical Claims Administration Services and /or Fully Insured Plan for the one year term from
21 October 1, 2010 to September 30, 2011; and
21 WHEREAS, the Provider Agreement had the option to extend the Agreement for
2! three additional one -year periods; and
2: WHEREAS, this extension is the third of the three additional one -year periods to
2 extend; and
2. 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
2r 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, 2013 to
2: September 30, 2014, for all city employees.
31 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
3 I THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
3 ' Section 1. The foregoing "Whereas" clauses are hereby ratified and confirmed
3 . as being true and correct and are hereby made a specific part of this Resolution upon adoption
3' hereof.
3.
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■
1 Section 2. The City Commission of the City of Boynton Beach, Florida does
2 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, 2013 to September 30,
4 2014 for all city employees, a copy of which is attached hereto as Exhibit "A ".
Section 3. The City Manager and City Clerk are authorized to execute the t
. Provider Agreement with CIGNA HealthCare.
r Section 4. That this Resolution shall become effective immediately upon passage.
: PASSED AND ADOPTED this 6 day of August, 2013.
11 CITY OF BOYNTON BEACH, FLORIDA
1
1► ✓
yor — Je Tayl 4 :4 1p-
1
1.
1 , Zi/OP'Arlo .i , 77: .. -j 7
1 : Vice Mayor — Woo ow L. Hay
1!
21
2 , l` , ` ti-
2 Commiss — Dav'd T. Merker
2.
2. e
2. )14,(7(
21 C
C. missioner — Michae . Fitzp rick
2
31 Co i issioner : asello
3 ATTEST:
3 . (iv - WI. AL/ax.lot-jD
3 ' - t M. Prainito, MMC y' v
3 . Ay Clerk , ` r � ` '�
I
3 . v at " ,
3 s r
3 : (Corporate Seal) �
.
3„ ;, r
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R13 -078
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 information outlined in Proposal
#1120031 included in Exhibit "A ". No additional modifications other than those described in
the Proposal #1120031 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, 2013 through September 30, 2014.
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. 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.
7. 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.
8. 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.
PA -1
R13 -078
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.
9. 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.
10. 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.
11. 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.
12 ASSIGNMENT. The Provider shall not sublet or assign any of the services covered by this
Agreement without the express consent of the City.
13. 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.
14. 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.
PA -2
R13 -078
15. 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.
16. 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
ATTN: Patricia Sholos
Notices to Provider shall be sent to the following address:
CIGNA HealthCare
1571 Sawgrass Corporate Parkway
Suite 140
Sunrise, FL 33323
ATTN: Tina Velez
17. PUBLIC RECORDS. The City of Boynton Beach is a public agency subject to
Chapter 119, Florida Statutes. The Contractor shall comply with Florida' s Public
Records Law. Specifically, the Contractor shall:
1. Keep and maintain public records that ordinarily and necessarily would be
required by the City in order to perform the service;
2. Provide the public with access to such records on the same terms and
conditions that the City would provide the records and at a cost that does not
exceed that provided in Chapter 119, Florida Statute, or as otherwise provided
by law;
3. Ensure that public records that are exempt or that are confidential and exempt
from public record requirements are not disclosed except as authorized by
law; and
4. Meet all requirements for retaining public records and transfer to the City, at
no cost, all public records in possession of the contractor upon termination of
the contract and destroy any duplicate public records that are exempt or
confidential and exempt. All records stored electronically must be provided to
the City in a format that is compatible with the information technology
systems of the agency.
The failure of Contractor to comply with the provisions set forth in this Article shall
constitute a Default and Breach of this Agreement and the City shall enforce the
Default in accordance with the provisions set forth in item 14.
PA -3
R13 -078
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
Attest /Authenticated:
Title
(Corporate Seal)
City Clerk
Approved as to Form: Attest /Authenticated:
Office of the City Attorney Secretary
Rev 1 /22/91
PA -4
R13 -078
"EXHIBIT A"
SCOPE OF SERVICES
PA -5
Cigna
CIGNA HealthCare Group Benefits Renewal
City of Boynton Beach
100 E. Boynton Beach Boulevard
Boynton Beach, FL 33425
SIC Code. 9111
Account Number: 3333691
Total Eligible Employees: Participating Subscribers: 800
Employer Contributions: Employee Contributions: 100%
Dependent Contributions: 0%
Waiting Period: 30 Days
Eligibility Definition: Active Employees working 30 hrs
Note The Quoted rates are subject to final Underw rrtmg 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 regulatory approval of rates It required
regulatory approval has not been obtained on the proposed effective date, the healthplan shall use rates
that are consistent with its then currently approved rating methodology and the quoted rates shall be
effective immediately on the date for which they are approved for use 1 he Quoted Rates are
guaranteed while the Group Service Agreement remains in effect until the next anniversary date, unless
enrollment changes by 10% in which case CIGNA I lealthCare may change the Quoted Rate
Proposal # 1120031 Page 1 of 13 7/23/13
Cigna
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2013
Category Description In Network Out of Network
Medical Benefits Copay
Modular Medical Management Program PHS+
Office Visit Copay NA
Primary Care Copay $20
Specialty Care Copay $30
Coinsurance 80% 60%
Hospital IP Copay - Per Admit NA
Hospital IP Deductible - Per Admit NA
Hospital IP Copay Per Day NA
Hospital IP Deductible - Per Day NA
Maximum Reimbursable Charge Option 2 - 110%
Incl NSP & 13i11
Negotiation
Collective Deductible /OOP Admin Option NO NO
Combined Medical/Pharmacy Deductible /OOP Admin NO NO
Option
Annual Individual Plan Deductible $100 $400
Annual Family Plan Deductible $300 $1,200
Deductible /OOP Max Accumulator Standard One Standard One Way
Way Accumulation
Accumulation
OOP - Individual Maximum Amount $2,500 $5,000
OOP - Family Maximum Amount $5,000 $10,000
OOP Max Plan Deductible Includes Ded includes Ded
OOP Max Copays All Copays All Benefit
Accumulate Deductibles
Accumulate
Lifetime Maximum Amount Unlimited
Lifetime Maximum - Annual Reinstatement Amount NA
Outpatient Facility Copay $100
Outpatient Facility Deductible $375
Emergency Room Copay $125
Emergency Room Deductible $125
Urgent Care Copay $75
Urgent Care Deductible $75
Emergency Room/Urgent Care Plan Ded Applies Admin YES YES
Option
Proposal # 1120031 Page 2 or 13 7123,'13
Cigna
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10 /01 /2013
Category Description In Network Out of Network
Medical Benefits Copay
Medical Outpatient Professional Ded /Coins
Other Health Care facility IP (SNI ) Maximum Day s 60
Diagnostic Lab /Radiology (Independent /Outpatient/In Ded /Coins of Ded /Coins or ()V
Office) Coverage OV applies applies
Advanced Radiology Imaging (ARI) C I Pt f Scans $50 $100
Copay
Lab /Radiology Mid -Point Coins Option Coinsurance NA NA
Home Health Care Maximum Days 60
Durable Medical Equipment Included Cvrd- Ded /Coins
Durable Medical Equipment Maximum Amount Unlimited
External Prosthetic Appliances included Cvrd - Ded /Coins
External Prosthetic Appliances Deductible $0
External Prosthetic Appliances Maximum Amount Unlimited
Short Term Rehab and Chiro Combined Maximum Da" 60
Short Perm Rehab Maximum Days NA
Chiropractic Care Maximum Amount NA
Chiropractic Care Maximum Days NA
Acupuncture Maximum Days Not Covered Not Covered
Infertility Treatment 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 1 plus Invitro, GIF"I, LIFT Not Covered
Infertility Opt 2 - Opt 1 plus Invitro, GIFT, LIFT, etc Excluded
Infertility Opt 2 - Lifetime Maximum Amount NA
Bariatric Services Excluded
Bariatric Surgery - Lifetime Maximum Amount NA
Preventive Care 100 °%, No Ded
Preventive Care - Children thru Age 2 Included Not Covered
Preventive Care - Annual Physicals Age 3+ Included Not Covered
Preventive Care - Immunizations included
Preventive Care - Annual Max Maximum Amount Unlimited
Breast - Feeding Equipment & Supplies Ded /Coins Not Covered
Supplemental Preventive Services included Not Covered
Family Planning Included Included
Proposal # 1120031 Page 3 of 13 7/23/13
Cigna
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2013
Category Description In Network Out of Network
Medical Benefits Copay
Family Planning - Women 5 Set vice. Covered, 100 °%o Not Covered
no ded
Contraceptive Devices Cov ered. 100% Not Covered
no ded
Allergy Treatment/Injections Standard - Same
as OV
Organ Transplant Included Cvrd - with
Transplant
Maximums
Routine Foot Care Buy -up Included Cvrd -Ded /Coins
Routine Foot Care Separate Buy -up Coinsurance NA
Routine Foot Care - Cal Yr Buy -up 13enefit Maximum $1.000 NA
Amount
FMJ Included Included
Elective Abortion Covered Covered
PCL Included Included
PAC /CSR - Standard IP Admit /Case Management UR Included
Program
PAC /CSR IP Non Compliance Penalty Percent 50%
Medicare COB Retirees > =65 Admm Option NA
Medicare COB Type None
Percent of Medicare Eligible NA
Integrated Personal Health Team A (IPHT A) Clinical Excluded
Program
Your Health First Clinical Program 200
Health Advisor Clinical Program I veluded
Incentives Programs Excluded
Social Engagement Not Available Not Available
24HIL Included
Healthy Rewards Included
LifeSource Organ Transplant Network 1 ransplant Included
Program
Language Line Included
Transition of Care Included
Case Management Included
Provider Channeling Included
Proposal # 1120031 Page 4 of 13 7'23 13
Cigna
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2013
Category Description In Network Out of Network
Medical Benefits Copay
Away From Home Care Included
Drugstore Com Included
Pharmacy Benefits CIGNA PharmacyPlus 3 -Tier Copay
Formulary Standard
Plan Buy Up Option Coinsurance NA
Retail - Generic Copay $10
Retail - Brand Copay $25
Retail - Non Preferred Copay $50
Home Delivery - Generic Copay $20
Home Delivery - Brand Copay $50
Home Delivery - Non - Preferred Copay $100
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
Generic Drugs Excluded from Deductible NO
Ded & OOP Max Apply to MOD Do Not Apply to
MOD
MOD Program No Mandatory
Maintenance Drug List NA
Oral Contraceptives /Des ices Covered
Contraceptive Devices, Drugs, OTCs(Certain Products at Included
100 %)
Lifestyle Drugs Not Covered
Oral Fertility Drugs Not Covered
Self - Administered Injectables Covered
Optional Injectables Buy -Up Not Covered
Insulin Covered
Insulin Needles & Sy rrnges Covered
Glucose test Strips CON
Lancets Cov ered
Prenatal Vitamins Cov ered
Proposal # 1120031 Page 5 of 13 7 -23/13
Cigna.
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2013
Category Description In Network Out of Network
Pharmacy Benefits CIGNA PharmacyPlus 3 -Tier Copay
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
Dispensing Requirement Generic Requirements No Generic.
Requirement
Prescriber Panel 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 Day Copay NA NA
MH Hospital IP Maximum Days 30
SA Hospital IP Coinsurance 80% 60%
SA Hospital IP - Per Admit Copay N A NA
SA Hospital IP - Pei Day Copay NA NA
SA Hospital iP Maximum Days NA
MH Outpatient Office Visits Copay $30
MH Outpatient Office Visits Coinsurance NA 60 °%o
MH Outpatient Facility Copay $30
MH Outpatient Facility Coinsurance NA 60%
MH Outpatient Facility Plan Ded Applied Admin Option NO YES
MH OP & Group Therapy Combined Maximum Visits 20
MH Intensive Outpatient Copay $30 $50
MH Intensive Outpatient Coinsurance 50% 50%
SA Outpatient Office Visits Copay $30
SA Outpatient Office Visits Coinsurance NA 60 °/o
SA Outpatient Facility Copay $30
SA Outpatient Facility Coinsurance NA 60%
SA Outpatient Facility Plan Ded Applied Admin Option NO YES
SA Outpatient Maximum Visits NA
Proposal # 1120031 Page 6 of 13 7/23/13
7i ~s
Cigna
Proposed Benefits
Product: Open Access Plus
Situs State: FL Effective Date: 10/01/2013
Category Description In Network Out of Network
MH /SA Benefits OA Plus MHSA Separate
SA Intensive Outpatient Copay $30 $50
SA Intensive Outpatient Coinsurance 50°%° 50 °r0
MH Grp Therapy Copay $30
MH Grp Therapy Coinsurance NA 60%
MH OP Tiered Copay Option Excluded
MH OP Tier 1 Copay NA
MH OP her 1 Visits (1 to _ ) Maximum NA
MH OP 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 (I her 2 max to _ ) Maximum NA
SA OP Tiered Copay Option Excluded
SA OP Tier 1 Copay NA
SA OP Tier 1 Visits (1 to ) Maximum NA
SA OP Tier 2 Copay NA
SA OP Tier 2 Visits (Tier 1 max to ) Maximum NA
SA OP Tier 3 Copay NA
SA OP Tier 3 Visits (1 ier 2 max to ) Maximum NA
Standard IP Review /Case Mgmt UR Program Included
OP Review /Case Mgmt Buy Up 1 UJR Program Excluded
OP Review /Case Mgmt Buy Up 2 t)R Program Excluded
Transition of Care (90 day period) Included
Vision Benefits None
Benefit Exceptions:
CCN Specialist Copay $30
Non -CCN Specialist Copay $35
Proposal # 1120031 Page 7 of 13 7/23,'13
ce
(Cigna.
Group Description: AL350C (CITY OF BOYN ION BEACH RE I IREES 65 +) C'0300A (C1 FY OF B 13
(FIREFIGHTERS) RETIREES -65) FL305A (CITY OF BOYN ION BEACH RETIREES -65)
FL305B (CITY OF BOYN1 ON BEACH RE'I TREES -65) FL305C (CI FY OF BOYN FON
BEACH RETIREES -65) 11,305E (CI IY OF 13 B
Inforce Current Renewal Monthly Billed
Tier Subscribers Members Rate Rate Amount Change
EMP 610 $660 85 $732 62 $446,898 20 10 86 %
EMP + SPOUSE 43 $1 282 05 $1,421 28 $61,115 04 10 86 %
FMP +CHILD(RI'19) 43 $1,18954 $1 318 72 $56,70496 10 86 ° 0
EMP +1'AMILY 104 $1,47370 $1,63374 $169,90896 1086 °i0
Total 800 1260 $734,627.16
Included in the proposed Monthly Billed Amount is the Benefit Advisor Fee which is not part of the monthly premium.
Proposal # 1120031 Page 8 of 13 7 23/13
Cigna
Underwriting Contingencies
For
City of Boynton Beach
A. General Terms of this Proposal
CIGNA HealthCare is pleased to present this Proposal for a Fully Insured Non - Participating group medical
and pharmacy benefit plan (the "Plan ") sponsored by City of Boynton Beach This proposal is valid for 60
days from its original date of release, 05/28/2013 Any revisions or updates to this proposal will not renew
this valid timeframe unless expressly communicated by CIGNA HealthCare
Proposal Caveats
CIGNA HealthCare 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 different than 12 months
3 the policy will not be soused in FL
4 the Plan benefits are different than shown in the RFP or benefit modifications are requested
5 there is a change in any law, regulation, or required assessment or tax that changes CIGNA HealthCare's costs in
offering the plan
6 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 tees set forth herein
7 participation is below 70% This will be based on the total eligible employees. identified as 0
8 it is not the exclusive provider of Medical (/ Phaimac). Vision) or like products for all of City of Boynton
Beach's employees in all worksites
9 the employ er contributes Tess than 50% toward the total cost of the plan
10 the employer changes its level of contribution toward the cost of the coverage
11 either one or more of the quoted sites withdraws prior to the effective date or terminates during the contract term
or at any time following enrollment
12 the current waiting period is different than 30 Days
13 the final enrollment deviates from the quoted enrollment such that it results in a needed change in premium
rates Rates are based on final enrollment factors, including total number of enrollees, their age, sex.
demographics. location and the distribution of enrollees by product or by customer tier
14 any of the information upon which these rates or benefits were based (including Medical History Information)
changes or is inaccurate
15 there is any reimbursement arrangement ( "gap" cards. etc) that subsidi,es or reduces the out -of- pocket
obligation of covered persons under the policy
Proposal # 1120031 Page 9 of 13 7;23/13
Cigna.
Underwriting Contingencies
For
City of Boynton Beach
B. Scope and Application of this Proposal
Unless otherwise indicated, this Proposal
1 supersedes and renders null and void any prior CIGNA I lealthCaic otter or proposal w rth respect to the Plan
2 or policy may be canceled as of any Premium Due Date it the number of insured Employees tails to meet the
minimum required per group participation rules, or for failure to comply with any other material plan provision
relating to Employer contributions or group participation rules
3 requires a separate benefit option due to state regulations, if you have purchased any product with CIGNA
HealthCare Behavioral Advantage and you have customers residing in NC or CA
4 does not apply to part-time or seasonal employees for any plan
5 includes the Network Savings Program (NSP) and other Cost Containment programs designed to contain costs vv ith
respect to charges for health care services /supplies that are covered by the Plan For administering these programs
CIGNA HealthCare retains a portion of the savings or recoveries generated
6 includes a maximum reimbursable charge for out -of- network cov erage equal to 1 I0% ()la fee schedule developed
by CIGNA HealthCare based upon a methodology similar to that used by Medicate to determine the allowable fee
for similar services in the geographic market OR 80th percentile of charges made by providers of such sere ice 01
supply in the geographic area where the service is recened
7 assumes all employees are located in the network area, and that all employees are only eligible for the CIGNA
I IealthCare or any other affiliated company product oftei rags specified
8 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
9 may require regulatory approval of rates If as of their proposed effective date, regulatory approval is not obtained,
the healthplan shall use rates consistent with its then currently approved rates and the foregoing rates shall be
effective automatically If a product is new and has never had approved rates, the effective date of coverage will be
postponed until regulatory approval is received
10 allows caveats and conditions set forth in this document to survive execution of any final contract and /or issuance
by CIGNA HealthCare of any policy and /or Group Sen. ice Agreement
11 Medicare eligible retirees are not included in this plan unless mandated by situs state legislation
12 excludes charges for converting a qualified customei of a group plan to an individual plan
13 is a high -level summary of the proposed coverage It does not identity all the categories of health care expenses that
are covered or excluded
14 may include state required continuation rates which will match the rates tor the underlying plan I or Nebraska and
New York Over Age Dependents the rates will match the employee rate for the underlying plan
15 assumes that the group health plan or health insurance coverage to which this proposal applies will not be a
"grandfathered health plan" under the Patient Protection and Affordable Care Act (the "Act ") and that it will be
subject to all requirements of the Act applicable to a group health plan or health insurance coverage unless
otherwise specified in writing
Proposal # 1120031 Page 10 of 13 7/23113
Cigna
Underwriting Contingencies
For
City of Boynton Beach
B. Scope and Application of this Proposal
Unless otherwise indicated, this Proposal
16 includes applicable Patient Protection and Affordable Care Act fees and assessments imposed upon health insurers
including the Comparative Effectiveness Research Fee, the Health Insurance Industry Fee and the Transitional
Reinsurance Assessment
17 assumes applicable requirements of the Patient Protection and Affordable Care Act will be implemented on the
effective date /renewal date unless you direct otherwise
18 Assumes a non -CIGNA HealthCare Pharmacy Benefit Manager administers oral or other self - administered
anti- cancer prescription medication claims at a copayment /coinsurance level that is no less favorable than that foi
intravenous or injected anti - cancer medication prescribed for the same purpose and coveted under employer's
CIGNA HealthCare plan This assumption is applicable only it (a) employ ei has contracted with a PBM (not
CIGNA HealthCare), (b) employer's plan is either insured, oi, it self - funded. not subject to I,RISA (i e • is a church
government or association plan), and (c) employer's CIGNA HealthCare plan is sitused in IA. HI, NM, OR, N I Ni ,
VA. MA or a state with similar chemotherapy coverage law, or covers one or more individuals residing in CO OK
VT, WA, TX or LA or in a state with similar extraterritorial chemotherapy coverage mandate
19 includes capitated charges for behavioral care services arranged by CIGNA Behavioral Health, inc However, this
may not apply in certain states
20 includes capitated charges for the provision of Hi -Tech Radiology services by MedSolutions. Inc However, this
may not apply in certain states
21 includes charges made by third parties tor care management programs to contain the cost of specific health
services /items and /or improve adherence to ev idence -based guidelines to piomote patient safety and efficient cane
(e g , charges for management of nuclear cardiology , radiation therapy and medical oncology )
22 In order to implement the requested benefit design, different funding arrangements (i e , insured, self- insured and /oi
HMO) involving affiliated CIGNA HealthCare companies may he required with respect to plan participants residing
in certain states
23 Important Notice Regarding Benefit Advisor Compensation - I'he premium tor this guaranteed cost (i e
non - Shared Returns) policy may not include compensation payable to your benefit advisor Check with your
CIGNA HealthCare Sales representative to confirm whether this is the case When that is the case, the proposed
billed amount includes both premium and benefit advisor fees, which are not part of the monthly premium and
CIGNA HealthCare will include any benefit advisor fees agreed to by the client and benefit advisor on client
invoices and forward payments received to the benefit advisor if both the client and the benefit advisor authortie
CIGNA HealthCare to do so by signing CIGNA HealthCare's Client and Benefit Advisor Acknowledgement Form
When required. this form must be signed before the date when the new rates take effect if the form is not signed,
the benefit advisor will be responsible for billing the client directly for an) benefit advisor tees
Proposal # 1120031 Page 11 of 13 7/23/13
Cigna
Statement of Understanding Regarding "Underlying Plans"
in establishing its premium rates /charges for all benefit plans insured and /or administered for you by CIGNA
HealthCare companies ( "CIGNA HealthCare "), CIGNA HealthCare assumes that there are no "Underlying Plans."
Underlying Plans means
• plans or arrangements that pay for or subsidize a portion of the cost - sharing responsibilities for people
covered by the plan(s) including, but not limited to, co- payments, deductibles and /or member coinsurance
balances
• a Health Savings Account (HSA)
• a Health Reimbursement Account (HRA)
CIGNA HealthCare also assumes that Underlying Plans will not be put in place in the future
The existence of Underlying Plans has a material impact on CIGNA HealthCare's premiums /charges and if not
previously disclosed to CIGNA HealthCare in connection w ith its underwriting constitutes a material modification of
the plan's benefits entitling CIGNA HealthCare to increase its premiums /charges to reflect the impact of the
Underlying Plans To ensure that CIGNA HealthCare has all the material information that it needs to appropriately
determine its premiums /charges, please complete and execute the follow mg certification
Employer Certification
(Employer /Group), by its duly authorized representative, hereby
represents, certifies and agrees that in connection with the plan(s) insured and /or administered by CIGNA HealthCare
1 an Underlying Plan is not offered,
OR
an Underlying Plan is offered and attached is a complete description of the Underlying Plan With respect to
a HSA or HRA that is offered, include in the description
• the level of employer funding to the HSA and /or HRA
• the order oI ieimbursement, and
• the provisions regarding annual rollover
2 it w 111 notify CIGNA HealthCare prior to implementing any tinderl_vrug Plan not identified above in response to
No 1,
3 the foregoing representations and the information provided above are true and complete and provided with the
understanding that they are material to CIGNA HealthCare's determination of its premium rates /charges both
currently and in the future, and
4 CIGNA HealthCare may rely upon the foregoing representations and information in establishing its
premiums /charges both now and in the future
Proposal # 1120031 Page 12 of 13 7/23/13
e
Cigna
Underwriting Contingencies
For
City of Boynton Beach
CIGNA HealthCare reserves the right to change the Quoted Rates and /or Quoted Benefits or to decline to offer coverage
if any of the foregoing information is inaccurate or changes prior to the proposed Effective Date indicated above, of if
the quoted rates and /or fees are not agreed to within 60 days of receipt of this summary information form It any of the
information identified above changes either prior to the proposed Effective Date or while coverage 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, application, etc ,
issued by CIGNA HealthCare or any other affiliated company. and shall further survive the effective date of any such
policies
The benefits displayed in this summary are, for the most part, modular benefit packages used to develop the
rates. Please review the Benefit Summary and its attachments for information about the benefits available in your
sites.
'CIGNA Healthcare' refers to various operating subsidiaries of CIGNA Corporation Products and services are provided
by these subsidiaries and not by CIGNA Corporation 1 hese subsidiaries include Connecticut General Lite Insurance
Company, CIGNA Health and Life Insurance Company, and LIMO or sersice company subsidiaries of CIGNA Health
Corporation and CIGNA Dental Health, Inc
1 UNDERSTAND AND AGREE ON BEHALF OF CONTRACTHOLDER THAT CIGNA HEALTHCARE MAY,
NOTWITHSTANDING THE TERMS OF THE INSURANCE POLICY OR SERVICE AGREEMENT, REVISE ANY
PREMIUM RATES OR PREPAYMENTS FELS AT ANY TIME IF THE ENROLLMENT OR EMPLOYER
CONTRIBUTION LEVEL IS DIFFERENT THAN ASSUMED BY CIGNA HEALTHCARE IN UNDERWRITING
THE CONTRACT OR IF CIGNA HEALTHCARE IS (i) REQUIRED TO PAY ANY ASSESSMENT, OR (n) INCUR
ADDITIONAL COST S IN ADMINISTERING THE CONTRACT AS A RESUL OF THE PATIENT
PROTECTION AND AFFORDABLE CARE AC C AND 111E. REGULA'IONS PROMULGATED THEREUNDER
Client Signature Date
Client Name Title
Proposal # 1120031 Page 13 of 13 7/23/13