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City of Sunny Isles Bfmch <br />Employee Benefits Renewal Analysis <br />Renewal Date: 3!112025 <br />Medical <br />L114=- IICMMH <br />Provider Network <br />Ct1RRENT l RENEWAL <br />United Healthcare Current 1 Renewal <br />BWRM.M / Rx E27 BWOM-M / Rx E27 <br />Employee Primary Residence <br />Nationwide <br />;Natlotiwlde <br />Calendar Year Deductible <br />Embedded <br />Embeddeii' <br />Individual I Family <br />$1,000 $2,000 <br />$260 $500 <br />The Plan Pays <br />100% <br />100%: <br />Calendar Year Out -of -Pocket Max <br />Embedded <br />Embedded <br />Individual I Family <br />$6,850 $13;700 <br />$6,850' $13,700 <br />Physician & Emergency Care <br />Employee <br />$87.9.05 <br />Preventive Care <br />Covered 100?h <br />Covered 100% <br />PCP I Specialist <br />$15 $30., <br />$1530 <br />PCP Selection Required I Referral Required <br />No No <br />NoI INo <br />Urgent Care <br />$30 <br />- $30 <br />Emergency Room (In or out of network) <br />$500 <br />$500 <br />Hospitalization & Outpatient Care <br />Employee + Spouse <br />$167.44 <br />Inpatient <br />Dedu'ctibls " .:: i <br />;$250 Pe[ AdmisslfeYDed(icObte <br />Outpatient <br />Deductible <br />Deductible`: <br />Physician Fees <br />Deductible <br />Deductible <br />Independent Facility Care <br />Employee <br />---------- <br />$936.80. <br />Labs <br />Covered 100%. <br />Covered';100% <br />X-rays <br />Covered 1006% <br />Covered 10D% <br />Complex Diagnostic Imaging <br />$160 - <br />$150 <br />Prescription Drugs <br />Annual Employer Contribution <br />Total Annual Employer Contribution <br />$668,670 <br />Tier 1 --- — <br />Variance from Current (s) <br />Tier 2 <br />$3.5j <br />$35. <br />Tier 3 <br />$70 <br />Specialty (GH, Self Injectable, etc.) <br />Applicable Cost Share _ <br />Applicable Cost'Shere <br />Retail Mail Order - 90 day supply <br />_ 2.6x retail copay, <br />2.5K retali copay <br />Current Enrollment <br />Employee <br />32 <br />136 <br />Employee + Spouse <br />7 <br />5: <br />Employee + Chlkl(ren) <br />6 . <br />25; <br />Employee + Family <br />:3 <br />14 <br />Enrollment Totals <br />48 ' <br />1130 ' <br />Monthly Premium <br />Employee <br />$87.9.05 <br />$919:28 . <br />Employee + Spouse <br />$1,669:92 - <br />$1,746.34 <br />Employee + Child(ren) <br />$1;845.70 <br />$1,93D.17 <br />Employee + Family <br />$2.636.94 <br />_. $2,757;61 <br />Monthly Employee Contribution <br />Employee-- — —.--- <br />- -$59.75 <br />419.52 <br />Employee + Spouse <br />$167.44 <br />$243:66 <br />Employee + Child(ren) <br />$441,05 <br />$525:52 <br />Employee + Family <br />$669.51 <br />$790;18 <br />Monthly Employer Contribution <br />Employee <br />---------- <br />$936.80. <br />$938,80 <br />Employee + Spouse <br />$1,502.48 <br />$1,502.48 <br />Employee + Child(ren) <br />$1,404.65 <br />$1,404.65 <br />Employee + Family <br />$1,967.43 <br />$1,9,67.43 <br />Annual Employer Contribution <br />Total Annual Employer Contribution <br />$668,670 <br />$2,374,194 <br />$3,032,863 <br />Variance from Current (s) <br />Annual Premium <br />Total Annual Premium <br />$705,646 <br />$2,647,376 <br />$3,353,024 <br />Brown & Brown Insurance, Inc. <br />364 <br />