HomeMy WebLinkAboutReso 2000-298
RESOLUTION NO. 2000 - .b9..f2
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF
SUNNY ISLES BEACH, FLORIDA, AWARDING A BID TO AETNA
INSURANCE CO. FOR HEALTH INSURANCE SERVICES AS
OUTLINED IN THE SCOPE OF SERVICES ATTACHED HERETO AS
EXHIBIT "A", AUTHORIZING THE CITY MANAGER TO EXECUTE A
CONTRACT FOR SUCH BID AND TO DO ALL OTHER THINGS
NECESSARY TO EFFECTUATE THE INTENT OF THIS
RESOLUTION; PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the City of Sunny Isles Beach issued a formal Request for Proposals for the
provision of health insurance to its employees and their families, and
WHEREAS, the Request for Proposals were sent out to eight (8) health care companies
and several bids were received from those companies; and
WHEREAS, a health insurance committee, comprised of City Hall and Police
Department employees, has viewed all bids received and has made a determination that the
Aetna Insurance Co. proposal, attached hereto as Exhibit "A", offers the broadest scope of
services and the most competitive pricing of all proposals received.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AS FOLLOWS:
Section 1. Award of Bid. Bid No. 00-11-01 is hereby awarded to Aetna Insurance Co. for
health insurance services as outlined in Exhibit "A" attached hereto.
Section 2. Authorization of City Manager. Provided the Aetna Insurance Co. contract is
approved as to form and legal sufficiency by the City Attorney, the City Manager is hereby
authorized to execute same and to do all other things necessary to effectuate the intent of this
resolution.
Section 3.
Effective Date. This Resolution shall become effective upon adoption
David Samson, Mayor
ATTEST:
~~~~~
iclia"rd Brown-Morilla, City Clerk
- 1-
Aetna Health Insurance- Res
APPROVED AS TO FORM AND
LEGAL SUFFICIENCY
~~::~:~y: ~~rv\~~~~~~:~~
Vote: 6-0
Mayor Samson
Vice Mayor Kauffman
Commissioner Iglesias
Commissioner Morrow
Commissioner Turetsky
~(Y es)
-0Yes)
V(Y es)
~(Yes)
---lL'(Y es)
_(No)
_(No)
_(No)
_(No)
_(No)
- 2-
Aetna Health Insurance- Res
DEC-os-iooo 13:51
FROM-BROWN AND BROWN INC
3053623442
T-023 P.001/003 F-6S9
tro~Vll.
&:
.. rO\\'11
Brown &: Brown, Inc. I@
Spt..'Ssard Holland Bldg. Suite 400
8000 Governors Square Blvd.
Miami Lakes, FL 33016-1588
305/364-7800 · Toll Free 800/432-8844
PAX 305/822-5687
..
TO:
Jean Watson, Director of Finance
City of Sunny Isles Beach
305-949-3113
DATE:
FROM:
December 8, 2000
Robert P. Hollander
NO. OF PAGES: 3
Re: CITY HAVE SUNNY ISLES BEACH
Dear Jean,
In accordance with your request, please see the attached City of Sunny Isle Beach Group
Health PROPOSAL FORM reflecting Health Plan Option 11 - Aetna US Access Plan 5.
This plan includes an Out of Network deductible of $500.00, 60% coinsurance and a $3,000
maximum out of pocket, per person.
Please note that the rates indicated are based on the enrollment of Aetna US Access Plan 5
only. A combination with an HMO plan would require a rate increase.
e opportunity to offer this alternative plan and 11001< forward to your response.
Si~;?
/
~obert P. Hollander
y xecuti\le Vice President
DEC-08-Z000 13:51
FROM-BROWN AND BROWN INC
30536Z344Z
T-OZ3 P.OOZ/003 F-689
Aetna US Access
PLAN 5
PROPOSAL FORM
City of Sunny Isles Beach
Bid #00-11-01
Group Health Insurance Coverage
We propose the folJowing f3r~ structure:
Group Health Insurance PPO Program, consistent with the City specifications and
details provided by the bidder on attached sheets.
Cost per month, per employee:
627.70
employee + spouse
employee + family
i_214. ~ employee $,
$, 401.60 employee + child/renl $
477 . 40
\~'e propose the following for covered Dental Expense:
C:llencl::tr year deductibl~
per participant
Calendar year maximum
per participant
Preventive
B~sic
Rescomticn &; Spec~alty
Orthodonti:l.
W'e propose the following for Vision Care:
~revp.111a.tlve vl~lon lncluded in premium.
Exam $10- Routine
Lenses Di scoul'ltE!d
Fr;1mes ni ~C'nl)n1-_pri
Contacts ni <:;t""nnntpd
W.'e propose the following for Prescription Drugs:
In Ne~"'orkl G~neric $10
Brand Name
$15
Non-Formulary J 30
Out oCNet'work_80% after d.eductible
The City resen.-es the right to reject an)- and all bids.
-:~1'~1: .."..~...,;~ ''':::,"~~,,~ 1.H")r).: .;.'" ";::-::...~~~ '!=1~.':~~' ::.,.~~.....,y ,-~.'-~6~wrltlns.
'DEC-os-iooo 13:52
FROM-BROWN AND BROWN INC
3053623442
T-023 P.003/003 F-6S9
PROPOSAL FORM (continued)
Business Name Brown & Brown _ Toc.
Address
Signature /'
~/
Name & Title 'Robert P. Hollander
Executive Vice President
Blvd.- suite 400
--
Date 11-29-00
Phone #
305-364-7818
Fax #305-822-5687
Please provide the names and phone numbers of three references that use the
Group Health Insurance Plan that you have proposed.
Company Name Contact Person
City of North Miami Beach Ellen Snow
~;t~ nr W;~'p~n GardenR
,TT. Jl.udio
RaLs~Snlis
Allan Mirsky
Phone
305-787-6022
305-558-4114
954-443-1100
-
Aetna U.S. Healthcare
USAccess'"
LJEtna
us Healthcare
4043-6/99
.-
Within these pages, you
will see photographs of
our employees and their
families. Like all our
members, our own
employees rely on the
wide range of programs
offered through Aetna
U.S. Healthcare to help
them stay healthy
through all stages
of life.
From our dedicated team
of medical directors and
our informative nurse
case managers to our
helpful Member Services
representatives, our
employees are working
behind the scenes to
make sure that your
experience with Aetna
U.S. Healthcare is a
positive one.
~
Cover: Matthew, son of Maureen Walters
You can count on
Aetna U.S. Healthcare
YOU have three convenient ways to access health care benefits with Aetna U.S. Healthcare's
USAccess plan, giving you more choices than ever before.
With USAccess, you can:
1. Coordinate your covered benefits through the
primary care physician you select and obtain
care within our network of specialists and
hospitals. You are responsible for a low
copayment for each visit.
2. Self-refer to specialists and hospitals in our
network at a higher copayment.
3. Go directly to a licensed provider or hospital
outside the network subject to a deductible
and coinsurance.
You determine the choice that's right for you.
USAccess gives you more options each time you
need medical care - it's the plan of choice.
You can count on a host of benefits and
services with USAccess:
· A wide choice of participating physicians
and hospitals.
· Lower out-of-pocket costs for primary care
and referred services.
· The flexibility to seek self-referred services.
· Emergency coverage - anytime, anywhere.
· Discounts on health-related products
and services.
· Coverage for dependents living away
from home.
And there's more ...
1nt"()l"IlH'd Ilc~lItl10 Un\'*
Staying informed is one step you can take toward
meeting the challenge to stay healthy. Our
24-hour, toll-free Informed Health Line is your
direct link to a team of experienced registered
nurses who can provide health information,
coaching and support on a variety of health
issues - anytime, day or night (program
effective 1/1/00).
Embrace the new millennium and take charge of
your health with help from Aetna U.S. Healthcare.
Sonia Morillo with son Santiago
"Informed Health Une nurses cannot diagnose, prescribe or give medical advice. Contact your physician first with any questions or
concerns regarding your health care needs.
You can count on
More Choices
YOU are covered for a broad spectrum of
benefits* with USAccess:
· Routine office visits and preventive care.
· Specialty care.
· Hospitalization and surgery.
· Emergency care.
· Diagnostic testing.
· Vision care.
· Maternity and newborn care.
· Limited mental health and substance abuse,
medical detoxification services.
· Home health care.
There are three ways to access your covered
benefits:
CI10icc I
Get the Most Out of Your Benefits by Working
Through Your Primary Care Physician
By coordinating covered services through the
participating primary care physician (PCP) you
select, you can have the lowest out-of-pocket
costs. There's a good chance your physician
already participates in Aetna U.S. Healthcare's
provider network.
If your PCP refers you to a participating specialist
or hospital, you're covered in full with a copay for
covered services.
Refer to your copayment schedule for applicable
copayments.
l,l111!l jl ...:
Self-Refer to Specialists and Hospitals in Our
Provider Network
You can also benefit when you go directly to a
participating provider or hospital without a referral
for covered benefits. You will be responsible for a
higher copay. However, you will not have to pay an
annual deductible and coinsurance and will not
have to file claim forms.
Samantha Kim, daughter of Tara Brophy,
and Trace, son of Sean McGinnis
*Benefit exclusions and limitations apply. Coverage for certain services may only be available for referred care. Check your plan
documents for details.
USAccess gives
you the flexibility
to choose how you
access your care.
{, .:1ldc{' >;
Self-Refer Outside the Network
You can even seek care for covered services outside of the network
without a referral. When you choose a licensed physician or hospital
outside the network, you pay a portion of your medical expenses
through a deductible and coinsurance. Certain benefit limitations
apply. You may also need to file a claim form and may receive balance
bills (the difference between the physician's actual fee and the
amount covered by your specific plan). Balance bill payments are not
a covered benefit.
! l/'( '( '(' rli Ikd lion I\\'q u if'(' m I' 11 L..;
To have the lowest out-of-pocket costs when you self-refer, you must
obtain authorization from Aetna U.S. Healthcare prior to receiving
certain self-referred medical services. This authorization is called
precertification.*
Choice 1
Choice 2
{~CllOi
'''''i?".~,__~_..ce. 3
Visit your PCP,
get a referral
to a participating
specialist or
hospital
Go directly to
.. any participating
. .. physician or
- hospital
'\,('''''',''
cost to you:
Copay
'Failure to precertify may lead to substantially reduced benefits. Refer to your plan documents for a list of medical services that require precertification.
3
You can count on quality
Benefits & Programs
YOU are covered for routine physicals,
preventive health and immu.nizations.
Benefits levels vary, depending upon
whether the care is coordinated through your
PCP (referred care) or accessed directly (self-
referred care).
In addition, our health and wellness programs are
designed to help you stay healthy through all
stages of life:
. Aetna U.S. Healthcare Check™ early detection
program that includes timely notices to help
remind you when regular screenings for breast,
cervical and colorectal cancers are due.
. Healthy Outlook Program@ that provides you with
educational materials and resources on chronic
conditions such as diabetes, asthma, heart failure
or low back pain.
. Healthy Eating™ and Healthy Breathing@' pro-
grams that help you lose weight and stop
smoking.
. Check It Out!TM educational brochures that
feature preventive steps and screening
recommendations relating to age- and gender-
specific health issues.
(111Iil1(' Ik,;\1I1Iri!()i'I1Ulirill
Visit our website (www.aetnaushc.com) for
valuable health information. From there, you can
link to the award-winning InteliHealth@ website,
developed in conjunction with Johns Hopkins
University and Health System. This interactive site
features a variety of health topics, along with
wellness and fitness tips. Furthermore, you can
complete a personal Health Risk Report to help
you evaluate your current health status and your
future risk of major diseases. And as an Aetna
U.S. Healthcare member, you are eligible for
discounts on products from the online InteliHealth
Healthy Home. store.
To visit InteliHealth and to receive your discounts,
go to the Aetna U.S. Healthcare website and click
on "lnteIiHealth."
\\Olllcn's I kaltll fnr Life Programs
Our female members can take advantage of a
variety of benefits and programs that support their
health and well-being:
. Direct access to participating Ob/Gyns for
covered obstetric and gynecologic services,
eliminating the need for referrals.
. Ongoing reminders to receive important
checkups and cancer screenings, such as Pap
smears and mammograms.
. Genetic testing for members at high risk for
breast and ovarian cancers.
. Maternity management programs.
. Infertility case management.
. At-home osteoporosis self-evaluation.
i
i Mayda Aponte
I
1.-_
l,'il \ppksccd" \l;ft('mil\
\ldnd~('lJ1t'nt I)ro~r(!m
Having a baby is one of life's most extraordinary experiences, filled
with months of excitement, planning - and questions.
Our L'il Appleseed Maternity Management Program enhances your
coverage for prenatal care and delivery. The program includes
prenatal and postnatal home nurse visits, a smoking-cessation
program, an allowance* for pregnancy-related classes, and discounts
on baby products, such as strollers and car seats.
You never need a referral to visit your participating obstetrician.
Should your pregnancy be identified as high-risk, we will help
coordinate the appropriate case management with your obstetrical
care providers.
\;l\ iOI1;il \ lc'dica! I-:\('('II(,IHT Pn i.:.:j'i 11 11
Through this unique program, we provide access to nationally
respected physicians and facilities if the appropriate treatment for
your complex illness or injury is not available locally. When
precertified, your care will be covered (less applicable copayments).
Your related transportation expenses may also be covered, including
an allowance for a companion.
'Availability varies by service area.
lVision One dealers, Cole Vision Network List (7/99).
A number of proactive
health and wellness
programs help you
stay healthy through all
stages of life.
:Gerl Caprerl and Jim Higgins
\dtllj'()1 \ltC'rIlati\C'sTM Program*
Many people are turning to alternative approaches for preventive
medicine and to maintain good health. The Natural Alternatives
program offers discounts on alternative therapies and products
including visits to acupuncturists, chiropractors, massage therapists
and nutritional counselors who have agreed to provide their services
at reduced rates. Where available, you can also save on vitamins,
herbal supplements, books and other health-related products.
! 'itlH'SS Program
Through this Fitness program, you can get special membership
rates at more than 2,000 fitness clubs worldwide. You can even try
out a participating club before joining, using free one-week trial
membership certificates. You are also eligible for discounts on home
exercise equipment.
\ isioll Olle' Discount Program
Under the Vision One discount program, you receive discounts on
eyeglasses, contact lenses and nonprescription eyewear at
thousands 1 of participating Vision One locations across the country.
5
You can count on a plan that's
Easy to Use
CllOo~ing <1 PCP
The provider directory is a good place to start
when you select your PCP. Your family doctor may
already participate with Aetna U.S. Healthcare.
You can also use DocFind@ - our online provider
directory at www.aetnaushc.com - to locate a
PCP based on geographical location, medical
specialty and hospital affiliation.
For more information about a PCp, you can call
1-800-PIC-A-DOC* to check a physician's
credentials, schooling and years of experience.
You can change your PCP anytime, for any reason,
by calling the toll-free number on your Aetna
U.S. Healthcare ID card or visiting the Member
Services page on our website (www.aetnaushc.com).
\lilh.c )(llll' elwin' \\itll CClill'idcl1cC
You can feel confident choosing a PCP for yourself
and each member of your family from the Aetna
U.S. Healthcare network. When a physician asks to
join our network, the physician's licenses,
education and work history are reviewed. In
addition, a committee of practicing physicians, who
also care for Aetna U.S. Healthcare members,
reviews information about the physician and the
office. Participating physicians also must undergo
recredentialing on a regular basis.
Many PCPs are compensated in accordance with
our Quality Care Compensation System (QCCS).*
This system compensates them for delivering
quality care in a cost-effective manner, including
payment on a per-member, per-month basis
(capitation). PCPs can receive additional payments
based upon patient satisfaction, in-office services
they offer members, participation in continuing
medical education programs and cost-effective
utilization of specialists and hospitals.**
. Availability varies by service area.
"This portion of aces is not used in some areas.
Other PCPs and participating providers are
compensated on a discounted fee-for-service
payment basis, on a per-day (per-diem) basis, and
through other capitation arrangements. Some are
compensated by Integrated Delivery Systems,
Independent Practice Associations, Physician
Hospital Organizations, mental health companies
and similar provider organizations that are
compensated by Aetna U.S. Healthcare on a
capitated or other basis.
You are encouraged to ask your physicians and
other providers how they are compensated for
their services, including whether their arrange-
ments include any financial incentives for
managing costs.
Rob Moore
Il'~ I-:(lS~ 1(1 lkc()nw ,I \lcmlwr
Once you review your enrollment materials:
· Completely fill out the enrollment form and sign where indicated. Be
sure to read both sides.
· Choose a PCP for yourself and each covered member of your family.
· Return the signed enrollment form to your employer by the
date specified.
CO\cl'age fur Out-of- \red Ikpell!lCl1lS
When you choose the Aetna U.S. Healthcare USAccess plan, you can
relax knowing that your covered dependents have the same quality
protection you do - even if they live away from home.
Eligible dependents who live within another Aetna U.S. Healthcare
USAccess service area can choose a participating PCP in their own
service area. Or, if they live in an area not serviced by an Aetna
U.S. Healthcare USAccess plan, they are eligible for coverage through
our Open Choice~ PPO plan (where available).
Female members
can take advantage
of our Women's Health
for Life programs.
"
Aracely Santiago-Justiniano
\1It'!" lOll Enroll
A USAccess plan 10 card will be sent to you after your enrollment
form is processed. Carry the card with you as proof of coverage. fJ.s of
your effective date, the member copy of your enrollment form may be
used as a temporary membership card until you receive your
permanent card.
You will also receive materials explaining how to use the plan. Refer
to these materials, as well as your plan documents, when you have
questions about your Aetna U.S. Healthcare benefits, limitations,
exclusions and other details. In the event of a problem with coverage
or for information on how to utilize the grievance procedure, call
Member Services at the toll-free number on your 10 card.
7
Additional
Information
E\t l'I'/l.:1I I~C\ ie\\
While we already offer a comprehensive grievance
and appeal system to review coverage decisions,
our external review process gives you the added
comfort of knowing that further recourse is avail-
able. With the external review process, you can
request an objective and timely external review of
certain coverage decisions by an independent
physician expert. You can request a review if the
decision involves more than $500* and is based on
lack of medical necessity or on the experimental or
investigational nature of the proposed service
or treatment.
Certain states mandate external review of additional
benefits or service issues, or mandate the use of
their own external review process. For further
details, refer to your specific plan documents, call
the Member Services toll-free number on your 10
card or visit our website at www.aetnaushc.com.
\ fl' n!l \(' i ((j II Ii d (' I! ti ell i l \
Aetna U.S. Healthcare protects the privacy of
confidential member medical information. We
require that participating providers keep member
information confidential in accordance with applic-
able laws. Furthermore, you have the right to
access your medical records from participating
providers at any time.
Aetna U.S. Healthcare (including its affiliates
and authorized agents, collectively "Aetna
U.S. Healthcare") and participating providers require
access to member medical information for a number
of important and appropriate purposes, including
claims payment, fraud prevention, coordination of
care, data collection, performance measurement,
fulfilling state and federal requirements, Quality
management, utilization review, research and
accreditation activities, preventive health, early
detection and disease management programs.
Accordingly, for these purposes, members authorize
the sharing of member medical information about
themselves and their dependents between Aetna
U.S. Healthcare, participating providers and health
delivery systems. We do not share identifiable
medical information with your employer, unless
allowed by applicable law or with your permission.
\\Iwt's \ot CO\CI'Ccl
This plan does not cover all health care expenses
and includes exclusions and limitations. Read your
plan documents carefully to determine which health
care services are covered and to what extent.
Services and supplies that are generally not
covered** include, but are not limited to:
· Cosmetic surgery, including breast reduction.
· Special duty nursing unless medically necessary
and preauthorized by Aetna U.S. Healthcare.
· Custodial care.
· Blood and blood byproducts (varies by state).
· Dental care and dental X-rays.
· Experimental and investigational procedures.
· Special equipment, including crutches and braces.
· Immunizations for travel or work.
· Hearing aids.
· Orthotics.
· Long-term rehabilitation therapy.
· Orthoptic therapy (vision exercises).
· Prescription drugs (unless covered by a
prescription plan) and over-the-counter
medications (except as provided in a hospital).
· Oral or topical drugs used for sexual dysfunction
or performance.
· Lifestyle-enhancing drugs.
· In certain prescription plans, prescription drugs on
the "Formulary Exclusions" list (formulary
information is available at our website,
WINW.aetnaushc.com).
· Substance abuse rehabilitation.
· All medical and hospital services not speCifically
covered in, or which are limited or excluded by,
your plan documents.
'The $500 requirement does not apply in all states.
,. LJependmg on the speCific benefits mandated in your state or offered by your employer. See your plan documents for details.
o Printed on recycled paper
American Heart 6
Associationll ~
Fighting Heatt Disease
and Stroke
n
C~-.J
~j
Wellriess
To Heart
Aetna u.s. Healthcare supports the American Heart
Association's battle against heart disease and stroke in
women. Cardiovascular disease, including stroke, isthe
leading cause of death in women, claiming more than
500,000 lives a year. To obtain information on how to
improve your health and reduce the risk of heart disease
and stroke, call1-888-MY HEART.
This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not
constitute a contract. Consult your plan documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate, Group Agreement and Group Policy) to determine goveming
contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations
and policies. The availability of a plan or program may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care
services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna
U.S. Healthcare or its affiliates. Certain providers, including your PCP or Ob/Gyn, may be affiliated with an Independent Practice Association (IPAl, a Physician Medical Group (PM G), an integrated
delivery system or other provider groups. Members who select these providers will generally be referred to specialists and hospitals within that system or group. The availability of any particular
provider cannot be guaranteed, and provider network composition is subject to change without notice. Natural Alternatives and Vision One, discount-only programs, and the Fitness program,
a rate access program, may be in addition to any plan benefits. Program providers are solely responsible for the products and services proVided under the programs. Aetna U.S. Healthcare
does not endorse any vendor, product or service associated with these programs. USAccess referred benefits may be provided or administered by: Aetna U.S. Healthcare Inc., Aetna
U.S. Healthcare Inc. (DE), Aetna U.S. Healthcare of Califomia Inc., Aetna U.S. Healthcare of the Carolinas Inc., Aetna U.S. Healthcare of Georgia Inc., Aetna U.S. Healthcare of Illinois Inc., Aetna
U.S. Healthcare of North Texas Inc., and/or Aetna U.S. Healthcare of Washington Inc.; USAccess self-referred benefits may be provided or administered by: Aetna U.S. Healthcare Inc., Aetna
U.S. Healthcare of California Inc., Aetna U.S. Healthcare of the Carolinas Inc., Aetna U.S. Healthcare of Washington Inc., Aetna Life Insurance Company, U.S. Health Insurance Company, and/or
Corporate Health Insurance ™ Company. Self-insured plan benefits are administered by Corporate Health Administrators, Inc. (CHA). The information in this document is subject to change
without notice.
In case of a conflict between your plan documents and this information, the plan documents will govern.
L~tna
~
www.aetnaushc.com
@1999 Aetna u.s. Healthcare Inc. 14043-6/99
Available in Spanish. Disponible en Espanol