HomeMy WebLinkAboutReso 2006-996
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RESOLUTION NO. 2006- ~
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, APPROVING
VOLUNTARY ENROLLMENT OF EMPLOYEES INTO A
CAREACCESS ALTERNATIVE LIMITED BENEFIT
HEALTH CARE PLAN, ATTACHED HERETO AS
EXHIBIT "A"; AUTHORIZING THE CITY MANAGER TO
DO ALL THINGS NECESSARY TO EFFECTUATE THE
TERMS OF THIS RESOLUTION; PROVIDING FOR AN
EFFECTIVE DATE.
WHEREAS, the City of Sunny Isles Beach currently provides regular full-time and part-
time employees with primary health care through United Healthcare which is a full-service
healthcare provider; and
WHEREAS, the regular intermittent employees and temporary employees are not
eligible to participate in the City's primary health care program; and
WHEREAS, CareAccess is a sole provider alternative limited benefit health care
program that may be offered to regular intermittent and temporary employees on a voluntary
basis at no cost to the City, as the employee enters directly into an agreement with CareAccess;
and
WHEREAS, this is a limited benefit health care program that covers doctor visits and
prescriptions only and is the alternative medical program that the Miami-Dade School Board
offers its employees; and
WHEREAS, the City's Insurance Broker, Brown & Brown Insurance, Inc., has provided
information on CareAccess, attached hereto as Exhibit "A", and recommends that the City
provide this voluntary service to the City's regular intermittent and temporary employees.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AS FOLLOWS:
Section 1. Approval of Voluntary Enrollment. The City Commission hereby approves the
voluntary enrollment of employees into a CareAccess Alternative Limited Benefit Health Care
Plan, attached hereto as Exhibit "A".
Section 2. Authority of City Manager. The City Manager is hereby authorized to do all
things necessary to effectuate this Resolution.
Section 3.
Effective Date. This Resolution shall become effective upon adoption.
PASSED AND ADOPTED this 19th day of October 2006.
R2006- CareAccess Alternative Health Care Program
Page 1 of2
ATTEST:
~ -A-~
Jane A. Hines, CMC, City Clerk
APPROVED AS TO FORM AND
LEGAL 'IENCY
Vote: 5-D
Mayor Norman S. Ede1cup
Vice Mayor Ros1yn Brezin
Commissioner Gerry Goodman
Commissioner Danny Iglesias
Commissioner Lewis Thaler
R2006- CareAccess Alternative Health Care Program
/
Moved by: r~~ ~
Seconded by: ("-A~ ::L-I)L'Z~l~
~(Yes)
V(Y es)
LdY es)
v(Y es)
-.0Y es)
_(No)
_(No)
_(No)
_(No)
_(No)
Page 2 of2
I
To:
Via:
From:
Date:
Re:
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
City Commission
Norman S. Edeleup, Mayor
Roslyn Brezin, Vice Mayor
Lewis J. Thaler, Commissioner
Gerry Goodman, Commissioner
Danny Iglesias, Commissioner
(305) 947-0606 City Hall
(305) 949-3 J J 3 Fax
(305) 947-2150 Building Department
(305) 947-5107 Fax
A John Szerlag, City Manager
Hans Ottinot, City AI/orney
Jane A. Hines. City Clerk
MEMORANDUM
The Honorable City Commission
A. John SzerIag, City Manager
.~
Thomas J. Acquaro, Human Resources Director
October 5, 2006
CareAccess Alternative Limited-Benefit Health Care Plan
RECOMMENDATION:
It is recommended that the City Commission approve the attached resolution to accept CareAccess as the
City's alternative limited benefit health care provider.
BACKGROUND:
The City currently provides eligible employees with primary health care through United Healthcare which is a
full-service health care provider (doctor visits/hospitalization/prescriptions). Eligible employees include
regular full-time employees (100% City-paid) and regular part-time employees who are appointed to work a
regular schedule of twenty (20) hours per week or more (employee pays a portion based on the appointment
hours). Currently, regular intermittent employees (those with imgular schedules and hours) and temporary
employees are not eligible to participate in the City's primary health care program.
Care Access is a sole provider alternative limited-benefit health care program that may be offered to regular
intermittent employees and temporary employees on a voluntary basis at no cost to the City. Similar to the
AFIAC voluntary programs that the City currently offers, the employee enters into an agreement directly
with CareAccess, again, at no cost to the City.
This is a limited benefit health care program that covers doctor visits and prescriptions but does not offer
hospitalization coverage (an employee would have to also enroll with the AFIAC program that offers
hospitalization coverage if this type of coverage is desired.) Care Access is the alternative medical program that
the Miami-Dade School Board currently offers its employees who are not eligible for their primary health care
plan. A summary of additional information as was provided by our insurance broker, Brown & Brown
Insurance, is attached.
Agenda Item , () 1:)
Date LCL::l9 - D ~
ADDITIONAL INFORMATION:
Again, there is no cost to the City for offering this voluntary benefit. The CareAccess Health Plan is a limited-
benefit health plan that is licensed in the state of Florida (641, Part 2) to provide limited health care benefits
such as doctor visits and prescription drugs but not hospitalization coverage. It is not a discount insurance
provider.
To:
From:
Date:
Re:
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
City Commission
Norman S. Edeleup, Mayor
Roslyn Brezin, Vice Mayor
Lewis J. ThaJer, Commissioner
Gerry Goodman, Commissioner
Danny Iglesias, CommiSSIOner
(305) 947-0606 City Hall
(305) 949-3 113 Fax
(305) 947-2150 Building Department
(305) 947-5 107 Fax
A John Szerlag, City Manager
Hans Ottinot, City Attorney
Jane A. Hines, City Clerk
MEMORANDUM
A. John Szerlag
-r
T. Acquaro, Human Resources Director
August 16, 2006
CareAccess Alternative Limited-Benefit Health Care Program
On June 26, 2006, representatives of CareAccess Health Plan made a presentation to us regarding
their program which they presented as a voluntary, alternative health plan similar to an HMO for
those City employees, and dependents, currently not eligible for the City's primary health plan
(United Health), i.e., our intermittent employees. They also indicated that they were selected by the
Miami-Dade School Board as their alternative health plan. You subsequently asked me to follow-up
and determine if this program would be a viable voluntary benefit, such as AFLAC, for our
intermittent employees.
As such, I met with Bob Hollander and Samantha Alvarez with Brown & Brown, Inc., our insurance
brokers and professionals in the field, and asked them to provide me more information regarding
CareAccess's position in the marketplace, their claim that they are the only company licensed to
offer this kind of benefit, and their general recommendation. I also had Yad check with the Miami-
Dade School Board to get a copy of their RFP in which CareAccess was the only one to bid, and
was subsequently selected, under the category "Medical Benefits-Alternative Medical Programs".
After doing their research, Brown & Brown confirmed that CareAcces Health Plan is in fact a
limited-benefit health plan that is licensed in the state of Florida (641, Part 2) to provide limited
health care benefits such as doctor visits and prescriptions (but not hospitalization coverage.) Also,
CareAccess is not a discount insurance provider, which there are many in Florida and many of them
are currently being scrutinized by the state for their false advertising claims, i.e. EyeMed, our vision
benefit, is not insurance but a discount eye product/ services provider.
To date, Bob indicated that CareAccess is the only company licensed in Florida as a limited-benefit
health provider and as such a sole source. Bob and Samantha both agreed that as a voluntary
benefit CareAccess would be fine, however, they cautioned that our interested employees need to be
properly educated to the fact that this company does not offer full benefit coverage such as
hospitalization coverage and that the premiums and co-pays are very high (in fact they
recommended that a healthy individual may be better served by self-insuring for doctor visits, which
CareAccess covers with high co-pays, and as an adjunct buy into a voIuntary hospitalization
coverage plan such as is offered by AFLAC.) They also indicated that Blue Cross/Blue Shield
currently offers an individual full health care plan at a cheaper cost than if an employee were to buy
into the CareAccess plan and the AFLAC hospitalization plan (they indicated that they could not
endorse such but could provide us the basic information so as to provide interested empIoyees with
choices). As a City we would not generate interest from full benefit insurance providers such as
United Health or Blue Cross/Blue Shield to offer individual plans (they work with empIoyers in
providing group insurance).
Overall the recommendation is to consider offering CareAccess Health Plan as a voluntary
alternative health benefit to our eligible intermittent employees and their dependents with the caveat
that the City (HRD) provide interested employees with full information regarding the pros/cons of
this plan and the other options that may be available without endorsing anyone product or coverage
option ~et the employee choose), etc.
CareAccess
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Care Access Health Plan, Inc.
An Overview
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Introduction
The need for affordable health care coverage is not a new concept. However, until
now it has been difficult for employers and individuals to go into the marketplace
and obtain a licensed and insured affordable alternative.
Care Access Health Plan, Inc. was formed to provide a licensed limited
benefit alternative health plan as a response to the continued upward spiral
of health care costs. Its corporate goal is to respond to the significant and
pressing need for a new form of managed care solution that delivers
defined comprehensive preventive and routine health care benefits at
affordable rates; providing care to keep its members well and out of the
hospital.
Licensed at the end of 2003 as a health plan under Florida Law, Chapter 64\, Part
II, Care Access is proud to be the first limited benefit health plan to receive in the
Fall of 2005 the prestigious accreditation award from URAC, the Washington,
DC based nationally recognized independent review agency for quality health
care.
Care Access took a unique approach to Chapter 64 I, Part II (known as the Prepaid
Health Clinic Statute) when it applied for its Office of Insurance Regulation
(OIR) license. As approved by OIR, Care Access offers a comprehensive list of
preventive care services for Primary and Specialty Physician Care, Urgent Care,
prescription medication, routine outpatient ambulatory surgery, behavioral health,
hearing and vision services, diagnostic treatment, and other preventive health care
services by utilizing a large network of credentialed private practice doctors rather
than local clinics. Under the requirements of the statute, Care Access does not
provide inpatient hospital services. Defined, insured Hospital benefit coverage
may be obtained through various A-Rated insurance companies licensed in
Florida that provide stand-alone defined hospital benefits or catastrophic hospital
insurance products.
While the Care Access product is relatively new, its key administrative
services are provided by two well-established healthcare companies that
enjoy common ownership with Care Access. These two companies are
over ten (10) years old; the first is a licensed operational Third Party
Administrator (TP A) HS I Medical Management, which is also licensed
as a Private Review Agent (PRA); and the second is Health Network One
2006 CAHP Overview
5-06 Emp w-o-h
(HN1) a provider network company.
Health Network One, Inc. (HN I) concentrates on establishing and maintaining
provider networks for the insurance and managed care industry. Currently it
provides services to managed care organizations in South and Central Florida.
This additional strategic and co-located partner further enhances Care Access
Health Plan by allowing it ready access to important provider contracting and
provider relations functions that usually much older and larger corporations would
have after many years of operation.
[Please see the following Chart, and for an overview of how these two
strategic partners affect the Care Access see below, Strategic Alliances
section. J
The following Chart illustrates the relationship between Care Access and its
strategic alliance/sister health care entities.
--- ---.---.......--.--- ___._.__..,_._.____ h..._ _. __ ._._._..__..._._..__+_......_.___~._..___._..., _._.. ___..,______.. __.......,
CareAccess
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Florida Licensed TP A
(Claims)
Private Revie\v Agent
(Medical Mgt.)
Pri mary Care
Specialty Networks
Ancillary Providers
2006 CAHP Overview
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The Need for an Affordable Alternative
The absence of an affordable alternative medical plan product is highlighted by
the growing number of Floridians who over the last decade are unable to afford
health care coverage of any kind. This need for affordable health care coverage is
not only in the population at large but is also present in the workplace where
employees are no longer covered by their employers, or where employees have
never been covered due to the high cost of such coverage. In addition, in many
areas dependents are no longer covered due to the high cost. This growing number
of working uninsured is found in the private small employer sector, the large
employer sector where many part-time employees are uninsured, and in the public
sector where dependent coverage may no longer be affordable for the government
entity. The need for these individuals to receive health care coverage to prevent a
more serious illness is just now being recognized as a looming crisis in health
care, see Chart below.
Percent of Floridians Delaying or Not Obtaining
Needed Medical Care Within the Last 12 Months
Because They Could Not Afford It, by Insurance
Status, 2004
20.0%
0.0%
40.0%
Insured
Uninsured
The lack of an option as an affordable alternative was further recognized by the
Florida Health Insurance Study, commissioned by the State of Florida, Agency
for Health Care Administration (AHCA) and conducted by the University of
Florida in 2004. It revealed that more than 2.8 million people, or about 19.2
percent of the state's population, did not have health insurance, this grew from
16.8% in 1999. In the Study, Miami-Dade County was identified as having the
highest rate of uninsured in the state at 28.7%. Statewide ofthose working, 32%
of self-employed lacked insurance, while 36.3% of those working full-time for
small employers with 4 or fewer employees lacked coverage.
2006 CAHP Overview
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Unjque Ability to Meet the Need
Care Access Health Plan (CAHP) is unique and its approach to serving the
population is fundamentally different than other health care companies due to the
fact that Care Access as corporation was designed from the ground-up with its
emphasis on providing comprehensive preventive care designed to keep its
members well. By overlaying a wellness health care assessment onto its product
CAHP brings this unique product to a part of the population who previously may
have been unable to afford any health care coverage, including individuals, the
employed, their dependents, or those who have been unable to obtain health care
coverage at their place of employment.
HIGHLIGHTS
CAHP offers its Members:
· An innovative new company with a unique approach, offering comprehensive preventive
health care coverage at affordable rates to those individuals not previously offered health
care coverage.
· Technical and administrative capabilities to administer the contract usually available to
much older, larger and more expensive health plans
· Alliance partner to provide affordable defined hospital coverage
· Knowledge and understanding of the population to be served and experience in operating
and delivering health care benefits to that population
Care Access built its wellness focused health plan model by contracting with
hundreds of credentialed independent practice physicians (over 75% of whom are
Board Certified) in Miami-Dade, Broward and Palm Beach counties to provide
comprehensive preventive care with primary and other specialty care services.
With its concept of preventive care and wellness, CAHP has in a few short years,
built an affordable limited benefit health plan whose members receive the
comprehensive coverage they need outside the hospital; this coverage coupled
with an ongoing program of continuous health care assessment, utilizing
providers and physicians on a par with more expensive health plans, is designed
to keep CAHP members well and out of the hospital.
In addition, Care Access has the administrative capability of an experienced team
that allows it the opportunity to navigate the difficult and often complex arena of
providing health care coverage.
2006 CAHP Overview
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The Management Team
The Company is fortunate to have the necessary experience in the health care
field to become a successful provider of health care coverage. The key individuals
responsible for the success of the Company in its efforts to reach the consumer
collectively have over 100 years of experience in the health care field. All aspects
of the health care field are covered by their expertise. This includes the important
areas of health care finance, health care administration of benefits to individuals
and employees; the provision of health care delivery through networks of primary
care and specialty care physicians; state regulatory experience to navigate the
highs and lows of the regulated industry which governs the licensed health plan
that the Company operates; and the administrative expertise to properly operate
the Company and respond to the day to day needs of its customers and employees.
Its President and Chief Operating Officer operate Care Access on a day-to-day
basis. However, the collective experience and expertise of the Company's
Executive Committee serves as the active principal management group
responsible for the operations and allocation of the resources of the Company.
The Committee oversees and coordinates the activities of the health plan,
activates, initiates and approves policies and procedures of the Company and all
of its business segments.
Executive Committee
Luis G. Mosquera
Chief Executive Officer
Mr. Mosquera has over 20 years of experience in the healthcare tield in a variety of disciplines and capacities
that provide him with a unique perspective of the industry. Currently Mr. Mosquera serves as Chief
Executive Officer for HS I Medical Management (HS I) and Health Network One (HN I), the fonner since
1999 and the later since 2000. Before joining Med Partners, Mr. Mosquera served in various capacities at
PCA a large Florida licensed health maintenance organization from June 1992 through September 1997.
During that time he held the position of Vice President of Expansion, Acquisition and Facilities and Vice
President of Business Development from June of 1996 to September of 1997.
Gerald B. Sternstein
President/Chief Operating Officer
Gerald 8. Stemstein is President and Chief Operating Officer of Care Access Health Plan. Previously, he was
Chief Operating Officer of Total Health Choice, Inc. a Florida licensed not-for-profit health maintenance
organization a position he assumed in May 01'2001. Prior to May 01'2001 he served as Total Health's General
Counsel beginning in 1998, from the health eare Law Finn which he founded in Tallahassee Florida,
Stemstein, Rainer & Clarke, P.A. Mr. Stemstein also represented Total Health's predecessor company in
Florida, PacitiCare Health Systems prior to their purchase by Total Health in 1997.
2006 CAHP Overview
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Dean A. Dalbery
Sr. Vice President
Mr. Dalbery has over 18 years of experience in managed healthcare. Mr. Dalbery has served as
Senior VP and Chief Development Officer of HS I Medical Management since May 1999. Mr. Dalbery was
the founder and CEO of Health Access, Inc., a multi-state Preferred Provider Organization. Mr. Dalbery also
currently serves as President of Florida NetPass a Florida MPN, which contracts with HS I and serves over
60,000 Medicaid lives in South Florida through its contract with the State of Florida Medicaid Office. Mr.
Dalbery attended SI. John's University in New York and the University of Miami and received his BA in
Marketing.
Ignacio A. Hidalgo, MD.
Medical Director
Dr. Hidalgo is Board Certified in Internal Medicine and Geriatric Medicine. Dr. Hidalgo has clinical training
and experience in emergency medicine, internal medicine, and geriatrics. He previously served as Medical
Director of skilled nursing facilities and as Regional Medical Director of Aetna Health, a managed care
organization.
Strategic Alliances & Partnerships Bring Added
Experience to Meet Need
As mentioned above, Care Access has as its strategic and co-located partner HS I
Medical Management, Inc. (HS I), a Florida corporation established in 1995 that
is a fully URAC accredited network management and credentialing company.
HS I provides the administrative services and population management expertise to
Care Access members. As a seasoned administrative entity, HS I provides key
"back-office" functions including claims adjudication, eligibility, credentialing,
utilization review, authorization management, enrollment and fulfillment.
Another key benefit of Care Access' derives from its use of HS I is its
information-based Population Management Model, which performs
administration of primary care case management, authorization/referral tracking,
health care assessment information and review, physician reporting, enrollment
tracking, population disease management and physician profiling.
As already mentioned, Care Access' other co-located strategic partner is Health
Network One, Inc. (HN I) a Florida Corporation, which concentrates on
establishing and maintaining provider networks for the insurance and managed
care industry. This additional partner further enhances Care Access' ability to
respond to the needs of its Members by allowing it ready access to important
provider contracting and provider relations functions.
2006 CAHP Overview
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The Health Plan Product
Care Access offers its health plan product direct to individuals and employers, or
through the broker community with a generous commission schedule available to
qualified licensed brokers. Care Access has an experienced in-house staff to aid
brokers with general assistance, quotes, marketing materials, or by participating in
enrollments for new individuals, employer !:,TfOUPS or Associations.
There are three Care Access product offerings; a Low and High Option, and an
Association/Chamber Option, all offer various co-pays for covered health care
services with no deductibles. Other products will be developed from time to time
in response to market conditions.
Individual rates for the Low Option Plan start at $59; blended rates by Age Only
or by Age/Sex grouping are available for Employer Groups or Groups of
Individuals without minimum participation requirements; Care Access also offers
Group Composite Tiered Rates based upon a census, for Employer Groups
agreeing to meet a 25% minimum contribution requirement.
The Hospital Product Discussion
Note: Stand-alone hospital defined benefit products are available through
independent and licensed A-Rated carriers in Florida, their rates are affordable
and their product offerings vary considerably. Some of the larger A-Rated
companies in the market are Genworth, Allstate (through its Work-Site Plan),
Markel Insurance Company, and Blue Cross Blue Shield, Florida through its Blue
Options offerings.
When the affordable comprehensive and routine preventive health care benefits of
Care Access are offered, they present a unique opportunity to allow the employer
to retain its employees with previously unavailable and unaffordable health care
coverage. In addition, and depending upon the unique Employer circumstances
and requirements of its employees, an additional unmet need is resolved when
Care Access is combined with an affordable defined hospital insurance benefit of
an A-Rated hospital insurance provider. This gives the Employer an opportunity
to offer a measure of previously unavailable hospital coverage to the employee,
and becomes an added retention incentive.
2006 CAHP OvelView
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~
FreQuentlv Asked Questions about Care Access Health Plan.. Inc.
Who can join Care Access Health Plan?
Care Access provides health care benefits through hundreds of credentialed independent
physicians to Individuals, Group of Individuals, and Groups. It is an ideal health plan for
employees, or people who have been uninsured because of the high cost, students, part-time
workers, dependents, and people who have newly arrived from other countries, regardless of
immigration status.
What Services are covered by Care Access Health Plan?
Care Access offers a wide range of routine and comprehensive medical services with an emphasis
on preventive care. Care Access benefits include Primary Care, Specialty Care, Urgent Care,
Diagnostic Services, Ambulatory Surgical Services, Chiropractic Care, Behavioral Care, Hearing
and Vision Services, as well as Prescription Drugs. Hospital Services are excluded from Care
Access Health Plan, however, supplemental Hospital and Dental Coverage are available from
select carriers. For a complete listing of benefits with specific coverage amounts and co-pays, see
our Schedule of Benefits or visit our website at www.mycareaccess.com
Does Care Access Health Plan offer Hospital Coverage?
While hospital services are excluded under our plan, hospital defined benefit and catastrophic
supplemental hospital plans are available through select carriers.
What is the Prescription Drug Benefit?
Each member can receive up to $100 per month ($ I ,200) per year in prescription drugs. Generic
Drug co-pays are as low as $7. After the $100 per month maximum is reached the Member
receives the Care Access Health Plan discount through the same pharmacy when filling a
prescription.
Do you need a Social Security Number to Join the Plan?
No. We accept members regardless of immigration status. Coverage is based on application
(Statement of Health) and underwriting assessment.
What Counties does Care Access Health Plan Service?
Care Access currently operates in Miami-Dade, Broward and Palm Beach counties. The Company
plans to expand statewide.
Does the applicant have to live in South Florida to qualify for Care Access?
Yes. Applicant reside within our service area to enroll in Care Access.
CAHP
Gen FAQ 12-15-05
..-::,"...
\Vhich services require a referral from Care Access?
Allergy treatments, Mental Health, certain specialists, Diagnostic Services, Home Health,
Ambulatory Surgical Services, Rehabilitative Services and Durable Medical Equipment require
referrals from your PCP and authorization from our UM Department.
Please refer to Schedule of Benefits for more specifics.
For Care Access, when are premiums due?
This answer is best addressed as follows:
· For Individuals the premium is due on the 15t of the month for the following
month's coverage (Premiumsfor coverage in the month of September are due by
August 1sl.)
.
· For Groups of Individuals the premium is due on the 151 of the month for the
following month's coverage. (Premiumsfor coverage in the month of September
are due by August 1st.)
· For Groups the premium is due by the 151 of the month for the month of coverage.
(Premiums for coverage for the month of September are due by September 1st.)
Is there a pre-existing clause?
Yes. If the underwriting department considers a condition as pre-existing, certain treatments andlor
medication pertaining to that condition will be not be covered for a period of up to 2 years, at the
sole discretion of the plan.
Can a member or applicant nominate their physician to be a part of the Plan?
Yes. Simply fill out the provider nomination form at the back of the Provider Directory or
download from our website (in the Enrollment section, under other downloads) and submit to Care
Access, We can't guarantee that a particular physician will choose to join Care Access, and of
course, s/he will have to pass our Care Access requirements, but we would be pleased to notify you
if s/he comes aboard.
Can I enroll a child without their parents?
Yes. We can accept children from birth, with or without their parents. Since applicants are
medically underwritten each can be viewed on an individual basis.
How can I access your Health Plan's Drug Formulary?
Each member receives a copy of the Drug Formulary in their new member welcome packet. It can
also be downloaded from our website at www.mycareaccess.com
CAHP
2
Gen FAQ 12-IS'{)S
How long does it take to enroll?
The enrollment process will begin upon submission of a complete application/so Processing time
varies according to the type of submission.
· Individuals: Complete application must be received by CAHP by the I 51h day of the
preceding month prior to the effective date of enrollment.
· Group of Individuals: Complete application must be received by CAHP by the 151h day of
the preceding month prior to the effective date of enrollment.
· Group: Complete application must be received by CAHP by the 20th day of the preceding
month prior to the effective date of enrollment
· Online Enrollment for Individuals, available at mycareaccess.com.
Group Information
Are there a minimum number of employees or members required to join this plan?
Yes, the Group of Individuals Plan is available for 10+ enrolled employees.
Do you have Group Rates?
Absolutely. Blended rates for age only as well as composite tiered group rates are available for
groups of 10 or more.
How do I get Enrollment Materials?
All of our enrollment materials can be downloaded from our website or you can call customer
service at 1-877-4] 1-2247 (CAHP)
CAHP
3
Gen FAQ 12-15-05
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Business Operations
Ofelia San Pedro, Deputy Superintendent
May 8, 2006
SUBJECT:
REQUEST FOR AUTHORIZATION TO AWARD REQUEST FOR
PROPOSAL (RFP) #019-FF10, MEDICAL BENEFITS,
BEHAVIORAL HEALTH, WELLNESS, AND PRESCRIPTION
DRUG PROGRAMS
COMMITTEE:
INNOVATION, EFFICIENCY & GOVERNMENTAL RELATIONS
At the Board meeting of November 16, 2005, the Board authorized release of Request
For Proposal (RFP) #019-FF10, Medical Benefits, Behavioral Health, Wellness, and
Prescription Drug Programs to seek competitive proposals for these programs providing
benefits for district employees, retirees, and their eligible dependents. Proposals
received in response to this RFP were opened at the regular bid opening of January 17,
2006. Proposals were received from the following companies in response to the RFP:
MEDICAL BENEFITS - TRADITIONAL MEDICAL PROGRAMS
. Blue Cross/Blue Shield of Florida
. CIGNA
. Humana
. UnitedHealthcare of Florida
. Vista Healthplans
~* MEDICAL BENEFITS - ALTERNATIVE MEDICAL PROGRAMS
~>. Care/Access Health Plan
MANAGED BEHAVIORAL HEALTH PROGRAMS
. UnitedHealthcare of Florida
WELLNESS - STAND ALONE PROGRAMS
. American Specialty Health
. StayWell
. WellCorp
PHARMACY PROGRAMS - STAND ALONE PROGRAMS
. Caremark Rx
. CIGNA
. Envision Rx
. Express Scripts
. Humana
. UnitedHealthcare (Medco)
. Medco Health Systems*
. Systemed (Florida Health Care Coalition)*
*Later deemed non-responsive and eliminated from further review
REVISED
E-68
Page 1 of 8
A brief summary of the CareAccess plan design is shown below:
General Provisions Hiah Ootion Low Ontion
Is a PCP election/referral required Yes Yes
Annual Benefit Maximum (Outpatient Onlv) $25,000 $25,000
Annual deductible (ifF) N/A N/A
Annual Out-of-Pocket Max (excludina deductible) N/A N/A
Hospital Admission Benefit $500/day up to 100 $500/day up to 100
(Provided through Markel) days/confinement days/confinement
Plan Coinsurance None None
Inpatient Surgery Benefit
(Provided throuah Markel) $2,000/1 per year $2,000/1 oer year
Outpatient Services
Primary Care Physician office visit 100% after $10 copay 100% after $20 cooay
Included in PCP office Included in PCP office
Immunizations visit cooav visit copay
Well Child Care 100% after $10 copay 100% after $20 cooav
Annual Physical 100% after ap~ cooay 100% after aDo CODay
GYN visit $25 soecialist $35 soecialist
Mammograms $25 soecialist $35 soecialist
Specialist Office Visit 100% after $25 cooay 100% after $35 copav
Maternity Care (Pre and Post Natall 100% after $25 cooav 100% after $35 cooay
$750 max after $100 $750 max after $200
Outpatient Surgery' cooav/eoisode cooav/episode
Oral Suraery N/A N/A
Emergency Room (in-area hospital) $300 (1 for injury/1 for $300 (1 for injury/1 for
siCkness/year) sickness/year)
Prescription DrullS"
Retail Generic I Formulary Brand / Non-
Formulary $7/25/25 $15/35/35
Mail Generic I Formulary Brand I Non-Formulary N/A N/A
*In addition, Markel pays for 1 outpatient surgery per calendar year at $800
"Plan pays maximum $1,200 per year, maximum $100 per month, no carry over. Monthly limit not
combined with specialty injectibles limIt or immunization limits
R
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Collective bargaining will be conducted with each union regarding plan design and
contribution levels.
Page 6 of 8
2. CareAccess Health Plan, Inc. for an alternative, limited R
healttl plan to be offered to employees on a voluntary basis } ~
for those employees who are not provided Board-paid I
coverage effective July 1, 2006 through December 31, 2007, ~
with the ability to extend for one additional year subject to 0
successful renewal negotiations, for the following monthly
rates per member:
Alternative, Limited Health Plan
Inpatient and Outpatient Combined Rates
Per Member Per Member
Age Band High Option Low Option
0-25 $118.00 $108.00
26-35 $132.35 $122.28
36-45 $157.90 $148.23
46-55 $196.05 $185.15
56-64 $288.90 $278.85
65 + $422.80 $412.45
OSP:sc
Page 8 of 8
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,
TO:
FROM:
DATE:
RE:
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
(305) 947-0606 City Hall
(305) 949-3113 Fax
(305) 947-2150 Building Department
(305) 947-5107 Fax
City Commission
Norman S. Edelcup, Mayor
Roslyn Brezin, Vice Mayor
Gerry Goodman, Commissioner
Danny Iglesias, Commissioner
Lewis J. Thaler, Commissioner
A. John Szerlag, City Manager
Hans Ottinot, City Allorney
Jane A. Hines, City Clerk
MEMORANDUM
October 25,2006
Approval of CareAccess Alternative Limited Benefit Health Care Plan
At its regular meeting of October 19, 2006, the City Commission adopted Resolution No. 2006-
996, which approved the above agreement. Attached is a copy of the approving resolution to
assist you in processing this item.
Upon completion, please forward an executed, original agreement to the Office of the City Clerk
for the record.
Thank you.
:pw
Attachments
cc: A. John Szerlag, City Manager (w/o attachments)
Hans Ottinot, City Attorney (w/o attachments)
Shaun Gelvez, Contracts Coordinator (w/o attachments)
Care access Alternative Health Plan Memo