HomeMy WebLinkAboutReso 2009-1390
RESOLUTION NO. 2009- 13 qo
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF
SUNNY ISLES BEACH, FLORIDA, APPROVING THE
SELECTION OF A VMED AS THE PROVIDER FOR EMPLOYEE
HEALTH INSURANCE, LINCOLN FINANCIAL GROUP AS THE
CITY'S PROVIDER FOR DENTAL INSURANCE, LIFE
INSURANCE, ACCIDENTAL, DEATH & DISMEMBERMENT (AD
& D) INSURANCE AND LONG TERM DISABILITY INSURANCE,
AND EYE MED AS THE CITY'S PROVIDER FOR VISION CARE
FOR A ONE- YEAR PERIOD; AUTHORIZING THE CITY
MANAGER TO ENTER INTO AGREEMENTS WITH THESE
PROVIDERS, PROVIDED SAID AGREEMENTS ARE APPROVED
AS TO FORM AND LEGAL SUFFICIENCY BY THE CITY
ATTORNEY; FURTHER AUTHORIZING THE CITY MANAGER
TO DO ALL THINGS NECESSARY TO EFFECTUATE THIS
RESOLUTION; PROVIDING FORAN EFFECTIVE DATE.
WHEREAS, the City of Sunny Isles Beach currently provides regular full-time and part-
time employees with primary health care through United Health Care, a full-service healthcare
provider; and
WHEREAS, the City's insurance broker (Brown & Brown Insurance, Inc.) issued
proposals to prospective firms on behalf of the City to provide for the same level of benefits with
a national provider; and
WHEREAS, after extensive negotiations with Brown & Brown, the City's current health
care provider United Health Care, submitted a proposal at a 39% increase based on the City's
claims history, and based on that increase, City staff and Brown & Brown representatives met
with representatives from AvMed, and the consensus was to move forward with the AvMed
proposal for health insurance, at the same level of benefits (HMO and POS plans) at a slight
decrease of 1 % to 2% in rates as compared to United Health Care, and on an annual basis the
total annual premium paid for this coverage will decrease by approximately $15,000.00; and
WHEREAS, the City team and Brown & Brown recommend Lincoln Financial Group as
the City's provider for dental, life, disability and accidental death and dismemberment (AD&D),
and on an annual basis the total annual premium paid for these coverages will remain
approximately the same, and to continue with EyeMed for vision care; and
WHEREAS, these agreements are for a period of one (I) year with a renewal date for the
City's health, dental and other employee insurances of March 1, 2009.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AS FOLLOWS:
Section 1. Approval of City Commission. The City Commission hereby approves the use of
A vMed as the City's health care provider, Lincoln Financial Group as the City's provider for
R2009- Health Insurance Renewal (Avmed Lincoln Financial Eyemed)
Page I of2
dental, life, disability and accidental death and dismemberment (AD&D), and to continue with
EyeMed for vision care, for a one-year period, with a renewal date of March 1,2009.
Section 2. Authorization of City Manager. The City Manager is hereby authorized to enter
into agreements with said insurance providers, provided said agreements are approved as to form
and legal sufficiency by the City Attorney.
Section 3. Further Authorization of the City Manager. The City Manager IS hereby
authorized to do all other things necessary to effectuate this Resolution.
Section 3.
Effective Date. This Resolution shall become effective upon adoption.
ATTEST:
~A~
Jane A. Hines, CMC, City Clerk
APPROVED AS TO FORM AND
LEG FFIC ENCY
Vote: S-o
Seconded by:
V \ u.ffi"(f' Il-\ I<\t. 'T.R..
~~~ (006CJrtthJ
Moved by:
Mayor Norman S. Edelcup
Vice Mayor Lewis Thaler
Commissioner Roslyn Brezin
Commissioner Gerry Goodman
Commissioner George "Bud" Scholl
---1LY es)
vcy es)
t/(Y es)
V (Yes)
:J2:'(Y es)
_(No)
_(No)
_(No)
_(No)
_(No)
R2009- Health Insurance Renewal (Avmed Lincoln Financial Eyemed)
Page 2 of2
BENEFIT
-(~6NSULTANTS
February 10, 2009
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
Attn: Douglas Haag
Re: Benefit Insurance Program
Dear Doug,
The City of Sunny Isles Beach Medical, Vision and Dental policies are due for renewal on March
1,2009. As you know, the medical market trend for increases are coming in between 12.5% to
14% annually and dental is 13%. This is based on the rising cost of medical services, dental
services, prescription drugs and healthcare administration. Our office has approached the
marketplace for both lines of coverage and with the diligent effort have been able to secure
quotations within that bracket on all policies.
It is our intention to offer a benefit program, based on the City's direction that does not reduce
benefits nor take away the large participating provider list that is now available. It is also our
intention to offer a benefit program for those members that reside outside the Tri-County area or
have children that live outside of the area. It is our general practice to approach multiple carriers
in the marketplace to ensure that we are able to offer the best product that suits our client's needs
with the most competitive pricing.
Health Insurance
The renewal United Healthcare (UHC) and Neighborhood Health Partnership (NHP) was
received on January 22, 2009. Updated claims experience was also received on that date. Due to
the very high claims loss ratio of 101 %, UHC and NHP would offer their most competitive rate
increase of 39,65 %. We had approached Aetna, AvMed, Cigna, BCBS. Humana and Vista on
December 24, 2008 with claims experience through November 2008 for quotations.
Aetna, AvMed and BCBS provided quotations. Humana has declined due to not being
competitive and Cigna and Vista at this point have not finalized either a quote or a declination.
After reviewing the carriers and the plan combinations they are willing to offer, A vMed has been
able to offer the plan closest to the benefits provided under the (UI-IC) and (NHP) contracts with
competitive pricing. Multiple options were provided and two meetings were held with myself,
Samantha Alvarez, Marisol Butcher and CSIB employees, Douglas Haag, Yael Londono and the
CSIB's committee.
5900 N. Andrews Avenue, Suite 401 I Fort Lauderdale, FL 33309-2366 I Phone: 954.453.6280 ! Fax: 954.772.6243
A Division of Brown & Brown of Florida, Inc. I Website: www.bbbenefitc.com
BENEFIT
CON~rU[.TANT"'S-
Page 2
February 10, 2009
City of Sunny Isles Beach
Dental Insurance
The dental plan renewal option with Sun Life was at a 34% increase. This is due to the
groups higher than anticipated utilization and they are currently running at a loss. The
dental went out to market the same day as the medical to Principal, Cigna, Aetna,
Humana, Standard and Lincoln Financial. Lincoln Financial was able to propose the
current plan offered with Sun Life with the cunent rates. This had be discussed the
previous year that this would be approached as at that time Lincoln could not quote
against Guardian Life the previous carrier.
Vision Insurance
The vision plan renewal was under the CUlTent trend Eye Med Vision Care. It was
proposed to change from a two-tier rate to a four-tier rate. This resulted in the plan
lowering the single employee cost below cunen!.
Recommendation
It is our recommendation to change medical carriers to A vMed Health plans with the
triple option they have recommended. They would implement two HMO plans and a POS
plan for those out of the area or have children out of the area. The main HMO plan
would be at 2.5% below current. This is allowing the employees the opportunity to have
a choice of benefit plans.
We also recommend that the CSIB switch dental can'iers to Lincoln Financial, as they
will provide the same contract as Sun Life with 0% cost increase over current and keep
the Vision with EyeMed under the current program but at a four-tier structure.
We appreciate the opportunity to continue to serve your insurance needs.
Please feel free to contact our office with any questions.
Sincerely,
Bro;~~'J & Bro~n Benefit Consultants
.:// ./
/'P: 0 lj' .
i.Rob Holla der
. Executive Vice President
RPH/sa
5900 N. Andrews Avenue. Suite 401 ! Fort Lauclerdale. FL 33309-2366 i Phone: 954.453.6280 I Fax: 954.772.6243
A Division of Brown & Brown of Florida. Inc. I Website: www.bbbenefitc.com
~'
A Proposal of Employee Benefits
Coverage and Service
for:
City of Sunny Isles Beach
Proposed by:
Robert Hollander
Executive Vice President
&
Samantha Alvarez
Sales Executive
Proposal Date: 1/26/09
Proposed Effective Date: 03/01/09
ALL INFORMATION IS STRICTLY CONFIDENTIAL AND PROPERTY OF
BROWN & BROWN BENEFIT CONSULTANTS
A Division of Brown & Brown of Florida, Inc.
/
1
IT ABLE OF CONTENTSI
I. Introduction
II. Our Approach and Services
III. Criteria for Selection
IV. Preliminary Benefits Overview
V. Carrier Websites
VI. AM Best Ratings
VII. Market Summary
VIII. Benefit Comparison! Benefit Summaries
IX: Team
X: Glossary
XI: Compensation
2
SECTION I
Introduction
Partnership
In the spirit of partnership and commitment, Brown & Brown Benefit Consultants is pleased to
provide the City of Sunny Isles Beach with our proposal for employee benefits services. Our
organization was founded on the philosophy that long-term success in the professional services
industry can only be achieved through innovative solutions and a passion for customer service.
We pride ourselves on the quality of our people, and the consistency of our performance. At
Brown & Brown Benefit Consultants, we believe the value that our people and performance
deliver is best measured by the longevity of our client relationships.
Brown & Brown of Florida, Inc. is one of the largest and most respected independent insurance
intermediaries in the nation, with over 62 years of continuous service. The Company is ranked
as the fifth largest such organization in the United States by Business Insurance magazine.
Brown & Brown of Florida, Inc.'s clientele is as diverse as the American economy itself. There
is hardly a business, industrial or professional insurance situation that has not presented itself to
Brown & Brown including: Medical, Retail, Construction, Marine, Transportation, e-Commerce,
High Technology, Financial, Legal, Agricultural, Colleges and Universities, Hospitality,
Governmental Entities, General Aviation, Hospitals, Manufacturing, Medical Care Facilities,
Museums, Nursing Homes, Restaurants, Religious Institutions, Schools and many more.
Employee Benefits is just one area of expertise we can provide. Our benefit programs include,
Medical, Dental, Vision, Cobra, Life, Disability and Section 125 pre-tax reimbursement accounts
just to name a few. We are able to provide fully insured programs for employers of all sizes and
self funded programs to meet the special needs of employers interested in that type of
arrangement. In addition to providing the insurance programs, we assist in the design, cost-
containment, management and development of your employee benefit package.
All Employee Benefit clients are assigned an " In House" service representative to assist with
Billing Claims, Eligibility, Enrollment or any other issues or questions that arise.
For our clients that opt for self insured programs, we not only provide the services mentioned
above, but also supply detailed reports to help you monitor your program closely. We also place
the reinsurance; help design a plan to meet your needs and work closely with you and the Third
Party administrator during the implementation as well as throughout the year to ensure the plan
operates smoothl y.
As for property and casualty, Brown & Brown of Florida, Inc. is a recognized leader in the area
of professional liability, governmental and municipal insurance programs, pollutions liability and
many other specialized areas of risk. All property and causality clients are also assigned an "In-
House" service representative along to assist with daily issues, along with some of the best
marketing representatives to search for the most competitive products and services for our
clients.
3
Summary
City of Sunny Isles Beach has indicated in their Request for Proposal that they are interested in
identifying a broker/agent that is familiar with the South Florida markets to assit them with the
strategy and renewal process for their health, dental, life, ad&d and long term disability
insurances who has experience working with small to mid-size nonprofit organizations for the
following services:
. Providing counsel on benefit strategies
. Reviewing and recommending strategic benefit design alternatives
· Negotiating financial and contractual terms
· Providing support during the annual rate renewal
· Suppling updates regarding changes to state and federal legislation
SECTION II
Our Approach and Services
In this section of our proposal we will touch on potential areas of concern for. and how we can
assist the City of Sunny Isles Beach in confronting these challenges. Your specific employee
benefits strategic plan may need to address one, many or all of the following components/issues.
Cost Containment/Plan Design
Double-digit inflation, cost shifting, aging, and changes in the workforce have all contributed to
a fundamental change in the theory of plan design. Controlling costs, as well as changing the
demographics of the workforce and the principal wage earners, have greatly influenced how
employers approach plan design.
Employers have begun to face these issues by asking some pointed questions:
· How much can employees afford to pay for health and welfare benefits?
· Are we paying for benefits our employees do not value?
· Should we steer employees towards managed care programs to control costs?
· Is our benefits package competitive with other employers in our industry/region?
Designing a plan that meets the needs of your employees, is in compliance with legislative
restrictions, and fits your firm's budget is no small challenge. We take great care to understand
the objectives of your benefits program before we make any recommendations on the design of
your plan. And once your plan is designed, we never stop reviewing your benefits to assure that
as your objectives, corporate structure and workforce change so too does your employee benefits
package.
The final plan design always stems from some combination of three criteria: your budget, your
objectives and your employee's needs. Depending on the budget and objectives, some
4
employers do not feel the need to gain employee input and feedback. If feedback is desired, we
have the resources to conduct an extensive employee survey that, when the responses are
tabulated, will provide insight as to your final plan design. Of course, as with any survey, you
must be prepared to react to it. Employees gain a feeling of involvement when given the
opportunity to participate in change. If no change occurs, the employer must be prepared to
address why.
As the City of Sunny Isles Beach workforce changes, the company must be prepared to address
how you will meet their changing needs. Areas where we have helped our clients address their
employees' perceived needs are through Flexible Benefit Plans and allowing employees more
choices for core and non-core benefits.
Administration
Administering employee benefit plans is complex and and can be problematic. Tracking
enrollment, monitoring flexible spending accounts, coordinating payroll and human resources
information and meeting governmental reporting and disclosure requirements can be burdensome
and time consuming. Therefore, it is critical that you select professionals and vendors that will
help streamline all of the administrative aspects of your benefits program. It is critical that you
make those selections based on experience and professional advice.
Communications
Developing a comprehensive communications campaign that effectively delivers a consistent
benefits message to all employees requires significant planning and a well thought out delivery
system. It must be positive and definitive to minimize employee questions and concerns.
Our work includes a review of current communication practices, anticipation of employee
concerns and questions, and development of an employee communication strategy that clearly
and positively communicates the benefits program to all employees. We focus our efforts on:
. Developing communication objectives for your employee benefits program;
. Critiquing all current employee booklets, handbooks, and other communication materials,
as well as previous communication efforts;
. Determining specific areas that need to be communicated more effectively;
. Creating an employee satisfaction survey after plan implementation, if necessary;
. Creating innovative enrollment materials and methods; and,
. Designing optional employee benefit statements to communicate a "total compensation"
message to your employees.
. Attend and present at Open Enrollment Meetings
It is helpful to supplement the enrollment material with some down-to-earth employee
communications materials. Ongoing education of employees will lead to more effective use of
5
the health care system, along with better quality of care and improved health cost management.
It will also maximize the employee relations value of providing benefits.
Brown & Brown Benefit Consultants can coordinate and attend regularly scheduled Benefit
Fairs. The fairs should be designed so that employees can have "face to face" interaction with
the various companies involved in their group insurance programs. The itinerary and
presentation at the fairs would enhance the following:
. Employees and managerial staff understanding of the benefit program.
. General employee satisfaction level.
. Relevant issues pertaining to recruitment of new employees and offering more attractive
benefits than the competition.
SECTION III
Criteria for Selection
Verifiable elements of quality and cost effectiveness
We have a demonstrated track record of delivering excellent service and significant cost savings
to our clients. We urge you to contact our references.
Geographic adequacy
Our firm maintains a national presence serving our clients throughout the United States, we have
many clients dibursed throughout the country. Through our database of national carriers and
multi-site client experience, we are able to establish a relationship with you that will meet your
geographic needs.
Doing business on a national stage often means that you need employees in many locations. Our
experienced consultants can help you manage the growing complexity of national workforce so
that your size and scope is an advantage rather than a problem.
Our team provides a national perspective on issues and ensure a consistent approach to dealing
with your people. We can help you develop, manage, and coordinate employee programs on a
national level.
Proactive account service
Brown & Brown Benefit Consultants has committed to this project a team of experienced
consultants from various disciplines within our firm, as you will see from their biographies. The
individuals assigned have an excellent reputation in the employee benefits consulting industry
and possess the necessary skills, expertise and knowledge to respond to any employee benefit
issue presented during the course of the consulting process.
6
This highly organized team will have the ability to interact with the Cityof Sunny Isles Beach
staff on your terms. Our team of consultants have the skills necessary to manage the City of
Sunny Isles Beach in a thorough, disciplined manner. This team approach is how we currently
handle all large accounts within our firm.
SECTION IV
Preliminary Benefits Analysis
This is only a preliminary review based on the information we were provided by the City of
Sunny Isles Beach and a full analysis will happen after we begin our relationship.
Medical Benefits
The City of Sunny Isles Beach offers full time employees a triple option of United and
Neighborhood Health Partnership plans.
Prescription Benefits
The City of Sunny Isles Beach offers a prescription drug benefit for those who participate in the
medical program.
Current Benefits Analysis - Strategic Considerations
In examining these trends and your current benefits package, the Brown & Brown Benefit
Consultants would like to assist the City of Sunny Isles Beach in examining the following
alternatives.
· Investigate alternatives vendors that would offer the same level of benefits at a reduced
cost.
· Explore design changes that would have minimal impact on employees, but would
generate savings and discourage over-utilization.
· Investigate carving-out certain components of the medical and/or prescription programs,
possibly on a self-funded basis, to investigate arbitrage situations that generate reduced
costs.
· Investigate alternatives and additional benefits outside of the medical programs that
would add choice and flexibility to the programs, so that the needs of a diverse employee
population are more adequately met.
· Enhance the communications that employees receive from the City of Sunny Isles Beach
regarding their benefit plans.
7
It is clear that the City of Sunny Isles Beach, like any employer group, will be faced with
numerous business challenges relating to your Employee Benefits Plan in the near future. While
many of those challenges are unique, others are similar to the challenges faced by any
government sector employer. Brown & Brown Benefit Consultants can work with you to tailor
and implement a focused, employee benefits strategic plan that addresses your long-term and
short-term corporate objectives.
8
SECTION V
Carrier Name Web Address Provider Website
Directory
Blue Cross www.bcbsfl.com On Line Yes
Vista www.vista.com On Line Yes
Aetna www.aetna.com On Line Yes
Av Med www.avmed.org On Line Yes
Humana www.humana.com On Line Yes
Neightborhood Health wwwmynhp.com On Line Yes
9
SECTION VI
Best's Rating:
Rating based on a company's financial strength and marketing profile.
Best's Rating Scale:
The Best's rating scale is comprised of 16 individual ratings grouped
into 10 categories. consisting of three Secure categories of"Superior", "Excellent", and "Very Good" and seven
"Vulnerable categories of "Fair", "Marginal", "Weak". "Poor", "Under Regulatory Supervision", "In Liquidation", and
"Rating Suspended".
Secure Best's Ratings
A++ and A+ (Superior)
A and A- (Excellent)
B++ and B+ (Very Good)
Vulnerable Best's Ratings
Band B- (Fair)
C++ and C+ (Marginal)
C and C- (Weak)
D (Poor)
E (Under Regulatory Supervision)
F (In Liquidation)
S (Rating Suspended)
Not Rated Companies
NR-I = Insufficient Data
NR-2 = Insufficient Size and/or Operating Experience
NR-3 = Rating procedure Inapplicable
NR-4 = Company Request
NR-5 = Not Formally Followed
Financial Size Categories:
Reflects the company's size based on its capital. surplus and conditional reserve funds in millions of US dollars. using
the scale below.
FSC I less than 1
FSC II I to 2
FSC III 2 to 5
FSCIV 5 to 10
FSC V 10 to 25
FSCVI 25 to 50
FSC VII 50 to 100
FSC VIII 100 to 250
FSCIX 250 to 500
FSCX 500 to 750
FSCXI 750 to 1000
FSC XII 1000 to 1250
FSC XIII 1250 to 1500
FSC XIV 1500 to 2000
FSC XV greater than 2000
10
MARKETING SUMMARY
Medical Carrier
Status
Blue Cross Quoted
Humana Decl ined
Aetna Quoted
Av-Med Quoted
NHP Quoted
Vista Waiting for Decision
Cigna Waiting for Decision
11
In Network/Participating
Deductible EE/Fam
Coinsurance EE/Fam
Office Visit Copay
Specialist Copay
Hospital Admission
ER
Referral Needed?
Urgent Care
Outpatient Surgical Facility
MRI-CAT-PET-ETC.
Max out of pocket
Prescription
Mail Order Prescription
Lifetime Maximum
Out of Network/Non-
Participating
Deductible EE/Fam N/A N/A $750/$1500
Coinsurance EE/Fam N/A N/A 30%
Office Visit Copay N/A N/A 30%
Specialist Copay N/A N/A 30%
Hospital Admission N/A N/A 30%
ER N/A N/A 30%
Urgent Care N/A N/A 30%
Outpatient Surgical Facility N/A N/A 30%
MRI-CAT-PET-ETC. N/A N/A 30%
Max out of pocket N/A N/A $5000
Prescription N/A N/A N/A
Mail Order Prescription N/A N/A N/A
Lifetime Maximum N/A N/A 1 M
Min Employer Contribution 99% 99% 99%
Min Employee Participation 75% 75% 75%
Monthly Rates Current Renewal Current Renewal Current Renewal
EE $299.42 $417.99 $430.26 $600.64 $453.17 $632.63
ES $664.71 4927.94 $955.18 $1333.43 $1006.05 $1404.45
EC $559.92 $781.65 4804.59 $1123.21 $847.44 $1183.03
Family $874.32 $1220.55 $1256.38 $1753.91 $1323.29 $1847.31
Actual Rates subject to Final Medical Underwriting and group under 50 may range +/-
15%
CARRIER
AM BEST RATING
PLAN NAME
PRODUCT TYPE
Employee Benefit Summary
Effective Period - 3/1/09 -3/1/10
NHP United
A- A-
EVG 5C
HMO HMO
United
A-
52C+
POS
$500/$1000
N/A
$25
$45
$0
$0
$50
$50
$0
$100
$3,000
$20/$40/$60/20%
Available
2M
N/A
N/A
$15
$15
$0
$75
$35
$35
$0
$0
$1,500
$8/$25/$40
Available
Unlimited
N/A
N/A
$15
$15
$500/Adm
$150
$50
$50
$250
$250
$2500
$8/$25/$40
Available
Unlimited
Employee Benefit Summary
Effective Period
CARRIER AvMed AvMed AvMed AvMed A vMed AvMed
AM BEST RATING B+ B+ B+ B+ B+ B+
PLAN NAME 3422 3424 5228 5076 5077 CH-5011
PRODUCT TYPE HMO-OA HMO-OA HMO-OA HMO-OA HMO-OA POS-OA
In
Network/Participating
Deductible EE/Fam
Coinsurance EE/Fam
Office Visit Copay
Specialist Co pay
Hospital Admission
ER
Urgent Care
Outpatient Surgical
Facility
MRI-CAT-PET-ETC.
Max out of pocket
Prescription
Mail Order
Prescription
Lifetime Maximum
Out of Network/Non-
Participating
Deductible EE/Fam
Coinsurance EE/Fam
Office Visit Copay
Specialist Co pay
Hospital Admission
ER
Urgent Care
Outpatient Surgical
Facility
MRI-CAT-PET-ETC.
Max out of pocket
Prescription
Mail Order
Prescription
Lifetime Maximum
Min Employer
Contribution
Min Employee
Participation
Monthly Rates
EE $457.21 $480.22 $420.12 $362.85 $339.85 $451.60
ES $1015.00 $1066.09 $932.66 $805.53 $754.46 $1002.55
EC $854.84 $897.87 $785.49 $678.42 $635.41 $844.35
Family $1293.63 $1358.74 $1188.68 $1026.66 $961.57 $1277.75
Actual Rates subject to Final Medical Underwriting and group under 50 may range +/-
15%
None
N/A
$15
$25
250/Adm
$75
$40
$250
$25
$1500/$3000
$10/$20/$30/$75
2x's
$5M
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
75%
None
N/A
$15
$25
$0
$75
$40
$0
$0
$1500/$3000
$10/$20/$30/$75
2x's
$5M
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
75%
$250/$750
N/A
$10
$20
$150/Adm
$75
$40
$150
10% after ded
$1500/$3000
$1 0/$20/$30/$75
2x's
$5M
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
75%
$1 000/$2000
N/A
$25
$50
0% after ded
0% after ded
$50
$1500/$3000
N/A
$25
$50
0% after ded
0% after ded
$50
0% after ded
0% after ded
0% after ded
$1500/$3000
$10/$20/$30/$75
2x's
0% after ded
$2000/$4000
$10/$20/$30/$75
2x's
$5M
$5M
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
N/A
50%
75%
75%
$500/$1000
20%
$20
$40
$250/Days 1-5
$100
$40
20% after ded
20% after ded
$2500/$5000
$10/$30/$50/$75
2x's
$5M
$1 000/$2000
40%
40%
40%
40%
40%
40%
40%
40%
$5000/$10000
N/A
N/A
N/A
50%
75%
13
CARRIER
AM BEST RATING
PLAN NAME
PRODUCT TYPE
In Network/Participating
Deductible EE/Fam
Coinsurance EE/Fam
Office Visit Copay
Specialist Copay
Hospital Admission
ER
Referral Needed?
Urgent Care
Outpatient Surgical Facility
MRI-CAT-PET-ETC.
Max out of pocket
Prescription
Mail Order Prescription
Lifetime Maximum
Out of Network/Non-Participating
Deductible EE/Fam
Coinsurance EE/Fam
Office Visit Copay
Specialist Copay
Hospital Admission
ER
Urgent Care
Outpatient Surgical Facility
MRI-CAT-PET-ETC.
Max out of pocket
Prescription
Mail Order Prescription
Lifetime Maximum
Minimum Employer Contribution
Minimum Employee Participation
Monthly Rates
Employee Benefit Summary
Effective Period
AvMed
B+
CH-5011
POS-OA
$500/$1000
20%
$20
$40
$250/Days 1-5
$100
$40
20% after ded
20% after ded
$2500/$5000
$10/$20/$30/$75
2x's
$5M
$1000/$2000
40%
40%
40%
40%
40%
40%
40%
40%
$5000/$10000
N/A
N/A
N/A
50%
75%
BC
A
3748
PPO
Aetna
A
HMO OA
HMO
$500/$1500
20%
$10
$25
$0/$500
$100/$200
No
$30
$150/$250
$125
$1500/$3000
$15/$30/$50
Available
$5M
None
N/A
$15
$15
$0
$75
No
$15
$0
$0
$1500/$3000
$10/$30/$50
2x's
Unlimited
Comb with In Network
40%
40%
40%
40%
$200
40%
40%
40%
$3000/$6000
N/A
N/A
$1M
50%
75%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
50%
75%
EE $462.47 $477.25 $553.42
ES $1026.67 $987.92 $1228.59
EC $864.67 $897.24 $1034.89
Family $1308.50 $1515.28 $1564.55
Actual Rates subject to Final Medical Underwriting and group under 50 may range +/-
15%
14
[,Hit l.ebr.. bears ,\
, uni(!ue set of stripr~.
.
Account ServicinQ Team
Our Employee Benefits Department has made a commitment to provide you
with customer service you can depend on
For all matters concerning your account
the people to contact are:
Samantha Alvarez
Sales Executive
Tel.(954)331-1476
Fax (954)772-6243
Marisol Butcher
Senior Account Executivel Team Lead
Tel. (954)453-6236
Fax (954)772-6243
Patti Hennessey
Account Executive
Tel. (954)331-1356
Fax (954)772-6243
Yvette Rodriguez
Account Executive
Tel. (954)453-6290
Fax (954)772-6243
15
SECTION X
Glossary: Medical
Balance Billinq: The practice of charging full fees in excess of covered amounts and then billing the patient
for that portion of the bill that the payer does not cover.
Breakpoint: Amount to which the plan and the participant co-insure covered expenses, after which the plan
pays 100%.
Capitation Fee: A fixed predetermined amount paid to a provider for each person served, without regard to
the actual number or nature of services provided to each person in a set period of time. Capitation is the
characteristic payment method in HMOs.
Carryover Deductible: A feature whereby covered charges in the last three months of the year may be
carried over to be counted toward the next year's deductible.
Coinsurance: A policy provision by which both the insured person and the insurer share covered medical
expenses in a specified ratio (e.g., 80%/20%), after the deductible is met.
Copayments: Payments made by consumers, in addition to deductibles and coinsurance, to help finance
health benefit plans.
Deductible: The amount of out-of-pocket expenses that must be paid for health services by the insured
before becoming payable by the carrier.
Exclusive Provider Orqanization (EPO): A more rigid type of PPO, closely related to an HMO. Provides
benefits or levels of benefits only if care is rendered by providers within a specific network (with some
exceptions for emergency and out-of-area services).
Explanation of Benefits (EOB): A description, sent to patients by health plans, of benefits received and
services for which the health care provider has requested payment.
Fee for Service: A method of billing for heath services, under which a health provider charges separately
for each service rendered. This is the usual method of billing by the majority of physicians.
Gatekeeper: The primary care provider responsible for managing medical treatment rendered to an
enrollee of a health plan.
Health Maintenance Orqanization (HMO): A prepaid medical plan that provides a comprehensive
predetermined medical care benefit package.
Inpatient: A person who occupies a hospital bed while under observation, care, diagnosis or treatment for
at least 24 hours.
Mandated Benefits: A specific set of benefits required by law to be provided by all insurance carriers and
reimbursed under all insurance policies.
Maximum Benefit: The highest annual or lifetime benefit that can be received under an insurance contract.
Maximum Out-of-Pocket Payments: The maximum amount of money a person will pay in addition to
premium payments. The out-of-pocket payment is usually the sum of the deductible and coinsurance
payments, and does not include copayments or non-covered expenses.
Medical Case Manaqement: This option, often offered by insurance companies, provides coordinators to
handle high cost claims and recommends specialized care and services targeted to an individual's treatment
16
goals and needs. Case management is most often used to deal with catastrophic illnesses. The case
management coordinator helps to oversee overall management of the patient, from the onset of the illness or
injury into acute care hospitalization, specialized care programs and follow-up treatment.
Outpatient: A person who visits a clinic, emergency room or health facility and receives health care without
being admitted as an overnight patient.
Outpatient Surqery: Same day surgery without anticipation of the overnight stay of patients. This is often
performed at an ambulatory care facility.
Outpatient Surqical Facility: A freestanding center or entity within the hospital that is approved and licensed
by the state to perform outpatient diagnostic services or surgical treatment of an illness or injury.
Point of Service Plan (POS): Members do not have to choose how to receive services until services are
needed. In some plans, for example, members decide whether to use a network provider or an outside
provider. Although the services of an outside provider are covered, benefits are greater if members select a
preferred provider (example 70% vs. 100% coverage).
Preferred Provider Orqanization (PPO): A group of hospitals and physicians that contract on a fee-for-
service basis with employers, insurance companies or other third party administrators to provide
comprehensive medical service. Providers exchange discounted services for increased volume.
Participants' out-of-pocket costs are usually lower than under a fee-for-service plan.
Preventive Care: Comprehensive care emphasizing priorities for prevention, early detection and early
treatment of conditions, generally including routine physical examinations, immunization and well person
care.
Primary Care: Routine medical care, normally provided in a doctor's office. Professional and related
services administered by an internist, family practitioner, general practitioner, or pediatrician.
Specialist: Physician who concentrates on medical activities in a particular specialty of medicine.
Stop-Loss Provision: A stop-loss provision is determined in two ways: either after a certain amount of
benefits is paid from the plan or after a certain amount of out-of-pocket expenses is paid by the individual or
family unit. When the dollar amount specified is reached, the coinsurance factor is raised to 100%. When
there is a stop-loss provision in the plan (besides the separate maximums and coinsurance levels on
outpatient mental and nervous disorders), outpatient mental and nervous charges usually do not apply
toward the dollar figures used to calculate when the stop-loss begins; after the stop-loss does begin, it does
not apply to these charges.
17
Glossarv: Prescription DruQs
Averaqe Wholesale Price (AWP): The published suggested wholesale price of a drug. It is often used by
pharmacies as a cost basis for pricing prescriptions. While a reliable pricing reference for brand-name
drugs, it can be misleading in the case of generic drugs since each manufacturer establishes its own AWP
for the generic drug. This can result in a broad range of prices for the identical product.
Brand-Name Druqs: A drug protected by a patent issued to the original innovator or marketer. The patent
prohibits the manufacture of the drug by other companies as long as the patent remains in effect.
Formularv: A listing of prescription medications that will be covered by a plan or insurance contract that
often fosters substitution of generic or therapeutic equivalents on a cost-effective basis.
Generic Equivalent Druqs: Drug that is equal in therapeutic power to the brand-name originals because
they contain identical active ingredients at the same doses.
Leqend Druqs: Drugs that must be obtained by doctor prescription, as opposed to those prescribed by a
doctor but available over the counter.
Over the Counter (OTC): Drugs available without a prescription.
18
Glossarv: Section 125
Cafeteria Plan: Defined by the Internal Revenue Code as a plan that permits the participant to choose
between two or more benefits consisting of cash and qualified benefits.
Dependent Care Spendinq Account: Employer-sponsored flexible benefit plan feature that permits
employees to use pretax (tax-free) dollars from their paychecks to pay the cost of care for children or elderly
dependents up to a certain legislated limit and within very specific guidelines.
Flexible Benefit Plan: A benefit program under Section 125 of the Internal Revenue Code that offers
employees a choice between permissible taxable benefits, including cash, and nontaxable health and
welfare benefits such as life and health insurance, vacation pay, retirement plans and child care. Although a
common core of benefits may be required, the employee can determine how his or her remaining benefit
dollars are to be allocated for each type of benefit from the total amount promised by the employer.
Sometimes employee contributions may be made for additional coverage.
Flexible Spendinq Accounts (FSAs): Many flexible benefit programs include flexible spending accounts,
which give employees a choice between taxable cash and nontaxable compensation in the form of payment
or reimbursement of eligible, tax-favored welfare benefits. FSAs can be funded through salary reduction,
employer contributions or a combination of both. Employees can purchase additional benefits, pay health
insurance deductibles and copayments, or pay for child care benefits with the money in their FSAs.
Section 125 Plan: A plan in compliance with Section 125 of the Internal Revenue Code, which protects an
employee from constructive receipt of the cash he or she has as a choice of benefits under a cafeteria plan.
Use-lt-or-Lose-lt Rule: A rule forbidding cafeteria plans to let participants defer receipt and taxation of
compensation from year to year by carrying over unused pretax contributions or plan benefits.
19
Glossarv: Miscellaneous Terms
Adverse Selection: The tendency of an individual to recognize his or her health status in selecting the
option under a retirement system or insurance plan that tends to be most favorable to him or her (and more
costly to the plan). In insurance usage, a person with an impaired health status or with expected medical
care needs applies for insurance coverage financially favorable to himself or herself and detrimental to the
insurance company. Also known as antiselection.
Carve-Out: A program separate from the primary plan designed to provide a specialized type of care, such
as a mental health carve-out; or for a designated group of employees, such as a management carve-out.
Contributory Plan: A benefit plan under which employees bear part of the cost.
Emplovee Assistance Plan (EAP): Designed to help employees whose job performance is being adversely
affected by personal problems. The program may also apply to many types of health education, prevention,
counseling and control of specific conditions (e.g. alcoholism, smoking, fitness, etc.).
Emplovee Contribution: Made by an employee into a plan. Mayor may not be required for participation.
Experience: Usually expressed as a ratio or percentage, it is the relationship of premium to claims,
coverage or benefits of a plan for a specified period of time.
Experience-Rated Premium: A premium based on the anticipated claims experience of, or utilization of
service by, a contract group according to its age, sex and any other attributes expected to affect its health
service utilization. Such a premium is subject to periodic adjustment in line with actual claims or utilization
experience.
Experience Ratina: The process of determining the premium rate for a group risk, wholly or partially on the
basis of that group's experience.
Minimum Participation Reauirement: Minimum number of eligible employees that must elect coverage in
order for a carrier to write a policy, normally expressed as a percentage.
Noncontributorv Provision: A term applied to employee benefit plans under which the employer bears the
full cost of the benefits for the employees. One hundred percent of eligible employees must be insured.
Preexistina Condition: A physical and/or mental condition of an insured person that existed prior to the
issuance of his or her policy. Excluded from coverage under some policies.
Reasonable and Customary (R&C) Charae: The prevailing charge made by providers of similar expertise
for a similar procedure in a particular geographic area. See also Usual, Reasonable and Customary Fees.
Trend Factor: The measurement for actuarial purposes of the change in the cost of health care after
weighing inflationary changes, changes in utilization and technology.
Usual. Customary and Reasonable (UCR) Fees: Usual is the fee usually charged for a given service by a
provider; customary is a fee in the range of usual fees charged by similar providers in area; reasonable is a
fee, according to the review committee, that meets the lesser of the two criteria or is justified in the
circumstances.
Voluntarv (Emplovee-Pav-AII) Benefits: Specific benefits that the employer administers and the employees
pay for. Commonly used for benefits that employees want but which the employer is unable or unwilling to
contribute toward.
20
SECTION XI
DISCLAIMERS
The rates contained in this proposal are based on the census illustrated and exposures to loss made known
to Brown & Brown Insurance. Final rates will reflect the actual census of insured persons and loss exposure
as underwritten by the insurer. Insurance companies offer many different plans that differ in deductible,
coinsurance, co-payments, stop-loss, etc. We have proposed various options similar to what you have now
or are requesting, but if you would like to see other options, please notify our office. Broader coverage may
be available.
The rates shown are not guaranteed and are subject to change.
This executive summary is for comparison purposes only. This proposal contains only a general description
of the coverages and does not constitute a policy or contract. Please refer to the carrier's plan document for
the actual terms, conditions, limitations, and exclusions. A specimen policy is available upon request.
Exclusions include, but are not limited to, those shown in the attached proposal.
It is imperative we be informed of any employee or dependent that is hospitalized or otherwise disabled and
not actively at work on the effective date of any new contract. Coveraae may not be available for these
individuals.
This proposal is provided only for the internal use of "City of Sunny Isles Beach". No further use
or distribution is authorized without our written consent.
IMPORTANT NOTICE
Compensation - In addition to the commissions or fees received by us for assistance with the placement,
servicing, claims handling, or renewal of your insurance coverages, other parties, such as excess and
surplus lines brokers, wholesale brokers, reinsurance intermediaries, underwriting managers and similar
parties, some of which may be owned in whole or in part by Brown & Brown, Inc., may also receive
compensation for their role in providing insurance products or services to you pursuant to their separate
contracts with insurance or reinsurance carriers. That compensation is derived from your premium payments.
Additionally, it is possible that we, or our corporate parents or affiliates, may receive contingent payments or
allowances from insurers based on factors which are not client-specific, such as the performance andlor size
of an overall book of business produced with an insurer. We generally do not know if such a contingent
payment will be made by a particular insurer, or the amount of any such contingent payments, until the
underwriting year is closed. That compensation is partially derived from your premium dollars, after being
combined (or "pooled") with the premium dollars of other insureds that have purchased similar types of
coverage. We may also receive invitations to programs sponsored and paid for by insurance carriers to
inform brokers regarding their products and services, including possible participation in company-sponsored
events such as trips, seminars, and advisory council meetings, based upon the total volume of business
placed with the carrier you select. We may, on occasion, receive loans or credit from insurance companies.
Additionally, in the ordinary course of our business, we may receive and retain interest on premiums you pay
from the date we receive them until the date of premiums are remitted to the insurance company or
intermediary. In the event that we assist with placement and other details of arranging for the financing of
your insurance premium, we may also receive a fee from the premium finance company.
Questions and Information Requests. Should you have any questions, or require additional information,
please contact this office at 1-800-432-8844 or, if you prefer, subm it your question or request online at
htto:/ /www.bbinsurance.com/custom erinQuirv. shtm I.
21
SURST303P020090204
SUNNYISLES
5395246
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
REGIONAL GROUP SALES OFFICE
Chad Gracy
200 W Cypress Creek Rd Suite 320
Fort Lauderdale, Florida 33309
Office: (954) 894-0077
Toll Free: (800) 279-4598
Fax: (954) 689-6590
SERVICE OFFICE
8801 Indian Hills Drive
Omaha, Nebraska 68114
Phone: 800-423-2765
Fax: (877) 573-6177
Home Office: Fort Wayne, IN
Facsimile Cover Sheet
To:
Phone:
From:
RE:
Samantha Alvarez
(954) 776-2222
Chad Gracy
CITY OF SUNNY ISLES BEACH
Sunny isles Beach, FL 33160
Total number of pages (Including this cover sheet): 15
COMMENTS:
Company:
Fax:
Date:
Brown & Brown Inc
(954) 772-6243
2/9/2009
Group Insurance products are issued by The Lincoln National Life Insurance Company, which is not
licensed and does not solicit business in New York. In New York, group insurance products are
issued by Lincoln Life & Annuity Company of New York.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
Each affiliate is solelv and independentlv responsible for its own financial and contractual oblioations.
Lincoln Financial Group is pleased to announce our new Dental program Lincoln DentalConnect
Plan starting October 1, 2008. With over 52,000 unique participating providers, Lincoln
DentalConnect Plan allows you to access a wide selection of highly qualified dentists. For more
details on how our new program can benefit your employees, ask your local representative today.
This facsimile transmission is intended only for the addressee named above. It contains information that is privileged, confidential or otherwise protected
from use and disclosure. If you are not the intended recipient you are hereby notified that any review, disclosure, copying or dissemination of this
transmission, or the taking of any action in reliance on its contents, or other use is strictly prohibited. If you have received this transmission in error,
please notify us by telephone immediately so that we can arrange for its return to us. Thank you for your cooperation.
n Lincoln
Financial Group@
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
February 9, 2009
The Lincoln National Life
Insurance Company
8801 Indian Hills Drive
Omaha, NE 68114-4066
toll free (800) 423-2765
www.LFG.com
Brown & Brown Inc
5900 N Andrews Ave #401
Fort Lauderdale, FL 33309
RE: City of Sunny Isles Beach
Dear Samantha:
This letter and the enclosed exhibits set out our proposal for the above group. The rates are based on those
benefits shown in the proposal using standard benefit provisions.
The Dental rates include a graded 10% commission schedule. You may be eligible for the group broker bonus
program in effect for the plan year. If you need additional information to satisfy any applicable producer
disclosure obligations, please contact me.
Lincoln Financial Group requires all producers receiving quotes for the purpose of soliciting, negotiating or
selling group insurance products hold valid licenses, as required by state regulations, and obtain all necessary
appointments with Lincoln Financial Group prior to the solicitation or sale of group insurance.
For appointment forms, please access our Web site at www.LFG.com. The Application for Licensing
Appointment can be printed, completed and returned to the address contained in the form. If you do not have
access to our Web site, please contact the Licensing Department at bplicensing@LFG.com.
I appreciate the opportunity to bid on this group. If you have questions about the plan or would like to review
some alternate quotes, please call me. I look forward to writing this case for you.
Sincerely,
Chad Gracy
Marketing Representative
Enclosure
WHY CHOOSE THE LINCOLN NATIONAL LIFE INSURANCE COMPANY?
Lincoln Financial Group maintains:
. Strong financial history
. Some of the highest ratings in the industry
o AA "Very Strong" Standard & Poor Rating
o A+ "Superior" A.M. Best Company Rating
o AA "Very Strong" Fitch Rating
. "Direct to Home Office Service" through group sales offices located nationwide
. One-stop shopping for comprehensive group benefits
o True group products including Life and AD&D, Short-Term Disability, Long-Term Disability(with
optional Critical Illness coverage), Dental and Employee Assistance Programs
o WORKSITE1 Voluntary products including Life and AD&D, STD, L TO, Dental and Vision
../ Featuring Voluntary enrollment form customization
o Exec-U-Care@ Medical Reimbursement Program
. Real Time Online Benefit Administration with Online Services
o Submit claims and check their status online
o Change member information online
o Enroll and terminate members and coverages online
o Utilize Virtual Billing capabilities to add or terminate members, then recalculate the bill to reflect
the actual amount owed, and pay the bill online
o View and print group forms, administration guidelines, contracts and certificates online
o Apply for group insurance coverage electronically with e-App
o Continuous enhancements are being made to our Online Service capabilities to better serve
both your needs and your clients' needs
. Interactive Voice Response (IVR) System allows service 24 hours a day, 7 days a week
o Use IVR to check on the status of claims, members and premium payments all hours of the day,
everyday.
. Lincoln DentalConnect Plan
o Our Lincoln DentalConnect Plan brings many distinct advantages including an expanded
nationwide network with access to more than 52,000 unique dentists.
WHAT THIS MEANS FOR YOU...
The Lincoln Financial Group companies:
.
have a long history of strength and stability, offering you superior products - and the service to back
them up.
focus on making life easier for the customer by doing business the way the customer wants to do
business - via the Web, telephone, IVR, e-mail or fax.
are committed to superior service, combined with a guaranteed commitment to technology, which
means less hassle for you!
.
.
The Lincoln National Life Insurance Company
2
2/9/2009
A GROUP INSURANCE PROGRAM
Designed for
CITY OF SUNNY ISLES BEACH
Submitted by
Brown & Brown Inc
Fort Lauderdale, FL
Underwritten by
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
Service Office
8801 Indian Hills Drive
Omaha, Nebraska 68114 - 4066
Home Office: Fort Wayne, IN
SUNNYISLES
5395246
City of Sunny Isles Beach
BENEFITS AND COST SUMMARY
FOR DENTAL PROPOSAL
Option 1.00
Proposed Effective Date: March 01,2009
PROPOSED SCHEDULE OF BENEFITS for Class 1
Class 1: All Active Full-time Employees (Retired, temporary and seasonal employees are not eligible)
Minimum Hours: 30, unless otherwise agreed upon.
CALENDAR YEAR DEDUCTIBLE:
Deductible applies to:
INDIVIDUAL
FAMILY
In Network
Type II and III
$50
$150
Out of Network
Type II and III
$50
$150
BENEFITS LEVELS
PPO Plan
TYPE I - Diagnostic & Preventive
TYPE II - Basic Services
TYPE III - Major Services
TYPE IV - Orthodontia for Children
Out of Network - 90th percentile U & C
100%
95%
60%
60%
100%
80%
50%
50%
MAXIMUM BENEFIT per covered person:
TYPES I, II and III combined, per calendar year $1500
TYPE IV, while covered by the plan $1000
Maximum benefits will be reduced by amounts paid by prior plan.
$1500
$1000
BENEFIT WAITING PERIOD
TYPE II Expenses None
TYPE III Expenses 6 Months
TYPE IV Expenses 12 Months
Terms of the Prior Carrier Credit Provision may apply.
Waived For:
Current Participants
Current Participants
COST SUMMARY
Rates shown are monthly and are guaranteed for one year from the program effective date.
Eligible For PPO Plan
Employees with child ortho
84 $28.33
12 $64.44
28 $73.03
29 $105.13
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
MONTHLY COST
$8,246.61
The Lincoln National Life Insurance Company
4
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
COVERED SERVICES
TYPE I - Diagnostic & Preventive
TYPE II - Basic Services
TYPE III - Major Services
TYPE IV - Orthodontia*
oral exams, cleanings & x-rays
fillings, extractions, sealants, endodontics & periodontics
bridges, crowns & dentures
for Children
*To include Orthodontic Coverage for children in your Lincoln Financial Group Group Dental Policy, the
policyholder must meet the following dependent enrollment criteria:
On the Policy's Effective Date and at each annual Renewal Date, 8 dependent units must be enrolled.
A 'dependent unit' is a 'spouse' or 'child(ren)' or 'spouse and child(ren)' covered by the dental plan.
If dependent enrollment in the group policy does not meet this minimum requirement, Orthodontic Coverage
(Type IV Services) will not be issued or continued. This requirement does not change the minimum
participation requirements, described below.
PROPOSAL ASSUMPTIONS:
Quoted rates are based on the following assumptions. If these assumptions are not correct, the rates may be
adjusted or the proposal may be withdrawn.
Employer contribution to employee premium -
Employer contribution to dependent premium -
Minimum employee participation -
Minimum dependent participation -
100%
100%
100% (A minimum of 10 employees must be enrolled)
100% (A minimum of 8 dependent units must be enrolled in
order to include orthodontic benefits in the policy)
Employees covered by another dental plan may be excluded from participation calculations, as long as they do
not exceed 30% of eligible employees.
Final rates will be calculated based on:
the agreed-upon plan;
employer contribution (changing the percentage of employer contributions for employee and/or dependent
coverage may affect quoted rates);
enrolled census;
employee location(s);
correct industry code (SIC); and
other pertinent underwriting factors.
If there are changes in these factors, the plan may be re-rated or coverage may be refused.
THIS IS NOT A CONTRACT: This illustration was prepared based on the information provided in the Request
for Proposal. It is a description of dental coverage available from Lincoln Financial Group and not an offer to
contract. More detailed information is available upon request concerning the terms, conditions and limitations
contained in the master policy, if issued. If there are discrepancies between the information contained in this
proposal and the master policy, the terms of the master policy will control. State-specific restrictions and
requirements may not be addressed in this proposal.
An Application for Group Insurance must be completed by the Employer and approved by Lincoln Financial
Group before coverage can become effective.
This proposal is subject to revision if not accepted on or before the Proposed Effective Date shown on the
Benefits and Cost Summary page of this proposal.
The Lincoln National Life Insurance Company
5
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
DENTAL INSURANCE PROPOSAL
General Information
EFFECTIVE DATE
The policy will become effective no earlier than the date the application is signed and the first month's
premium, shown in the COST SUMMARY of this proposal, is received in the Lincoln Financial Group Service
Office.
ELIGIBLE EMPLOYEES
All active, full-time permanent employees may be covered. "Active, full-time" means the employee works at
least 30 hours per week. (Lower minimum hours may apply in certain states). Retired, temporary and
seasonal employees are not eligible.
For employees who enroll within 31 days of the date they become eligible, coverage usually becomes effective
on the later of:
the first of the month following the date the employee completes the eligibility waiting period established
by the employer; or
the first of the month following the date the employee enrolls and makes any required premium
contribution.
Employees who enroll more than 31 days after becoming eligible will be subject to the policy's late entrant
limitation.
Newly hired employees will become eligible upon completion of the company's eligibility waiting period n for
example, 30 days of full-time employment. New employees can be covered by the dental plan on the first of
the month following completion of that eligibility waiting period, provided they enroll and make any required
premium contributions within 31 days of the date they become eligible.
ELIGIBLE DEPENDENTS
Dependents eligible for coverage include the employee's lawful spouse and unmarried children from birth
through age 18 (through age 22, for full-time students). Higher age limits may apply in certain states.
Stepchildren are eligible if they live in the employee's home and are chiefly dependent upon the employee for
support. Foster children may also be eligible under certain conditions. Dependents' coverage usually
becomes effective on the same date as the employee's, if they are enrolled. Dependents acquired after the
employee's coverage begins may be enrolled immediately, subject to payment of any increase in premium.
Dependents enrolled more than 31 days after they are first eligible will be subject to the policy's late entrant
limitation.
FL
The Lincoln National Life Insurance Company
6
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
PARTICIPATION REQUIREMENTS
If the dental plan is provided on a noncontributory basis (the employer pays the entire premium), 100% of
eligible persons must be enrolled in the plan.
If the dental plan is contributory, no less than 75% of eligible employees and 60% of eligible dependent units
must be enrolled.
There are two exceptions to these requirements:
If an employee and/or dependent is covered by another group dental plan, that person(s) will not be
counted as an eligible person, if a signed waiver card is submitted. However, if 30% or more of eligible
employees do not enroll because of other coverage, the plan may be reevaluated and new rates
illustrated.
When a husband and wife are employed by the same company and have dependent children to enroll,
then either the husband or the wife may be covered as a dependent of the other spouse.
In any event, a minimum of 10 employees must be enrolled. A minimum of 8 family units must be covered in
order to include - or continue - coverage for Orthodontics.
PREFERRED PROVIDER OPTION*
The dental Preferred Provider Option (PPO) allows each employee and each dependent to select the dentist of
his or her choice n each time he or she goes to the dentist.
In-Network benefits are payable when the patient receives treatment from a dentist who is participating in the
dental network. With the PPO, employers and employees can save in several ways:
Negotiated discounts from participating dentists may allow lower premium rates for a dental plan which
includes a Preferred Provider option, due to expected lower claim costs.
Those discounted fees can reduce the amount a participating dentist would charge the patient.
The PPO dental plan can include a higher level of reimbursement when patients visit a participating
dentist.
*inside Texas - Contracting Dentist Plan
DIRECTORY OF PARTICIPATING/CONTRACTING DENTIST
Directories can be provided to eligible employees at the time of enrollment. A look-up function is available at
www.LFG.com or through our member web site at www.jpfic.com by accessing Lincoln DentalConnecfM - our
online dental information tool providing health information, ask a dentist, and a dental cost estimator. Plan
participants can locate over 52,000 Lincoln DentalConnect Plan dentists by specialty. Copies of the directory
can also be obtained by calling our Client Management Department.
PRIOR CARRIER CREDIT PROVISION
To ensure continuity of coverage for plan participants during a change in carriers, 'prior carrier credit' is
available for employees and dependents who are covered on the policy effective date; but only if they were
covered under the employer's prior group dental plan on the day before the policy effective date. Except in FL,
10 and NJ, the employer's dental plan must have been in force with the current carrier for at least 12 months,
to be eligible for the credit.
The Lincoln National Life Insurance Company
7
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
The Prior Carrier Credit Provision provides covered persons with a 'credit' toward:
covered charges applied to the prior plan's DEDUCTIBLE during the same calendar year.
the BENEFIT WAITING PERIOD, if included in the policy, for each covered person's continuous
months of coverage under the prior plan just before it terminated. (The 'credit' applies only if the prior
plan included the Type(s) of coverage which are subject to the new policy's benefit waiting period.)
The provision also extends coverage for replacement of natural teeth lost while covered under the prior plan
and allows the plan to deduct previously paid benefits from the annual and lifetime maximums included in the
policy.
BENEFIT WAITING PERIOD
The policy may include a benefit waiting period for employees and dependents. The benefit waiting period is a
period of time a person must be covered by the plan before some of the more extensive dental procedures are
covered. In takeover situations, credit toward benefit waiting periods may be given for the time employees and
dependents were covered under the employer's previous plan.
ALTERNATIVE BENEFITS
The policy covers expenses incurred for necessary dental treatment. In the case where two or more methods
of treatment are available, the covered expense will be limited to the least costly option. This determination is
based on current professional dental standards and the patient's total oral condition.
PREDETERMINATION OF BENEFITS
The policy includes a provision which allows the patient and the dentist to find out, before the work is done,
how much of the dentist's charge will be covered by the plan. It is recommended that this predetermination be
used whenever a dentist's charges for non-emergency treatment are expected to exceed $300.
LATE ENTRANT LIMITATION
The policy may include a late entrant limitation of benefits. If included in the policy, the limitation says:
When an employee or dependent:
- is enrolled in the dental plan for more than 31 days after first becoming eligible; or
- cancels then re-enrolls for coverage
benefits are limited to Type I Services for the first 12 months of coverage.
The Lincoln National Life Insurance Company
8
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
COVERED DENTAL SERVICES
After any applicable deductible is satisfied, the following dental services will be covered, at the reimbursement rate quoted.
Type III and Type IV procedures may be subject to a Benefit Waiting Period.*
TYPE I - DIAGNOSTIC & PREVENTIVE SERVICES
ORAL EXAMINATIONS - up to two per calendar year
DENTAL X-RAYS, including:
bitewing films - up to four films per calendar year
one complete full mouth or panoramic series each five years
PROPHYLAXIS (Routine Cleanings) - up to two per calendar year
FLUORIDE TREATMENTS - for dependent children through age 15
one treatment per calendar year
SPACE MAINTAINERS
TYPE II - BASIC SERVICES
FILLINGS
STAINLESS STEEL CROWNS - for dependent children through age 15
SEALANTS - first and second permanent molars for dependent children through age 15
one application per tooth in three years
ORAL SURGERY - includes extractions and many dental surgeries
PATHOLOGY - biopsy and examination of oral tissue
GENERAL ANESTHESIA and I.V. sedation
EMERGENCY TREATMENT and consultations
ENDODONTICS (root canal therapy)
PERIODONTAL CLEANINGS - following active periodontal therapy
PERIODONTAL SCALING AND ROOT PLANING - one treatment in 24 months
PERIODONTAL SURGERY - including gingivectomy, osseous surgery, and soft tissue graft
REPAIR of DENTURES
RECEMENTATION of CROWNS and BRIDGES
TYPE III PROCEDURES - MAJOR SERVICES
CROWNS, BRIDGES, and ONLAYS
FULL and PARTIAL DENTURES
ALVEOLAR or GINGIVAL RECONSTRUCTION SURGERY
TYPE IV PROCEDURES - ORTHODONTICS for dependent children
DIAGNOSTIC SERVICES - examinations, x-rays, and casts or study models
TREATMENT PLAN - including orthodontic extractions
ORTHODONTIC APPLIANCES
*Where Benefit Waiting Periods are included, Prior Carrier Credit may apply.
The Lincoln National Life Insurance Company
9
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
DENTAL LIMITATIONS & EXCLUSIONS
Covered Expenses will not include and Dental Expense Benefits will not be payable for:
1. any procedure begun:
a) before the covered person was covered under the policy, subject to the Prior Carrier Credit
provision, if included in the policy; or
b) after termination of the covered person's coverage under the policy.
2. treatment or service which:
a) is not recommended by a dentist or is not provided by or under the direct supervision of a dentist;
b) is not a necessary dental procedure, required for the care and treatment of a dental condition;
c) is not specifically listed as covered by the policy;
d) does not meet accepted standards of dental practice; or
e) is provided by a physician or other health care provider, but is beyond the scope of his or her
license.
3. charges which exceed covered expenses, as defined in the policy. Benefits will not be payable when:
a) total benefit payments would exceed the annual maximum or lifetime orthodontic maximum benefits
payable under the policy; or
b) services exceed the frequency limitations contained in the policy.
4. procedures which are subject to a benefit waiting period or a late entrant limitation, until that benefit
waiting period or late entrant limitation has been satisfied.
5. orthodontic (Type IV) procedures:
a) which begin before the dependent child becomes covered under the policy for orthodontic services,
subject to the Prior Carrier Credit provision, if included in the policy;
b) received after the dependent child's coverage ends, due to attainment of the maximum age, or for
any other reason; or
c) received after coverage for Type IV services is terminated under the policy.
6. any treatment or services which:
a) are for mainly cosmetic purposes (facings or veneers on crowns or pontics distal to the second
bicuspid will be considered cosmetic); or
b) are related to the repair or replacement of any prior cosmetic procedure.
7. services related to the repair or replacement of third molars (wisdom teeth) with prostheses.
8. bone grafts or any regenerative procedure in an extraction site.
9. orthognathic recording, orthognathic surgery, osteoplasty, osteotomy, LeFort procedure, stomatoplasty or
magnetic resonance imaging (MRls).
FL
The Lincoln National Life Insurance Company
10
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
DENTAL LIMITATIONS & EXCLUSIONS (Continued)
10. initial placement of any prosthetic appliance or fixed bridge ;unless such placement is needed to replace
one or more functioning natural teeth extracted while the person is covered under the policy; subject to
the Prior Carrier Credit provision, if included in the policy. Any such appliance or fixed bridge must
include the replacement of the extracted tooth or teeth.
11. the retreatment or adjustment, recementation, reline, rebase, replacement or repair of restorations,
crowns and prostheses, when made by the same dentist or dental office which provided the initial
service, within 6 months of the completion of the service.
12. the replacement of:
a) any full or partial denture, within five years; or
b) fixed prosthetic (crown, inlay or onlay restoration, or fixed bridge) within eight years of the date of
the last placement of these items. If a replacement is required because of an accidental dental
injury sustained while the person is covered under the policy, it will be a covered expense.
(Damage resulting from biting food or other objects is not considered to be an accidental injury.)
13. the insertion, maintenance or removal of implants, and any related expenses.
14. specialized procedures, including:
a) precision or semi-precision attachments;
b) precious metals for removable appliances;
c) overlays and overdentures; or
d) personalization or characterization.
15. duplicate prosthetics, or for initial placement or replacement of athletic mouth guards, bruxism appliances
or any appliance to correct harmful habits; and for replacement of:
a) space maintainers; or
b) misplaced, lost or stolen dental appliances.
16. appliances, restorations or procedures, or their modifications, that:
a) alter vertical dimension;
b) restore or maintain occlusion or for occlusal adjustment or equilibration;
c) splint teeth or replace tooth structure lost as a result of erosion, abfraction, abrasion or attrition; or
d) surgically or non-surgically treated disturbances of the temporomandibular joint (TMJ), or other
craniomandibular or temporomandibular disorders, except as required by law.
17. charges for services provided by:
a) an ambulatory surgical facility;
b) a hospital;
c) any other facility; or
d) an anesthesiologist.
18. analgesia, sedation, hypnosis or acupuncture, for anxiety or apprehension.
19. any medications administered outside the dentist's office or for prescription drugs.
FL
The Lincoln National Life Insurance Company
11
2/9/2009
SUNNYISLES
5395246
City of Sunny Isles Beach
DENTAL LIMITATIONS & EXCLUSIONS (Continued)
20. charges which do not directly provide treatment for a dental injury or condition, such as:
a) the completion of claim forms;
b) broken appointments;
c) interest or collection charges;
d) sales or other taxes or surcharges;
e) education, training and supplies used for dietary or nutritional counseling, personal oral hygiene or
dental plaque control;
f) caries susceptibility tests, bacteriologic studies, histopathologic exams or pulp vitality testing; or
g) duplication of x-rays or other dental records.
21. itemized or separated charges for dental services, supplies or materials when those services, supplies
and materials may be combined into a single, more comprehensive procedure payable under the policy.
This also includes itemized charges which are routinely included in the dentist's charge for the primary
service, such as:
a) sterilization or asepsis charges;
b) a charge for local anesthesia;
c) charges for pre- and post-operative care; or
d) temporary dental services (for example, a temporary crown), which are considered to be part of the
permanent service. If the temporary service is billed separately, benefits for the temporary service
will be deducted from the amount payable for the permanent service.
22. duplication of services.
23. charges for which the covered person is not liable, or which would not have been made had no coverage
been in force.
24. a covered person, because of a dental injury or condition:
a) for which he or she is paid for benefits under Workers' Compensation or any similar law; or
b) sustained while performing military service.
25. services received for dental conditions caused directly or indirectly by:
a) war or an act of war;
b) intentionally self-inflicted injury;
c) engaging in an illegal occupation;
d) commission or attempt to commit a felony; or
e) a covered person's active participation in a riot.
26. for treatment rendered by a Dentist or dental hygienist:
a) who ordinarily resides in the covered person's household; or
b) who is related to the covered employee or dependent by blood, marriage or legal adoption.
27. root planing; unless the presence of periodontal disease (bone and attachment loss of 4mm or more) is
confirmed by x-rays and pocket depth charting of each tooth involved.
FL
The Lincoln National Life Insurance Company
12
2/9/2009
n Lincoln
Financial Group@
LINCOLN FINANCIAL GROUP@ PRIVACY PRACTICES NOTICE
The Lincoln Financial Group companies' are committed to protecting your privacy. To provide the products and services
you expect from a financial services leader, we must collect personal information about you. We do not sell your
personal information to third parties. We share your personal information with third parties as necessary to provide
you with the products or services you request and to administer your business with us. This notice describes our current
privacy practices. While your relationship with us continues, we will update and send our Privacy Practices Notice as
required by law. Even after that relationship ends, we will continue to protect your personal information. You do not
need to take any action because of this notice, but you do have certain rights as described below.
INFORMATION WE MAY COLLECT AND USE
We collect personal information about you to help us identify you as our customer or our former customer; to process your
requests and transactions; to offer investment or insurance services to you; to pay your claim; or to tell you about our
products or services we believe you may want and use. The type of personal information we collect depends on the
products or services you request and may include the following:
. Information from you: You give us information when you submit your application or other forms, such as your
name, address, Social Security number; and your financial, health, and employment history.
. Information about your transactions: We keep information about your transactions with us, such as the
products you buy from us; the amount you paid for those products; your account balances; and your payment
history.
. Information from outside our family of companies: If you are purchasing insurance products, we may collect
information from consumer reporting agencies such as your credit history; credit scores; and driving and
employment records. With your authorization, we may also collect information from other individuals or
businesses, such as medical information.
. Information from your employer: If your employer purchases group products from us, we may obtain
information about you from your employer in order to enroll you in the plan.
HOW WE USE YOUR PERSONAL INFORMATION
We may share your personal information within our companies and with certain service providers. They use this
information to process transactions you have requested; provide customer service; and inform you of products or services
we offer that you may find useful. Our service providers mayor may not be affiliated with us. They include financial
service providers (for example, third party administrators; broker-dealers; insurance agents and brokers, registered
representatives; reinsurers; and other financial services companies with whom we have joint marketing agreements). Our
service providers also include non-financial companies and individuals (for example, consultants; vendors; and companies
that perform marketing services on our behalf). Information obtained from a report prepared by a service provider may be
kept by the service provider and shared with other persons; however, we require our service providers to protect your
personal information and to use or disclose it only for the work they are performing for us, or as permitted by law.
When you apply for one of our products, we may share information about your application with credit bureaus. We also
may provide information to group policy owners, regulatory authorities and law enforcement officials and to others when
we believe in good faith that the law requires disclosure. In the event of a sale of all or part of our businesses, we may
share customer information as part of the sale. We do not sell or share your information with outside marketers who
may want to offer you their own products and services; nor do we share information we receive about you from a
consumer reporting agency. You do not need to take any action for this benefit.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
GB06714
Page lof2
7/08
SECURITY OF INFORMATION
Keeping your information safe is one of our most important responsibilities. We maintain physical, electronic and
procedural safeguards to protect your information. Our employees are authorized to access your information only when
they need it to provide you with products and services or to maintain your accounts. Employees who have access to your
personal information are required to keep it strictly confidential. We provide training to our employees about the
importance of protecting the privacy of your information.
Questions about your personal information should be directed to:
Lincoln Financial Group
Attn: Enterprise Services Compliance-Privacy, 6C-00
1300 S. Clinton St.
Fort Wayne, IN 46802
*This information applies to the following Lincoln Financial Group companies:
Allied Professional Advisors, Inc. Lincoln Financial Securities Corporation (formerly
First Penn-Pacific Life Insurance Company known as Jefferson Pilot Securities Corporation)
Hampshire Funding, Inc. Lincoln Investment Advisors Corporation
JPSC Insurance Services, Inc. Lincoln Life & Annuity Company of New York
Lincoln Financial Advisors Corporation Lincoln Variable Insurance Products Trust
The Lincoln National Life Insurance Company
ADDITIONAL PRIVACY INFORMA TION FOR INSURANCE PRODUCT CUSTOMERS
CONFIDENTIALITY OF MEDICAL INFORMATION
We understand you may be especially concerned about the privacy of your medical information. We do not sell or rent
your medical information to anyone; nor do we share it with others for marketing purposes. We only use and share your
medical information for the purpose of underwriting insurance, administering your policy or claim and other purposes
permitted by law, such as disclosure to regulatory authorities or in response to a legal proceeding.
MAKING SURE MEDICAL INFORMATION IS ACCURATE
We want to make sure we have accurate information about you. Upon written request, we will tell you, within 30 business
days, what personal information we have about you. You may see a copy of your personal information in person or
receive a copy by mail, whichever you prefer. We will share with you who provided the information. In some cases we
may provide your medical information to your personal physician. We will not provide you with information we have
collected in connection with, or in anticipation of, a claim or legal proceeding. If you believe that any of our records are
not correct, you may write and tell us of any changes you believe should be made. We will respond to your request within
30 business days. A copy of your request will be kept on file with your personal information so anyone reviewing your
information in the future will be aware of your request. If we make changes to your records as a result of your request, we
will notify you in writing and we will send the updated information, at your request, to any person who may have received
the information within the prior two years. We will also send the updated information to any insurance support
organization that gave us the information, and any service provider that received the information within the prior 7 years.
Questions about your personal medical information should be directed to:
Lincoln Financial Group
Attn: Medical Underwriting
P.O. Box 21008
Greensboro, NC 27420-1008
The CONFIDENTIALITY OF MEDICAL INFORMATION and MAKING SURE INFORMATION IS ACCURATE sections of
this Notice apply to the following Lincoln Financial Group companies:
First Penn-Pacific Life Insurance Company
Lincoln Life & Annuity Company of New York
The Lincoln National Life Insurance Company
GB06714
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7/08
CITY OF SUNNY ISLES BEACH
Benefit presented is for 03/01/2009
effective date.
Member Copay:
Exam
Lens
Frequency:
Exam
Frame
Lenses or Contacts
$10.00
$10.00
Once per 12 mths
Once per 24 mths
Once per 12 mths
Monthly Fee:
Subscriber Only
Subscriber + Spouse
Subscriber + Child[ren]
Subscriber + Family
$5.68
$10.76
$11.32
$16.68
Rate Contribution Level Definition:
Non-Voluntary (Employer pays greater
than 80% or bundled with Medical/Dental)
Rate Terms and Conditions:
Benefit presented has a 24-month policy
term and rate guarantee.
Pricing includes broker commissions.
Rates are valid based on group domiciled
in the state of FL and group size of 10 -
500 eligible employees.
Fees quoted are valid until the stated
effective date.
www.eyemedvisioncare.com
Plan Limitations / Exclusions:
Select Exam & Materials - Medium Option
BENEFIT DESIGN SUMMARY
EyeMed Vision Care in conjunction with Fidelity Security Life Insurance Company
Vision Care Services In-Network Out-of-Network
Exam with Dilation as Necessary:
Member Cost
$10 Copay
Up to $35
Member Reimbursement
Contact Lens Fit and Follow Up(Contact lens fit and two follow-up visits are available after comprehensive
eye exam):
Standard'
Premium'
Up to $40
10% off Retail
N/A
N/A
$48
Frames(any available frame at provider
location):
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Standard Progressive Lens'
Premium Progressive Lens'
$0 Copay; $120 Allowance, 20%
off balance over $120
$10 Co pay
$10 Co pay
$10 Copay
$10,80% of charge less $55
allowance
$10,80% of charge less $55
allowance
Up to $25
Up to $40
Up to $60
Up to $40
Up to $40
Lens Options(paid by the member):
UV Treatment
Tint (Solid and Gradient)
Standard Plastic Scratch Coating
Standard Polycarbonate
Standard Anti-reflective Coating
Other Add-Ons and Services
20% off retail price
20% off retail price
20% off retail price
20% off retail price
20% off retail price
20% off retail price
N/A
N/A
N/A
N/A
N/A
N/A
Contact LenSeS:(allowance includes materials only)
Conventional $135 allowance, 15% off balance
over $135
Disposable $135 allowance, plus balance
over $135
Medically Necessary $0 Copay, Paid-in-Full
$95
$95
$200
1 Standard Contact Lens Fitting. spherical clear contact lenses in conventional wear and planned replacement (examples include but
not limited to dIsposable, frequent replacement, etc.)
2 Premium Contact Lens Fitting. all lens designs, materials and specialty fittings other than Standard Contact Lenses (examples include
torie, multifocal, etc.)
3 Standard/Premium Progressive Lens not covered - fund as a Bifocal Lens
Standard Progressive Lens covered - fund Premium Progressive as a Standard
Additional Value Added Savings
Members will receive a 20% discount on items not covered by the plan at network Providers, which may not be combined with any other
discounts or promotional offers, and the discount does not apply to EyeMed Provider's professional services, or contact lenses. Retail
prices may vary by location.
Discounts do not apply for benefits provided by other group benefit plans. Allowances are one-time use benefits; no remaining balance.
Lost or broken matenals are not covered.
Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the
funded benefit has been used.
Members also receive 15% off retail pnce or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by
LeA Vision. Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not
always be available from a provider in your immediate location. For a location near you and the discount authorization please call 1-877-
5LASER6.
After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the
member. Details are available at www.eyemedvisioncare.com. The contact lens benefit allowance is not applicable to this service.
This plan design is offered with the EyeMed Select panel of providers. Minimum 10 enrolled employees required.
Underwriter
Insured plans are underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri, except in New York. Fidelity Security
Life Policy number VC-73 andVC-74, form number M-9059.
This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer.
. Orthoptic or vision training, subnormal vision aids, and any associated supplemental testing
Services provided as a result of any Workers Compensation law
Aniseikonic lenses
Services or materials provided by any other group benefit providing for vision care
Certain frame brands in which the manufacturer imposes a no discount policy
Corrective eyewear required by an employer as a condition of employment, and safety eyewear
unless specifically covered under plan
Medical and/or surgical treatment of the eye, eyes, or supporting structures
Two pair of glasses in lieu of bifocals
PIano lenses and non-prescription sunglasses (except for 20% discount)
Some provisions, benefits, exclusions or limitations listed herein may vary by State
If CITY OF SUNNY ISLES BEACH has chosen this benefit and agrees to the administrative services and requirements outlined above. please sign below and return this sheet
with your completed application to your EyeMed sales representative.
CA
Signature
February 10, 2009
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
Re: Lincoln Financial
Life, Short Term Disability, Long Term Disability and Voluntary Life
Doug,
Our current contract with Lincoln Financial is still in a multi-year rate guarantee. We did approach
numerous carriers and at this time, our current contract has the most comprehensive benefits and
pricing.
The cost on the life will continue at .22/.02 per $1000 of benefit.
The L TD cost is .46 per $100 of benefit.
We still will market every year as we have in the past to insure that your program is the most
competitive.
Please feel free to contact our office with any questions.
Regards,
Br~n & Brown Benefit Consultants
f j
II
\
5900 N. Andrews Avenue, Suite 401 I Fort Lauderdale, Fl 33309-2366 i Phone: 954.453.6280 ! Fax: 954.772.6243
A Division of Brown & Brown of Florida, Inc. I Website: www.bbbenefitc.com
To:
Via:
FROM:
DATE:
RE:
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
CitJ. CommissioN
Norman S. Edelcup, ,lld)'or
Lewis J. Thaler, Vi," ,\tu)'or
Roslyn Brczin, CommirJioner
Gerry Goodman, CommirJirmer
George "Bud" Scholl, Commi...i(J/ler
(305) 947-0606 City I I all
(305) 949-3113 Fax
(305) 947-2150 Building Departmmt
(305) 947-5107 Fax
Rick Connery'ldi~~ Cit)' MUll".Wr
Hans Ottinot, Cit)' /lttome)'
Jane A. Hines, Cit)' Clerk
MEMORANDUM
The Honorable City Commission
Rick Conner, Acting City Manager
Doug Haag, Asst. City Manager-Finance
Yael Londono, HR/Benefits Administrator
February 19, 2009
HEALTH, DENTAL, LIFE, DISABILITY AND VISION INSURANCE
PROVIDERS AGREEMENTS - EFFECTIVE MARCH 1,2009
RECOMMENDATION:
It is recommended that the City Commission adopt the attached resolution approving the City's
insurance providers as follows:
Coverage Type Current Provider New Provider Effective Date
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Accidental Death and
Dismemberment AD & D
Long
Term Disabili T
United Health Care
Sun Life
E 'e Med
Lincoln
Lincoln
AvMed
Lincoln Financial Grou
E 'e Med
Lincoln Financial Grou
Lincoln Financial Group
March 1, 2009
March 1, 2009
March 1, 2009
March 1, 2009
l\Iarch 1, 2009
Lincoln
Lincoln Financial Group
March 1, 2009
BACKGROUND:
Employee health care is one of the most important benefits available to our employees. It is also
one of our single biggest line item expenses. As you know health care has been one of the fastest
rising consumer cost areas. As an example, the City's rate for a single employee has increased
47% since 2003, not including the current proposals.
Health Insurance - As in previous years the city's insurance representative, Brown & Brown
Insurance, issued proposals to prospective firms on behalf of the City. Their mission was the
Funding a\'aihble:
\0.0
2 - ~ -O~
j\pprm'al:
Agenda Item No.:
Finance Department
City Manager
J\IEf\IO W-02-1'U I LILT! I INSURANCE RENEWAL-doc
Commission f\tcl:ting Date:
same as last year: provide for the same level of benefits with a national provider. Proposals were
submitted to the following 8 firms with their response indicated:
1. Aetna- Quoted 1 plan
2. BCBS- Quoted 1 plan
3. Cigna- Still waiting for their decision
4. United-Quoted 2 plans
5. NHP-Quoted 1 plan
6. A vMed -Quoted 7 plans
7. Humana-Declined due to claims history
8. Vista - Verbally declined due to claims history, but have not yet received letter
After extensive negotiations with Brown & Brown, the City's current health care provider,
United Health Care (UHC), submitted a 'best and final offer' that proposed a 39.65% increase
based on the City's claims history. This was essentially a 'take it or leave it' approach. Brown
& Brown represents other UHC clients and they experienced rate increases ranging from 12% -
60%, with an average of approximately 30%. Per Siver Insurance Consultants, state-wide
increases in health insurance for 2009 are expected to range from 10.5% to 14%.
Based on the amount of the increase from UHC, City staff met with representatives from AvMed
on Wednesday, February 4, 2009. The meeting was facilitated by Robert Hollander and
Samantha Alvarez from Brown & Brown Insurance. Representatives from all city departments
participated in the session. After two hours of discussion and an in depth question & answer
session, the consensus of the City team was to move forward with the A vMed proposal for health
Insurance.
A vMed is a Florida based company that is known for their quality service and willingness to
work with customers that have a one-time spike in claims and they have a large number of local
government clients. Other Brown & Brown customers have found that there is not much
difference between UHC participants (physicians, hospitals, clinics, etc) and A vMed
participants. All Brown & Brown AvMed customers had a renewal rate of less than 10% this
past year. The proposal A vMed submitted to the City is actually a slight decrease (2.5% for a
Single Person) from our current rates with UHC. A vMed offers plans comparable to the three
plans currently offered by the City (HMO, POS and NHP). There are also some coverage
differences in the form of deductibles and co-pays that will help the City in controlling costs in
the future. This information will be covered in detail with employees at upcoming informational
and enrollment meetings.
Based on the above, the City's review team fully concurs with the Brown & Brown
recommendations (attached) which include:
. Selection of A v Med as the healthcare provider with a slight decrease (1 % - 2 %) in
annualized premiums. The plans selected are the HMO-OA 5228, POS-OA 5011 and
HMO-OA 5076. The third plan is the lower cost option that we started making available
last year. On an annual basis the total annual premium paid for these coverages will
decrease by approximately $15,000.
. Selection of Lincoln Financial Group as the provider for dental, life, disability and
accidental death & dismemberment (ADD). This switch was planned for last year so that
we could realize a costs savings by bundling these coverages with a single provider. We
are also changing dental providers because our current provider, Sun Life, proposed a
34% increase. Lincoln Financial offered identical coverages with no increase in
premium. Their dental plan also has a larger provider list.
. Continuation of Eye Med as the provider for the vision insurance. The coverages and
tiers are slightly different and the overall premiums are essentially the same.
Funds are currently budgeted in the line item account 5230 within each department and no
transfers are required.