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HomeMy WebLinkAboutExhibit8Benefit and Capabilities Outline Be Prepared for: City of Miami Prepared by: Cathy Krumpos CIGNA Healthcare January, 2008 Valid for Effective date of July 1, 2008 Unless extended in writing by CIGNA HealthCare CIGNA CIGNA" Plan design and rates may vary.rvided by these subsidiaries Tel -Drug, y Inc.and affiliates, CIGNA and not by ration. Products and services are p Underwritten and administered by the o Connecticut subsidiariesueneral Life lat CIGNA Gore) ny refer to various operating ,oration and CIGNA. a Dental Health, Inc. Not and aviGNA eHaa ,Inc., I trac subsidiaries of CIGNA Health Corp CIGNA Corporation. These subsidiaries include Connecticut General life Insurance Company, Behavioral Health, Inc., IMracorp. and HMO or service company available in WA. 1� �^ Executive Summary City of Miami RFP & Questionnaire CIGNA HealthCare Voluntary Limited -Benefit Plans Starbridge Choices Enrollment Options Enrollment Strategy Starbridge Choices Website Claims Administration/Customer Service Plan Administration Addendum Executive Summary As the incumbent carrier, CIGNA Voluntary is pleased to present this renewal opportunity to the City of Miami. We understand that as an employer, you want a benefit program that provides access to quality health care for your part time and temporary employees and their families, yet respects everyone's need to manage expenses. In this proposal we describe the products and services you requested, as well as the value of these products and services. We want you to have a clear understanding of how CIGNA Voluntary can continue to provide health care advantages for your employees. Starbridge Choices is a voluntary limited -benefit medical plan that provides part-time and hourly employees with coverage to help with minor medical expenses. It requires no employer contribution and has no minimum participation requirements. Starbridge Choices offers: Provider Networks: Starbridge utilizes the Beech Street network for Proposed Option 1. Starbridge will utilize the CIGNA PPO network for Starbridge Choices Proposed Option 2. The City of Miami's employees have the best of both worlds; the opportunity to receive up- front network discounts by choosing a network provider and the freedom to choose any provider with no out -of -network penalty. Affordability: Starbridge plans are designed to cost only one and a half to two hour's pay per week. Experience has shown that for hourly employees the cost of the plan is the most important factor in purchasing insurance. The ability to customize your plan designs around City of Miami's average hourly wage provides the flexibility needed to optimize participation. Plan Choices: Our multi -level medical plans give your employees the ability to choose a plan that best fits their day-to-day medical and financial needs. Additionally, supplemental benefits are available on a stand-alone basis. Employees do not need to select a medical plan in order to participate in supplemental plans. This makes the program attractive to more employees, thereby increasing employee satisfaction. Simplicity: Starbridge was designed to provide coverage for the day-to-day medical expenses most often incurred. The benefits are straight forward and easy to understand. Insured employees receive access to healthcare with low co -payments and low deductibles. Employee Assistance: The CIGNA 24-Hour Employee Assistance Program is available to City of Miami's employees. The Health Information Line is always open to help direct employees to appropriate sources of medical care. Your employees can call anytime for helpful answers and reliable information on a wide range of health -related topics. Additionally, up to 3 face-to-face visits with local counselors are also provided. This benefit is especially valuable to first time insured employees as many of them do not have a primary care physician. The access to medical assistance and advice 24/7 gives your insured employees additional peace -of -mind. Executive Summary Healthy Rewards: Healthy Rewards provides members with access to a variety of health and wellness products and services arranged by CIGNA affiliates. These are programs and services often not covered by many traditional benefit plans. Program features include discounts on vision care, weight management, tobacco cessation, fitness club memberships, magazines and much more. Healthy Rewards discounts include brand names, such as Weight Watchers, Lasik Vision Correction, Jenny Craig and more. As a discount program, there are no claims to file, no enrollment forms or paperwork. The choice to use Healthy Rewards is completely up to your employees. Online Tools: Our comprehensive online tools provide employees access to information and advice that will help them save money and stretch their benefit dollars. Online capabilities enable them to • Locate participating physicians • Research medical conditions and treatments • View their medical plan and benefit information • Check claims status and history Ease of Administration: The CIGNA Voluntary years of experience has produced an infrastructure that provides for smooth implementation of the programs and ongoing administrative support that ensures that administration for our clients is kept to a minimum. A 2005 client survey indicates that 76% of our large national clients spend less than 5 hours per week on Starbridge administration attesting to the ease of administration of our programs. Member Advocacy: Many Starbridge insureds are new to medical insurance. Often their only experience with the medical system has been trips to the Emergency Room. Starbridge helps teach your employees the most cost-effective way to seek treatment. We teach insureds: • The Value of using network providers (Geo-coded provider lists, steerage activities) • How to find a network provider and schedule an appointment • The benefit of using the Web portal and CIGNA 24-hour Employee Assistance Program • Why they should avoid the ER if it's not an emergency These messages are facilitated by our Customer Services teams, SPDs, and other member collateral. Starbridge helps insureds manage their out-of-pocket costs by avoiding unnecessary ER visits, utilizing network providers, and seeking preventative care. Certifications Legal Name of Firm: CIGNA Voluntary Entity Type: Partnership, Sole Proprietorship, Corporation, etc. Corporation Address, City, State, Zip 2222 West Dunlap Avenue, Suite 350, Phoenix, AZ 85021 Office Location: City of Miami, Miami -Dade County, or Other CIGNA Voluntary, 2222 West Dunlap Avenue, Suite 350, Phoenix, AZ 85021 Occupational License Number: N/A Occupational License Issuing Agency: N/A Occupational License Expiration Date: N/A Respondent certifies that (s) he has read and understood the provisions of City of Miami Ordinance No. 10032 (Section 18-105 of the City Code) pertaining to the implementation of a "First Source Hiring Agreement.": (Yes or No) N/A Do you expect to create new positions in your company in the event your company was awarded a Contract by the City? (Yes or No) No, since the City of Miami is an existingcustomer, no additional positions are expected. In the event your answer to question above is yes, how many new positions would you create to perform this work? N/A Please list the title, rate of pay, summary of duties, number of positions, and expected length or duration of all new positions which might be created as a result of this award of a Contract. N/A Minority/Women Business Affairs Registration Status: Hispanic, Female, Black or None CIGNA has dedicated resources to promote our Supplier Diversity Program, with the goal of increasing our Minority and Women Business Owned Enterprises (MBE/WBE) spends from the current five percent to six percent over the next year. Will Subcontractor(s) be used? (Yes or No) Yes. Medlmpact is used for our prescription benefit. Does the City of Miami Living Wage Ordinance apply to this formal solicitation? ( See Section 1.40 of the General Terms and Conditions) (Yes or No) N/A Service Total Contract Amount (which includes base term and renewal options): N/A Is this service contract a citywide contract? (Yes or No) CIGNA Voluntary currently administers the City of Miami's contract. The City has designated the contract to cover all Part-Time/Temporary Employees are eligible, excluding seasonal & board members, after 90 continuous days of employment. If the above answer is no, please indicate the name of the city (end user) department that your contract will serve: Provide brief description of the project or service to be provided Limited benefit medical insurance to the City of Miami's part time and temporary employees (excluding seasonal and board members) after 90 days of continuous service I/We hereby state compliance with the City of Miami Living Wage Ordinance, Section 18-556 through Section 18-559 as summarized in Section 1.40 of the General Terms and Conditions? N/A Reference — CIGNA Voluntary already partners with the City of Miami and has since 2004. CIGNA Voluntary is committed to continuing our partnership with the City. We are extremely excited to be a part of CIGNA HealthCare and are already reaping the benefit of synergies from CIGNA to increase our offerings for the City of Miami. Subcontractor (If Applicable)- Company Name Medlmpact - PBM Subcontractor (If Applicable)- Address 10680 Treena Street Subcontractor (If Applicable)- City, State, Zip San Diego, CA 92131 Include Current National Committee for Quality Assurance (NCQA) Accreditation Rating of Commendable or higher for Commercial HMO/POS business combined (Yes/No) CIGNA completed its first NCOA PPO/OAP survey in 4th quarter 2007—preparations and the submission process are completed. The decision should be received in early in 2008. CIGNA has a history of very strong results on NCOA surveys and expects the same on the PPO survey. Include AM Best rating of A or A+ and financial size category of X (ten) or higher and State of Florida Department of Insurance letter stating you are meeting current State of Florida Reserve Factors. A.M Best Date Rating December 2006 Fitch, Inc. March 2007 A+ Moody's February 2007 A2 Standard & Poor's March 2007 A 3.3.1. Provide various Levels of the Plan for the employee and/or family, based upon cost and service(s) offered, and allow the part-time / temporary employee(s) make a choice based upon Level of Service and cost, that which is in his/her best interest. See Plan Design portion of the proposal. 3.3.2. Offer no waiting period or be required to provide medical evidence of insurability prior to enrollment. The City of Miami has specified a 90 day waiting period in its current contract with CIGNA Voluntary. The City determines eligibility requirements and can set the business rules regarding the waiting period. Starbridge plans do not require a waiting period for coverage. There is no medical evidence required prior to enrollment because these are group plans. 3.3.3. Require no minimum number of hours worked for eligibility or minimum number of employee participation. The City of Miami determines eligibility requirements and can set the business rules regarding the hours worked. 3.3.4. Provide low health premiums to each enrolled part-time / temporary City employee. Starbridge plans are impacted by age, gender and turnover. Rates are also adjusted for plan design. 3.3.5. Provide a "self -bill" Program instead of billing statements. Employers follow the "self -bill" approach, meaning the employer reports to CIGNA Voluntary the employees on each plan and how much was deducted by pay period. Payments can be made either by check or via ACH transfer. Since premiums are paid in arrears, the employer submits to CIGNA Voluntary only the amount that was deducted during the previous payroll cycle as well as any employer contribution amounts. 3.3.6. Provide free COBRA Notification and premium collection. CIGNA Voluntary handles all of the COBRA and HIPAA administration for the Starbridge plans. This includes the pre and post termination notifications, billing and premium collection. These services are provided at no additional cost. CIGNA Voluntary accepts and issues Certificates of Creditable Coverage for the Starbridge plans. 3.3.7. Provide an Enrollment Center for direct communication to eligible employees. The Enrollment Center's inbound call center is staffed with licensed, bilingual Benefit Specialists who can answer your employees' questions and work with them to determine which coverage is best suited for their individual needs. The additional service takes the burden off your benefit staff and site managers in answering questions about the plans. 3.3.8. Provide all premium/fee accounting services necessary to administer the Plan, and any banking charges that may apply, in addition to any other related costs to administer said Plan. All costs are included in the premium. 3.3.9. Provide booklets or booklet certificates, approved by the City, in sufficient quantity for all potential Plan participants and reprint as required by the City. Booklets or certificates are to be sent directly to insured's homes. Summary Plan Description books are created based upon the individual insured's plan choice(s) and are mailed directly to each insured's home. 3.3.10. Provide applicable network directories in sufficient quantity for all potential Plan participants and reprint as required by the City. Directories are to be sent to insured's homes during initial enrollment period and at applicable periods thereafter. CIGNA Voluntary does not provide hardcopies of the Provider Directory. Since both the Beech Street network and the CIGNA network are national PPO networks, the size of a national PPO network directory makes it prohibitive to produce one national network directory. This information can be obtained through our website. The Getting Started packet also will include a Geo Report of 10 providers in the insureds area sent with the ID Cards. CIGNA Voluntary's Customer Service line is also equipped to assist any insured in locating a participating provider. Medical - The City of Miami employees currently enrolled in the Starbridge plan (Option 1) utilize the Beech Street network, a Concentra Company. The alternative (Option 2) Starbridge plans included in this proposal use the National CIGNA PPO Network for your members. Dental — The supplemental dental plan included in this proposal utilizes the CIGNA Dental Network. This program provides reimbursment on 45 of the most common preventive and basic dental procedures. Enrolled members will receive discounts on an additional 200+ dental procedures when they visit a participating CIGNA Dental network provider. Vision — A City of Miami employee who enrolls in the Dental Plan also has Vision Discount Plan in Vision One discount network. Vision One discount network provides discounts on frames, lenses and exams. 3.3.11. Provide appropriate I.D. Cards as specified and approved by the City. Once enrolled, employees will receive a geo-coded Getting Started Packet mailed to their residence that includes a list of ten in -Network Primary Care Physicians located in their area as well as confirmation of the benefits in which they are enrolled, their ID cards and EAP/Nurseline information. 3.3.12. Provide all related enrollment materials to insured's homes. Currently CIGNA Voluntary sends pre -enrollment material to the City of Miami to distribute to eligible employees. This is our standard practice. Insured employees will receive a geo-coded Getting Started Packet mailed to their residence that includes a list of ten in -Network Primary Care Physicians located in their area as well as confirmation of the benefits in which they are enrolled, their ID cards and EAP/Nurseline information. This is followed by a Summary Plan Description booklet that that is created for the insured based upon the plan(s) chosen. 3.3.13. Provide an 800 phone number as well as dedicated representatives (for long distance calls) for claims service and plan information and related customer services. A single total free number is provided to all eligible employees and permits the calls to be answered by a designated team of Customer Service Representatives skilled for this product. CIGNA Voluntary has bi-lingual CSR's and utilizes the AT&T language line for further assistance. 3.3.14. Provide technical/sales staff, as may be required, for: initial enrollment, open enrollment, claim resolution and plan information and interpretation and costing of alternative benefits from time to time. Cathy Krumpos is the Client Manager for the City of Miami. Cathy is based in Arizona and has over 30 years experience in the health care industry. She has been with Star HRG since 1999..She will continue to oversee the account management process for the City of Miami and is responsible for being engaged in strategic account oversight. She will also continue to be the point of contact for plan information, interpretation and costing of alternative benefits. Lara Perez is the Client Specialist who will assist Cathy in the day to day interface with City of Miami. Rose Lopez is the File Analyst who is responsible for the processing of enrollment files, as well as maintenance of the ongoing eligibility. Claims Resolution - CIGNA Voluntary provides a special Client Service Unit for our HR professionals. This unit is staffed by supervisory level employees who work only with our clients' HR Departments to assist with eligibility questions or other issues regarding their employees. 3.3.15. Provide EOBs which are to be sent to the employee's home. An Explanation of Benefit (EOB) is sent to the member and/or provider whenever a claim is processed. A description of that claim's status is provided on the EOB. 3.3.16. Provide the City and its agent with paid claims and premium reports on a quarterly basis and with a complete financial analysis for the plan year within four (4) months after the end of the Plan year. Reports regarding the turnaround time, member numbers, utilization, and claims per member are available by request on a quarterly basis. 3.3.17. Provide complete COBRA/HIPAA administration, including certification of coverage, under the City's plans according to the applicable Federal regulations. CIGNA Voluntary will continue to handle the COBRA/HIPAA administration for the City of Miami. Once we receive termination information for an insured we will then send out the COBRA notification and HIPAA certificates. If the insured elects COBRA they will work directly with CIGNA Voluntary. 3.3.18. Provide a minimum guarantee premium cost per part-time and temporary employee for an initial period of eighteen (18) months through December 31, 2009, followed by a minimum guarantee premium cost per part-time and temporary employee for each annual twelve (12) month renewal period. Rates reflected in the proposal are for 18 months through December 31s`, 2009. 3.3.19. Provide upon request, City's logo to appear on various printed materials. Successful Proposer must agree to do this at no additional cost and must ensure that logo placement and color requirements are met, as applicable. Company logos can be reflected on various enrollment communication pieces at no additional cost. 3.3.20. Provide an electronic enrollment option. CIGNA Voluntary offers flexible enrollment options depending on the needs and capabilities of City of Miami. General options include: • THE CIGNA Voluntary On-Line/Web Enrollment (Available only for the 170 Series Plan) • The CIGNA Voluntary Interactive Voice Response System (IVR) • The CIGNA Voluntary Enrollment Center • Paper Enrollment Forms The CIGNA Voluntary Web enrollment process is available to further meet the employees' needs. The Web enrollment process will provide employees with answers to most all of their benefit questions. The CIGNA Voluntary state-of-the-art IVR system for telephonic enrollments provides employees a quick and easy enrollment experience 7 days a week, 24 hours a day. Employees have the ability to speak with a Benefit Specialist during regular business hours. The Enrollment Center's inbound call center is staffed with licensed, bilingual Benefit Specialists who can answer your employees' questions and work with them to determine which coverage is best suited for their individual needs. The additional service takes the burden off your benefit staff and site managers in answering questions about the plans. 3.4 Proposed Options Proposers are to submit within its Proposal, responses based on each of the following: Census data (Exhibit A) and, Claims Experience data (Exhibit 8) are attached. 3.4.1. City of Miami spent $85,647.44 during Calendar Year 2006. 3.4.1.1. Part time employees working 35 hrs or Tess weekly. (Approximately 187 employees working with the City as of the issuance of the RFP) 3.4.1.2. Temporary employees working 40 hours or more weekly. (Approximately 221 employees working with the City as of the issuance of the RFP) Description: Monthly Rate for Part -Time Employees Working 35 Hours or Less Weekly Description: Monthly Rate for Temporary Employees Working 36 Hours or More Weekly Option 1 - Monthly Medical Rates (128 series Medical Plan Series EE EE+1 FAM 128 $41.17 $101.23 $152.88 148 $75.70 $186.77 $283.40 168 $115.61 $286.43 $435.02 Option 2 - Monthly Medical Rates (170 series Medical Plan Series EE EE+1 FAM 170 Choices Standard $44.20 $108.42 $163.80 171 Choices Standard $84.93 $208.22 $314.47 172 Choices Standard $130.26 $319.19 $482.08 4. Overall Qualifications and Experience a) Describe the Proposer's organizational history and structure; years Proposer and/or its partner(s), principal(s), officer(s) or owner(s) has been in business providing a similar service(s), and indicate whether the City has previously awarded any contracts to the Proposer/firm. CIGNA and its predecessor companies have a long history of supporting the health care needs of Americans. Starting with the formation of Connecticut General Life Insurance Company and Insurance Company of North America (INA) in 1792, we have more than 200 years of history. In 1990, CIGNA became the largest investor -owned managed care organization in the country and still concentrates on meeting customer needs for best -in -class health care and employee benefit products and services. The rich and exciting history of CIGNA reveals the foundation of experience that shapes our current products and business strategies. Today, CIGNA companies comprise one of the nation's leading providers of employee benefits, health care coverage, and insurance products to businesses and individuals worldwide. In 2006, CIGNA acquired Star HRG, one of the premier providers of health plans for non - benefited hourly and part-time workers in the U.S. Star HRG was founded in 1989 and developed rapidly into a well -established organization, offering insurance to more than 1,000 corporate clients, including several Fortune 500 companies. Their market -leading products satisfy the basic, everyday medical needs of hourly employees, while helping our clients to reduce turnover, improve recruiting, and stabilize expenses within their hourly workforce. Star HRG's name was changed to CIGNA Healthcare Voluntary Limited -Benefit Plans. City of Miami is currently offering their Limited Benefit Plan through CIGNA Voluntary. b) Provide a list of principals, owners or directors. Robert H. Campbell H. Edward Hanway Isaiah Harris, Jr. Jane E. Henney, M.D. Peter N. Larson Roman Martinez IV James E. Rogers Harold A. Wagner Carol Cox Wait Eric C. Wiseman Donna F. Zarcone William D. Zollars c) Provide a verification letter from State of Florida, Department of Insurance, reflecting Proposer is currently and properly authorized to conduct business in the State of Florida. See attached d) As indicated before, provide current NCQA Accreditation Letter for commercial/HMO/POS combined business, and AM Best certificate, and State of Florida Department of Insurance letter, stating you are meeting current Reserve Factors. CIGNA Voluntary is not NCOA accredited. e) Demonstrate your qualifications and other relevant experience in areas similar to the Scope of Work, magnitude, and complexity identified within this RFP. CIGNA Voluntary is currently administering the Group Health Benefits for City of Miami Part -Time Temporary employees. f) Provide a complete list of clients for which Proposer has provided a similar service(s) as required in this RFP, particularly those of governmental entities, for whom similar services have been performed during the past three (3) years. Include the name, address, name of contact, and telephone number of each reference. The City reserves the right to contact any reference as part of the evaluation process. CIGNA Voluntary provides insurance for hourly and part time workers for over 1000 clients as noted above. The City of Miami has been an existing customer since 2004. g) Provide a complete list of the personnel, including the Account Representative and any sub - consultants that will be assigned to handle the work to be performed for the City. Include a resume describing their experience, training, certifications, and other relevant details. Cathy Krumpos is the Client Manager for the City of Miami. Cathy is based in Arizona and has over 30 years experience in the health care industry. She has been with Star HRG since 1999. She will continue to oversee the account management process for the City of Miami and is responsible for being engaged in strategic account oversight. She will also continue to be the point of contact for plan information, interpretation and costing of alternative benefits. Lara Perez has been with CIGNA for the past 7 years. 4 years as File Analyst, and 3 years as a Sales Assistant. She has worked with large accounts on our National Sales team. Rose Lopez has been with CIGNA Voluntary for over four years, and has a total of five year's experience in the healthcare insurance industry. Rose is focused on ensuring member eligibility data is efficiently and accurately loaded to the CIGNA Voluntary claims system. h) Provide a minimum of one (1) Letter of Reference on letterhead from one of the entities referenced in this proposal, particularly from a governmental entity of a similar size for whom similar services have been performed. The City of Miami has been an existing client since 2004. 5. Proposed Plan(s), Network, and Employee Cost(s) a) Detail its overall Plan and its approach to provide a Health Benefit Plan for the City's part-time / temporary employees. See Plan Design and Enrollment Strategy in the proposal b) Provide description of Levels of coverage and applicable premiums, prescription benefits, and co -pays for each Level of Service proposed. See Plan Design in the proposal. c) Detail its Network, including hospitals, physicians, specialists, etc. in Miami -Dade, Broward, Monroe and Palm Beach Counties. See attached GEO Access Report. d) Provide monthly cost, per part-time / temporary City employee, for each proposed Level of Service. Proposed cost(s) must include each of the following: See Plan Design in the proposal. Exhibit A: a) Part time employees working 35 hours or less per week. (Approximately 187 employees currently working with the City as of the issuance of the RFP) b) Temporary employees working 36 hours or more per week. (Approximately 221 employees currently working with the City as of the issuance of the RFP) 6. Proposer's Ability and Capability to Provide Required Services a) Describe the overall size of Proposer and include a description of how the Proposer intends to staff this engagement. List the office from where the work for the City is to be performed, and discuss any additional needs that might be requested of the City pursuant to the Scope of Work. Customer Service for the City of Miami is administered in our Phoenix, AZ office, where the CIGNA Voluntary team has easy access to the benefits and services for the City of Miami through advanced claim and call systems. CIGNA Voluntary 2222 West Dunlap Avenue, Suite 350 Phoenix, AZ 85032 CIGNA Voluntary has over 300 employees. No additional staffing or procedures will be necessary as we are currently handing the administration for City of Miami b) Provide copy of the most current audited or current unaudited Financial Statement, for the past year. See attached., c) Provide information as to any and all pending or previous lawsuits, including the disposition of same, filed against the Proposer relating to similar services being sought within this RFP. In an industry where lawsuits are commonplace, CIGNA receives an insignificant number of lawsuits per year. Confidentiality concerns preclude further comment or description.