HomeMy WebLinkAboutExhibit9CIGNA HealthCare, headquartered in Bloomfield, CT, offers a broad portfolio of group
medical and specialty health care products and services, as well as a wide range of funding
and plan design options.
Since 1989, the Starbridge insurance plans have continued to satisfy the basic everyday
medical needs of hourly employees, by providing meaningful and affordable benefits.
Starbridge has also proven to be effective in helping companies improve recruiting, reduce
tumover, and stabilize the rising costs of company funded medical plans.
CIGNA is recognized as the premier provider of limited -benefit medical plans for non -
benefited hourly workers in the U.S. We are rated A (Excellent) by A.M. Best.
CIGNA Voluntary Administration Highlights:
Sole focus is limited -benefit plans
Over 300 employees
Over 1,000 corporate clients
Over two -dozen Fortune 500 clients
Over 200,000 insured employees
94% persistency/client retention rate
All services handled out of Phoenix, AZ
Sickness and Accident Plans:
Starbridge Choices has been designed to offer useable benefits that are easy to understand.
With Starbridge Choices there is flexibility to customize a plan offering to match the needs of
City of Miami's workforce.
Studies show that over 90% of medical charges are for outpatient benefits. Less than 10% of
employees incur over $10,000 in medical costs annually. The quoted plan designs put
emphasis on covering outpatient services which are what employees use most.
The City of Miami may choose Option 1 or Option 2 as well as the dental/vision supplemental
plan that is currently offered. The following plan designs stay within the suggested target
price of one and a half to two hour's wage per week while illustrating the range of coverage's
available.
Supplemental Benefits:
Supplemental Benefits appeal to employees who want coverage in addition to, or as a stand-
alone, to the medical plan. These additional options, combined with flexibility of choice, give
City of Miami's employees the protection they deserve, all at an affordable price.
Supplemental Benefits are optional and City of Miami determines which, if any, you would like
to offer to their employees. Supplemental Benefits include:
Dental Assistance Plan
ILLNESS
BENEFIT
Physician Office Visit*
$15 Co -pay — 100%
$10 Co -pay -100%
$10 Co -pay -100%
Wellness Benefit**
Not Included
$20 Co -pay — pays 100%,
max $100/visit
(max 1 visit/year)
$20 Co -pay — pays 100%,
max $100/visit (max 1
visit/year)
Outpatient Care
$1,000 /Year Benefit
Pays 80% after $50
annual deductible
$1,500/Year Benefit
Pays 80% after $100
annual deductible
$2,000/Year Benefit
Pays 80% after $150
annual deductible
Non -Emergency Care
In Emergency Room*
$500 Near Benefit
Pays 50% after $100 per
occurrence deductible
$500 /Year Benefit
Pays 50% after $100 per
occurrence deductible
$500 Near Benefit
Pays 50% after $100 per
occurrence deductible
Inpatient Care
$2,000 /Year Benefit
Pays 100%,
$0 deductible
$3,000 /Year Benefit
Pays 100%,
$0 deductible
$5,000 /Year Benefit
Pays 100%,
$0 deductible
In -Hospital Surgery
Included in Inpatient
Benefit
$1,500 per
occurrence max.
Pays 100%,
$0 deductible
$2,500 per
occurrence max.
Pays 100%,
$0 deductible
Maternity Benefit
Included in Inpatient
Benefit
$1,500 per
occurrence max.
Pays 100%,
$0 deductible
$2,500 per
occurrence max.
Pays 100%,
$0 deductible
ACCIDENT BENEFIT : .
Accident Medical
Benefit
$2,000 /Year Benefit
Pays 80%, Max. $1,000
per occurrence (max 2)
after $50 per occurrence
deductible
$5,000 /Year Benefit
Pays 80%, Max. $2,500
per occurrence (max 2)
after $50 per occurrence
deductible
$10,000 /Year Benefit
Pays 80%, Max. $5,000
per occurrence (max 2)
after $100 per occurrence
deductible
Accidental Death
Benefit
$10,000
$15,000
$25,000
PRESCRIPTION BENEFIT .
Prescription Discounts
Brand Name or Generic
Discount Included
Brand Name or Generic
Discount Included
Brand Name or Generic
Discount Included
Prescription Benefit
Not Included
Co -Pay
$15/generic, $30/pr brand
pays 100%, $300/Year
Benefit
Co -Pay
$15/generic, $30/pr brand
pays 100%, $600/Year
Benefit
ADDITIONAL FEATURES.
CIGNA 24-Hour EAPsM
Yes
Yes
Yes
Healthy Rewards2
Yes
Yes
Yes
Online Tools
Yes
Yes
Yes
MONTHLY RATES
Employee Only
$44.20
$ 84.93
$130.26
Employee + 1
$108.42
$208.22
$319.19
Family
$163.80
$314.47
$482.08
The benefits above are provided by policy form SBCII-GMP-02. All yearly benefits are paid per coverage year.
Starbridge Choices utilizes the CIGNA PPOS"" Network that provides discounts on outpatient and inpatient services.
'The paid benefit amount will count toward the outpatient basic medical expense coverage year maximum.
*Provision varies by state. 1. The prescription discount program is not insurance. 2. Some Healthy Rewards are not available in all states.
The discount program is not insurance.
OUTPATIENT BENEFIT
Physician Office Visit
After the $15 or $10 co -pay, Starbridge Choices pays 100% of the remaining physician's
office visit charge. The paid benefit amount counts toward the annual Outpatient Care
maximum. Charges in connection with the office visit are paid at 80% once the annual
deductible is met.
Outpatient Benefit
Each covered person receives coverage under the Outpatient Benefit that includes (but is not
limited to) urgent care, emergency rooms, ambulance charges, durable medical equipment,
diagnostic X-ray and lab and services performed in a physician's office or outpatient surgery
facility.
Wellness Benefit
Each covered person receives coverage for the Wellness Benefit. Types of services include
well woman exam, well child exam, immunizations, and routine physicals. The amount paid
does not count towards the outpatient benefit maximum. This applies to the 170. series plans
only.
Prescriptions
This is a point -of -sale prescription benefit. The insured is responsible for the Generic or
Preferred Brand co -pay only until the annual maximum benefit is met. Once maximum
benefits are met, insured employees continue to receive discounts through the discount
program. The amount paid does not count towards the outpatient benefit maximum. This
applies to the 170 series plans only.
Please see benefit table for prescription detail for the 128 series plans.
ACCIDENT BENEFIT
Starbridge Choices pays 80% for inpatient and outpatient expenses for off -the -job accidents
once the deductible is met up to the maximum benefit shown.
City of Miami may select the following benefit to offer to your employees. Employees do not
need to participate in the medical plan to elect supplemental benefits.
The scheduled Dental plan reimburses each insured
person for expenses incurred for the 45 most common
preventive and basic dental procedures.
$25 Annual Deductible
Use any Dentist
Discounts available through CIGNA Dental Network
Over 69,000 participating dentists
Average savings within network of 35%
Vision discount plan through Vision One discount network
provides discounts on frames, lenses and exams.
Monthly Premiums:
Employee $18.42
Employee +1 $35.53
Family $52.65
Maximum
Covered
Charge
$25 per person annual deductible
ORAL EXAM
D0120 Periodic Oral Exam*
D0140 Limited Oral Exam Problem Focused
D0150 Comprehensive Oral Exam**
D9110 Emergency Palliative Treatment
X-RAY AND PATHOLOGY
D0210. Entire Denture Series (Itraoral)
Including Bitewings***
00220 Single Film Initial
D0230 Single Film — Each Additional
D0240 Intra-Oral Occlusal View***
D0250 Extraoral — First Film
D0260 Extraoral — Each Additional
D0270 Bitewing Film, One*
D0272 Bitewing Films, Two*
D0274 Bitewing Films, Four*
PROPHYLAXIS AND FLUORIDE
D1110 Prophylaxis for age 14 and over*
01120 Prophylaxis for age under 14*
D1203 Topical App. of Fluoride, Child*
D1204 Topical App. of Fluoride, Adult*
D1351 Sealant Per Tooth
AMALGAM RESTORATION — PRIMARY/
PERMANENT TEETH
D2140 Cavities —1 Surface
D2150 Cavities — 2 Surfaces
D2160 Cavities — 3 Surfaces
D2161 Cavities — 4+ Surfaces
The benefits above are provided by policy form SBCII-
GMP-02. SBCII-DNTLR-02.
Maximum
Covered
Charge
SYNTHETIC RESTORATIONS
$17 • D2330 Composite Resin —1 Surface
$27 D2331 Composite Resin — 2 Surfaces
$27 D2332 Composite Resin — 3 Surfaces
$38 D2335 Composite Resin — 4+ Surfaces
02390 Composite Resin Crown, Anterior Primary
D2391 Composite Resin —1 surface
D2392 Composite Resin 2 Surfaces
D2393 Composite Resin — 3 Surfaces
$40
$ 7
$ 7
$10
$11
$ 9
$ 8
$12
$17
$30
$20
$12
$12
$16
$35
$45
$56
$64
EXTRACTIONS
D7140 Extraction -Erupted tooth of exposed root
D7220 Removal of Impacted Tooth —Soft Tissue
D7230 Removal of Impacted Tooth —Partially Bony
D7240 Removal of Impacted Tooth —Completely Bony
D7241 Removal of Impacted Tooth —Completely Bony
with Unusual Surgical Complications
D7250 Removal of Residual Tooth Roots
D7510 Incision & Drainage of Abscess
D9220 General Anesthesia
PERIODONTICS
D4341 Scaling/Root Planing Per Quadrant
D4355 Full Mouth Debridement to enable
Comprehensive Periodontal Evaluation
D4910 Periodontal Maintenance
$53
ENDODONTICS
(excluding final restoration)
D3220 Therapeutic Pulpotomy
D3310 Root Canal 1 — Anterior
D3320 Root Canal 2 — Bicuspid
D3330 Root Canal 3 — Molar
Footnotes:
* Limited to once every 6 months
** Limited to once every 12 months
*** Limited to once every 3 years
$42
$55
$67.
$69
$77
$50.
$68
$85
$39
$45
$70
$85
$85
$30
$45
$52
$72
$50
$20
$125
$135
$140
1.
LIMITATION FOR PRE-EXISTING CONDITION — Benefits are not paid for a Pre Existing condition. A Pre-existing
Condition is one in which you have been diagnosed, treated or sought advice from a physician during the 6 months before
becoming insured. A condition will no longer be pre-existing after 12 months of continuous coverage.
Pre-existing coverage does not apply to a pregnancy or to newborn or adopted children. The pre-existing limitation can be
reduced by the amount of time you were previously insured if you became insured under this policy within 63 days after
termination of prior coverage.
r.
BENEFIT LIMITATIONS — Coverage is not provided for services, supplies or equipment when a charge is not usually made
in the absence of insurance. No coverage is provided for Toss caused by or resulting from:
1. Injury or sickness arising out of or in the course of employment;
2. War or act of war
3. Expenses which are not ordered by a Physician;
4. Cosmetic surgery. This does not apply to reconstructive surgery due to:
a. trauma, infection, or other disease; or
b. congenital disease or anomaly of a covered dependent newborn or adopted infant; or
c. surgery on a non -diseased breast to restore and achieve symmetry between two
breasts following a mastectomy.
5. Hearing examinations or hearing aids;
6. Vision services and supplies other than for a disease process, radial keratotomy,
keratomileusis or excimerlaser photo refractive keratectomy or similar type procedures
or services;
7. Charges made by a health care provider who is a member of your family or who is living with you;
8. Custodial Care confinement in a Hospital or. Skilled Nursing Facility;
9. Home Health Care Services, unless provided in place of a Hospital confinement.
10. Commission of felony;
11. Manipulations of the musculoskeletal system;
12. Treatment of mental or nervous disorders, alcoholism, or any form of substance abuse;
13. Intentionally self-inflicted injury or suicide attempt;
14. Dental care and treatment, except that required by injury and rendered within 6 months of the injury;
15. Treatment which is experimental or investigational.
16. Any expense incurred after the date the policy terminates.
TERMINATION — When your coverage ends, You or your dependent's coverage will end:
1. when you no longer pay your premium
2. when you or your dependent enters the armed forces,
3. the day you or your dependent is no longer eligible for insurance, or
4. when the policy is terminated by your employer or us.
1.
DEFINITION OF DEPENDENT — Your Dependent is:
1. Your spouse,
2. Your unmarried children under 19 years old, and
3. Your unmarried children who are 19 years old through 25 years old if the child is
attending an accredited school full time and is dependent on you for support.
ACCIDENTAL DEATH — No coverage is provided by death caused by:
1. War or act of war
2. Suicide within 2 years of your effective date,
3. Medical or surgical treatment of sickness of disease, or
4. Flight except as a passenger in a commercial airline
FOOTNOTES
1 This provision or limitation varies by state.
*Membership in the reserves is not deemed entry into the armed forces.
Starbridge offers flexible enrollment options. City of Miami can choose the enrollment method
or methods that best meets the needs and culture of your employees. Options include:
Paper Enrollment Forms
Interactive Voice Response System (IVR)
Enrollment Center
On-Line/Web Enrollment
Our IVR system for telephonic enrollments provides employees a quick and easy enrollment
experience 7 days a week, 24 hours a day. City of Miami's employees have the ability to
speak with a Benefit Specialists during regular business hours.
The Enrollment Center's inbound call center is staffed with, bilingual Benefit Specialists who
can answer your employees' questions and work with them to determine which coverage is
best suited for their individual needs. This additional service takes the burden off your benefit
staff and site managers in answering questions about the plans.
Our Web enrollment process is available to further meet your employees' needs. The Web
enrollment process will provide City of Miami's employees with answers to most of their
benefit questions.
Offering,voluntary benefit programs has been shown to offer many benefits to both the
employer and the employee:
For the employer:
■ Improved Recruitment results
• Improved Retention
• Reduced Absenteeism
• Improve associate's health and, therefore, productivity
• Increased Profits
• Decreased workers' compensation claims
Managers can spend more time concentration on running the business, and Tess time on
recruiting, interviewing, hiring, orienting and training new employees.
For most employees, these plans can provide:
• Opportunities for coverage outside a core medical plan
• Comprehensive emergency care —access to physicians and hospitals, anywhere in
the country.
• Preventive Care
• Prescription Drug coverage
• Easy to understand benefits — clearly defined in advance.
• The value of holding an ID card — provider recognition and guaranteed minimum of
coverage.
■ Peace of Mind
To gain maximum results, we will work with City of Miami to maximize employee participation.
CIGNA HealthCare's Market -leading focus:
The CIGNA Voluntary reinvigorated enrollment focus puts our extensive employee
communications and participation growth experience to work for you. The voluntary industry
has historically focused on open enrollment activities. In order to maximize participation, the
focus must be year -long and must encompass three key initiatives:
Open Enrollment
New Hire Enrollment
Retention of Current Insured Employees
We will work with City of Miami to customize an employee participation strategy based on the
information, functionality, and access to employees and managers you determine.
Open Enrollment (OE)
Managers Campaign/Support
o Communication and resource support to managers via e-mail/voice-mails
Manager conference call sponsored by CIGNA
o Outlines ROI, program, collaterals, timeline, and CIGNA resources
available
DVD/CD Rom for managers for use during OE meetings
o Highlights benefits, programs, and "How to enroll" for employees
Meeting -in -a -box for managers
o Provides enrollment material, suggested agenda, talking points to simplify
manager's role
Postcard reminders to eligible employees
o Plan highlights, costs, enrollment options, OE timeframe
o Follow-up postcards for employees who call E-Center but do not initially enroll
Outbound Calling
o Eligible Employees
Benefit Education
Questions and consultation
Enrollment Capability
o. Managers
Value Proposition
Eligibility requirements and timeline
Procedure for communication and enrollment
Flexible enrollment options
o IVR, web, and benefit counselor supported enrollment
New Hires Strategy
Managers Campaign/Support
o Communication and resource support to managers via e-mail/voice-mails
Periodic manager conference call sponsored by CIGNA
o Outlines program, collaterals, timeline, and CIGNA resources available
New Hire Enrollment Package
o Plan designs, program offerings, costs, enrollment instructions
Personalized outreach to new hire employees
o Postcard reminders to new hire employees
• Plan highlights, costs, enrollment options, OE timeframe
Outbound Calling
o Eligible Employees
• Benefit Education
• Questions and consultation
• Enrollment Capability
o Managers
• Value Proposition
• Eligibility requirements and timeline
• Procedure for communication and enrollment
Flexible enrollment options
o IVR, web, and benefit counselor supported enrollment
Retention
Periodic communications — in conjunction with City of Miami
o Seasonal health/wellness reminders
o Program highlights - 24 hour EAP, Healthy Rewards, discounts for using
network providers
Expected Outcome
Our experience has shown that there is a direct correlation between the frequency of
contacts with employees and managers and the level of enrollment and retention. This is
especially true for a voluntary, limited -benefit program. Our commitment is that based on the
recommended types and frequency of the communications outlined above, we will help City
of Miami increase plan participation — both at open enrollment and throughout the year.
We prepare customized communication materials that are available in English and Spanish.
As part of the enrollment and communication strategy development, we will work with City of
Miami to determine the communication materials that best fits your company's culture. All
standard costs for the printing and bulk distribution of the materials are included in the quoted
premium.
Pre -Enrollment Communications:
Printed materials are tailored for the programs you select. We will create enrollment
materials for your eligible employees which may include:
Enrollment Brochures
Posters
Employee Memos
Post -card Reminders
Manager Memos
Manager Guides
PDFs, which can be posted on your website, are provided and links can also be provided to
direct your employees to the Starbridge Choices website. At this site they can find additional
information to assist them in making the right benefit choices.
Post -Enrollment Communications:
Enrolled employees receive a Getting Started Packet that is geo-coded for each employee.
This packet includes a list of ten CIGNA PPO Network Primary Care Physicians located in
the employees area and directions on how to locate additional providers, as well as a
confirmation of the benefits in which they enrolled, their ID Cards, EAP information, Healthy
Rewards information and directions on how to create and access their Starbridge account on-
line.
A second mailing to the insured employees will include their Summary Plan Description
Booklet.
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The Starbridge Choices site provides both an HR Portal and an Insured Employee Portal.
This tool can be of great help for City of Miami's field managers and human resources
personnel as well as employees.
Highlights of the HR Portal include:
= Access to Eligibility Information
• Access to Plan Information
• FAQ's
• Supply order information
• Contact Information
The Insured Employee Portal provides:
Enrollment Capability
▪ Plan Status
▪ Plan Outline
• Provider Search
Access to Health Information Library
• Access to Claims Status
• Ability to Download Temporary ID Cards or Claim Forms
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The Claims and Customer Service Departments handle only Starbridge products. This
differentiates us from most other limited -benefit plans.
We adhere to a Claims Administration Standard of all claims being processed within 10
business days of receipt.
Claims Highlights:
68 Member team
Average Industry Experience
Managers/Supervisors —19 years
Claims Analysts 14 years
Average Tenure with CIGNA Voluntary
Managers/Supervisors — 6 years
Claims Analysts — 5 years
2006 Processed Claims/Correspondence — Over 1.5 million
99% audited accuracy
Customer Service Highlights:
85 Customer Service Representatives including Spanish speaking agents
15 to 1 Employee to Supervisor ratio
70% of all calls answered in 30 seconds or Tess measured monthly
3% or less abandoned call rate measured monthly
Witness Learning System Software used to capture client transactions for training
and evaluation purposes. Additionally, Power Que is an issue management
system used to track all aspect of member/provider interactions.
The implementation team will work with your IT, Payroll and Human Resources Department
(or vendor) to determine the enrollment and reporting processes that best meet your needs.
We have the ability to accept various file formats to ease our client's administration. Data is
transmitted via a secure site to CIGNA.
Billing:
Employers follow the "self -bill" approach eliminating cumbersome list bills. Under our self -bill
approach City of Miami would submit to CIGNA only the amounts that were deducted during
the previous payroll cycle. City of Miahii is not required to pay or have liability for any
premiums they are unable to collect.
An employee's coverage will not be terminated for a "missed deduction." CIGNA will work
with City of Miami to determine the business rules for terminations.
COBRA & HIPAA:
CIGNA 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. The Starbridge plans are subject to HIPAA and
do accept and issue Certificates of Credible Coverage.
Client Service Unit:
CIGNA 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.
• Verification Letter from State of Florida
• CIGNA Quarterly Statistical Supplement
CIGNA HealthCare Limited -Benefit Plans - ROI
Sample Communication Materials
• Sample Poster
• Manager's Guide
• Sample Enrollment Brochure
• Getting Started
• Sample ID Cards
• Personalized Postcards
Member Benefit Portal
File Requirements
GEO Access Report