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24620
AGREEMENT INFORMATION AGREEMENT NUMBER 24620 NAME/TYPE OF AGREEMENT CIGNA HEALTH & LIFE INSURANCE COMPANY DESCRIPTION AMENDMENT NO. 2 TO PROFESSIONAL SERVICES AGREEMENT/USE OF ON -SITE VIRTUAL CLINIC BY ALL CITY EMPLOYEES REGARDLESS OF THEIR ENROLLMENT/FILE ID: 13-01078/R-13-0460/MATTER I D : 23-1967 EFFECTIVE DATE October 6, 2023 ATTESTED BY TODD B. HANNON ATTESTED DATE 10/6/2023 DATE RECEIVED FROM ISSUING DEPT. 10/10/2023 NOTE DOCUSIGN AGREEMENT BY EMAIL CITY OF MIAMI DOCUMENT ROUTING FORM Department of Procurement ORIGINATING DEPARTMENT: DEPT. CONTACT PERSON: Aimee Gandarilla EXT. 1906 NAME OF OTHER CONTRACTUAL PARTY/ENTITY: CIGNA IS THIS AGREEMENT A RESULT OF A COMPETITIVE PROCUREMENT PROCESS? I TOTAL CONTRACT AMOUNT: $ FUNDING INVOLVED? r TYPE OF AGREEMENT: ❑ MANAGEMENT AGREEMENT ■❑ PROFESSIONAL SERVICES AGREEMENT ❑ GRANT AGREEMENT ❑ EXPERT CONSULTANT AGREEMENT ❑ LICENSE AGREEMENT OTHER: (PLEASE SPECIFY) YES NO ES ❑ NO ❑ PUBLIC WORKS AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ INTER -LOCAL AGREEMENT ❑ LEASE AGREEMENT ❑ PURCHASE OR SALE AGREEMENT PURPOSE OF ITEM (BRIEF SUMMARY): Amendment No. 2 to the PSA for Group Benefit Health Plan, RFP 369325. COMMISSION APPROVAL DATE: 1/1/14 FILE ID: ENACTMENT NO.:13-0460 IF THIS DOES NOT REQUIRE COMMISSION APPROVAL, PLEASE EXPLAIN: ROUTING INFORMATION Date PLEASE PRINT AND SIGN DIRECTOR OF PROCUREMENT/CHIEF PROCUREMENT OFFICERDoc.9netl September 27, Annie Pereez PPQ 2023 107:� :2 EDT by � SIGNATURE: 4^ 2 `-D9516E&F3EhEA6f3... RISK MANAGEMENT September 27, Ann-Mariee Shaarpp 2023 I 07:08:'3 eYEDT 5 g etl by. SIGNATURE: Fri ��� �2]995G5J, 0214E] _ CITY ATTORNEY matter 23-1967 October 3, 2023 Victoria Mendez I 12:49:36 F,D-oc.i,.by: SIGNATURE: 7a ASSISTANT CITY MANAGER, CHIEF FINANCIAL OFFICER October 4, 2023 Larry Spring, CPA T I 12:14:25 EDTsi9 etl by: SIGNATURE: SP'" ASSISTANT CITY MANAGER, CHIEF OF OPERATIONS Natasha Colebrook -Williams SIGNATURE: DEPUTY CITY MANAGER Nzeribe Ihekwaba, Ph.D., PE SIGNATURE: CITY MANAGER October 6, 2023 Arthur Noriega V I 10:04:55 ,EDT ignetlby: SIGNATURE: Q Nov;, CITY CLERK October 6, 2023 see56e5,2 DA2, Todd Hannon I 20:47:47 EDT.ed y: SIGNATURE: CE46D]560,51 59 PLEASE ATTACH THIS ROUTING FORM TO ALL DOCUMENTS THAT REQUIRE EXECUTION BY THE CITY MANAGER IAFI I{�1AAT 11 I City of Miami Office of the City Attorney Legal Services Request To: Office of the City Attorney From: Charles Johnson Contact Person Sr. Procurement Contracting Officer Title 9/26/2023 Date: Procurement Requesting Client (305) 416-1924 Telephone Legal Service Requested: Matter 23-1967: Amendment No. 2 to the PSA for Group Benefit Health Plan, RFP 369325. Complete form and forward to the Office of the City Attorney or e-mail to Legal Services. Do not assume that the Office of the City Attorney knows the background of the question and/or issue, such as opinions on the same or similar issues, the existence of relevant memos, correspondence, etc. Please attach to this form and/or e-mail all pertinent information relating to the subject. Once your request has been assigned, an e-mail will be sent to you with the Assigned Attorney's name and the issued matter identification number. All attorneys in the Office of the City Attorney shall fully comply with the Rules Regulating the Florida Bar. For Legal Services requesting an opinion from the Office of the City Attorney: nlssue opinion in writing. Publish opinion after issuance. Authorized by: Annie Perez Date response requested by: BELOW PORTION TO BE COMPLETED BY THE OFFICE OF THE CITY ATTORNEY Assigned Attorney: Date: File No. Approved by: Ultimate Client: Comments: D / R Date: Copy returned to Requesting Client Type: Matrix: Category: Copy to Ultimate Client rev. 04/14/2017 PROFESSIONAL SERVICES AGREEMENT OVERVIEW PSA TITLE: RFP 369325, Group Benefit Health Plan - Amendment No. 2 1. AWARD DELEGATED AUTHORITY: ❑ Chief Procurement Officer — Authority level of $ ❑ City Manager — Authority level of $ 8 City Commission — RESOLUTION No. 13-0460 2. PROCUREMENT METHOD: E RFP/RFQ ❑ IFB ❑ SOLE SOURCE ❑ PIGGY -BACK ❑ PROFESSIONAL SERVICES UNDER $25,000 ❑ OTHER (Please explain): 3. WHAT IS THE SCOPE OF SERVICES? Amendment 2 to amend the Agreement to allow for the use of the on -site virtual clinic by all City employees regardless of their enrollment in the City's Group Benefit Health Plan. 4. IF CITYWIDE, WHAT ARE THE MOST FREQUENT USER DEPARTMENTS? Risk Management 5. IS THE AWARDEE THE INCUMBENT? N/A - Amendment 6. IS THE PRICING HIGHER, LOWER OR THE SAME AS THE CURRENT CONTRACT? The same 7. WHEN DOES THE CURRENT CONTRACT EXPIRE? 12/31/2024 8. WHAT WAS THE PREVIOUS SPEND ON THE CURRENT CONTRACT? Unknown - Employee benefit partially paid by employee premiums 9. WHAT IS THE METHOD OF AWARD (Group, Item by Item etc.)? N/A - Amendment CITY OF MIAMI AMENDMENT NO. 2 TO THE PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI AND CIGNA HEALTH AND LIFE INSURANCE COMPANY This Amendment No. 2 to the Professional Services Agreement dated January 1, 2014 ("Agreement"), by and between the City of Miami, a municipal corporation of the State of Florida ("City"), located at 444 S.W. 2nd Avenue, Miami, Florida 33130 and Cigna Health and Life Insurance Company, a foreign profit corporation authorized to conduct business in the State of Florida ("CIGNA"), or ("CHLIC"), located at 900 Cottage Grove Road, Bloomfield, CT, 06002, is entered into this 6th day of October 2023. RECITALS WHEREAS, on January 1, 2014, the City entered into an Agreement with CIGNA ("Agreement") for the provision of administrative services to the City's Group Benefit Health Plan ("Services""), pursuant to Request for Proposals No. 369325 and authorized by Resolution No. 13-0460; and WHEREAS, Pursuant to Amendment 1 to Agreement, executed on May 25, 2021, the City amended the above -mentioned Agreement to include the administration of an on -site virtual health clinic WHEREAS, the City wishes to amend the above -mentioned Agreement to allow for the use of the on -site virtual clinic by all City employees regardless of their enrollment in the City's Group Benefit Health Plan; NOW THEREFORE, for the considerations hereinafter as set forth, the Agreement is hereby amended as follows: 1. Exhibit B to the Agreement, titled "Administrative Services Only Agreement", Schedule of Financial Changes is hereby deleted in its entirety and replaced with Amended Schedule of Financial Changes, effective January 1, 2021, attached as Exhibit A to this Amendment: 2. Section 16 of the Agreement, titled Nondiscrimination, has been deleted in its entirety and replaced with the following language: The Provider represents and warrants to the City that Provider does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with Provider's performance under this Agreement on account of race, color, gender, religion, age, disability, sexual orientation, marital status, or national origin. Provider further covenants that no otherwise qualified individual shall, solely by reason of their race, color, gender, religion, age, disability, sexual orientation, marital status, or national origin, be excluded from participation in, be denied services, or be subject to discrimination under any provision of this Agreement. 3. Section 32 of the Agreement, titled E-Verify Employment Verification, has been added with the following language: Provider shall E-Verify the employment status of all employees and subconsultants to the extent required by federal, state and local laws, rules and regulations. The City shall consider the employment by Provider of unauthorized aliens a violation of Section 247A(e) of the Immigration and Nationality Act. If the Provider knowingly employs unauthorized aliens, such violation shall be cause for termination of the Agreement. Furthermore, Provider agrees to utilize the U.S. Agency of Homeland Security's E-Verify System (https://e-verify.uscis.gov/emp), to verify the employment eligibility of all employees during the term of this Agreement. The Provider shall also utilize the E-Verify System to verify the employment eligibility of all employees of any subconsultants during the term of this Agreement. 4. Counterparts, Electronic Signatures: This Agreement may be executed in counterparts, each of which shall be an original as against either Party whose signature appears thereon, but all of which taken together shall constitute but one and the same instrument. An executed facsimile or electronic scanned copy of this Agreement shall have the same force and effect as an original. The parties shall be entitled to sign and transmit an electronic signature on this Agreement (whether by facsimile, PDF or other email transmission), which signature shall be binding on the party whose name is contained therein. Any party providing an electronic signature agrees to promptly execute and deliver to the other parties an original signed Agreement upon request. All other terms, covenants and conditions of the original Agreement issued thereto shall remain in full force and effect, except to the extent herein amended. IN WITNESS WHEREOF, the parties have executed this Amendment to the Agreement. ATTEST: By: "CIGNA" Cigna Health and Life Insurance Company a Connecticut profit corporation ,eeC cluZ�?GN By: Print Name: Deborah Coolidge, CPA Print Name: Aimee E. Burnham Title: Finance Officer 09/19/2023 01:29 PM CDT Title: Contractual Operations Manager (Corporate Seal) (Authorized Corporate Officer) ATTEST: DocuSigned by: By: `Enso,ssooc Todd B. Hannon, City CIrk Arthur Noriega V, City Manager DocuSigned by: "City" CITY OF MIAMI, a Florida municipal corporation DocuSugn. by By: rrfla,ur Nolriu�a LSbCFBE9?46CMiA APPROVED AS TO LEGAL FORM APPROVED AS TO INSURANCE AND CORRECTNESS: Ignetl by: F, EF9gAF6FEgA5].. DS Pr Victoria Mendez (Matter 23-1967) City Attorney REQUIREMENTS: "—Dee/Signed by: Fro& 6awvy n-rrat,ralln Ann -Marie Sharpe Risk Management Director State of TEXAS County of TRAVIS This instrument was acknowledged before me on the 19th day of September, 2023 by Aimee E. Burnham, Contractual Operations Manager of CIGNA Health and Life Insurance Company, a Connecticut profit corporation, on behalf of said corporation. 09/19/2023 Jeruufer B Xoyers s,,, 01:31 PM CDT Jennifer B. Rogers Notary Public State of Texas (Seal) ,,. JENNIFER S, ROGERS Nolary Publlo, State of Texas os Notary Ill# 124513507 ' Mycommission Tres Z,4tl„$s" MARCH 28, 2027 Online Notary Public. This notarial act involved the use of online audio/video communication technology. Notarization facilitated by SIGNIX® EXHIBIT A Client Name: City of Miami Administrative Services Only Agreement Schedule of Financial Charges Certain fees and charges identified in this Schedule of Financial Charges will be billed to Employer monthly in accordance with CBLIC's then standard billing practices. However, CHI..IC is authorized to pay all fees and charges from the Bank Account unless otherwise specified in this Agreement. Medical Medical Vision Medical Medical Description Network Point of Service Open Access (POSOA) with PHS Plus Medical Management (All Plans Comprehensive with PHS Medical Management (AU Plans Network POSOA Access Fee (All Plans Comprehensive Care Coordination Fee (All Plans) Dependent Care Flexible Spending Account (DI' SA) Administration Charge $16.73/employee/month $17.06/employee/month S0.35/employee/month Charge $19.53/employee/month $5. 73/employee/month l+br tit SA Products: $5.90/employee/month Health Care Flexible Spending Account (FSA) Administration For FSA Products: $5.90/employee/month 09/19/2023 3 Client Name: City of Miami Administrative Services Only Agreement Amounts paid by CHLIC with its own funds on behalf of Employer or the Plan with respect to charges for which Employer or the Plan is obligated to pay under this Agreement including Plan Benefits, Bank Account Payments (including fixed per person payments and pay -for -performance payments to Participating Providers), governmental taxes or assessments will be billed to Employer and CHLIC is authorized to pay all such amounts from the Bank Account. b. F' ' =_.. K. s `_ srfi!g" ^ r?~✓ 36VPa y ''^. • A vc't 't'� ' ; ¢wkl;, ,L`I' 9Ci:A "s °..s, 4 a -. '' '-' '" ' +�a : 'S :;�w '. ? �•63«." s.='LP y uV. Cigna Pharmacy Product Administration. Fee, only if applicable, is separate from the Medical Administration Charge shown above, but included on same billing line as the Medical Administration Charge for billing purposes only. S FQR:D GS`COVERED DER E E.,PLAN'S P .BE.:, 1 . w ,�� arantee'tiie CoveredDgD�spen :gn amenP,armscy o 0 ors eyed igna'-..HOrl1E:, . lives;{ r 42 'r e i ti e Brand Drug Claims: For all Cigna Home De ivery Pharmacy Brand Drug aims, t e Emp oyer s guarantee annual average discount will be AWP minus 25.00%. Generic Drug Claims: For all Cigna Home Delivery Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 82.00%. Dispensing Fees for Drug Claims: For all Cigna Home Delivery Pharmacy Brand Drug Claims and Generic Drug Claims the Employer's guaranteed annual average Dispensing Fee will be $0.00. 11' b� �o�d ,.. �1�AVW7RiA© y;�.VW 'a14��� V�' �tS��Ll-�.. eSRrEI �., TIC �� R y.�" :.E, V- W�a,' .,y. .: rrrs ..%- sf 'w'v;, S wseir 4Y 'ie`•. '�T' '�. `� % ''�. ^T!"' f'tiv°t i41 ei° +r :. 'Q. ,.. q %, /Y.� '�1® y % � .: 5 4 y,; Y Sfl`3 +'' , ^ ;, �� h t; {. a . �.�.` 4. , a p ..e.• �^' '+h .., _ � �� S��'�� ��iiI 1711 PyiS�'1 I=; 1 �fY- Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 18.50%. Generic Drug Claims: For all Retail Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 79.50%. 1 Dispensing Fees for Both Brand Drue: Claims and Generic Dru2 Claims: For all Retail Phannacv Brand Drug Claims and Generic Dru 09/19/2023 4 CJient Name: City of Miami Administrative Services Only Agreement Claims, the Employer's guaranteed annual average Dispensing Fee will be $0.95. _.. i „ * s u Plies: CHLI,. ill'guarantee the following charges for Covered x. Covered- Drug���33isgensed' ;by Retail Pharmacies in `9{}-dam in�p � g g D�ctg�s= dispensed by Retail Pha ,aeies in 90-day supplies, subject to the provisions in the section titled "PBM Pricing - Additional Provisions": _**A 90-day supply means any Covered Drug dispensed, by a Retail Pharmacy in an a n iit equal to or greater than an 83-daysupply. -. ::., , Brand Drug Claims: For all Retail Pharmacy Brand Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 25.00%. Generic Drug Claims: For all Retail Pharmacy Generic Drug Claims, the Employer's guaranteed annual average discount will be AWP minus 82.00%. Dispensing Fees for Both Brand Drug Claims and Generic Drug Claims: For all Retail Pharmacy Brand Drug Claims and Generic Drug Claims, the Employer's guaranteed annual average Dispensing Fee will be $0.00. a,.� pi is'.'"� , l' fW j''. I'}i � (.l.L,::�36.: r4 ,2 it ' . r •S.w A s,;.r 4'- / a` CHUC shall guarantee an aggregate annual average discount of AWP minus 17.75% for covered Specialty Drug prescriptions dispensed by Retail Pbannacies and Cigna Home Delivery Pharmacy. CHLIC's performance will be measured based on analysis of Plan -specific utilization for the contract year. lut ui \TI TStI II\ I.ri Ktth2IN IUL\ I IUIN I{ tst.IV.I_It.FF H htIVItINIUrm,IV T(. if its( T/T C{TIi\: ( 414 ; (q J T(:::T% Pricing Guarantee Calculation. The following calculation will be performed on an aggregated basis for all paid Claims for Covered Drugs processed during the applicable contract year in order to reconcile against the average annual ingredient cost discount guarantees set forth above: 1- [(the total ingredient cost charged to the Employer prior to application ofthe Plan's Member cost -share requirements)/ (the total AWP) for all Covered Drugs] For the purposes of the pricing guarantee calculation, and notwithstanding anything herein to the contrary, the total ingredient cost shall also include the ingredient cost for a Covered Drug for which a Member pays 100% in the form of cost -share. The application of brand and generic pricing may be subject to certain "dispensed as written" ("DAW") protocols and Employer defined plan design and coverage policies for adjudication and Member Copayment purposes. For example, DAW 5 (House Generic) claims will be considered a Generic Drug claim for pricing purposes. Pricine: Guarantee Exclusions. The following_Claims or products shall be excluded from the calculation of an y pricing guarantee set forth in this 09/19/2023 5 Client Name: City of Miami Administrative Services Only Agreement Agreement: - Specialty Drugs, unless otherwise noted in this Schedule of Financial Charges. - Workers' Compensation Claims. - Non-standard facility Claims (Indian Tribal, Veterans Administration, or Dep. of Defense facilities). - Limited Distribution Drugs and Exclusive Distribution Drugs. - Subrogation Claims - Repackaged products. - Products filled through Pharmacies not participating in the network accessed by Employer under this Agreement (including a contracted pharmacy that does not participate in a sub -network or preferred network tier). - Over-the-counter (OTC) products. - Secondary Payer Claims. - Direct Member Reimbursement Claims. - Compound Drugs. - Claim reversals. - Products identified as prescriptions covered under the federal 340B drug pricing program. - Claims for Covered Drugs paid at the Retail Pharmacy's U&C Charge shall be included in the calculation of any Retail Pharmacy pricing guarantee set forth in this Agreement. Provided, however, that Claims for Covered Drugs at a U&C Charge shall not be included in the calculation of any Dispensing Fee guarantee, as no separate Dispensing Fee is charged for such Claims. ,'. ;;7,'.t ; 02 -::8-1 .i :g:sz:. 1 gaN:elt1+ wib ffitOEESEl'S:}Q jl:N(m G1.1J. ij ht: M15k i i4'k zj)h0A¥#1 CHLIC will report on the guaranteed amounts within one -hundred eighty (180) days following the end of each contract year. Upon reconciliation, CII1JC's performance with respect to each ingredient cost discount or Dispensing Fee guarantee offered under this Agreement will be individually measured and then reconciled in the aggregate across all ingredient cost discount or Dispensing Fee guarantees. PB 'PRK NG - ADDITIONAL PROVISIONS f : The amount paid by CHUC to the Retail Pharmacy for Claims for Covered Drugs may or may not be equal to the amount charged to Employer and/or Member, and CHUC will absorb or retain any difference. For a specific Claim for a Covered Drug dispensed by a Retail Phannacy or Cigna Home Delivery Pharmacy, and after application of any Plan cost -share requirements, CHUC shall charge the Employer the lowest of the following amounts: (I) The Prescription Drug Charge; or 09/19/2023 6 Client Name: City of Miami Administrative Services Only Agreement • (2) The pharmacy's submitted U&C Charge, if any. For a specific Claim for a Covered Drug dispensed by a Retail Pharmacy or Cigna Home Delivery Pharmacy, CHUC shall charge the Member in accordance with the terms of the Pharmacy Benefit. For example, for a Covered Drug subject to a fixed dollar copayment requirement, CHLIC shall charge the Member the lowest of the following amounts: (1) The fixed dollar copayment for the Covered Drug, if any; (2) The Prescription Drug Charge; and (3) The phannacy's submitted U&C Charge, if any. • Home Delivery Pharmacy Dispensing Fees and Dispensing Fee Guarantees are inclusive of shipping and handling. If carrier rates (i.e., U.S. mail and/or applicable commercial courier services) increase during the term of this Agreement, the Home Delivery Pharmacy Dispensing Fee and Home Delivery Pharmacy Dispensing Fee Guarantee will be increased to reflect such increase(s). • Unless specifically noted herein, the discounts to Employer for Covered Drugs set forth in this Agreement are not guaranteed to result in an average aggregate discount off the aggregate AWP of all such Covered Drugs. • Any pricing guarantees, including any ingredient cost discount or Dispensing Fee guarantee, set forth in this Agreement shall be rendered null and void in the event Employer terminates CHLICs administration of the Pharmacy Benefit prior to completion of the then -current Plan Year. CHLIC's fees, Rebates (if any), discounts or guarantees (if any) are, among other conditions communicated in this Agreement or otherwise in writing to Employer, contingent on, and assume, adoption by Employer of a specific Fonnulaiy, Retail Phannacy network, and Plan design features (e.g. cost -share structure, utilization/cost management programs). • Notwithstanding any other provision of this Agreement. CHUC may, effective upon written notice to Employer, adjust any or all of the fees, Rebates (if any), discounts or guarantees (if any) in this Agreement to the extent reasonably necessary to preserve the economic value of this Agreement to CHUC as it existed immediately prior to any of the following events or changes: (a) there are any significant changes in the composition of the CHLIC pharmacy network utilized by Employer hereunder or in such pharmacy network's contract compensation rates, or the structure of the pharmacy stores/chains/vendors that are contracted with CHUC, including but not limited to disruption in the retail pharmacy delivery model, or bankruptcy of a chain pharmacy; or there is a change in or to the phannacy network reflected in the pharmacy pricing summary; or (b) there is a change in government laws or regulations which has a significant impact on pharmacy claim costs; or (c) any material manufacturer -rebate contracts with, or for the benefit of, CHUC are tenilinated or modified in whole or in part; or (d) there is any legal action or law that materially affects or could materially affect the manner in which CHLIC's rebate program.is 09/19/2023 7 Client Name: City of Miami Administrative Services Only Agreement administered or an existing law is interpreted so as to materially affect or potentially have a material effect, on CHLIC's administration of the Plan; (e) a major change in market conditions affecting the pharmaceutical or pharmacy benefit management market, a drug shortage in the market, an issue involving the safety of the drug supply, an unexpected introduction of a new drug (e.g. authorized generic), or similar market event occurs; (f) the Phannacy Benefit enrollment decreases by equal to or greater than 15% from the enrollment on which CHLIC's financial offer is based; or (g) there is material change in the Plan that is initiated by Employer (and which CHUC agrees to administer) such as a change in Formulary selection or pharmacy network, or Employer fails to disclose a material feature of the Plan or the Plan's Pharmacy Benefit r"RU &i %t f -iifJt¥st Subject to the caveats below, CHLIC will remit to Employer the following portion of Rebates and Manufacturer Administrative Fees that C111.,IC collects with respect to utilization of Covered Drugs under the Plan's Pharmacy Benefit: For All Products: The greater of: 100.00% of Rebates and Manufacturer Administrative Fees on such utilization dispensed in the full calendar year immediately preceding CHLIC's remittance, or the sum of $208.67 multiplied by the number of Retail Phannacy Brand Claims dispensed in 30-day* supplies plus $513.93 multiplied by the number of Retail Pharmacy Brand Claims dispensed in 90-day** supplies plus $1,416.98 multiplied by the number of Cigna Horne Delivery Pharmacy Brand Claims processed in such full calendar year. Caveats: (1) Upon termination of this Agreement, CHI.IC may use Rebates otherwise payable to Employer to offset payable Bank Account Payments or other payable fees or charges identified in this Agreement. CHUC may also use Rebate attributable to claims for which CHLIC has the financial responsibility under any applicable stop loss policy issued to Employer for purposes of paying or offsetting any stop loss reimbursement payments owed by CHLIC or its affiliates to Employer or otherwise to reconcile stop loss reimbursements. Should Employer terminate this Agreement before completion of the then -current Plan Year, no Rebates shall be due with respect to that Plan Year, and any Rebate minimum or fixed dollar guarantees shall be null and void, as payments of Rebates is conditioned on CHLIC exclusively ad.ministering the Pharmacy Benefits for the entire Plan Year. For percentage -based sharing arrangements, payout amount may differ slightly from the stated percentage when payout occurs before manufacturers' final reconciliations and payments are made to CHI.IC. For the purposes of clarity, C111.,IC shall reconcile its performance with respect to any Rebate payment guarantees. includin g. without limitation. an_ymiQirnum or fixed dollar guarantees! in the aggregate. 09/19/2023 8 Client Name: City of Miami Administrative Services Only Agreement Moreover, any amount directly or indirectly provided by a manufacturer or other third party that is allocated to reduce and/or wholly or partially satisfy a Member's cost -sharing obligation for a Covered Drug shall not be considered a "Rebate" for the purposes of Rebate payments to Employer but may be included when reconciling CHLIC's performance against any Rebate minimum guarantee set forth in this Agreement. (4) For percentage -based sharing arrangements, the percentage share payment of Rebates shall not include the payment of any Rebates received, if any, for Run -Out Claims, 340b Claims, Medical Specialty Claims, Direct Member Reimbursement Claims, Reversed Claims, and Compound Claims. (5) CID.JC or its agent contracts with drug manufacturers on CHLIC's own behalf, and not as agent of the Employer or the Plan. (6) The Rebate payment commitments, including any minimum or fixed dollar guarantees, if any, set forth in this Schedule of Financial Charges are, among any other conditions communicated in this Agreement or otherwise in writing to Employer, contingent on the availability of Rebates to CHLIC and Employer's Pharmacy Benefit applying a 90-day supply limit for Specialty Drugs. and standard days' supply limits. In the event that Employer has adopted, or adopts, a 30-day supply limit for Specialty Drugs, or participates in the Clinical Day Supply Program, CHLIC may revise on an equitable basis the stated Rebate minimum or fixed dollar guarantees, if any, to the extent necessary to reflect CHLIC's revised estimate of Rebates it may collect on a plan design having adopted a days' supply limit for Specialty Drug of less than 90 days or the Clinical Day Supply Program. Timing of Rebate Pay -Out: Remittance will be provided within ninety {90) days after the close of each applicable calendar quarter for the portion of such calendar quarter that coincides with the Plan Year. ,...tr.%` j ffi'. PA Lt1.SION$i;;f i \ t ( it t:.: Jt -4. tl;1-11 1 I1 "/o. The Rebate Guarantee payment obligations set forth in this Schedule of Financial Charges shall exclude the following types of claims and/or products: Claims paid pursuant to a Dispense as Written (DAW) S code. Direct Member Reimbursement Claims. Repackaged products. Pharmaceutical supplies. Biosimilar Claims. Multi -source Brand Drugs. Limited Distribution Drugs and Exclusive Distribution Drugs. Vaccines. Compound Drugs. Claim reversals. 09/19/2023 9 Client Name: City of Miami Administrative Services Only Agreement Products identified as prescriptions covered under the federal 340B ensuring that any pharmacy affiliated with or operated by Employer 340B prescriptions on Claim transactions administered by CHLIC. Claim transactions submitted to CHLIC, then CHUC may withhold otherwise attributable to utilization at such pharmacy. Run -Out Claims. Rebate guarantee reconciliation calculations will not include member -submitted drug pricing program. Employer shall be or its affiliate, such as an in-house pharmacy, If such pharmacy fails to systematically identify all Rebates, or modify any minimum or fixed solely responsible for systematically identifies 340B prescriptions on dollar Rebate guarantee, coupon copay assistance. " Yi .w-' r;'°F'+5".a # o11 1 C - 0:y f. it Notwithstanding anything to the contrary vaccines by CHUC under the Cigna Vaccine Claims will adjudicate at the in this Agreement or otherwise, Pharmacy Program. lower of the U&C Charge or the amounts retail price charged by an in -network in a cash transaction on the date the vaccine a Covered Drug which is a vaccine. Claim when the Vaccine Clah"11 the following terms and conditions shall apply to the administration of shown in the Vaccine Pricing Schedule below. For Vaccine participating retail pharmacy for the particular vaccine, including is dispensed as reported to CHLIC by the in -network participating "Pass Through Pricing" means the actual ingredient cost and dispensing is adjudicated by an in -network participating pharmacy, as set forth in Vaccine Claim. Notwithstanding anything to the contrary in this measurement, and payment of any and all fmancial guarantees, and dispensing fee guarantees set forth in this Agreement. Claims, the U&C Charge shall be the administration and dispensing fees, pharmacy "Vaccine Claim" means a claim for fee amount paid by CHLIC for the Vaccine the specific in -network participating Agreement or otherwise, all Vaccine guarantees, including but not limited pharmacy remittances related to the Claims shall be excluded from the calculation, to rebate guarantees, ingredient cost Vaccine Pricing Schedule Retail Pharmacy INFLUENZA Retail Pharmacy Member Submitted Vaccine Claims ALL OTHER VACCINES Vaccine Administration Fee Pass -Through Pricing (Capped at $15 per in -network Vaccine Claim) Pass -Through Pricing (capped at $20 per in -network Vaccine Claim) Submitted amount 09/19/2023 10 Client Name: City of Miami Administrative Services Only Agreement Ingredient Cost Retail Pharmacy Ingredient Cost Retail Pharmacy Ingredient Cost as set forth in this Agreement Submitted amount as set forth in this Agreement Dispensing Fee Retail Pharmacy Dispensing Fee as set forth in this Agreement Retail Phannacy Dispensing Fee as set forth in this Agreement Submitted amount _ t -. r�s m 0 i rk4 vi..e ice. tt . 4'> '...J'::Prod ro tic ..il��4.5"�.N.amt Ch4ry, 3�_'. Cigna Home Delivery Pharmacy (a CI:11.,IC affiliated company(ies)) Specialty drugs dispensed by Cigna Home Delivery Plan's medical benefit. "Cigna Home Delivery Phannacy" means a duly its affiliates, where prescriptions are filled and delivered Delivery Pharmacy may maintain product purchase service arrangements with phannaceutical manufacturers Home Delivery Pharmacy contract for these arrangements its pharmacy operations. These arrangements relate Agreement and other pharmacy benefit management without regard to whether a specific drug is on one entities like Employer that sponsor group health payments received by Cigna Home Delivezy Pharmacy or other C!Iarges paid to CHLIC in connection with This provision shall survive ennmexpiration Pharmacy and administered under the licensed pharmacy operated by CHLIC or via the mail service. Cigna Home The drug's charge under a national specialty drug discount schedule that generates a 19.00% annual average aggregate discount off AWP across specialty drug claims dispensed at discount arrangements and/or fee -for- and wholesale distributors. Cigna on its own account in support of to services provided outside of this arrangements and may be entered into of the formularies that CID.JC offers to plans. Discounts and fee -for -service are not part of the administrative fees CHLIC's services hereunder. of the Areement. g� Cigna Home Delivery Pharmacy to CHLIC's self -funded and insured group -client book of business. :.� �a { rt �'' '} ���,.,. ; �.:1 . _ g,<f:�7-74 _ Network POSOA, Comprehensive and Vision Run -Out Period of twelve (12) months No Additional Cost Pharmacy. Run -Out Period of three (3) months for all pharinac claims No Additional Cost a �''- '"ty-V4� .74t-'�' .,, 1.fi s 50 11: ' l ii r KVsL V:" k'r n2,1T�. -4 E ; �;N. 'R 54. z, a k �� 7:+� CHLIC administers the programs listed below to contain costs with respect to charges for health care service/supplies that are covered by the Plan 09/19/2023 11 Client Name: City of Miami Administrative Services Only Agreement (the "Cost -Containment Programs"),In administering these Cost -Containment Programs, CHUC may contract with vendors to perform various Cost -Containment Program related services. CHLIC's charge for administering a Cost -Containment Program is the percentage indicated in the table below of the: 1) "gross savings" (i.e., the difference between the charge the provider made and the allowable amount resulting from the Cost -Containment Program); 2) 'net savings" (i.e., the gross savings less the applicable vendor charge); or 3) "gross recovery" (i.e., the amount recovered as a result of the Cost -Containment Program) as applicable. CII1,IC will make a per claim charge to the Bank Account that includes both CHLIC's applicable Cost Containment Program charge, as shown in the table below, and the applicable vendor charge. CHUC will pay the vendor its charge. For charges for covered services received from a non -Participating Provider (including emergency/urgent care services that are covered at the in - network benefit level), CHLIC may apply discounts available under agreements with third parties or through negotiation of the non -Participating Provider's charges whether on a claim -by -claim basis or in advance of services being rendered. The programs for obtaining these discounts are identified in Section A of the table below as Non -Participating Provider Cost -Containment Programs. Applying these discounts may result in higher payments than if the maximum reimbursable charge is applied. Whereas application of the maximum reimbursable charge may result in the patient being balance billed for the entire unreimbursed amount, applying these discounts avoids balance billing and may substantially reduce the patient's out-of-pocket cost CHLIC's per claim charge for administering the Non -Participating Provider Cost -Containment Programs in Section A of the table below plus any per claim vendor charges associated with the Non -Participating Provider Cost -Containment Programs in Section A of the table shall not exceed $30,000.00 per claim. Vendor charges for the Non -Participating Provider Cost -Containment Programs in Section A of the table generally range from 7-11% of gross savings. Specific rates charged by vendors for the programs in Section A of the table are available upon request, subject to execution of a mutually agreed upon non -disclosure agreement to protect the proprietary vendor information from unauthorized use/disclosure. If no discount is available or negotiated, reimbursement will be based upon: (i) If charges are not subject to CHLIC's benefit enhancement policy - the plan's maximum reimbursable charge (in which c e the patient may be balance billed by the provider if the provider's charge exceeds the plan's maximwn reimbursable charge); or 09/19/2023 12 Client Name: City of Miami Administrative Services Only Agreement (ii) If charges are subject a. the amount (the 80th or federal, balance billed b. the provider's The administration of to CHLIC's benefit enhancement policy -depending upon the Employer's election: of provider's billed charge not exceeding the greater of a CHLIC determined percentage of the Medicare allowable amount percentile of the reasonable and customary charge if there is no Medicare allowable charge) or the amount required by state law (in the case of emergency room services) for charges subject to CHLIC's benefit enhancement policy (patient may be by the provider if the provider's charge exceeds such amount), or billed charge. charges for covered services from non -Participating Providers described above is consistent with the claim administration to CHLIC's own health care insurance business where applicable. practices with respect A. Non -Participating Provider Cost -Containment Programs 1. Network Savings Program 29% of net savines 2. Supplemental Network 29% of net savines 3 , Medical Bill Review -(Pre-payment Cost Containment for Non -contracted claims): Inpatient Hospital Bill Review • Professional Fee Negotiation 29% of net savings • Line Item Analysis Re -pricing 29% of net savings Outpatient Hospital Bill Review • Professional Fee Negotiation 29% of net savings • Line Item Analysis Re -pricing 29% of net savings Physician/Professional Bill Review • Professional Fee Negotiation 29% of net savings • Line Item Analysis Re -pricing 29% of net savings B. Other Cost -Containment Programs 1. Medical Bill Review - (Pre or Post -payment Cost Containment for Non -contracted and 09/19/2023 13 Client Name: City of Miami Administrative Services Only Agreement Contracted claims): • Bill Audit 29% of the gross savings/gross recovery achieved plus hospital fees or expenses passed throueh Diagnosis Related Grouping (DRG) Validation/Audits and Recovery. An overpayment audit and recovery program in which CHUC or its vendors review paid claim data to identify overpayments based on inaccurate DRG coding. 29% of gross savings/gross recovery plus any fees or expenses passed through by the hospital or regulatory a ency Medical Implant Device Audits 29% of the gross savings/grossrecove 1-y 2. COB Vendor Recoveries [Exclusive of pharmacy programs where claims are adjudicated at 29% of the gross recovery time prescription is received.1 3. Secondary Vendor Recovery Program 29% of the gross recovery 4. Provider Credit Balance Recovery Program 29% of the gross recovery 5. High Cost Specialty Pharmaceutical Audits (this service is only provided with respect to Medical coverage) 29% of the gross recovery 6. Eligibility Overpayment Recovery Vendor Services. Identification and recovery of funds in situations where the overpayment is due to the late receipt of Member tennination infonnation. (This service is only provided with resoect to Medical coverat: !:e). 29% of the gross recovery 7. Class Action Recoveries 35% of the gross recovery 8. Subrogation/Conditional Claim Payment. Identification, investigation and recovery of claim 5% of the gross recovery plus litigation costs if counsel is retained and an appearance is filed on payments involving other party liability or where another entity is responsible for payment (including by way of example but not by limitation automobile insurance, homeowner insurance, commercial property insurance, worker's compensation). (This service is only 09/19/2023 14 Client Name: City of Miami Administrative Services Only Agreement provided with respect to Medical coverage.) behalf of CBLIC or Employer in any litigation, or a lawsuit is filed on their behalf; 29% of the gross recovery if no counsel is retained and in all other instances, including cases where state Jaw requires that employee benefit plans be named as party defendants or involuntary plaintiffs. CHLIC administers the following programs to contain costs with respect to charges for health care service/supp ies that are covere • •y the P an. In CHUC contracts with vendors to perform program related services. CJi1.JC's charge for administering these (indicated below) of the "recovery" (i.e. the amount rec-Overedj as applicable. administering these programs, prosis the percentage 1.1 Aarmacy Vendor Recoveries. CHLIC perfonns periodic audits of contracted pharmacies in order to determine the accuracy of payments to the pharmacy(ies). CHLIC's recovery vendor collects and remits to CHUC all overpayments to pharmacy(ies), and CHUC remits to the Bank Account the balance collected from the recovery vendor, less the recovery fee set forth herein. j 30% of recovery 2. [ Class Action Recoveries. C111.,IC identifies, monitors and may (but is not required to) participate, on behalf of Employer, in class action lawsuits or similar legal proceedings against phannaceutical manufacturers, including, without limitation, lawsuits alleging legal or equitable claims like fraud, anti-trust violations, or unfair trade practices by a manufacturer. As part of this authority, CHUC may participate in a settlement, exclude Employer from a settlement and/or otherwise represent Employer's interests outside the settlement. CJi1.JC collects and retains as a recovery fee set forth herein of any recovery (net of attorneys' fees }attributable to Employer's Plan. 35% of recovery 09/19/2023 15 Client Name: City of Miami Administrative Services Only Agreement ,,. M1 t) M.t fZtlt ' .. 2V4i tq4' a 6 ," "v« .4 t: Le . F:4 4. 70'1 Frz +; - tx Fd ._ vi . ', ' t.: .-Yt!q e" '-;�-t'A,,,: ck:1 r : t 21 Na ',. 'ell tlk et A 'Ito..., ,.Y _ '. ,m.arc Benefit lo provide financia protection rom the high cost, HLfC as contracted witi an at 1 iate, $0.99 per Member/per Protection eviCore ("eviCore" refers to eviCore healthcare MSI, LLC d/b/a/ eviCore healthcare certain of its affiliates), to arrange for the provision of the following gene therapy and drugs for month. Members when both drugs are covered by the Plan administered by C:m.JC, and medically If, across eviCore's entire necessary (as determined by CHLIC) to treat the conditions indicated: Embarc Benefit Protection book of business (Cigna i. Luxtuma® to treat inherited form of progressive blindness ii. Zolgensma® to treat children under 2 years old with spinal muscular dystrophy and non -Cigna clients), eviCore's cost for the two (Luxturna is the registered trademark of Spark Therapeutics, Inc. and Zolgensma is the (2) drugs provided in a registered trademark of AveXis, Inc.) given calendar year is lower than a As a result of this network contracting arrangement, evi.Core is in most cases the exclusive, in -network Participating Provider of these drugs. eviCore arranges for the provision of these predetermined percentage of the PMPM charges drugs through its network of specialty pharmacies (including its affiliate, Accredo), and received, eviCore will certain facilities authorized to administer the gene therapies by the drug manufacturers. refund the difference pro eviCore will reimburse these specialty pharmacies and facilities at negotiated reimbursement rata, after having fully rates. This network solution is called Em.bare Benefit Protection. recovered the outstanding balance created by any For arranging for the provision of these drugs, eviCore will be reimbursed by CHI.JC on a prior year deficits. The fixed Per Member Per Month (PMPM) basis. eviCore's PMPM fee (which is subject to refund, in any, will be change) will be charged to the Bank Account one month in arrears. (e.g., eviCore's charges determined on an eviCore for January will be made in February.) These Bank Account Payments will appear in Embarc benefit Protection Employer's monthly reporting. Embarc Benefit Protection does not provide financial book -of -business basis. protection from the cost of administering the two drugs. These costs are small in comparison The refund will be to the drug costs. provided by March 31st of the following year. When covered under the Plan and determined by CHLIC to be medically necessary for the treatment of the specified conditions, Members will not incur any out-of-pocket costs for the Assuring Transparency: two drugs and the Plan will not be required to reimburse any expenses for the two drugs with After the refund is made two exceptions: for a particular calendar year, eviCore will, upon 09/19/2023 16 Client Name: City of Miami Administrative Services Only Agreement Exceptions: request, provide Embarc Benefit Protection book- 1. For Members born before the date that Embarc Benefit Protection is effective for the of -business information Plan and receiving Zolgensma,® the Plan's in -network reimbursement and the Member's for that calendar year. in -network cost -sharing apply to either (as applicable): • eviCore's fee -for -service charge for Zolgensma® when provided through Accredo: Average Wholesale Price (AWP) minus 15.8% AWP (based on Medispan) _ $2,550,000, or • the reimbursement rate of the participating facility or specialty pharmacy. 2. Members with an HSA must have met the applicable minimum deductible required for a high deductible health plan. eviCore's Embarc Benefit Protection and P.MPM charge do not apply to a plan that: i. does not cover either or both drugs; ii. covers both drugs under its pharmacy benefits which are not administered by CHLIC,or m. does not utilize a Cigna participating provider network. Upon Employer's request on or after the Effective Date, CHUC shall provide to Employer an updated drug list, if applicable. CHUC may revise charges/fees by giving Employer at least thirty (30) days' prior written notice. 09/19/2023 17 Client Name: City of Miami Administrative Services Only Agreement CHLIC arranges for third parties to provide care management services to: (i) contain the cost of specified health care services/items overall with respect to all plans insured and/or administered by CHUC, and/or Specific vendor fees and care management program services are available upon request. (ii) improve adherence to evidence based guidelines designed to promote patient safety and efficient patient care. Charges for these services will be processed through the Bank Account. Medical Management (inclusive of Medical Necessity Review) of Chiropractic selVices. National Average is $0.16 PMPM; rates vary by market and are available 1 upon request. In addition to such third parties, CHLIC has arranged for an affiliate, eviCore, to provide the following care management/cost-containment programs (programs and charges identified below are not applicable to Participants who have elected PHS or Basic Low Medical Management (see Administrative Charges section above)): • Pre -certification of coverage of radiation therapy services. $885.00 per episode of care(EOC • Pre -certification of coverage of diagnostic cardiology services (If Employer has elected Basic Standard Medical Management (see Administration Charges section above) this ,row am and char.r: e is not avvlicab/e to that membership). ' $0.19 PMPM $1,000.00 per episode of care(EOC) r • Pre -certification of coverage of medical oncology services. i• Pre -certification of coverage of musculoskeletal therapy services (If Employer has elected Basic Standard Medical Management (see Administration Charges section above} this vro£Yam and char e is not applicable to that membership). [$0.39 PMPM Fee reimbursement method and rates may • Services related to the coverage of high tech radiology which may include pre- , certification. 09/19/2023 18 Client Name: City of Miami Administrative Services Only Agreement In certain instances, the Plan will pay eviCore a fee on a per member/per month basis for pre -certification, arranging care, and other services that eviCore may render. Such reimbursement will be in addition to the amount that the Plan pays to reimburse the provider through which eviCore arranged for the provision of the service or supply, which will be based on eviCore's contracted rate with that provider. In such instances, Plan Benefits and member cost -share will be determined based on the rate that eviCore contracted to pay the provider for the provision of the service or supply. (If Employer has elected Basic Standard Medical Management (see Administration Charges section above) this program and a charge is not applicable to that membership). eviCore may also charge for services related to the provision of high tech radiology as described below in «other Vendors and Health Care Services Providers." vary by market and are available upon request • Pre -certification of coverage of sleep management services (If Employer has elected Basic Standard Medical Management (see Administration Charges section above) this prof !ram and charfle is ,wt aoulicable to that membership). $O.IOPMPM • Pre -certification of coverage of gastroenterology services (If Employer has elected Basic Standard Medical Management 7see Administration Charges section above) this program and char e is not auvlicable to that membershiD). $0.09PMPM • Pre -certification of coverage for appropriate setting of care/service for high tech radiology services (IfEmpToyer has elected Basic Standard Medical Management (see Administration Charges section above) this program and charge is not applicable to that membershir,). No more than $0.20 PMPM. Billing method may vary by market and is available upon request. • Pre -certification of coverage for appropriate setting of care/service for certain medical oncology drugs (redirection may be to Accredo, a CHUC affiliate). 30.00% of shared savings (where savings is derived from the difference between drug dose cost at higher cost provider initially requested and 09/19/2023 19 Client Name: City of Miami Administrative Services Only Agreement drug dose cost at lower cost provider). Fee shall not exceed $5,000.00 per dose for a maximum of three doses resulting in a maximum total of $15,000.00. Note: CHLIC may retain a portion of the shared savings fee before reimbursine eviCore. • Network management and care coordination of coverage of home health. durable medical equipment and home infusion services. $0.30PMPM CHLIC may revise charges/fees by giving Employer at least sixty (60) days' prior written notice. aY `3... 5^t 'blMr•' - at !yj� _.�...L:—i-_.............. ...�.� Si.S', et} _4..ii a^'� i rY,y �'c S C'_0. i Vie, * .%—t 'Pi! Y-3 'm" ._ . ..� ._,:,,—......-M.a.,:.M a:._:.., _ _..r,, $S00-$1,500 Review When a Member elects an External Review (as that term is defined in the Patient Protection and Affordable Care Act (PPACA)) of a benefit determination by an independent third party, the cost of a specific third party review is dependent on the nature and complexity of the issue on appeal. Third party review charges will be commensurate with the level of expertise nee -- and the time re s uired to com..lete the review. 'a'x ": mr w �a t - •.- >;l Q F k C ..; • r Y p 34 —4��yr'` Charges for vision care services will be paid as claims and will appear in Employer's standard Bank Account activity data reports. Such payments will be at CHLIC's applicable charges then in effect, which may be amended from time to time. The applicable charges made b in -network vision care .roviders wil�lybe made available upon request All Vision Products � CHLIC contracts directly or indirectly with other managed care entities aad third party network vendors for access to their provider networks and discounts. These third parties charge either a network access fee, which is included in CHLIC's monthly charges, or a percent.age of the savings realized on a claim by claim basis as a result of the application of their discounts. Charges based on percentage of savings may be paid from the Bank Account All Medical Products 09/19/2023 20 Client Name: City of Miami Administrative Services Only Agreement Additional details regarding specific charges vill be provided uoon request. Mm y �_ ine rix.ea per person per perioa anaior Ice -RN -service cnarges mat LriuL has direcLry vi r`tiu riuuucis indirectly negotiated with Participating Providers for in -network health care services and/or supplies will be charged to the Bank Account and will be used in calculating any applicable Member cost -sharing. In addition, performance -based payments to Participating Providers will be charged to the Bank Account. Such payments will be at the payment rates then in effect, which may be amended from time to time. For certain types of specialty care, including, but not limited to, home health care, durable medical equipment, sleep management, high tech radiology, chiropractic care, acupuncture, physical medicine (such as physical and occupational therapy), speech therapy, orthotics and prosthetics, implants, and hearing, in certain markets CHLIC may contract with various third parties and/or affiliated companies, including eviCore, ("Specialty Vendors") to arrange for the provision of care through their own networks of health care providers on a fee -for -service basis. In addition to arranging for care through their own networks of providers, these Specialty Vendors may also provide additional services. including utilization management services and case management services designed to (i) improve adherence to coverage guidelines; and (ii) contain overall healthcare costs to the Plan. Specialty Vendors are included within the definition of "Participating Provider" set forth in this Agreement and in any benefit booklet covering the Plan. When care is arranged through a Specialty Vendor's network of providers, the fonn of reimbursement to the Specialty Vendor will be through one of the following methods: • Fee -For -Service Payment: In certain instances, the Plan will pay the Specialty Vendor rather than the treating provider on a fee -for -service basis as a claim for Plan Benefits. The Specialty Vendors' fee -for -service charges may be higher than the amounts that the Specialty Vendor contracts to pay the provider for the provision of any particular service or supply, and some portion of the Specialty Vendor's charges may be attributable to the services that the Specialty Vendor provides in addition to those services or supplies provided by the Specialty Vendor's network of providers, including any utilization management services and case management services. In such instances, Plan Benefits and member cost -share will be determined based on the Specialty Vendor's charges 09/19/2023 21 Client Name: City of Miami Administrative Services Only Agreement Rebate and Other Remuneration Disclosure (Pharmacy) according to Plan terms. • Administration Capitation Payment: In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis for arranging care and other services that the Specialty Vendor may render. Such reimbursement will be in addition to the amount that the Plan pays to reimburse the provider through which the- Specialty Vendor arranged for the provision of the service or supply, which will be based on the Specialty Vendor's contracted rate with that provider. In such instances, Plan Benefits and member cost -share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. • All -Inclusive Capitation Payment In certain instances, the Plan will pay the Specialty Vendor a fee on a per member/per month basis that covers (i) the services that the Specialty Vendor may render, including arranging care, and (ii) the fees charged by the provider through which the Specialty Vendor arranged for the provision of the service or supply. In such instances Plan Benefits and member cost -share will be determined based on the rate that the Specialty Vendor contracted to pay the provider for the provision of the service or supply. CHLIC's arrangements with Specialty Vendors are subject to change at any time, and upon request, additional information can be provided that identifies current Specialty Vendors, their area ofspecialty(ies), whether they are CHLIC affiliates, and the form of payment that they currently receive. Notwithstanding the terms of the Plan, CHLIC shall not administer Member cost -sharing with respect to charges made by Cricket Health. Inc. for its personalized, evidence -based approach to managing chronic kidney disease and end -stage renal disease for clinically eligible Members in CA and such cost -sharing expenses shall, instead, be reimbursed by the P an (not applicable ifEmployer has opted out}_. All Products (excluding BSA Products) CHLIC or its affiliates may contract with pharmaceutical manufacturers or other third parties f. r Rebates, Manufacturer Administrative Fees, and other remuneration on its or their own behalf and for its and their own benefit, and not on behalf of Employer or the Plan. Accordingly, unless otherwise specified in this Schedule of Financial Charges, CHLIC and its affiliates retain all right, title and interest to any and all actual Rebates,_ Manufacturer Administrative Fees, and other All Pharmacy Products 09/19/2023 22 Client Name: City of Miami Administrative Services Only Agreement remuneration received from manufacturers or other third parties; neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in any such remuneration, which shall be considered part of the general assets of CHUC and its affiliates. As an example of the renumeration other than Rebates or Manufacturer Administrative Fees that CHLIC or its affiliates may earn, CHLIC or its affiliates may also directly or indirectly earn from pharmaceutical manufacturers remuneration in connection with value payments and/or services that CHUC provides to Employer ("Value -Based Payments"). Notwithstanding anything in this Agreement to the contrary, any Value -Based Payments earned by-CHUC or its affiliates are separate and apart from any Rebates or Manufacturer Administrative Fees that CHUC or its affiliates directly or indirectly earn from pharmaceutical manufacturers, and CHUC and its affiliates may retain any Value -Based Payments it earns. As examples of the value payments and/or services that CHLIC may provide to Employer in connection with Value -Based Payments that CHUC or its affiliates may earn, CII1,IC may provide care management or related services to Employer and/or remit to Employer monetary credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services, and/or monetary credits or other financial value. for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions, including the products for which monetary credits or other financial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHUC to Employer are subject to change or termination by CIB.,IC as the value program(s), if any, offered by CHLIC change(s) or tenninate(s). Information on the projected aggregate amount of such Rebates with respect to the Plan Pharmacy Benefit will be provided upon request. This provision shall survive tennination or expiration of the Agreement. Rebate and Other CHI.JC may directly or indirectly receive and retain payments under contracts with pharmaceuticalf All Medical Remuneration manufacturers or third parties with respect to Members' utilization of the manufacturer's products Products Disclosure (Medical) covered under the Employer's Plan medical benefit. These payments may include rebates, service fees (e.g. administrative fees), or other remuneration. CHUC directly or indirectly contracts with pharmaceutical manufacturers or other third parties or any remuneration on its own behalf and for its own benefit, and not on behalf of Employer or the Plan. Accordingly, CHUC retains all right, title and interest to any and all such remuneration received from manufacturer; neither Employer, its Members. nor- Employer' 1 reJa,ins anJ'.' beneficial rietaryj! }.ter st 11 anv such 09/19/2023 23 Client Name: City of Miami Administrative Services Only Agreement remuneration, which shall be considered part of the general assets ofCHLIC. This provision shall survive tennination or expiration of the Agreement. Implementation/Referra I Fee Disclosure From time totime, CHUC, directly or through its affiliates, arranges with third pl:U"lies (e.g., service vendors; provider network managers) to provide various services (e.g., cost -containment All Products services or health care services) in connection with the Plan. CHLIC and its affiliates may receive payments from such third parties to help defray CHLIC's expenses associated with its implementation and/or ongoing administration of these arrangements or as a reimbursement for services or network access provided to such parties by CHLIC. CHLIC may also receive compensation from third -party vendors that Employer may retain based upon a referral from CHLIC or that Members may utilize following an introduction facilitated by CHLIC or an affiliate. CHLIC may also receive: • network administration fees from some providers participating in its provider network, • credits from banks on balances in accounts utilized to administer claims, • non -material incidental compensation/benefits from other source as a result of administering the Plan. ..Xt.. .- ''e��+W�"Y'b-;� ... �.�.-.z k Va •4.'"p $ Vi;P Z1vF��fQ4 ®rC716:17"i°�ifiylg ''��-...3 ��Y,Al�.._ _. t��'W-,4,,: Where applicable, the following California and PPACA fees/assessments/taxes attributable to t e Cigna Health Care of California group service agreement that provides in -network coverage for Members in California: • Comparative Effectiveness Research Fee • California Managed Care Organization Tax Network Products: • Network POSOA 09/19/2023 24 Client Name: City of Miami Administrative Services Only Agreement t�r. [^ .. ..._ J A 4 #CAL(''# %-'ek2A'.. 4 {rt�.x,'.L, �r.y i _.._ e. —.._ ..... ...r'ti'Irr .% n � — •A' .[�'iY rYt�.fj mare.+%. ,+--i . i"'S w,...,5[x.-. s fr �� ., := � CHLIC shall`provide the following services to assist - Employer in meeting its compliance obligations under won 2715 of the Public Health Service' Act as added by the Patient Protection and Affordable Care Act and applicable regulations with respect to the provision of the Sunnnary of Benefits and Coverage ("SBC"), translation notice and glossary. Applicable to all medical plans including :HRA and FSA which are considered "group health plans" subject to the SBC requirements. 1.1 Preparation of SBC, translation notice. CHUG will not be responsible for any changes that 1 Employer makes to the SBC. No charge 2. [ Provide SBC, translation notices prepared by CHLIC to Employer electronically as well as any updates or material modifications. _ No charge 3. E Include in SBC a summary of benefits administered by carve -out vendor if Employer or carve -out $500 for each benefit option under the Plan for which carve - out vendor benefits are included in SBC vendor provides CHLIC with necessary carve -out benefit information at least twelve (12) weeks prior to the date the SBCs are to be delivered to Employer. _1 f , �F � 1-s.i i" F % 3'; 4'ICES ,4, � . Y d "'!.. s�`- w+-c',�"fi.` .;y r'�.; .,_'..k $ V7� Y°#z:ri� th $.`� `:Y lE u'M1`e X .Y. { .... 14Jy R. T c�.4 . ;. ii WTSl iiVRA 1, .: �-I'+ ¢� Pharmacy Utilization Management Program (Opioid medications and Specialty Drugs) In administering the Pharmacy Benefit, CHUG shall apply quantity limits, prior authorization and/or step therapy requirements to certain Specialty Drugs, opioid medications, or other products identified for safety/clinical reasons. For All Products: Included in Pharmacy Administration Fee Clinical Program A targeted condition medication therapy management program in which CHLIC provides support for Members using specialty medications for certain chronic conditions and that are obtained or administered at retail pharmacies or outpatient, office or home health care settings. As part of the Included at No Additional Cost rram. Members are counseled on their condition, medicationi<! e effects, and importance of 09/19/2023 25 Client Name: City of Miami Administrative Services Only Agreement adherence. For the sake of clarity, if a specialty pharmacy affiliate of CHLIC provides therapy management for specialty medications the pharmacy dispenses to Members, then it does so in its capacity as a specialty pharmacy and not on behalf ofCHLIC; CHLIC does not exert direction or control over the pharmacists at any specialty pharmacy affiliate. SafeGuardRx Program A medication therapy management and cost containment program for select therapeutic conditions Included at No such as but not limited to oncology, inflammatory conditions, and multiple sclerosis and select Additional Cost drugs within therapeutic categories. This program seeks to help reduce drug therapy costs through its program offerings. For example, Employers may qualify for the payment of discontinuation drug therapy credits and/or the reimbursement of drug therapy through drug cost caps, on select medications and therapeutic conditions. This program may also provide for Member outreach or counseling on select medications. CHLIC reserves the right to revise, modify, or terminate this program, in whole or in part, at any time. Additional and specific program information is available upon request. Your Health First A proactive health education and improvement program for Members with a chronic condition. For Network The program involves services that span across the Member's health needs. Behavioral coaching POSOA principles and evidence based medicine guidelines are utilized to optimize self -management skills Products: and foster sustained health improvements. Included in Medical Access The program targets a chronic population at high risk for near term and future high cost medical expenses. Members are identified as having a chronic condition through a variety of sources which may include: claims data, referrals, and self -identification. A variety of resources is provided to those with a chronic condition, including access to online tools, personalized support, and targeted Fee materials. The program includes the following components for those with a chronic condition: • Chronic condition -specific coaching • Pre- and post -discharge calls • Lifestyle management coaching: stress, weight management and tobacco cessation • Treatment decision support and coaching In order to continuously assess the effectiveness of the program and/or test new ideas to further 09/19/2023 26 Client Name: City of Miami Administrative Services Only Agreement engage Members around their health, a small sample of Members may be placed in a comparison group which for a defined period of time receives alternative services or is suppressed from receiving proactive outreach, such as engagement letters and/or calls. This could affect a few Members targeted for outreach during this limited time period. Claim and Appeals CHLIC will administer an optional second level of claim appeals Included in Medical Administration Charge Transparency in Coverage CHUC, within reason, will make certain data required under the Transparency in Coverage Rule available in machine readable file disclosures for Employer through CHLIC's web site, Cigna.com Included in Medical Administration Fee or CignaForEmployers,com, on a monthly basis. Virtual Health Center Cigna Health and Life Insurance Company ("CHLIC") will provide or arrange through a Cigna affiliate ("Cigna") a virtual health center for the City of Miami ("Employer"). Employer owns or leases a facility located at 444 SW 2nd Avenue, Miami, FL 33130 (the "Facility") and desires to provide an onsite virtual health center at the Facility for the benefit of its employees (the "Virtual Health Center"). CHUC and Employer are sometimes referred to herein individually as the "Party" or collectively as the "Parties." Employer shall provide a secured non -mobile trailer at the Facility to house the Virtual Health Center. Employer's project management team will ensure that the trailer is functional and compliant. Employer will obtain any needed permits and ensure Virtual Health Center is in accordance with all applicable federal, state and local laws and regulations, including but not limited to municipal Fire and Building Codes, American Disabilities Act and other statutes and regulations related to equal access and non-discrimination. Cigna will provide interactive audio visual communications via the Tyto Care platform within Epic, and will lease the peripheral equipment, the Tyto Clinic device (the "Device"), for patient examination on behalf of Employer. Employer shall be responsible for payment to Cigna for the cost of the leased Device. An estimate of the cost to lease the Device is included in the Operating Budget. Employer shall also be responsible for the costs of all maintenance, repairs, parts or other items necessazy for the functioning of the Device. 09/19/2023 27 Client Name: City of Miami Administrative Services Only Agreement 1. Services. Commencing on May 26, 2021, or such other date as may be mutually agreed to in writing by the Parties ("Virtual Health Center Commencement Date") and continuing for the Tenn, Cigna will operate and staff a Virtual Health Center at the Facility and provide or arrange for the provision of the Virtual Health Center Services ("Services") described below, for the benefit of Participants (as defined herein). The Services shall be rendered by medical provider(s) who shall be provided for or arranged for by Cigna ("Virtual Provider") through telemedicine interactive audio-visual communication with Participants. A Cigna Registered Nurse Health Coach ("Cigna Personnel") shall provide assistance making the appointment with the Virtual Provider, entering patient data and summary into the medical record and otherwise assisting with the telemedicine visits by initiating the call, assisting with the equipment and connection, obtaining vitals and assistance with use of peripheral medical equipment. The scope of Virtual Provider's services shall include the services set forth in herein. Virtual Provider shall not be required to provide any services, including those identified in herein, if in the Virtual Provider's medical judgment the services should not be provided through telemedicine in accordance with the standard of care. Employer understands and acknowledges that the Services shall be provided through Virtual Provider. Employer understands and agrees that Cigna shall not be required to provide the Services unless and until the Cigna has the Virtual Provider in place and available to perform. Should this not occur by the Virtual Health Center Commencement Date, Employer understands and agrees that Cigna will provide the Health Coach Services set forth below. Once Cigna has in place the required contract amendments, the Services. shall be provided through Virtual Provider. Cigna will adjust/prorate the Operating Budget set forth in herein and will not charge Employer for Virtual Provider expenses during the period Cigna is providing Coach Services only. a. Health and Wellness Services. Through this telemedicine model with Virtual Provider, Cigna will provide acute and episodic care and wellness visits. Additionally, the Cigna Personnel, under the supervision of Virtual Provider as applicable, shall provide the following services: 07/20/2023 28 Client Name: City of Miami Administrative Services Only Agreement b . Immunization Services. Cigna Personnel shall provide, or arrange for the provision of, immunizations, as agreed upon by the Parties, including: Annual flu vaccinations, Hepatitis A & B Series, Tetanus & Pertussis (Tdap), Tetanus (Td), Tuberculosis (TB PPD) (Test), Pneumovax, Measles, Mumps, and Rubella (MMR) (under age 26), Human Papilloma Virus (HPV) (under age 26), Shingrix (age 50 and old), Travel immunizations (as needed at Client's request). Pediatric vaccinations are excluded, except for annual flu vaccinations for Pediatric Participants age nine and older. c . Monitoring Chronic Conditions. Cigna Personnel shall verify that Participants with chronic medical conditions have appropriate community primary care provider relationships and collaborate with primary care provider and specialist, as needed; refer Participants with chronic conditions to appropriate Employer telephonic and online wellness programs; and encourage health lifestyle habits that address the chronic condition. d. Laboratory Services. Cigna Personnel shall conduct laboratory testing onsite at the Virtual Health Center including: CUA-waived testing (rapid testing); and specimen collection (blood draw station, urine collection, and collection of other specimens ordered by Virtual Provider or by community providers for pick up by contracted lab vendor). Results will be delivered to ordering provider. e. Biometric Screening. Cigna Personnel shall provide scheduled screenings that may include but not limited to; Height, Weight, Bivil, Body Composition, Blood Pressure, Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Coronary Risk Ratio, Blood Glucose. f. Lifestyle Risk Assessment. Cigna Personnel shall conduct lifestyle risk assessments; facilitate a discussion of health improvement and preventive care opportunities; provide referrals and coordinate additional care for Participants, as required; and encourage Participant engagement in Employer -sponsored wellness programs (if any) as appropriate. _g_. Pharmacy. Cigna and Cigna Personnel shall make available to Participants as 07/20/2023 29 Client Name: City of Miami Administrative Services Only Agreement needed limited selection of first dose medications to treat acute aliments, if Cigna can reach agreement with Virtual Provider and do so in accordance with applicable law; and written prescription and/ore-prescribing by Provider, as allowed by law. h . Primary Care. Basic primary care performed in support of Participants' individual primary care physicians (excludes pediatric physicals). 2. Virtual Provider Scone of Services. In addition to the below, any additional conditions amenable to virtual treatment shall be based on the judgment of the Virtual Provider. Provider shall not provide virtual treatment for these or any other conditions if the provider believes in the provider's reasonable medical judgment that treannent cannot be provided within the standard of care. Injury Care (minor) Collaborating with patients PCP Minor acute pain/strains Obtaining aooropriate labs Upper respiratory infection Ensure Evidenced -Based care is being provided to patients Sinus infection Closing Gaps in Care Ear infection Chronic Referring to appropriate Telephonic/Online programs Acute Episodes Sore throat Conditions Referring to Centers of Excellence and Preferred specialists (high quality/low cost) when needed Conjunctivitis Lifestyle and Behavioral modification to address conditions Urinary tract infection Diagnostics/ Individual biometric screenings/body fat analysis and subsequent Diagnoses ePrescribing/ Temp Med Refills Screenings Basic vision screening Preventive Wellness Review Cholesterol measurement / 09/19/2023 30 Client Name: City of Miami Administrative Services Only Agreement Health dimrnosis Vaccinations, including: Diabetes screening/ dirumosis - Flu Shots Testing/basic checks (CLIA- waived, 'rapid' tests, or specimen collection for higher -level lab tests outsourced to preferred laboratories) including: - Immunizations (e.g.,- Tetanus) glucose Diabetes Education/ Management Lab Services - Cholesterol Medication Adherence - Rapid strep Weillht Management - Pre! ! 11 ancv test Personalized Smoking Cessation - Urine dipstick (UTI) Coaching Stress Management - Phlebotomy blood draw as required Other - Covid-19 Diagnostic Testing 3. Health Coach Services. The following health coaching and wellness promotion services ("Health Coach Services") will be provided by the Cigna Personnel for eligible Participants as follows: Nutrition a. Establish nutritional health goals collaboratively; b. Collaboratively (Participant and Cigna Personnel) establish coaching for a duration and at a frequency based on the coaching plan; and c. Deliver topic -specific education and referrals, as needed. Physical Activity 09/19/2023 31 Client Name: City of Miami Administrative Services Only Agreement a.. Establish coaching duration and :frequency collaboratively between Participant and Cigna Personnel based on the coaching plan; and b. Deliver topic specific education and referrals, as needed. Wellness Education and Referrals For: a. Prevention; b. Women's issues (includes mettopause, infertility); c. Children's health issues (includes the importance of vaccines, healthy eating, exercise, etc.); d. Men's health; e. Sleep; f. Stress; g. Weight; h. Other health topics and concerns; and i. Collaboratively (Participant and Health Coach) establish coaching for a duration and at a frequency based on the coaching plan. High Blood Pressure: a. Establish blood pressure reduction goals collaboratively (Participant, Physician and Health Coach); b. Collaboratively (Participant and Health Coach) establish coaching for a duration and at a frequency based on the coaching plan; 09/19/2023 32 Client Name: City of Miami Administrative Services Only Agreement c. Deliver condition -specific education and referrals, as needed; and d. Identify any Gaps in Care ("GIC") and educate and assist in closing the GICs. High Chole terol a. Establish cholesterol reduction goals collaboratively (Participant, Physician and Health Coach); b. Collaboratively (Participant and Health Coach) establish coaching for a duration and at a frequency based on the coaching plan; c. Deliver condition -specific education and referrals, as needed; and d. Identify any GIC and educate and assist in closing the GICs. Mattmi.i!y a. Education on and referrals to Health Pregnancy/Healthy Baby program (if purchased by Employer) or Healthy Babies; b . Education on the importance of prenatal care; c. Leverage clinical guidelines used in existing programs; and d. Coordinate with a lactation consultant. Benefits Navigation a. Deliver basic information concerning benefit resources and tools to maximize benefits, including cost and quality tools, mycigna.com resources, etc.; b. Refer to Employer Human Resources contact for detailed plan questions, concerns, and issues requiring escalation; 09/19/2023 33 Client Name: City of Miami Administrative Services Only Agreement c. Education and referrals to plan clinical programs (internal and external); and d. Assist employees with health care professional referrals, (e.g., primary care physician or specialist referrals in the Cigna network). Wellness Promotion. Cigna Personnel shall support onsite wellness promotion events and activities for Employer employee population, as agreed upon by the Parties (i.e. completing health risk assessments, group seminars, etc.). 4. Participants. Participants are individuals who are eligible to receive Clinical Services at the Virtual Health Center in accordance with this Agreement as determined by the Employer. Participants are classified into two eligible classes: Comprehensive and Limited Episodic Care. a. Comprehensive Care: City's CIGNA POS employee plan participants, under-65 retiree plan participants and their dependents age six (6) years and older, and former employees entitled to Clinical Services as Participants under the Consolidated Omnibus Budget Reconciliation Act (COBRA) b. Limited Episodic Care - Sworn Police, Sworn Fire, Part-time and Seasonal city employees ONLY (not their dependents) 5. Health Center Days and Hours of Operation. The Virtual Health Center will operate forty (40) hours per week, Monday, Wednesday, and Friday from 7:00 a.m. until 4:00 p.m. and on Tuesday and Thursday from 9:30 a.m. until 6:00 p.m. (..Virtual Health Center Operating Hours"). The Parties may change Days and Hours of Operation from time to time, as mutually agreed in writing. Electronic communication is deemed acceptable for such written agreement. 6. Virtual Health Center Closure. The Virtual Health Center will be closed on inclement weather days as determined by Employer, and on Cigna recognized holidays, including: New Year's Day, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, day after Thanksgiving, and Christmas Day. The Virtual Health Center may be closed during Cigna Personnel vacancies as further described herein. 09/19/2023 34 Client Name: City of Miami Administrative Services Only Agreement 7. Virtual Health Center Utilities and Services. Employer shall, at its sole expense, provide the following services and utilities necessary to the operation of the Virtual Health Center. a Telephone Services. Employer shall furnish a telephone system, that includes hardware and phone and fax vendor services for provision of the telephone solution. b. High Speed Internet Access. Employer shall ensure there are High Speed Internet seivices available to the building and extended to the Virtual Health Center. A minimum of 20 Mbps Down / 20 Mbps Up bandwidth to enable the Cigna Personnel to access the data tracking documentation and reporting system throughout the worksite and any other expanded services that require bandwidth. If no internet service providers have services established to the building or if services are not adequate to support the Virtual Health Center due to stability issues, Employer shall: Be responsible for all costs associated with establishing service to the building and installation of the line, including but not limited to trenching, wiring, materials and labor charges; or Provide connectivity to the Employer network and supply two (2) Public IP addresses. c. IT Resource for Internet Troubleshooting. Employer and Cigna shall identify IT resources to work collaboratively to: Prior to engaging Employer, Cigna will exhaust all troubleshooting activities on Cigna system and vendor services; Employer will assist in coordination with the internet service provider to resolve issues at the Virtual Health Center; Acknowledge notice of the issue within one (1) hour; and 09/19/2023 35 Client Name: City of Miami Administrative Services Only Agreement Be available within a three (3) hour timeframe after acknowledgement, pro ided the timeframe is during normal business hours of the Employer. Em.Bloyer shall not be responsible to support Cigna's network, hardware, and bther user IT equipment. d. Utilities, Seiices and Supplies. Employer shall provide the following: adelate heating, ventilation, and air conditioning to maintain conditions and temperatures appropriate for the operation of the Virtual Health Cen r during Virtual Health Center Operating Hours; hot and cold running water; restrLm facilities and supplies for use by Cigna Personnel and Parttpants; electricity adequate for computer systems, lighting, normal office use and heatilig and air conditioning; air c nditioning adequate for computer systems within location of IT wiring closet; light lg, and replacement of standard lamps when necessary; pest (control and extermination services in accordance with LEED stan s; cleanf g and janitorial services each day the Virtual Health Center is open that feet safety and exposure control requirements of Occupational Safety and. eal.th Regulations, including those relating to slip/trip/falls, blood born pathogens and toxic and hazardous material. Such cleaning and wast removal must be adequate to minimize or eliminate risk to Cigna Pers el and Participants from germs, unsanitary conditions and blood born !hogens. Employer ees to r uirej itorial service to comply 09/19/2023 36 Client Name: City of Miami Administrative Services Only Agreement with Cigna specifications for cleaning; adequate security services for the Virtual Health Center and Facility and common areas around the Facility, including fire and burglar alann devices and guard protection. smoke detectors and fire extinguishers in the Virtual Health Center and elsewhere in the Facility. Employer shall also provide for the period maintenance and annual inspection of the Facility fire alarm system; adequate parking spaces as available for Cigna Personnel at no charge to Cigna or the Cigna Personnel; service availability contingent on construction timeframe deliverable. Employer shall provide a detailed timeline on constructions activities and completion dates; and telephone services. 8. .I£ t : m: The initial term of this Agreement ("Initial Term") shall begin on the Virtual Center Commencement Date and shall continue for a period of thirty six (36) months. After the Initial Tenn, Employer has the option to renew for three (3) additional subsequent twelve (12) month terms by providing Cigna with ninety (90) days' prior notice of intent to renew (each a "Renewal Term"). The Initial Term and any Renewal Terms shall constitute the "Term" of the Agreement. This subsection is subject to the termination rights set forth elsewhere in this Agreement. Notwithstanding the above, the Initial Term shall not be longer than the term or extended term of Cigna's agreement with the Virtual Provider. 9. Termination. For Cause. Either Party may terminate this Agreement by written notice to the other Party if the other Party materially breaches this Agreement and does not cure such breach to reasonable satisfaction within sixty (60) calendar days after receiving a written notice of breach. Unless the breach has been cured the termination is effective on the sixty-first 09/19/2023 37 Client Name: Qty of Miami Administrative Services Only Agreement (61 st) calendar day after the breach notice is received. For Convenience. This Agreement may also be terminated without cause by either Party, in its entirety or with respect to a specific Facility, at any time after the first twelve months of the Initial Term by providing ninety (90) days' written termination notice to the other party. Such termination is effective on the ninety-frrst (91st) calendar day after the notice is received by the other Party. When terminating the Agreement for convenience, Employer shall pay a "Severance Fee" to Cigna in an amount equal to the actual severance obligation owed by Cigna to Cigna Personnel as of the date such termination of this Agreement is effective. The Severance Fee will be reduced to the extent that Cigna can recoup costs by successfully redeploying Cigna Personnel to a similar position within Cigna. Employer shall remain liable for any Operating Expenses incurred prior to the date of termination. For Financial Instability. This Agreement may also be terminated if either Party becomes insolvent, by providing ten (10) days' notice to the other Party provided that such termination shall be deemed effective as of the date said notice is delivered. 10. Operational Expenses. Cigna will use the attached Operating Budget as the projected budget for Operational Expenses (Salaries and Benefits, Supplies. Other Direct Expenses, System Expenses) and Other Infrastructure Costs, estimated Implementation Costs and Management Fees related to tile Virtual Health Center Services for the Initial Term. The Operating Budget may be modified based on any change in the Virtual Health Center Commencement Date, delay in providing a compliant Facility to house Vntual health Center, or modification of services requested by the Employer, as mutually agreed upon by the Employer and Cigna. Cigna shall use its best efforts to manage all Total Operational Expenses to those amounts listed in the Operating Budget. Employer acknowledges that said Operating Budget constitutes Cigna's good faith projection of anticipated operating costs and expenses for the Virtual Health Centers. Employer understands and acknowledges that the Operating Budget may change, based upon the volume of Participants seen at the Virtual Health Centers, charges by Virtual Provider, Cart maintenance and repairs, and other factors, such as a change in Cigna Personnel with respect to level of professional licensure or salary. Cigna agrees that prior to making any changes to the scope of services or delivery of care strategies that may materially impact the budget. Cigna will discuss such changes with_the Employer and obtain prior approval. 09/19/2023 38 Client Name: City of Miami Administrative Services Only Agreement 11. Payment. Employer shall pay and reimburse Cigna for the following as listed in the Operating Budget. In the event that Employer requests permanent additional clinical and/or administrative personnel to provide the Services at the Virtual Health Center or other services, the cost of which will exceed the estimates set forth in the Operating Budget, Employer shall pay to Cigna, in addition to all Management Fees and Operational Expenses, an amount equal to the additional expenses incurred in connection with the additional Services ("Additional Resource Charges"). In addition, Employer shall reimburse Cigna for all Virtual Provider -related charges, maintenance and repair costs, all which shall be paid by Cigna and passed through as expenses to Employer for Employer reimbursement. Employer shall also reimburse Cigna for any Additional Resource Charges incurred under this Scope of Services. Payments shall be sent to: Evernorth Direct Health, LLC, A Cigna Company, 25600 North Norterra Drive, Phoenix, AZ 85085. 12. Invoicing Procedures. On or before the 20th day of each month, Cigna will issue to Employer an invoice for Fees, Operational Expenses, Implementation Costs and Additional Resource Charges (collectively, "Virtual Health Center Fees") due and owing for Virtual Health Center Services performed during the preceding month. Employer shall pay Cigna's affiliate within forty-five (45) days of receipt of an invoice for Virtual Health Center Fees. Invoice charges for supplies shall reflect actual amounts billed to Cigna from the supply manufacturer/vendor and shall not be adjusted for any rebate Cigna may receive from an affiliated Group Purchasing Organization. 13. Renewal Terms. Sixty (60) days prior to the expiration of the Initial Term of the Agreement, Cigna shall present to Employer a proposed Operating Budget for the Virtual Health Center for any Renewal Tenn, and Employer and Cigna shall mutually agree on such Operating Budget. Thereafter during any Renewal Tenn of the Agreement, sixty (60) days prior to the expiration of the Renewal Tenn, Cigna shall present to Employer a proposed Operating Budget for the Virtual Health Center for the upcoming Renewal Term, and Employer and Cigna shall mutually agree on such Operating Budget. 14. Cigna Staffing. Cigna shall recruit, interview, engage, hire, supervise and discharge all Cigna Personnel needed to assist Virtual Provider with providing the Clinical Services. All employment related decisions, including but not limited to hiring, firing, and performance man emen h shall be at the sole discr tion _Qf Cjgna Jmd not Employer. Such Cigna 09/19/2023 39 Client Name: City of Miami Administrative Services Only Agreement Personnel shall in all events, and for all purposes, be employees or subcontractors of Cigna and not Employer. Cigna shall comply with all federal, state and local laws regulations and requirements relating to such employees and subcontractors. Cigna, and not Employer, shall be .fully responsible for the payment of all salaries, wages, payroll and other compensation, taxes, fees, workers compensation insurance and other charges or insurance levied or required by any federal, state, or local law, regulation or ordinance relating to the employment of the Cigna Personnel. Cigna, and not Employer, shall be solely responsible for determining salaries, bonuses, and other compensation of Cigna employees and subcontractors. 15. Use of Subcontractors. Cigna may use third party vendors contracted with Cigna, its Affiliates, for supplies and equipment without Employer's prior written consent, e.g. pharmacy providers, temporary labor, and laboratory service providers. 16. Cigna Personnel Performance. In the event that Employer is dissatisfied with the performance of any Cigna Personnel, or asserts that any Cigna Personnel has engaged in misconduct as defined by Employer or has materially failed to perform the Services in accordance with the Agreement, Employer shall so advise Cigna immediately and provide in writing the facts necessary to validate the concern or complaint. Cigna shall promptly consult with Employer as to the nature of the conduct complained of and the severity of Employer's dissatisfaction, and shall endeavor to resolve such issues to the satisfaction of Employer provided such resolution is non-discriminatoiy and otherwise legal. Employer acknowledges and agrees that the policies and procedures of Cigna or its Affiliates as to the perfonnance shall govern, including any confidentiality requirements contained therein. Employer agrees, where necessary, to cooperate with Cigna in conducting any investigation or inquiry, and in providing documentation and testimonial support in event of litigation concerning Cigna Personnel misconduct or failure to peiform. 17. Indeuendent Contractors. The Parties are independent contractors, and no Party is or shall represent itself as having, and nothing in this Agreement shall be construed as creating between the Parties, a relationship as employer -employee, partners, principal - agent, joint ventures, or any relationship other than that of independent parties. 18. Provision of Sen-ices at Virtual Health Center. Clinical Services may only be provided 09/19/2023 40 Client Name: City of Miami Administrative Services Only Agreement by Virtual Provider with the assistance of Cigna Personnel, or any other professional provided by or arranged for through Cigna. Employer employees and contractors shall not be allowed to provide Clinical Services or any oth r health care services at the Virtual Health Center even if they are licensed to do so. 19. No Co-Emnlovment. All Cigna Personnel performing Services hereunder shall work under Cigna's supervision, provided, however, that the Cigna Personnel and Virtual Providers shall exercise independent professional judgment within the scope of their professions. Due to their status as contractor and not employee of Client, no Cigna Personnel shall be entitled to any employer fringe benefits. 20. Virtual Health Center Staffing. Cigna shall provide or arrange for the provision of one (I) full-time Registered Nurse who will assist with telemedicine visits with Virtual Provider and who will also act as a Health Coach ("Cigna Personnel"). Full -Time is defined as regularly working a forty (40) hour week. Employer acknowledges and agrees that, in addition to Cigna Holidays, as defined herein, Cigna Personnel shall be entitled to paid time off ("PTO") and Leave in accordance with applicable law and policies of Cigna or its Affiliates, or applicable contract between Cigna Personnel and Cigna. PTO and Leave shall include vacation days, personal days, sick days, military leave, family medical leave (FMLA), caregiver leave, disability leave, and other leave in accordance with applicable law or Cigna policy. The number of days of PTO is the same applicable to all employees of Cigna and its Affiliates but may vary based on the job level and number of years of employment with Cigna, and will be prorated for part- time work status. Cost of such PTO and Leave is included under the "Salary & Benefits" component listed in the Operating Budget. For any independent contractors that may be used, the number of days of PTO shall be defined in the contract between Cigna and applicable agency or individual. If Cigna Personnel is expected to take Paid Time Off or Leave or there is otherwise an inability to provide Services that is to be expected to be in excess often (10) business days ("Vacancy"), Cigna will inform Employer of such Vacancy, and will detennine in consultation with Employer if the position will be temporarily staffed. In the event that Employer elects to have such position filled on a temporary basis, Employer shall so notify 09/19/2023 41 Client Name: City of Miami Administrative Services Only Agreement Cigna in writing. Cigna shall use best efforts to secure temporary labor to fill Vacancies within a reasonable amount of time. Employer shall be responsible for payment of temporary labor costs. Employer will remain responsible for the payment of the costs for the Cigna Personnel that has taken Paid Time Off or Leave. The health center will be closed and no onsite services will be provided if the Cigna Personnel is absent and there is no temporary or substitute labor. However. customers needing coaching will be directed to Cigna's telephonic coaching program, and customers needing medical services may utilize the Cigna Telehealth Connection services. Cigna shall not reduce the Compensation/Fees set forth in the Operating Budget for any absence of Cigna Personnel due to the following: PTO, sick time or short term disability leave under the then current Cigna policies; closure of the Employer's work site within which the Cigna Personnel provides services under this Agreement, due to Employer or other reasons beyond Cigna's control such as inclement weather, pandemic, acts of nature, or actus of the public enemy; or short term disability or caregiver leave for which the Cigna Personnel is paid. 21. Non -Solicitation. During the term of this Agreement, and for a period of one (1) year after expiration or tennination of this Agreement for any reason, Employer shall not directly or indirectly. alone or in concert with others, solicit or entice an employee or independent contractor engaged by Cigna to provide services under this Agreement, to leave the employment or engagement of Cigna in order to provide substantially similar services as those provided in this Agreement, to or on behalf of Employer, or to otherwise work in competition with Cigna. Should there be a termination of this Agreement and Employer desires to have a Cigna Personnel work for Employer or another health center vendor or otherwise serve in a similar capacity to benefit Employer within one (1) year following termination of this Agreement, Employer agrees that it shall reimburse Cigna all severance costs Cigna has paid to any and all Cigna Personnel resulting from a termination of this Agreement. 22. Jndemnificatiou. Section 11, Indemnification, of the ASO agreement applies to the Amendment as revised herein. For purposes of this Amendment only, and specific only to the services described beginning with the phrase "Virtual Health Center" starting on page 25 continuing through page 42. caused in w hole or in_part" is removed and replaced with 09/19/2023 42 Client Name: City of Miami Administrative Senices Only Agreement "to the extent caused by". Additionally, for the purpose of this Amendment only, and only for the "Virtual Health Center" services, the end of Section 11 shall include the following: "Cigna shall only be liable for indemnification to the extent caused by Cigna's acts or omissions as stated herein." Operating Budget 09/19/2023 43 Client Name: City of Miami Administrative Services Only Agreement Evernorth Direct Health, LLC, A Cigna Company Cost Projection Prepared for: City of Miami (R.) - Virtual Standalone Estimaktilr Three FuH Yeas £VERNORT..._ , i:1. rF%t'r?' 51112022 - 5/31F1023 I '» - mucIpam. 1 iOO Pewn11111 Visits 2,500 2.500 2,600 Panelrlltlon Rafa 30.0% 37.5% 45.0'Xa Projeclvd Prevanlive/Acute Care Visits 750 931 1.126 FT Fs Coach-Repislere Nurse TotalAE's 1.00 1.00 1.00 1.00 1.(JO 1.00 Salaries&Benefits 123,000 128,000 132,000 Supplies 21,000 21.000 21.000 PrwidurSenices Concierge Practice Fee 20,000 20,000 20,000 Fer'lisitcost 49,000 61,000 73,000 Olhes'-Dinct Lxoenses 14.000 12,000 12.,000 ilY:em Expenses 32, 32,000 32,000 i mate .0/-):: £i i8 :F: '..:::<::: 0 f:& 1. ::. -: f:: tf::.2 '. \f:f h' fnfrest ticture Costs litattagesnent Fee 10JJ00 10,000 11,000 llotalFeeEsti ffiff $00 - 'A000. rtf2ttJ f .J'i gifff' ,Total On Site: Virtual Ceit nit,000 3fi = Cigna Coauiixtion t Annual Fundtrgj 141,518 151,944 156.502 J 1 i . / W _ = @ Sc = W/_ 1j tiThefaclily isstiffedaslndlcaled in!he REIIIIdier,ablMl 2J N-1111181sccnsidenlll be40 houlsperW!iek:mdrepesenledb'j 1.00FfE,111tt8tllp laborlspuvldad ding 3 !smodeledtolncmaseat7 peryearup1o60'!4 4} Mm!fingforC011lflllri!:a to111 Dseelgibleflll'accesst>1 hede islllamedatS5000rnyeal'one1R1$2500ttleflllbm!I years 5} Reauilmenl alSt I'crSlalf is Ilfojedad atS!J(E house). MadlmV&any ex:!eulat mcnilhnel'te.IlpIllsesilB 111U. dillntnallliledlallesslllc:Umld. 6j Doesoot lnclu:lelhe(Ostllffadlilyblifdol.t Yl Does not Inclu:le Ih&cost Orlease 8) Assumes,!i0'Ir,afeligille iafiCipan15 R1t1!M!alu shot ii Ille CInit. 9)&11m:111abvenoorwllsu!3mltacla1111. 10J Ompr.ilePiaclredMedldne Iawand,Stilelelemtdr,ilei 1,nayaeedtotlereviewed...AddlllOnal chages111;11)'asipjyb COl.l,lillancP . 11} Thecm:toainnctl'ol"apadilicnerlDdeiwl" wilmllleJawmaybehil,llel" k1M1f11&'lpigectsd.adu;faJlts.119JJi198m1hRllgl. 12) Hgt,SpeedlnlBmelJIIU5lbeavailablelothebmmgaridextendedtudemartwitllSlwndDl"81!1ViatdslancerequiremarD. Addilimal ameaivlydlargaSb InfernefJOSUTelephen,svascould lllJPlylf dlnlc:cannotuse dlenfsaxlStilgseNkei,rovlders. 09/19/2023 44 Client Name: City of Miami Administrative Services Only Agreement Health Improvement Fund For clinical/wellness/behavioral programs offered by CHLIC that are purchased, CHLIC will establish a Health Improvement Fund in the amount of $200,000.00. This fund will be used to defray the cost of CHLIC designated and arranged health and wellness improvement programs (e.g. biometric screenings, flu shots) for Employees of Employer and to reward participation in these programs. The Health Improvement Fund is a one-time credit to be used :from January 1, 2022 - December 31, 2022. Unused funds cannot be rolled over and the City can use the Health Improvement Fund at their discretion. The Health Improvement Fund shall- be extinguished upon termination of this Agreement and any fund amount not used prior to tennination of this Agreement shall only be available to Employer for the purpose of funding the cost of those reimbursable services provided prior to such termination. 09/19/2023 45 Client Name: City of Miami Administrative Services Only Agreement Exhibit B - Services .K .'. :-+.#' 4 ,v`<,'u(' rt -;,T,,'kx �T»'� sy..w t'.ja',.•HY1: .i y"..r'\ �Yz R s,+y q, kx.._z ttd _?.� , `: '. � l �-. '.e -,,, .to,:. R�.e'� ; :... _ ,--k-_9;v-,� 1'.� ?4, �..i�i �l:.:iri-- Mk.L� H .`. 1 m, �. 0..'�, :�� F F ,...Y.i _;. 1¥1 ` _ 1-urnis`hing CHLIC's stanaara bank Account activity data reports to Employer as and when agreed 1 upon. CHLIC's administration of the Plan does not include performing obligations, if any, under All Products All Medical and Pharmacy Products state escheat or unclaimed property laws. It is Employer's responsibility to determine the extent to which these laws may apply to the Plan and to comply with such laws. If Employer has elected, pursuant to section 63 of the New York Health Care Reform Act of 19961 (section 2807-t of the Public Health Law) ("the Act"), to pay the assessment on covered lives set forth in section 63 and has consented to the conditions set forth in section 63, CHLIC shall file such forms and pay such surcharge and assessment on covered lives on behalf of Employer through the Banlc Account to the extent set forth in section 63. Such obligation shall end immediately upon Employer's failure to provide any information required by CHLIC to fulfill this obligation, the failure to comply with any requirement imposed upon Employer pursuant to the Ac or the failure of Employer to sufficiently fund the Bank Account. In addition, where permitted and agreed to by CHI.JC, CHLIC will file applicable forms and pay on behalf of Employer and/or the Plan any assessment, surcharge, tax or other similar charge which is required to be made by Employer and/or the Plan based on -covered lives and/or paid claims or otherwise in accordance with and as required by other applicable state and/or federal laws and regulations and the Bank Account will be charged for any such payments made by CHIJC. CHLIC's obligation to pay on behalf of Employer shall end immediately upon Employer's failure to sufficiently fund the Bank Account. Where permitted and agreed to by CHLIC, CHUC will file applicable forms and pay on behalf of All Vision Products Employer and/or the Plan any assessment, surcharge, tax or other similar charge which is required to be made by Employer and/or the Plan based on covered lives and/or paid claims or otherwise in accordance with and as required by other applicable state and/or federal laws and regulations and the Bank Account will be charged for any such payments made by CHI.JC. CHUC's obligation to pay on behalf of Employer shall end immediately upon Employer's failure to sufficiently fund the Bank Account. 09/19/2023 46 Client Name: City of Miami Administrative Services Only Agreement S..Y:')':xC `E 'S]* $'r u µti 4.b-' lVl I�� GSM,-'4 f. 7. 7-S" q'�v= S' v.:k :,: _ . „"..- _ excluding ea l Saving it t aunt: Calculate benefits, check and/or electronic payments disbursed from the Bank Account. Bank I' Account payments will apear in Employer's standard Bank Account activity data reports. All Products All Products CHLIC's generic claim forms are made available to Employer for individuals eligible to enroll in 1 the Plan. CHLIC's Special Investigations Unit will investigate, pend, recommend denial of claims in whole I or in part. and/or reprocess claims. as appropriate. AU Products [ All Products I All Products Discuss claims, \vll_en appropriate, with providers of health services. Perform, based on CHLIC's book of business internal audits of plan benefit payments on a random sample basis. Claim control procedures reported annually in Statement on Standards for Attestation I Engagements (SSAE) No. 18 Report (or any applicable successor thereto). All Products All Products All Products All Products (excluding Pharmacy} All Products Resoond to Insurance D-71-....,. ,..,..,.,,.*:...,. Desfanated toll -free telephone line for Member and Provider calls to CHLIC Service Centers. Member Explanation of Benefit ("EOB") statements including, when applicable, notice of denied claims, denial reason(s) and appeal rights. Verify enrollment and eligibility using Member information submitted by Employer and/or its authorized went. Medical .l On CHLIC's generic enrollment form is made available to Emp dyer for individuals eligible to enroll-1 in the Plan. All Medical Products CHLIC's standard ID card with toll -free telephone number are prepared and mailed directly to All Medical Products Members. Administration of subrogation/conditional Claim Payment{terms described in Exhibit El. All Medical Products Vision Only Alt Vision Products CHLIC's standard ID card with toll -free telephone number are prepared and mailed directly to Members. Providing generic enrollment forms and reimbursement request forms to Employer for use in connection with Health Care Flexible Spending Account ("FSA") and/or Dependent Care Flexible Spending Account {"DFSA") under which eligible employees (collectively "FSA Members") may, FSA and DFSA Products 09/19/2023 47 Client Name: City of Miami Administrative Services Only Agreement elect to reduce their salary on a pre-tax basis up to the IRS maximum contribution allowed for deposit into a FSA and/or DFSA. At the end of each reimbursement period of the Plan Year, CHUC shall issue payments to the extent that funds remain in each FSA Member's account, for the amount that is determined by it to FSA and DFSA Products be proper under the Plan. At the end of the final reimbursement period of the Plan Year, CHUC shall issue payments for any amount then due for those expenses that are determined by it to be proper under the Plan. Allowable expenses for reimbursement under a DFSA include all allowable expenses incurred for the care of dependents pursuant to I.RC. Sections 125 and 129. DFSA Products Allowable expenses for reimbursement under a FSA include all allowable health -related expenses, pursuant to I.R.C. Sections 125 and 213 except where reimbursement under a FSA is prohibited. FSA Products FSA Member accounts will remain open after conclusion of the Plan Year until March 31, (the FSA and DFSA Products "Run Out Period"), so that FSA Members can submit any remaining expenses incurred but not paid out during the Plan Year. Separate account balances will be maintained as per FSA Member's election for the new Plan Year. The amount allowed by Applicable Law (or a lesser amount as defined by the Employer, however not less than the Minimum Carryover amount allowed as defined by the Employer) will carry over FSA Products into the subsequent Plan Year causing the FSA Member to be automatically enrolled, regardless of FSA Member's election for the subsequent Plan Year. FSA Members will have the right to opt out of Carryover with notification of their intent to opt out to be given prior to the end of the Plan Year. The account balances for any FSA Members who have opted out of Canyover will remain open after conclusion of the Plan Year until March 31, (the "Run Out Period"), so that FSA Members can submit any remaining expenses incurred but not paid out during the Plan Year. FSA Members who have enrolled in a Health Savings Account for the new Plan Year will be assumed to be enrolled in a Limited Purpose FSA, if available. The Carried Over FSA balance will be available through the March 31 (the "Run Out Period"), so that FSA Members can submit any remaining expenses incurred during the Plan Year. The Carried Over balance will also be available both during and beyond the March 31 (the "Run Out Period"), for claims incurred during the new Plan Year, and will be supplemental to the FSA Member's current Plan Year contribution election, if aoolicable. Reimbursement requests of tenninating FSA Members will continue to be processed for 30 days following termination of FSA Membership for any expenses incurred prior to the FSA Membership tennination date. In the case of a DFSA, reimbursement will be up to the balance in FSA and DFSA Products 09/19/2023 48 Client Name: City of Miami Administrative Services Only Agreement the DFSA and in the case of a FSA, reimbursement will be to the originally selected goal amount/2 minus prior reimbursements. regardless of whether this amount has been funded. For FSA payments that are not made with a Debit Card but are a result of automatic claim forwarding ("AutoPay") of medical or dental claims from a medical or dental plan administered by CHLIC or Direct Submit Request For Reimbursement, an explanation of payment will be mailed to the FSA Member at their home address or, if elected, provided electronically. An explanation of payment is not issued for FSA payments that are issued to a pharmacy at the point of service as a result of automatic claim forwarding from the employee's phamlacv Plan. FSA Products For DFSA payments made as a result of a Direct Submit Request For Reimbursement, an explanation of payment will be mailed to the DFSA Member at their home address or, if elected, provided electronically. DFSA Products An 800 nwnber directly linked to CHLIC's Member Services will be available for FSA Members' questions and status inquiries. This 800 number will be listed in the instructions on the reimbursement request form as well as having access to account information via Internet. FSA and DFSA Products The Employer will identify through eligibility submission, FSA Members who elect to have medical and pharmacy claims processed but unpaid by CHLIC automatically submitted ("rolled over") to their FSA. Such rollover claims will be processed without additional submissions by the FSA Member and CHUC shall be entitled to rely on the Employer's submission of the FSA Member's rollover election that the submitted expenses were properly incurred, not reimbursable from any other source and are eligible for payment under the regulations governing flexible spending accounts. FSA Products When CHUC takes over a FSA administration mid -Plan Year, CHLIC will provide administration FSA and DFSA Products services from the date CHLIC receives the FSA Plan information for claims incurred anytime during the Plan year. For employees enrolled in a health care FSA plan with a debit card, a debit card will be issued to each FSA Member (employees enrolled in both a health care FSA plan with a debit card and a Health Reimbursement Account plan with a debit card will only receive one debit card covering both plans). The card is pre -loaded with the FSA Member's annual Health Care FSA goal amount for the Plan Year. Plan Year FSA funds are available using the debit card for transactions actually processed during the Plan Year period. The card does not access funds from a prior Plan period unless the Plan has the extended claim period and the Employee re -enrolls in the FSA for the subsequent period. If an Employee terminates their FSA Plan or does not re -enroll in the FSA, the debit card will be de -activated and will not be available for use after the last day of the Employee's FSA Products 09/19/2023 49 Client Name: City of Miami Administrative Services Only Agreement FSA enrollment. The card is used by the FSA Member to access available FSA funds based upon the submitted goal amount less amount paid Plan Year to date from the fimd. Since debits made with the card are not submitted by the card vendor to CHLIC in real-time but only on a daily basis, Employer agrees to fund all debits made by the FSA Member through the daily feed from the card vendor that indicates the FSA Member account is exhausted. The card is restricted to specific merchant types that are considered health care related. Although the card is limited to these types of merchants, the card does not limit specific items within these merchants. When the debit card is used, funds are automatically deducted from the FSA. FSA Members may be required to submit receipts to CHLIC to substantiate debit card expenditures. If appropriate substantiation is not receiv the debit card will be suspended and no longer available for use. For employees enroUed in a health care FSA plan who have had no account activity for the prior two plan years, their account will be terminated as of the end of the prior plan year. FSA Member accounts will remain open after conclusion of the Plan Year until March 31, (the "Run Out Period"). so that FSA Members can submit any remaining expenses incurred but not paid out during the Plan Year. FSA Products e.are and make a ssible Member ben 5500 Schedule C reporting. 5500 Schedule A or Annual Reconciliation Disclosure reporting (when applicable) CHLIC's standard Underwriting services: a) benefit desi:n anal sis b protected cost anal sis. ,produc uc Handling of requests from Members for access to, amendment and accounting of protected health information, and requests for restrictions and alternative communications as required under federal HIPAA law and regulations, as set out in this Agreement and its Exhibits. Maximum reimbursable charge determinations of non -Participating Provider charges for covere services. Products Produc All Products All Products All Products d All Medical Products (with out -of -network benefits 09/19/2023 50 Client Name: City of Miami Administrative Services Only Agreement CHUC's standard cost containment controls: Application of non -duplication and coordination of All Medical Products benefits mies and coordination with Medicare. Delivery of information, as necessary, regarding standard application of non -duplication or coordination of benefits. All Medical Products Review of medical bills in accordance with CHLIC's then current Medical Bill Review program. AU Medical Products Network Savings Program, a national vendor network that provides discounted rates when a Member accesses care throufili a Network Savings trogram contracted provider. All Medical Products Annual reporting of CHLIC's standard cost containment results upon Employer's request. AU Medical Products Pharmac Vendor Recoveries. All Pharmacy Products sl `n^. .v . r' w.N.,: ;a:Y` .: �, f@� Y 9 , b„ u w.. p. 1�'" ?k'^^rf,'.i„ u^"4^.4P r.+m ..... .wv....� �. .. ""4 1il�% fiM. '.v,F i+Y§ Y$uZ+yg3,,'^Ydr i;,�i. '�'n'i'"8�`+'Ym1� Summary reports of medical and pharmacy cost and utilization experience (where app icable), web site, All Medical and Pharmacy Products Pharmacy Product On upon completion of internal report generation, are available through Cigna's CignaforEmplovers. com. CHLIC's standard pharmacy utilization reports. Claim Reporting: CHUC will provide standard banking and financial report information based claims, on a All Medical and Pharmacy Products upon paid claim data. CHLIC will not provide information on incurred -but -not reported projected claims, pre -certifications of coverage, case management information or information Member's prognosis or course of treatment. Stop Loss Reporting is an optional service provided at an additional fee to Employers who have stop loss through another entity other than CHLIC. CHLIC will provide its standard reporting only after the stop loss carrier and Employer have executed CHLIC's standard Hold Harmless/Confidentiality Agreement. All Medical Products FSA and DFSA Products CHLIC's standard management and statistical reports for Employer. CHLIC's standard Individual Summ Statements for Members. FSA and DFSA Products ap.licable . articipating ✓,» -..=r'+•+r +""i,we�.ka"�' .�an k s 'n d > c.^ ". w""` ^ y arr "a ,,..' .. r hc :c..rca } . dCt.,''b ;a" �tiRy "pw .� ..:. ?�� z., �u :�.e, 3 ss,.' .�. » �" a ,,m ;w . x�a.�>.n.��..s +�t,..,''�« "u. s ,,. ,"§G"3�' w. �� `�� - �•, tsr•.,"»a•„` sms. 7^ "`,w r � � .� �P a+, �v. � p �, � � �"S � � a�' •''�,„t' n � h „?"',� ..�'r� I "t'v�1^• ». r" ��sG Xw�R�t�� � , °"4^...... ..... Emplover is CH JCm ".".adminisierui,".".ffielH tlf �a a0.:Flexible: s ndifr'Ac:couiif,:Heaft.li\ " ,"� `*a. � +�`' �•� t c, � ��,,..�,� ;�:. A ,�"•�,�`.. � u+:; -_' "3 +:,sc-:r, rfa., a r�hd �i:s�ATv"wu' a Awards,• ;'. • i. % i fain! { ' tt! tfii ! Y• oil w 1 Each FSA Member who experiences a qualifying event and elects continuation coverage in accordance with COBRA will be maintained until the earlier of the end of of account FSA Products the Plan Year, the exhaustion of the FSA balance or othertennination of the FSA. 09/19/2023 51 Client Name: City of Miami Administrative Services Only Agreement FSA Members electing continuation of FSA coverage under COBRA will continue contributions at a rate not to exceed 102% of the applicable premium. The Employer may require after-tax contributions, or may allow the continuant to elect a lump -sum salazy reduction in the amount required in contributions for the remainder of the coverage period. . FSA Products FSA Members who continue under COBRA and whose contributions have been made as required may submit Reimbursement Requests for themselves and any eligible dependents, for expenses incurred before or after the date of the qualifying event but prior to the end of the coverage period. Requests may be submitted until the earlier of the end of the Plan Year or the termination of the FSA, includin_ any applicable Run -Out Period. : FSA Products CHLIC contracts with a minimum of three (3) independent review organizations that meet the l All Medical Products Patient Protection and Affordable Care Act (PPACA) external review requirements. Members may appeal eligible claims requiring medical judgment to an external independent review organization which is selected by CIII.,IC on a random basis. If Employer has chosen not to participate in this program, the Employer may be responsible for making other arrangements to meet the Patient Protection and Affordable Gare .A.ct (PPACA) external review requirements. h!s t6 3s eaw i e} rd3k1' aaa { `t*a :3,. } VE b`_ CaC provides integrated medical management that includes (depending upon the terms of the Plan)._ hefollowing core services. Pre -Admission Certification and Continued Stay Review (P. \( (' V) services to c ertify coverage of acute and sub -acute inpatient admissions/stays or provides guidance to appropriate alternative settings. Administered in accordance with CHLIC's then applicable medical management and All Medical Products [ All Medical Products claims administration policies, practices and procedures. Case Management, a service designed to provide assistance to a Member who is at risk of developing medical complexities or for whom a health incident has precipitated a need for rehabilitation or additional health care support. Assist providers with resources and tools to enable them to develop long term treatment plans in 1 the management of chronic or catastrophic cases. AU Medical Products The Cigna HealthCare Healthy Babies Program is an educational program which provides Participants with prenatal care education and resources to help them better manage their pregnancy. Other benefits of this program include the Health Information Line, high risk maternity and pregnancy information on mvCigna.com. [ All Medical Products 09/19/2023 52 Client Name: City of Miami Administrative Services Only Agreement HealthCare Cost and Quality tools available on myCigna.com and mvCi pa mobile app. All Medical Products All Medical Products All Medical Products All Medical Products A panel of physicians and other clinicians to assess the safety and effectiveness of new and emerging medical technologies. The panel meets monthly to review and update coverage policies. Health Information Line is a service that provides twenty-four (24) hour toll free access to nurses who provide convenient and confidential services. Health Information Line nurses can help guide Members in finding the right care, make informed decisions about symptom -based health issues the Member is experiencing when they call the Health Information Line and recommend appropriate settings for care. Health Information Line nurses can help inform and educate Members about a wide variety of health and medical information, including access to a library of En t l sh and Spaniskpodcasts. Cigna LifeSOURCE Transplant Network® contracts with more than one hundred sixty-five (165) independent transplant facilities which includes over seven hundred fifty (750) transplant programs and provides access to solid organ and bone marrow/stem cell transplantation while improving cost A health education program that delivers mailings to Members with certain conditions. All Medical Products Behavioral health services are provided/arranged by a CHUC affiliate (details available upon request), including utilization review and case management for both inpatient and outpatient, in- network behavioral health services. Network POSOA Products: (All Members) Implement a quality oversight process that includes monitoring of utilization management erformance measurements and a continuous9uality improvement .rocess when warranted. All Medical Products All Medical Products Except Comprehensive andlndemni Transition of care services to allow Members with defined conditions to continue treatment with non -Participating Providers after enrollment for continued uninterrupted care for a limited time. Focused utilization management of outpatient procedures and identification of appropriate alternatives Administered in accordance with CHLIC's then applicable medical management and All Medical Products with PBS Plus claims administration policies, practices and procedures. 09/19/2023 row ae or arrange access to the appncaoie networx or rarticipatmg rroviaers to rurmsn neaitn Alt ivieatcai an care services/products to Members at negotiated rates and methods of reimbursement (e.g. fee -for Pharmacy Products 53 Client Nrune: City of Miami Administrative Services Only Agreement service, fixed per person per period, per diem charges, incentive bonuses, case rates, withholds etc.). The amount and type of negotiated reimbursement may vary depending upon the type of plan. For example, a hospital may accept less for patients enrolled in certain types of plans than others. In addition, CHLIC may contract with Participating Providers and other parties (for example Independent Practice Associations) for performance -based incentive payments to promote quality of care, patient safetv and cost e:fficiencv. Provide or arrange access to the applicable network of Participating Providers to furnish health care services/products to Members at negotiated rates and methods of reimbursement (e.g. fee -for service, •fixed per person per period, per diem charges, incentive bonuses, case rates, withholds etc.). In addition, CHLIC may contract with Participating Providers and other parties for performance -based incentive payments to promote quality of care, patient safety and cost efficiency; All Vision Products Credential and re -credential Participating Providers in accordance with CHLIC's credentialing requirements and ensure that third -party network vendors credential/re-credential Participating Providers in accordance with CHLIC's requirements; All Medical, Pharmacy and Vision Products Monitor Participating Provider compliance with protocols and procedures for quality, Member satisfaction, and grievance resolution; All Medical, Pharmacy and Vision Products Facilitate the identification of Participating Providers by Members; and All Medical, Pharmacy and Vision Products Designated toll -free telephone line for Member and Provider calls to CHI.JC Service Centers. All Medical, Pharmacy and Vision Products Access to online and/or on demand medical and health -related consultations via secure telecommunications technologies, telephones and internet are permitted and may include MDLive, All Medical Products a CHLIC affiliate (see details on mvCigna.com). 09/19/2023 54 Client Name: City of Miami Administrative Services Only Agreement CII1.JC has contracted with an affiliate (details available upon request), to provide or arrange for the provision of managed in -network behavioral health services, the affiliate is a Participating Provider, and is reimbursed primarily on a monthly fixed fee basis. This fixed fee for behavioral health services will be paid as claims and will appear in Employer's monthly reporting and on financial documents. Such payments will be at the relevant monthly rates then in effect. The monthly rates paid to the affiliate vary depending on geographic location of Members and on benefit design, and may be subject to change..The rates will be made available upon request. The fixed fee also includes lifestyle management programs, a cognitive behavioral modification program, a Complex Psychiatric Case Management program, and a Narcotics Therapy Management program. Behavioral claims from a client specific network are not included in the behavioral monthly flXed fee and will be paid from the Bank Account. In some states, payment for behavioral health services must be paid on a fee: -for -service basis. In these states, fee -for -service payments for behavioral health services and the behavioral health administrative fee (including the lifestyle management programs, a cognitive behavioral modification program a Complex Psychiatric Case Management program and a Narcotics Therapy Management program) will be aid from the Bank Account as claims and will gear in Employer's monthly reporting. 09/19/2023 55 These services are included in the following products: Network POSOA Products Client Name: City of Miami Administrative Services Only Agreement 09/19/2023 56 Client Name: City of Miami Administrative Services Only Agreement The Cigna HealthCare of Arizona, Inc. staff model ("Cigna Medical Group" or "CMG") is a I All Medical Products multispecialty participating provider group located in metropolitan Phoenix, Arizona. CMG's integrated care delivery model and population health management team work together to facilitate the way in which patients and doctors communicate and interact in order to increase patient satisfaction and improve health outcomes. Plan Participants may at some time receive treatment from a CMG facility or provider even if they do not reside in Arizona (as when traveling). Plan Participants utilizing Cigna participating provider networks in Arizona may access certain specialty and/or ancillary services (such as imaging and urgent care services) through the CMG system. For covered services provided to Participants, CMG is paid at the rates in effect at the time of service (as may be revised from time to time). Representative rates for routinely performed services are attached to the Schedule of Financial Charges herein. A complete copy of the rates is available on request under a mutually agreed nondisclosure agreement ("'NDA"). If the Plan requires or allows Participants to select a primary care provider ("PCP"), Phoenix area Participants who do not select a PCP during open enrollment may be assigned to or otherwise encouraged to consider a CMG PCP. CMG has established collaborative referral relationships with specialty and ancillary providers in Cigna's participating provider networks, which includes affiliated entities. CMG may also receive applicable performance -based incentive payments for its participation in programs designed to improve quality, patient safety and affordability. The incentive payments that CMG may receive will be determined using the same performance measures and reward formula as used in determining the incentive payments made to similarly situated non -Cigna affiliated provider entities. The amount of the incentive payments made to CMG and attributable to the .lan will be .rovided upon request. 09/19/2023 57 The Urgent Care case rate excluding radiology and laboratory services is $135. co • ƒ 'c \• pko�2n ,c;,) z co m m 5® ® Q § � �»?�5 • % k Fry • $ c®� [%Q\$° co ¥ 4 / R [ ƒ 2. F Z.,Q co co )/ \ \y=k2 ct)m�(% $ 7-2 Z., C4 d �. ' Q 4. t �.m %• 3 � � 2k« gym \ Q • )) ƒ 3 » co c• o- /-se��§ / / % \® ) \ • z / \ \f \)\ o (CC, ) *� m ASC Endoscopy Suite Grotiper 8 ASC (Ambulatory surgical center) / Endoscopy Suite Optometry 92014 General Surgery 47562 Radiology 77067 & 77063 Radiology 71046 Podiatry 11721 Ophthalmology 66984 Pediatrics Adult Medicine AH Departments P § \ $ \ $ \ $ / I EFFECTIVE JANUARY 1, 2020 CPT e scri • tion EYE EXAM & TREATMENT LAPAROSCOPY;CHOLECYSTECTOMY- Professional Fee only, at a facility SCREENING MAMMOGRAPIN DIGITAL CHEST X-RAY, PA & LAT DEBRIDEMENT NAIL SIX OR MORE REMOVE CATARACT, INSERT LENSw Professional Fee only, at a facility WELL EXAM, EST, 1-4 YEARS WELL EXAM EST. 40 64 YEARS \ \ f / $ \ \ c to \ . " / 0 $ 0 $158.56 / o Q / $278.56 $43.54 $57.93 / o ( k $124.36 ._ ƒ / 5 \ Client Name: City ofMiami Administrative Services Only Agreement Appendix A - Pharmacy Benefit Management Services ft.. . --T-i--Tii'n iilff t - t7fl u i T9fl • 'in BF NFM ACrF T- 2T1FTTNtrlONSit fel-9T\i#<>- \(iff .ifl >i Tft T> 7f>c•1 • •..... • • • Definitions Any capitalized term not defined below shall have the meaning given -to such tenn in the Agreement. Any capitalized term utilized in the Schedule of Financial Charges or Exhibit B shall have the meaning given to such teen in the Agreement, including the meanings set forth below. • "Actuarially Estimated" shall mean that the discount(s) listed in the Schedule of Financial Charges are estimated, but not guaranteed, to result in a particular average discount for Covered Drugs administered by CHLIC under this Agreement Actuarially estimated discounts are calculated based on evaluation of an expected distribution of drag utilization across C111,IC's aggregate group client book of business. As measured in the aggregate for Employer's Pharmacy Benefit, Employer's average discount results may vary based on the Plan -specific factors such as drug mix utilization. • the Foo zand Deinug �"dmlinlistration aunc er se tion �5s�c�dof the edera oo t rugdancl osrnet g ACtl( JJLA) that as iiliarvkee sold or distributed under a different labeler code, product code, trade name, trademark, or packaging (other than repackaging the listed drug for use in institutions) than the innovator brand name drug. "Average Wholesale Price" or "AWP" shall mean the average wholesale price of a Covered Drug as established and reported by Medi- Span. The applied AWP of a Covered Drug shall be the AWP for the actual eleven (11) digit National Drug Code ("NDC"), Covered Drug specific, quantity appropriate actual package size (or the manufacturer -packaged quantity closest to the dispensed size), submitted by a Retail Pharmacy, Home Delivery Pharmacy, or Specialty Pharmacy at the time that the Covered Drug is adjudicated. Notwithstanding any other provision in this Agreement, in the event of any major change in market conditions affecting the pharmaceutical or pharmacy benefit management market, including, for example, any change in the markup, methodologies, processes or algorithms underlying the published AWP(s), CHLIC may adjust any or all of the Rebates, charges, rates, discounts, guarantees and/or fees in connection with CHLIC's administration of the Phannacy Benefit hereunder, including any that are based on AWP, as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such change. Additionally, and notwithstanding any other provision in this Agreement. CHUC may replace AWP as its pharmaceutical pricing benchmark with an alternative benchmark and/or may replace Medi-Span, or other such publication, as its source for the AWP or alternative benchmark with a different pricing source, provided that CHUC adjusts any or all such AWP-based charges or such alternative benchmark -based charges as it reasonably deems necessary to preserve the economic value or benefit of this Agreement to CHLIC as it existed immediately prior to such replacement or immediately prior to the event(s) giving rise to such replacement, as the 09/19/2023 59 Client Name: City ofMiami Administrative Services Only Agreement • • • • • • case maybe. SBiosimiAlar" 1 1 iSa1 productpthat is licensed by the FDA as a biosimilar �ssuant to Section 351(kl)p f the Public Health ervice ct ..�a du on a snowing at i is i similar to a single icense io o ica product, own as a reference product, and has no clinically meaningful differences compared to the reference product in terms of safety, purity, and potency. A biosimilar biological product may be licensed by the FDA as biosimilar or interchangeable, and in either case such biological product is a Biosimilar for the purposes of this Agreement. "Brand Drug" shall mean a pharmaceutical product, including a Covered Drug that is a prescription drug, including over-the-counter drugs dispensed pursuant to a prescription, medicine, agent, substance, device, supply or other therapeutic product that is not a Generic Drug. Except if and where the language expressly states otherwise, a Brand Drug does not include a Specialty Brand Drug for ingredient cost discount purposes. "Business Decision Team" shall mean a committee comprised of voting and non -voting representatives across various Cigna business units such as clinical, medical and business leadership that is duly authorized by Cigna to make decisions regarding coverage treatment of pharmaceutical products based on clinical fmdings provided by the P&T Committee, including, but not limited to, decisions regarding tier placement and application of utilization management to pharmaceutical products. "Cigna Home Delivery Pharmacy" shall mean a duly licensed pharmacy operated by CHUC or its affiliates, where prescriptions are filled and delivered via the mail service, which may include, for example, Accredo Health Group, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy Inc., Tel -Drug of Pennsylvania LLC and Tel -Drug, Inc. "Claim," for purposes of this Appendix A, is a claim or request for coverage under the Pharmacy Benefit. "Compound Drug" shall mean a medication that (a) is comprised of two or more gaseous, solid, semi -solid, or liquid ingredients (other than water or flavoring added to any preparation) that are weighed or measured at a pharmacy and then prepared according to the prescriber's order and the pharmacist's art; (b) contains at least one FDA -approved federal legend drug as an active ingredient; (c) is not otherwise generally available in its compound fonn; and (d) is not a compound preparation administered by infusion or injection. "Covered Drugs" shall mean prescription drugs, including over-the-counter drugs dispensed pursuant to a prescription, biologics, medicines, agents. substances, devices, supplies, and other therapeutic products that are prescribed for Members and are covered under the Pharmacy Benefit and shall include all associated standard services usually and customarily rendered by a pharmacy or provider in the normal course of business, including dispensing, administration, counseling and product consultation. 09/19/2023 60 Client Name: City ofMiami Administrative Services Only Agreement "Dispensing Fee" means an amount paid to a pharmacy for providing professional services necessary to dispense a Covered Drug to a Member. • "FDA" shall mean the U.S. Food and Drug Administration. • • • "Formulary" shall mean the list of FDA -approved prescription drugs and supplies developed and managed by CHUC across its self - funded and insured group book of business and that is selected and adopted by Employer. The drugs and supplies included on the Formulary will be modified by CHUC from time to time as a result of factors including, but not limited to, economic and clinical factors like clinical appropriateness, manufacturer Rebate arrangements and patent expirations. Any changes CHUC makes to the Formulary are hereby adopted by Employer. "Generic Drug" means a pharmaceutical product, including a Covered Drug, whether identified by its chemical, proprietary, or non- proprietary name, that is accepted by the FDA as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient(s), and which is identified as such in CHLIC's master drug file using indicators from First Databank, Medi- Span, or other nationally recognized source as used by CHUC across its book of business on the basis of a proprietary algorithm, a summary of which may be made available for review by Employer or, subject to CHLIC's consent, its auditor upon request in accordance with the terms set forth in this Appendix A. Employer and, as applicable, its auditor shall sign a confidentiality agreement acceptable to CHLIC relating specifically to such summary. The reference to a drug by its chemical name does not necessarily mean that the product is recognized as a generic for adjudication, pricing or copay purposes. Except if and where the language expressly states otherwise, a Generic Drug does not include a Specialty Generic Drug for ingredient cost discount purposes. For pricing purposes, a Generic Drug includes a Covered Drug that is otherwise identified as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient(s) and is within its exclusivity period or other period of limited competition; provided that, notwithstanding the foregoing, a Generic Drug excludes an Authorized Generic identified as a brand name drug by the aforementioned proprietary algorithm used by CHLIC. For pricing purposes, a Generic Drug also excludes a Biosimilar. "Limited Distribution Drug" or "Exclusive Distribution Drug" shall mean a Specialty Drug that is not generally available from most or all pharmacies but is restricted to select pharmacies as determined by a phannaceutical manufacturer. The list of Limited Distribution Drugs and Exclusive Distnbution Drugs will be maintained by CHLIC. • "Maximum Allowable Charge" shall mean the maximum unit price for a Covered Drug included on the applicable MAC List as set forth on such MAC List. • "MAC List" shall mean a then -current list maintained by CHLIC of prescription drugs, devices, supplies and over-the-counter drugs identified as readily available as a Generic DruJLQ!_generally equivalent to a Brand Drug (in which case it may also be on a MAC List) 09/19/2023 61 Client Name: City of Miami Administrative Services Only Agreement • • • • • • and that, in each case, are deemed to require or are otherwise capable of pricing management due to the number of manufacturers, utilization and/or pricing volatility. sManufacturer Administrative Fees" shagmean administrative fees allocating by pharmaceutical x n ufacturers to CHLIC or its affiliate or u contractor erectly m connection wit a mmistermg, mvoicmg oca g and collectmg Kebates. "Phannacy Benefits" shall mean amounts payable for covered phannacy benefit services and products under the terms of the Plan; Pharmacy Benefits shall be considered Plan Benefits for purposes of this Agreement. "P&T Committee" shall mean a committee comprised of clinicians that represent a range of clinical specialties. The committee regularly reviews pharmaceutical products, new pharmaceutical products, for safety and efficacy, the findings of which clinical reviews inform coverage status decisions made by the Business Decision Team. The P&T Committee's review may be based on consideration of, without limitation, FDA -approved labeling, standard medical reference compendia, or scientific studies published in peer -reviewed English -language bio-medical journals. "PBM Proprietary Information" shall mean information relating to CHLIC's pharmacy benefit management products and services, including, without limitation, CHLIC's reporting and web -based applications, eligibility and adjudication systems and coding methodologies, system formats and databanks, clinical or fonnulary management operations or programs, information and agreements relating to Rebates and other fmancial information, prescription drug evaluation criteria and coverage policies, drug pricing information, including MAC List and Specialty Drug pricing, paid Claims information integrated into CHLIC's adjudication systems, and pharmaceutical manufacturer, vendor or pharmacy network agreements. "Prescription Drug Charge" shall mean the amount that, prior to application of the Plan's cost -share requirement(s), Employer is obligated to pay for a Covered Drug dispensed at a Retail Pharmacy or Cigna Home Delivery Pharmacy, including any ingredient cost, applicable Dispensing Fee, service fee, and tax. The ingredient cost charged to Employer may be expressed as, for example, a discount off of AWP or other benchmark price, or a MAC. "Rebate" shall mean retrospective formulary rebates received by CHLIC pursuant to the terms of a formulary rebate contract negotiated independently and directly attributable to or arising from the utilization by Members of certain Covered Drugs manufactured, sold, marketed, or distributed by a manufacturer. However, "Rebates" shall exclude: (i) pricing adjustments, payments and credits made in the ordinary course by any manufacturer on account of product returns, delivery errors or shipping damage or losses arising from drugs and other products purchased from such manufacturer by or on behalf of CHUC pricing_di_sc:ounts paid or credited by a manufacturer to pharmacies affiliated with CHLIC for 09/19/2023 62 Client Name: City of Miami Administrative Services Only Agreement • • • prescription drugs and other products purchased from such manufacturer; {iii) any fees or other compensation paid by any manufacturer in consideration of any services, products, activities or programs performed, provided or implemented by CHLIC or any of its affiliates for such manufacturer; (iv) Manufacturer Administrative Fees; (v) Value -Based Payments; (vi) any rebates or other amounts th.at are allocated to reduce and/or partially or wholly satisfy a Member's cost -sharing obligation for a Covered Drug; and (vii) rebates or other amounts paid to CHLIC for prescription drugs that are administered or otherwise provided to Members in providers' offices, home health care settings, or outpatient clinics. "Retail Pharmacy" shall mean any licensed retail pharmacy with which CHUC has contracted directly or indirectly with a third party, to provide Covered Drugs to Members, and is not a mail order pharmacy. A mail order pharmacy is a pharmacy that primarily fills and delivers pharmaceutical products via the mail service. The term "Retail", when immediately preceding the term "Brand Drug Claim", "Generic Drug Claim", "Specialty Drug Claim", "Specialty Brand Drug Claim", or "Specialty Generic Drug Claim" means that the resulting term (e.g., naetail Brand Drug Claim") refers to such claim as dispensed by a Retail Pharmacy. "Specialty Dru.g" shall mean a pharmaceutical product, including a Covered Drug, considered by CHUC to be a Specialty Drug based on consideration of the following factors: (i) whether the pharmaceutical product is prescribed and used for the treatment of a complex, chronic or rare condition; (ii) whether the pharmaceutical product has a high acquisition cost; an (iii) whether the pharmaceutical product is subject to limited or restricted distribution, requires special handling and/or requires enhanced patient education, provider coordination or clinical oversight. A Specialty Drug may not possess all or most of the foregoing characteristics, and the presence of any one such characteristic does not guarantee that a pharmaceutical product will be considered a Specialty Drug. The term "Specialty," when immediately preceding the terms "Generic Drug" or "Brand Drug", means that the resulting term (e.g. "Specialty Generic Drug") refers to a Generic Drug or Brand Drug that is considered a Specialty Drug, respectively. "Specialty Pharmacy" shall mean a duly licensed pharmacy designated by or operated by CHLIC or its affiliates that primarily dispenses Specialty Drugs or provides services related thereto; provided, however, that when the Cigna Horne Delivery Phannacy dispenses a Specialty Drug, it shall be considered a Specialty Pharmacy hereunder. • "U&C Charge" shall mean the price the applicable Retail Pharmacy would charge a regular cash -paying customer for a Covered Drug (and any services related to the dispensing thereof) on the day on which the Covered Drug is dispensed. t3/4!1117o IJF1'74I1j 1-I It "ill 1 X..ch 11LINLP1:1' J 1\.4LL1V1L1IJ,;}; :wl EN'.1 111 K 1!Itn IT 1 it'll mg tn:I;IIIIZ zr 1. Retail Pharmacy Network. (a) General. CHUC shall maintain a Retail Pharmacy network. Retail Pharmacies included in the network shall provide Covered Drugs to which the Retail Phannacies have access to Members during their normal business hours. A list of the Retail Phannacies 09/19/2023 63 Client Name: City of Miami Administrative Services Only Agreement included in the network, as updated from time to time, shall be made available to Members online. CHLIC maintains multiple networks and/or sub -net -works and may periodically consolidate networks and/or migrate clients, including Employer, between networks and sub -net -works. CHLIC shall require each Retail Pharmacy included in the network to meet its requirements for participation in the Retail Pharmacy network, which include, but are not limited to, satisfaction of licensing and insurance requirements. (b) Retail Pharmacy Audits and Overpayments. CHUC shall review 100% of all claims, with each claim to be reviewed by either desk audit or field audit as determined through the use of random risk based predictive model to ensure that each Retail Phannacy is complying with the terms of its contract with CHLIC. In the event that CHLJC discovers that an overpayment has been made to a Retail Pharmacy, CHUC shall talce reasonable steps to recover the overpayment pursuant to the terms of this Agreement. (c) Independent Contractors. The Retail Pharmacies are independent contractors, and as such CHUC does not direct or exercise any control over the pharmacists at Retail Pharmacies or the professional judgement exercised by any pharmacies in the dispensing or filling of prescriptions or performing other pharmaceutical services. Neither CHLIC nor any CHLIC affiliate shall have any liability to Employer, any Member or any other person or entity for any act or omission of any Retail Pharmacy or it agents or employees. (d) Collection of Cost Sharing. CHLJC shall require Retail Pharmacies to collect all applicable Plan cost shares from Members. 2. Cigna Home Delivery Pharmacy. (a) General. Members may submit new or refill prescription orders for fulfillment through Cigna Home Delivery Pharmacy or such other mail service pharmacy that CHLIC in its sole discretion may select from time to time. Such orders may be placed via mail, telephone, or electronic means. Subject to Applicable Law, Employer shall permit communication with Members regarding the availability and use of the Cigna Home Delivery Pharmacy potential cost savings associated therewith, and the provision of supporting services (e.g. phannacist consultation) in connection with any prescription dispensed by the Cigna Home Delivery Phannacy. Cigna Home Delivery Pharmacy shall deliver all drugs to Members in accordance with its standard procedures. For the purposes of clarity, CHUC does not exert direction or control over the pharmacists at Cigna Home Delivery Pharmacy in filling prescriptions or performing other pharmaceutical services. (b) Cost Sharing. Members are responsible for the payment of the applicable cost sharing to Cigna Home Delivery Pharmacy for each prescription or prescription refill. Employer acknowledges that Cigna Horne Delivery Pharmacy may suspend services to a Member who is in default of any cost -sharing obligations, in accordance with Cigna Home Delivery Pharmacy's standard credit policy. If payment of such cost -sharing has not been received from the Member within one hundred twenty (120) days of 09/19/2023 64 Client Name: City of Miami Administrative Services Only Agreement dispensing of the product, the Plan will be billed for the outstanding amount following the one hundred twenty (120) day collection period. (c) Affiliation with CHUC. Accredo Health Group, Inc., ESI Mail Pharmacy Service, Inc., Express Scripts Pharmacy Inc., Tel -Drug of Pennsylvania LLC and Tel -Drug, Inc. are licensed pharmacy affiliates of CHLIC that fill and deliver Covered Drugs via the mail service. 3. Claims Processing. (a) General. CHLIC, in accordance with Section 2 of the Agreement, shall perform claims processing services for Covered Drugs dispensed by Retail Pharmacies or Cigna Home Delivery Pharmacy. In -network Claims shall be submitted via paper or electronically. Members using out -of -network covered services are required to submit a paper claim form. A separate charge shall apply for the submission of any paper claim form, whether in -network or out -of -network. CHUC is not required to provide coordination of benefits (COB) services for Claims for drugs dispensed, and electronically processed, at a pharmacy; Claims may be processed without consideration of a Member's coverage under another plan. (b) Drug Utilization Review. CHLIC shall perform a concurrent Drug Utilization Review ("DUR") analysis of each prescription submitted for processing. Such DUR Analysis may include, for example: (1) prescribed dosage within a safe range; (2) drug -to - drug interaction; (3) drug -to -allergy interaction; (4) age -to -drug interaction; (5) duplicate therapy; (6) quantity limitations; and (7) days' supply. DUR processes shall not override the prescriber's, the pharmacist's or other health care provider's professional judgment. 4. Utilization Management Program. CHUC shall, in accordance with Section 2 of the Agreement, administer the Pharmacy Benefit utilization management program(s) identified in this Agreement. Employer acknowledges that CHLIC's coverage policies and claims administration procedures, which are utilized across CHLIC's self -funded and insured book -of -business to adjudicate claims and administer appeals, may change periodically. As an example of the coverage criteria that may apply to a pharmaceutical product, a Member may have to try one or more preferred pharmaceutical products, or demonstrate why tiying the preferred pharmaceutical product(s) would be clinically inappropriate, in order to obtain coverage under the Plan for a given phannaceutical product Employer further authorizes CHUC to allow coverage for a use that otherwise would be excluded in the event of co -morbidities, complications and other factors not expressly addressed by the coverage policies utilized by CHLIC in reviewing Claims for coverage. CHUC may rely wholly upon information about the Member and the prescn"ber's diagnosis of the Member's condition. CHLIC shall not substitute its judgment for the judgment of the prescribing physician, nor shall it determine medical necessity or make other medical determinations other than for coverage purposes. 09/19/2023 65 Client Name: City of Miami Administrative Services Only Agreement 5. R bate Manaffement. CHLIC shall pay Employer amounts equal to the Rebate amounts specified in the Schedule of Financial Charges. 6. l>1"u J-Related Services. (a) Specialty Drugs. CHLIC shall process Claims regarding Specialty Drugs subject to the following provisions: (1) The Specialty Pharmacy shaH fill prescriptions for Specialty Drugs based on the professional judgment of the dispensing pharmacist, accepted pharmacy practices and product guidelines. (2) A list of Specialty Drugs available via the Specialty Pharmacy and the pricing for those Specialty Drugs shall be made available as in effect on the Effective Date, as set forth in Appendix B. After the Effective Date, Employer may request that CHUC provide it with an updated list of Specialty Drugs available via the Specialty Pharmacy and the pricing with respect thereto. (3) To the extent acting in the capacity as a mail order pharmacy, the Specialty Pharmacy shall ship Specialty Drugs to Members in accordance with its standard procedures. (4) Members are responsible for the payment of the applicable cost sharing to the Specialty Pharmacy for each prescription or prescription refill. Employer acknowledges that the Specialty Pharmacy may suspend services to a Member who is in default of any cost -sharing obligations, in accordance with the Specialty Pharmacy's standard credit policy. If payment has not been received from the Member within one hundred twenty (120) days of dispensing, the Plan will be billed following the one hundred twenty (120) day collection period. (5) For the purposes of clarity, CHLJC does not exert direction or control over the pharmacists at the Specialty Pharmacy in filling prescriptions or performing other phannaceutical seivices. (b) Compound Drugs. CHLIC shall process prescribed Compound Drugs to the extent covered under the Plan. CHLIC shall treat as Covered Drugs only those components of a Compound Drug that would otherwise be treated as Covered Drugs were they not part of a Compound Drug. 7. Member Communkations and Services. (a) Member Communication. CHI.JC shall provide to Members an ID card and instructions to access Member materials online, including the Fonnulary, the Retail Pharmacy directory, CignaJ-IQme Delivery Pharmacy infonnatiolI. and an out -of -network 09/19/2023 66 Client Name: City of Miami Administrative Services Only Agreement Claim reimbursement form. (b) Rx Savings Messenger. CHLIC may send personalized mailings to Members regarding the Generic Drugs and preferred Brand Drugs and savings available from Cigna Home Delivery Pharmacy. (c) Ca11 Center. CHUC shall maintain toll -free customer service lines twenty-four (24) hours per day, seven {7) days per week for the purpose of responding to inquiries from Members regarding Retail Pharmacy, Cigna Home Delivery Pharmacy or Claims issues. 8. Formulary Management: Clinical Programs: Other Services. CHLIC shall provide Formulary management services, which shall include implementing Formulary placement decisions and determinations to apply utilization management requirements made by CHI.JC's Business Decision Team. The Business Decision Team makes Formulary determinations based on consideration of clinical and economic factors. Clinical factors may include, but are not limited to, the CHLIC P&T Committee's evaluation of the place in therapy, relative safety or relative efficacy of the drug, as well as whether certain supply limits or other utilization management requirements should apply. Economic factors may include, but are not limited to, the drug's acquisition cost including, but not limited to, assessments on the cost effectiveness of the drug and available Rebates. Employer acknowledges that the Formulary, utilization management requirements, and coverage policies used by CHUC to perform coverage reviews, including any changes made thereto, are adopted by Employer. When considering a drug for Formulary placement or other coverage conditions, CHLIC's Business Decision Team reviews clinical and economic factors regarding enrollees as a general population across its relevant book -of -business. CHLIC may also provide the clinical, safety and/or trend programs, or other programs and services to Employer, some of which may require payment of additional fees by Employer. If additional fees are required for such a program or service, CHLIC shall include the fee in the Schedule of Financial Charges or otherwise communicate the same in writing to by Employer. .:1 tzll:,tc,;,;M:n/, : :1pu'As>1)11t'A.•.c.•Y ••.•.tib.N:rot Vr•. J1'ANl,'A•libl$1:;N•1-t'K• o . h ll:a•'llff.o „ p•,pKA••••1••1•o•N•s••„ T !! r.I. 1. Implementation of Agreement. (a) Proiect Plan. Employer and CHLIC shall develop an agreed upon implementation project plan with respect to the Agreement prior to the Effective Date or prior to the implementation with respect to any new Pharmacy Benefit under this Agreement following the Effective Date. (b) Initial Data and Commencement of Pharmacy Benefit Management Services. Prior tO the Effective Date, Employer shall provide CHLIC with all data and/or documentation necessary for CHUC to provide the services specified in this Agreement. Such data and/or documentation shall include, but is not necessarily limited to, claims history and Member prior authorization history. 09/19/2023 67 Client Name: City of Miami Administrative Services Only Agreement Assuming all data specified in the preceding sentence is received sufficiently in advance of the Effective Date, CHLIC shall commence providing services under this Agreement as of the Effective Date. 2. Timely Provision of Data by Employer. Employer acknowledges that CHI.JC shall not be held responsible for, and shall be released from, fulfilling any obligation or performing any seivice under this Agreement if Employer or its designee does not provide accurate information in a timely manner 3. Renorting. CHUC shall make available to Employer CHLIC's standard reporting applications, subject to Applicable Law and Exhibit D, including, without limitation, HIPAA and state privacy laws. 4. Claims Data. (a) Retention. CHLIC shall retain data with respect to Claims for at least seven (7) years from the date the prescription is filled. Following the close of such retention period. CHLIC shall retain and dispose of such Claims data pursuant to its then -current standard policies and procedures, Applicable Law and the Business Associate Agreement described in the Agreement (b) Disclosure to Vendor. Upon Employer's written request and subject to execution of a non -disclosure agreement acceptable to CHLIC, CHUC shall provide prescription Claims data in its standard format to a vendor contracted with Employer and otherwise acceptable to CHLIC solely for the purposes of such vendor's support of Plan administration functions. Employer agrees that its vendors may not utilize Claims data for any other purpose, including, without limitation, developing products and services, analyzing the Claims data against market benchmarks or CHLIC competitors or adding to a normative database (even if de - identified and/or blinded as to Member and PBM/carrier) for the Employer's or vendor's commercial use. Employer shall be responsible for any use or disclosure of Claims data, or any services provided, by the vendor. Notwithstanding the foregoing, all audits of any pricing guarantees, Rebate -sharing obligations or Claims processing accuracy shall be conducted in accordance with the tenns in this Agreement specifically relating to such audits. (c) De -Identified Data. During and after the term of this Agreement, CHUC may use Claims, drug, and medical data that has been de -identified in accordance with IDPAA for research, provider evaluation, database maintenance, and other commercial purposes. This provision shall survive termination or expiration of the Agreement. 09/19/2023 68 Client Name: City of Miami Administrative Services Only Agreement S. Pharmacy Claims Processing Aqdits. (a) Employer may, to the extent specified below and at no additional charge, conduct a claims processing audit of CHLIC's administration of Plan Benefits, once every Plan Year. New audits shall not be initiated until all parties have agreed that any and all prior pharmacy -related audits are closed. In order to balance the need to adequately support the audit process for all CHLIC clients, with an efficient allocation of resources, Employer's who choose to audit one or more components of the phannacy arrangement must do so through a single annual audit. (b) Claims processing audits shall be subject to the following conditions: (1) the audit may take place while the Agreement is in effect or within one (1) year after the termination or expiration of the Agreement; (2) the initial audit period for a retrospective claims audit shall not exceed the twenty-four (24) months period immediately preceding CHLIC's receipt of the request to audit; (3) Employer shall provide to CID.JC at least forty-five (45) days prior written notice of its intent to audit; (4) Employer shall designate, with CHLIC's consent, such consent not to be unreasonably withheld, an independent, third party auditor to conduct the audit (the "Auditor"); (5) Employer shall be responsible for its incurred costs regarding the audit; (6) except as otherwise may be agreed to by the parties, in writing, and prior to the commencement of the audit, the audit shall be conducted in accordance with the terms of CHLIC's Audit Agreement attached hereto as Exhibit C2 which is hereby agreed to by Employer and which shall be signed by the Auditor prior to the start of the audit; (7) CHLIC will provide all data as reasonably necessary for Auditor to perform the claims processing audit within thirty (30) days following the latter of the audit kick-off call and the Audit Agreement being ful)y executed or, when applicable, as otherwise agreed upon by the Parties; (8) following Auditor's initial review of the claims, Auditor will provide CHLIC in writing with all suspected categories of claim errors, if any, together with an electronic data file, in a mutually agreed upon fonnat, containing up to three -hundred (300) claims, so that CHLIC may evaluate and investigate Auditor's suspected errors; (9) CHLIC will respond to the suspected errors within sixty (60) days from Cffi.,IC's receipt of such written fmdings; (10) upon receipt and review of CHLIC's responses, Auditor will provide CHLIC with a written report of Auditor's fmdings and recommendations before or at the same time such audit report is provided to Employer; (11) CHLIC will respond to the audit report within thirty (30) days of the issuance of Auditor's report; (12) once both Parties have accepted the audit results, the audit shall be considered closed and final; (13) to the extent the mutually accepted audit results demonstrate claims errors, CHUC will reprocess the claims and make corresponding adjustments to Employer; {14) CHLIC's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer -and/or its Auditor and CHLIC, including but not limited to no new or additional issues that appear in the fmal report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. 09/19/2023 69 Client Name: City of Miami Administrative Services Only Agreement Pharmag Rebate Audits. (a) Employer may, to the extent specified below, in accordance with the following requirements, and at no additional charge while this Agreement is in effect, audit CHLIC's payment of Rebates. Any Rebate audit shall occur following CHLIC's issuance of the annual fmancial reconciliation to Employer once in each twelve (12) month period. New audits shall not be initiated until all parties have agreed that all prior pharmacy -related audits are closed. In order to balance the need to adequately support the audit process for all CHLIC clients, with an efficient allocation of resources, Employers who desire to audit one or more components of the phannacy arrangement must do so through a single annual audit. (b) Rebate audits shall be subject to the following conditions: (1) Employer and CHUC shall agree on a mutually acceptable, independent, third -party auditor to conduct the audit, including the individual(s) employed or contracted to perform the audit to ensure that they shall not have a conflict of interest that could reasonably diminish their impartiality (the "Auditor"); (2) Employer shall be responsible for its incurred costs regarding the audit; (3) Employer shall provide CfilIC with at least forty-five (45) days prior written notice of its intent to audit; (4) a mutually agreed upon nondisclosure/nonuse agreement for rebate audits shall be executed by Employer, the Auditor and CHUC; (5) the scope ofrecords to be audited as being necessary to determine CHLIC's compliance with its contractual Rebate payment obligations under the Agreement shall be as mutually agreed upon by the Auditor and CHLIC; (6) the Auditor may select for audit purposes the records of up to five (5) manufacturers for two (2) calendar quarters from the last reconciled plan year immediately preceding the written request to audit; (7) the audit shall be conducted at a mutually acceptable time during regular business hours at CHLIC's offices where such records are located; (8) records shall not be removed or photocopied without CfilIC's express written consent; (9) for the sole purpose of confirming compliance with the audit Confidentiality Agreement, Auditor will first submit in draft to CHUC, and prior to submission to Employer its Rebate audit report, so that CHUC can confirm that no terms of the applicable rebate agreements which are confidential, are disclosed in the audit report; (10) the Auditor shall provide its :final audit report to CfilIC and Employer at the same time; and (11) the Auditor may disclose the aggregate amount of Rebates due Employer but no other details of CHLIC's rebate contracts of which the Auditor is apprised, if any. This provision shall survive termination or expiration of the Agreement. 7. Phanuacv Financial Guarantee Recon iliationAudits. (a) Employer may, to the extent specified below and at no additional charge, conduct a Financial Guarantee Reconciliation audit once every Plan Year following CHLIC's issuance of the annual financial reconciliation to Employer. New audits shall not be initiated until all parties have agreed that all prior phannacv-related audits are closed. In order to balance the need to adequately supoort 09/19/2023 70 Client Name: City of Miami Administrative Services Only Agreement the audit process for all CHUC clients, with an efficient allocation of resources, Employers who choose to audit one or more components of the phannacy arrangement must do so through a single annual audit (b) Financial Guarantee audits shall be subject to the following conditions: (1) the audit may take place while the Agreement is in effect or within one (1) year after the termination or expiration of the Agreement; (2) such audit may cover up to two prior contract years to the extent such prior contract years have not previously been audited; (3) Employer shall provide CHLIC with at least forty-five {45) days' prior written request for the audit; (4) Employer and CHUC shall agree on a mutually acceptable, independent, third party auditor to conduct the audit (the "Auditor"), and the individuals(s) employed or contracted to perform the audit shall not have a conflict of interest that could reasonably diminish their impartiality; (5) Employer shall be responsible for its incurred costs regarding the audit; (6) CHLIC will provide all data as reasonably necessary for Auditor to determine that CHUC has performed in accordance with its contractual obligations regarding the financial guarantees, and CHI.JC will provide such data within thirty (30) days following the latter of the audit kick-off call and the Audit Agreement being fully executed or, when applicable, as otherwise agreed upon by the Parties; (7) except as otherwise agreed to by the parties prior to the commencement of the audit, the audit shall be conducted in accordance with the terms hereof and a Pharmacy Financial Guarantee Audit Agreement, a sample of which is attached hereto as Exhibit C2, which shall be signed by CHLIC and the Auditor, and together with written authorization from the Employer prior to the start of such audit; (8) any adjustments resulting from the audit will be based upon the actual Claims reviewed and not upon statistical projections or extrapolations, as the Auditor will be furnished with 100% of the paid Claims processed during the applicable contract period for purposes of the audit; (9) following Auditor's initial review and prior to the submission of its written audit report, the Auditor will provide CHLIC in writing with all of the suspected errors, if any, and CHLIC will respond to such suspected errors within sixty (60) days from CHLIC's receipt of such preliminary - findings; (10) CHLIC will respond to any audit report issued by the Auditor within thirty (30) days of the issuance of same; and (11) CHLIC will reconcile mutually agreed upon amounts due to Employer within a reasonable period of time following mutual agreement regarding any amount due to the Employer. CHLIC's obligations to respond within the designated periods above is conditioned upon a good faith and cooperative working relationship between Employer and/or its Auditor and CHLIC, including but not limited to no new or additional issues that appear in the final report that were not otherwise provided to CHLIC during the preliminary review of suspected errors. This provision shall survive termination or expiration of the Agreement. Mi.rWaplioiupiZ��i��iii<a yiifi i i_ TiU1c 1. Funding and Payment of Claims. With respect to Pharmacy Benefits, (1) CHUC may withdraw funds from the Bank Account for the purposes specified in Section 3 of the Agreement five times per month, and (2) any recovered overpayments shall be credited to Employer via a line item on its invoice, less the fee set forth on the Schedule of Financial Charges. 09/19/2023 71 Client Name: City of Miami Administrative Services Only Agreement 2. Retroactive Member Changes and Terminations. Notwithstanding anything in the Agreement to the contrary, Employer shall remain responsible for all charges and Bank Account Payments incurred or charged through the date CHUC processed Employer's notice of a retroactive change or termination of a Member's enrollment in the Plan. Notwithstanding anything to the contrary in Section 4.c. of the Agreement, with respect to Phannacy Benefits, CHUC generally will implement eligibility updates received from Employer that adhere to CHLIC's standard electronic format as soon as reasonably practicable following receipt of such updates. k?li4)ft0±tt£.X:'}.t\.{tit:'.fitI:J§!p :t\J C' E'.NEM Giffi:N::ij mfue wiij Q El)GIfi:N:itsffl[f 1:?k:.:.: K('10 '}:.'ilL: CHUC offers pharmacy benefit management services for consideration by Employer and other entities. The general parameters of such services and the supporting systems have been developed by CHI.JC as part of CHLIC's administration of its general business as a pharmacy benefit manager for entities that sponsor group health plans. The Parties have negotiated the terms of this Agreement in an arm's-length fashion. Except to the extent C1i1JC conducts the final level of internal appeal as set forth in Section 2.c of the Agreement, the Parties assert that neither Party intends that CHLIC shall be a fiduciary with respect to Pharmacy Benefits for either ERISA (if applicable) or state law purposes. and neither Party shall name CHLIC or any of its affiliates as a "plan fiduciary" with respect to its management of Pharmacy Benefits. Employer acknowledges and agrees that CHUC (i) does not have discretionary authority or control respecting management of the Pharmacy Benefits. and (ii) does not exercise any authority or control respecting management or disposition of the assets relating to Phannacy Benefits or of Employer. Rather, Employer retains all such authority and control. The Parties agree that, upon reasonable notice, CHUC shall have the right to terminate its Pharmacy Benefit services under this Agreement to any Plan andior Members located in a state that requires a pharmacy benefit manager to be a fiduciary to Employer, the Plan or a Member. This provision shall survive tennination or expiration of the Agreement. r 1 r lr% 1 i? i J,> ¥wBENEff1 tl' Nf{ GE S . 'tli 1 tW iJft 1. General. CHUC contracts with its PBM affiliate for the provision of pharmacy benefit services and financial arrangements. As such, CHLIC or its PBM affiliate, directly or indirectly contract on their own accounts with Retail Pharmacies and Cigna Home Delivezy Pharmacy to dispense covered pharmaceutical products to Employer's Members, and not on behalf of, or for the benefit of, Employer or the Plan; accordingly, any discounts or other remuneration CHLIC or its PBM affiliate earns under an arrangement with a Retail Pharmacy or Cigna Home Delivezy Pharmacy are obtained for, and inure to, the sole and exclusive benefit of CHLIC or its PBM affiliate, and not the Employer or the Plan. Amounts paid by CHLIC or its PBM affiliate or by the PBM affiliate for Retail Pharmacy or Cigna Home Delivery Pharmacy for Brand Drug, Generic Drug, or Specialty Drug Claims may or may not be equal to the amount charged to Employer and/or Member. If the amount paid by Employer and/or Member does not equal the amount paid by CHLIC or its PBM affiliate or by the PBM affiliate to a particular pharmacy, CHI.JC and its PBM affiliate will absorb or retain such difference. CHLIC may directly or indirectly contract for Rebates, Manufacturer Administrative Fees, and other remuneration on its own behalf and for its own benefit, and not on behalf of Employer or the Plan. As an example of other remuneration other than Rebates or Manufacturer 09/19/2023 72 Oient Name: City of Miami Administrative Services Only Agreement Administrative Fees that CII1..1C may earn, CHLIC may also directly or indirectly from pharmaceutical manufactuTers remuneration in connection with value payments and/or services that CHLIC provides to Employer ("Value -Based Payments"). Notwithstanding anything in this Agreement to the contrary, any Value -Based Payments earned by CHI.JC are separate and apart from any Rebates or Manufacturer Administrative Fees that CHUC directly or indirectly earns from pharmaceutical manufacturers, and CHI.JC may retain any Value -Based Payments it earns. As examples of the value payments and/or services that CHLIC may provide to Employer in connection with Value -Based Payments that CHUC may earn, CHUC may provide care management or other services to Employer and/or remit to Employer monetaty credits if Members discontinue therapy on certain pharmaceutical products. Information regarding any services. and/or monetary credits or other fmancial value, for which Employer may be eligible with respect to specific pharmaceutical products or therapeutic classes/conditions, including the products for which monetary credits or other fmancial value may be available to Employer, the amount of that value, and other payment terms, is available upon request. Any value payments and/or services provided by CHUC to Employer are subject to change or termination by CHUC as the value program(s), if any, offered by CHUC change(s) or tenninate(s). Accordingly, CHLIC retains all right, title and interest to any and all actual Rebates, ManufactuTer Administrative Fees, Value -Based Payments, and other remuneration directly or indirectly received from manufacturers. CHUC may provide Employer amounts equal to all or some portion of the Rebate and Manufacturer Administrative Fee amounts, or other financial value generated in connection with any value program(s), allocated to Employer, if any, and as specified on the Schedule of Financial Charges, from CHLIC's general assets (neither Employer, its Members, nor Employer's Plan retains any beneficial or proprietary interest in CHLIC's general assets). Rebate and Manufacturer Administrative Fee amounts received vary based on factors including, without limitation, Employer -specific utilization. the volume of utilization as well as Formulary position applicable to the drug or supplies, and adherence to various formulaiy management controls, benefit design requirements, and Claims volume. Employer acknowledges and agrees that neither it, its Members nor its Plan will have a right to interest on. or the time value of, any Claim payments charged by CHLIC to Employer or any Rebate, Manufacturer Administrative Fee or other payments received by CHUC during the collection period of moneys payable under this section. if any, and that CHUC shall retain any such remuneration. For purposes of this provision, the term CHUC shall also include and mean CHLIC's PBM affiliate, Express Scripts. Inc. 2. A:ffUiates. Cigna Home Delivery Pharmacy may maintain product purchase discount arrangements and/or fee -for -service arrangements with pharmaceutical manufacturers and wholesale distributors in its capacity as a mail service and/or specialty pharmacy. Cigna Home Delivery Pharmacy may contract for these arrangements on its own account in support of its pharmacy operations, and not on behalf o:t: or for the benefit of, Employer or the Plan. Accordingly, Cigna Home Delivery Pharmacy retains the sole and exclusive benefit of any difference between its acquisition cost for a pharmaceutical product and the amount charged to Employer under this Agreement. Further these arrangements relate to services provided outside of this Agreement and other pharmacy benefit management arrangements and may be entered into without regard to whether a specific drug is on one of the formularies that CHLIC offers to entities that sponsor group health plans_ Discounts and fee -for -service payments received by Cigna Home Delivery Pharmacy are not part of the pharmacy benefit management formulary rebates or associated administrative fees or charges paid to CHUC in connection with CHLIC's pharmacy benefit 09/19/2023 73 Client Name: City of Miami Administrative Services Only Agreement management formulary rebate programs. This provision shall survive termination or expiration of the Agreement. Itl lJlii:tif£lfit}'..t:f [ 11t}1 ff.e :BE:NEffl: i13/4t 1 o»)]tf:i:i'l@N'Si ijNiU i&i'I8N:,,.7 i, ( ttfJ/J@fJiiiiAf\lt)Tr, 1:-1 Upon notice oftermination of this Agreement, the following provisions shall apply with respect to Pharmacy Benefits: a) Employer shall notify Members at least thirty (30) days prior to the termination of the Agreement becoming effective of any transition to a successor pharmacy benefit manager. b) If mutually agreed upon by CHLIC and Employer, CHUC sball provide services following termination of the Agreement at CHLIC's then -prevailing rate. Such services, if any, shall be determined by mutual agreement of CfilIC and Employer in advance of the termination of the Agreement becoming effective. c) Upon request by Employer and subject to execution of a nondisclosure agreement acceptable to CHUC, CHI.JC shall transition Claims files and/or history to the pharmacy benefit manager or other third party specified by Employer and otherwise acceptable to CHI.JC. Any disclosure of Claims files and/or histozy shall be limited to the information the successor phannacy benefit manager or other third party needs to implement or administer Employer's pharmacy benefits. CHUC shall not be required to directly or indirectly release, and Employer shall not release, PBM Proprietary Information to any such third party. d) Upon termination of the Agreement for any reason. the Parties shall handle Confidential Information, PBM Proprietary Information and Protected Health Information (as defined in the Business Associate Agreement attached as Exhibit D) pursuant to the terms of the Agreement. e) In the event that C111.,IC terminates the Agreement pursuant to Section I.vi of the Agreement, CHLIC shall have no further obligation following the date of such termination to pay Employer any Rebates, or any other amount that may otherwise be payable by C111.,IC to Employer. This provision shall survive termination or expiration of the Agreement. S>:2 Z£Ii@: Li:)......:::J• ....2:>.1 :i 41Jt CXBBNEEIT) *G 111£N"iHtcONFibEN!ctflL1TI'tkF[1:Z2s=::::SZ'.17Jt .1 ::ts'rn:: T: r1{::'.::1':57""! 1. General. Employer acknowledges and agrees that CHLIC's PBM Proprietary Information constitutes competitively sensitive trade secrets, and that its misuse or mis-disclosure could result in material :financial and legal loss or liability to CHLIC, its affiliates and their respective subcontractors. CII1JC shall not he required to disclose PBM Pro Q!"ie !a.ry Information to Employer except to the extent 09/19/2023 74 Client Name: City of Miami Administrative Services Only Agreement necessary for Employer to exercise any audit rights expressly provided hereunder or perfonn other Plan administration functions. If CII1.,1C discloses PBM Proprietary Information to Employer, or, if CHUC consents, to the Employer's vendor or designee, CHLIC may require Employer, or its vendor or designee, to execute a non -disclosure agreement specifically relating to the requested PBM Proprietary Information. Employer agrees that it and its vendors may not utilize PBM Proprietary Information for any purpose other than performing Plan administration functions, including, without limitation, developing products and services, de -identifying, blinding or analyzing the PBM Proprietary Infonnation against market benchmarks or CHLIC competitors or adding to a normative database for the Employer's, or vendors or designee's, commercial use. For the purposes of clarity, information shall not cease to qualify as PBM Proprietary Information if Employer or its vendor or designee de -identifies and/or blinds the PBM Proprietary Information such that the information cannot be traced or identified to a Member or CHUC, its affiliates or their respective subcontractors. Employer shall be solely responsible for any disclosure of PBM Proprietary Infonnation by CHLIC to Employer or its vendor or designee, or any subsequent use or disclosure by Employer or its vendor or designee, or services provided by the same. Notwithstanding anything herein to the contrary, in no event will CHLIC be required to disclose to Employer, or its vendor or designee, information related to, or including, its pharmacy network agreements, vendor agreements or pharmaceutical manufacturer agreements. 2. Compelled Disclosures. If at any time Employer, or its vendor or designee, is required by law, court order or other valid legal process to disclose any Confidential Information, it will promptly notify CHLIC prior to any such compelled disclosure and, upon request, cooperate with CHLIC in seeking a protective order or other available relief to contest or limit the scope of such compelled disclosure. 3. Return or Destruction of Information. At any time upon C111.,IC's request or upon expiration or termination of this Appendix A or the Agreement, whichever occurs first, Employer will, at CHLIC's option, promptly deliver, or, as the case may be, compel its vendor or designee to deliver, to CHUC all PBM Proprietary Information or other Confidential Information (or such portion thereof as requested) and not retain any copies in whole or in part of such PBM Proprietary Information or other Confidential Information, or securely destroy or dispose, or, as the case may be, compel its vendor or designee to destroy or dispose, of those portions of documents and other materials in any form, including electronic form, prepared by or received by the Employer or its vendor or designee, that contain or reflect such PBM Proprietary Information or other Confidential information. Employer, or its vendor or designee, shall certify such return and destruction, as the case may be, to CHLIC. 09/19/2023 75 Client Name: City of Miami Administrative Services Only Agreement Appendix B - Cigna Home Delivery Pharmacy Specialty Drug List THIS SPECIALTY DRUG LIST IS CONFIDENTIAL, PROPRIETARY INFORMATION OF CHLIC. IT IS PROVIDED SOLELY FOR EMPLOYER'S PLAN ADMINISTRATION PURPOSES. RE -DISCLOSURE IS STRICTLY PROHIBITED EXCEPT AS OTHERWISE PROVIDED BY APPLICABLE LAW. CHLIC RESERVES ALL LEGAL RIGHTS AND REMEDIES TO ENFORCE THESE PROHIBITIONS ON USE AND DISCLOSURE. The Specialty Drug List shall be provided separately to Employer, and is hereby incorporated into the Agreement by reference, inclusive of any changes made subsequent to CHLIC's initial issuance of the Specialty Drug List to Employer to the pharmaceutical products included on the Specialty Drug List or the discounts pertaining to such pharmaceutical products. Upon Employer's request on or after the Effective Date, CID.,IC shall provide to Employer an updated Specialty Drug List. Currently Marketed SpeciallY Drugs on this Specialty Drug List. The discounts in this Specialty Drug List are the discounts that will be adjudicated in CHLIC's claim processing system for the drug indicated when dispensed by Cigna Home Delivery Phannacy, subject to all of the following. • The discounts in this Specialty Drug List are based on the terms and design of the Pharmacy Benefit that Employer has adopted and disclosed to CHLIC. Accordingly, if Employer fails to disclose to CHLIC, for example, that it uses or intends to use a consumer -driven health plan, a major cost - sharing program, or a utilization management program promoting generic or OTC drugs over brand drugs, CHLIC may adjust the discounts as it reasonably deems necessary to preserve the economic value or benefit of this Agreement as CHUC anticipated based on the tenns and design of the Pharmacy Benefit previously disclosed to CHUC and prior to CHLIC's discovery of the Pharmacy Benefit design feature that materially impacts CID.JC's discounts in this Specialty Drug List • The discmmts in this Specialty Drug List shall not apply to Compound Drug claims, Claims that process at U&C, direct member reimbursement (DMR) Claims, and drugs adjudicated under the medical benefit. • Any or all of the discounts in this Specialty Drug List may be adjusted by CHLIC to the extent reasonably necessary to preserve the economic value of this Agreement as it existed immediately prior to the occurrence of any of the following events: (a) there are any significant changes in the composition ofCHLIC's phannacy network or in CHLIC's phannacy network contract compensation rates, or the structure of the pharmacy stores/chains/vendorsthat are contracted with CHLIC, including but not limited to disruption in the retail pharmacy delivery model, or bankruptcy of a chain pharmacy; or (b) there is a change in government laws or regulations which has a significant impact on pharmacy claim costs; or (c) any material manufacturer -rebate contracts with or for the benefit of CHLIC are terminated or modified in whole or in part; or (d) there is any legal action or Law that materially affects or could materially affect the manner in which CHLIC's rebate program is administered or an existing Law is interpreted so as to materially affect or potentially have a material effect on CHLIC's administration of the Pharmacy Benefit; (e) there is a material change in the Plan or the Plan's Pharmacy Benefit that is initiated by Employer which impacts CHLIC's costs or (f) a major change in market conditions affecting the pharmaceutical or pharmacy benefit management market, a drug shortage in the market, an issue involving the safety of the drug supply, or similar market situation. 09/19/2023 76 Client Name: City of Miami Administrative Services Only Agreement New -to -Market Specialty Products. Specialty Drug Claims, excluding Limited Distribution Drugs and Exclusive Distribution Drugs, that are for new -to -market drugs will have a minimum market -introduction guaranteed discount of 11.45% off the drug's AWP. "Limited Distribution Drug" or "Exclusive Distribution Drug" shall mean a Specialty Drug that is not generally available from most or all pharmacies and is restricted to select pharmacies as detennined by a pharmaceutical manufacturer. The list of Limited Distribution Drugs and Exclusive Distribution Drugs will be maintained by CHLIC. 09/19/2023 77 �� ® �`CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/20/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Phi 1 adel phi a PA Offi ce 100 North 18th Street 15th Floor Philadelphia PA 19103 USA CONTACT NAME: PHONE (A/No. Ext): C866) 283-7122 FAX No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED The Cigna Group 900 Cottage Grove Road Bloomfield CT 06002 USA INSURER A: ACE American Insurance Company 22667 INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: ACE Property & Casualty Insurance Co. 20699 INSURER D: American Guarantee & Liability Ins Co 26247 INSURER E: Lexington Insurance Company 19437 INSURER F: COVERAGES CERTIFICATE NUMBER: 570100168334 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YY LICY EXP -//,, DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CGLG47313958 SIR applies per policy terms `0' 07/01/ & C✓ . . �//•�'�I�� /01/2024 ions EACH OCCURRENCE $2,000,000 DAMAGE Io HEN IhD PREMISES (Ea occurrence) $2,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL& ADV INJURY $2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $4, 000, 000 PRODUCTS - COMP/OPAGG $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED ISA H10708904 SIR appl i es of 1 I /l ``. \\VvJJ ^ `') t+�r /O1/2023 s & condi 07/01/2024 ti ons COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) C X UMBRELLALIAB EXCESS LIAR X - OCCUR CLAIMS -MADE R.1G7258448A002 cludes Pol# #35407110 07/01/2023 07/01/2024 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N / A WLRC70313728 SIR applies per policy terms 07/01/2023 & conditions 07/01/2024 x PER STATUTE OTH- ER E.L. EACH ACCIDENT $1, 000 , 000 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 E.L. DISEASE -POLICY LIMIT $1, 000, 000 E Managed Care Liability 33085874 Managed Care E&O SIR applies per policy terms 07/01/2023 & conditions 07/01/2024 Agg-Claims Made $15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 01, Additional Remarks Schedule, may be attached if more space is required) City of Miami is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A retro date of November 3, 1981 applies to the above referenced Managed Care E&O policy. CERTIFICATE HOLDER CANCELLATION City of Miami Attn: Gisela Z. Rodriguez 444 SW 2nd Ave. Miami FL 33130 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Me �1� tieseeD i � 5i 74. Holder Identifier : 570100168334 Certificate No ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10042023 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Central, Inc. NAMED INSURED The Cigna Group POLICY NUMBER see Certificate Number: 570100168334 CARRIER see Certificate Number: 570100168334 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR wVD POLICY NUMBER PO E ) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS EXCESS LIABILITY D AXF957096615 �° 07/01/2023 07/01/2024 Aggregate $5,000,000 am/ ^� O ` IV. C^ I Each Occurrence $5,000,000 OTHER4qL IS)35407110 OV 4(e E Products Liability Express Scripts Only 07/01/2023 07/01/2024 Comp/Op Agg $4,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Additional Named Insureds (1 of 2) Accredo Health Group, Inc. Accredo Health, Incorporated AHG of New York, Inc. Airport Holdings, LLC Allegiance Benefit Plan Management, Inc. Allegiance Cobra Services, Inc. Bravo Health Mid -Atlantic, Inc. Brighter Inc. Biopartners in Care, Inc. Care Continuum, Inc. CareCore National Group, LLC CareCore National Intermediate Holdings, LLC CareCore National, LLC CareCore NJ, LLC CareNext Managed Care, LLC CareNext Post -Acute, LLC Chiro Alliance Corporation Cigna Corporate Services, LLC Cigna Dental Health of California, Cigna Dental Health of Delaware, Cigna Dental Health of Florida, Inc. Cigna Dental Health of Kentucky, Inc. Cigna Dental Health of Maryland, Inc. Cigna Dental Health of Missouri Cigna Dental Health Cigna Dental Health Cigna Dental Health Cigna Dental Health Cigna Dental Health Cigna Dental Health Cigna Dental Health Cigna Dental Health, Inc. Cigna European Services (UK) Limited Cigna Health and Life Insurance Company Cigna Health Management, Inc. Cigna Healthcare of Arizona, Inc. Cigna Healthcare of California, Inc. Cigna HealthCare of Colorado, Inc. Cigna HealthCare of Connecticut, Inc. Cigna HealthCare of Florida, Inc. Cigna Healthcare of Georgia, Inc. Cigna HealthCare of Illinois, Inc. Cigna HealthCare of Indiana, Inc. Cigna HealthCare of New Hampshire, Inc. Cigna HealthCare of New Jersey, Inc. Cigna Healthcare of North Carolina, Inc. Inc. Inc. of New Jersey, Inc. of North Carolina, 1 of Ohio, Inc. Q` of Pennsylvani of Texas, Inc. of Virginia, Inc. Plan of Arizona, Inc. Cigna HealthCare of St. Louis, Inc. Cigna HealthCare of South Carolina, Inc. Cigna Healthcare of Tennessee, Inc. Cigna HealthCare of Texas, Inc. Cigna Healthcare of Utah, Inc. Cigna Healthcare, Inc. Connecticut General Life Insurance Company CuraScript, Inc. Diversified NY IPA, Inc. Diversified Pharmaceutical Services, Inc. Econdisc Contracting Solutions, LLC ESI Canada ESI GP Canada ULC ESI GP Holdings, Inc. ESI GP2 Canada ULC ESI Mail Ordnrocessing, Inc. ESI Mail ' q, acy Service, Inc. ESI Pa ESIurces, Inc. orth Behavioral Health Inc. na Behavioral Health, Inc. h Behavioral Health of California, Inc. J�v via Cigna Behavioral Health of California, Inc. eqfvernorth Behavioral Health of Texas, Inc. Of/k/a Cigna Behavioral Health of Texas, Inc. O`V Evernorth Care Group f/k/a Cigna Medical Group Evernorth Care Solutions, Inc. Evernorth Direct Health, LLC eviCore healthcare MSI, LLC Express Reinsurance Company Express Scripts Administrators LLC Express Scripts Canada Co. Express Scripts Canada Holding Co. Express Scripts Canada Holding, LLC Express Scripts Canada Services Express Scripts Canada Wholesale Express Scripts Holding Company Express Scripts Holding Company, Inc. Express Scripts, Inc. Express Scripts Pharmaceutical Procurement, Express Scripts Pharmacy Atlantic, Ltd. Express Scripts Pharmacy Central, Ltd. Express Scripts Pharmacy Ontario, Ltd. Express Scripts Pharmacy West, Ltd. Express Scripts Pharmacy, Inc. Express Scripts Sales Operations, Inc. LLC 12/01/2022 Additional Named Insureds (2 of 2) Express Scripts Senior Care Holdings, Inc. Express Scripts Senior Care, Inc. Express Scripts Specialty Distribution Services, Inc. Express Scripts Strategic Development, Inc. Express Scripts Services Co. Express Scripts Utilization Management Company Freco, Inc. Freedom Service Company, LLC Gulfquest, LP Healthbridge Reimbursement & Product Support, Inc. Healthbridge, Inc. HealthCare of Colorado, Inc. Healthspring Life & Health Insurance Healthspring of Florida, Inc. Healthspring USA, LLC Healthspring, Inc. Home Physicians Management, LLC Innovative Product Alignment, LLC Inside RX, LLC Lynnfield Compounding Center, Inc. Lynnfield Drug, Inc. MAH Pharmacy, LLC Matrix GPO, LLC Matrix Healthcare Services, Inc. MDLIVE, Inc. Medco Containment Insurance Compan Medco Containment Life Insurance C Medco Health Services, Inc. Medco Health Solutions, Inc. MedSolutions Holdings, Inc. MedSolutions of Texas, Inc. MHS Holdings, CV MSI Health Organization of Texas, Inc. MyM Technology Services, LLC myMatrixx Holdings, LLC myMatrixx-B, LLC Newquest Management Northeast, LLC Newquest Management of Alabama, LLC Newquest, LLC Palladian Health of Florida, LLC Palladian Independent Practice Association, LLC Priority Healthcare Corporation Priority Healthcare Distribution, Inc. QPID Health, LLC Quallent Pharmaceuticals Health LLC Specialty Products Acquisitions, LLC Company, Inc. SpectraCare Health Care Ventures, Inc. SpectraCare, Inc. Tel -Drug of Pennsylvania, L.L.C. Tel -Drug, Inc. Verity Solutions Group, Inc. 12/01/2022 From: Ouevedo, Terry To: Carbonell, Aileen; Gomez Jr., Francisco (Frank) Cc: Aviles. Yesenia Subject: RE: PROCUREMENT INSURANCE REVIEW FOR CIGNA CORPORATION COI Date: Thursday, June 22, 2023 11:05:10 AM Aileen The certificate is adequate. Regards, XPill 'teaecd City of Miami Risk Management Department 9th Floor 444 SW 2nd Avenue Miami, Florida 33130 (305) 416-1641 Office (305) 416-1710 Fax TquevedoPmiamigov.com a ati(('��� :S�rarur9, � ra�rccar�, rd 7za ossccr� rvr �V C� l ,V From: Carbonell, Aileen <ACarbonell@ igov. Sent: Thursday, June 22, 2023 10:53' ^C3 To: Gomez Jr., Francisco (Frank) <FGomez@mlamigov.com> Cc: Quevedo, Terry <TQuevedo@miamigov.com>; Aviles, Yesenia <YAviles@miamigov.com> Subject: PROCUREMENT INSURANCE REVIEW FOR CIGNA CORPORATION COI Importance: High Good morning, Please review the insurance attached at your earliest convenience and advise if adequate according to insurance requirements contained therein. Thank you! Kind regards, Aileen Carbonell, MPA Procurement Assistant Department of Procurement 444 SW 2nd Avenue, 6th Floor Miami, Florida 33130 Office: (305) 416-1922 Facsimile: (305) 416-1925 Email: acarboneMmiamigov.com Remit W9 to: PurchasingSupplierAdminsl@miamigov.com Website: https://beta.miamigov.com/Government/Departments-Organizations/Procurement "Serving, Enhancing, and Transforming our Community" CONFIDENTIAL COMMUNICATION The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please immediately contact the sender by reply e-mail and destroy all copies of the original message. Thank you. *Please Note: V Due to Florida's very broad public records law, most written communications to or from City of Miami employees regarding City business are public records, available to the public and media upon request. Therefore, this e-mail communication may be subject to public disclosutr7 i SECRETARY'S CERTIFICATE CIGNA HEALTH AND LIFE INSURANCE COMPANY The undersigned, a duly elected Assistant Secretary of Cigna Health and Life Insurance Company (the "Company"), does hereby represent and certify that the following resolutions were adopted by the Board of Directors of the Company via written unanimous consent effective July 1, 2022 and that such resolutions remain in full force and effect as of the date hereof, not having been amended, modified or rescinded since the date of their adoption: Signature Authority RESOLVED, that any person holding the underwriter business title for Cigna Corporation and/or its subsidiaries and affiliates of Operations Director, Contractual Agreement Unit Manager or Operations Senior Manager is hereby authorized to enter into customer agreements, act as a registrar on insurance policies issued by the Company, and to sign such agreements and policies for and on behalf of the Company. FURTHER RESOLVED, that the foregoing resolution supersedes the resolution adopted by the Board effective as of December 19, 2018 with respect to the subject matter therein. The undersigned further certifies that the following individuals hold the business title indicated next to their respective name and are authorized to enter into customer agreements, act as a registrar on insurance policies issued by the Company, and to sign such agreements and policies for and on behalf of the Company: Victoria A. Sirica Aimee Burnham Anna Palmieri Operations Director Contractual Agreement Unit Manager Contractual Agreement Unit Manager IN WITNESSS WHEREOF, I hereunto set my hand and set the seal of the Company this 12th day of July, 2023. 0 1r, usan M. Metrow Assistant Secretary Olivera, Rosemary From: Gandarilla, Aimee Sent: Tuesday, October 10, 2023 8:32 AM To: Hannon, Todd Cc: Lee, Denise; Olivera, Rosemary; Brown, Sadie; Cabrera, Paola Subject: Amend to the PSA Group Benefit Health Plan Matter 23-1967 Attachments: Amend 2 PSA Group Benefit Health Plan Matter 23-1967.pdf Good morning Todd, Please find attached the fully executed copy of an agreement from DocuSign that is to be considered an original agreement for your records. Thank you, Qunee caxtdaNifia Procurement Assistant City of Miami Procurement Department 444 SW 2nd Avenue, 6t"floor, Miami, FL 33130 P (305) 416-1906 F (305) 400-5338 E agandarilla@miamigov.com https://www.miami.gov/My-Government/Departments/Procurement "Serving, Enhancing, and Transforming our Community" 1