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September 15, 2020 Reader Friendly Agenda

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TOWN OF GOLDEN BEACH

One Golden Beach Drive Golden Beach, FL 33160

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Official Agenda for the September 15, 2020

Special Town Council Zoom Virtual Meeting called for 6:30 P.M.

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Zoom Room Meeting ID: 842 5910 4928     Password: 652930 For Dial In Only: Call 929.205.6099 Meeting ID: 842 5910 4928‌

THE PUBLIC MAY PARTICIPATE AT GOOD AND WELFARE; PLEASE HOLD ALL QUESTIONS AND COMMENTS UNTIL THEN! THE PUBLIC IS ENCOURAGED TO SUBMIT ALL COMMENTS VIA EMAIL TO LPEREZ@GOLDENBEACH.US BY 2:00 P.M. TUESDAY, SEPTEMBER 15, 2020.

  1. MEETING CALLED TO ORDER

  2. ROLL CALL

  3. PLEDGE OF ALLEGIANCE

  4. TOWN RESOLUTIONS

    1. A Resolution of the Town Council Awarding A Comprehensive Health Insurance Plan for the Benefit of the Town of Golden Beach Employees.

      A RESOLUTION OF THE TOWN OF GOLDEN BEACH, FLORIDA, AWARDING A COMPREHENSIVE HEALTH INSURANCE PLAN FOR THE BENEFIT OF THE TOWN OF GOLDEN BEACH EMPLOYEES AND ELIGIBLE DEPENDENTS; PROVIDING FOR IMPLEMENTATION; AND PROVIDING FOR AN EFFECTIVE DATE.

      Exhibit: Agenda Report No. 1

      Resolution No. 2698.20

      Sponsor: Town Administration

      Recommendation: Motion to Approve Resolution No. 2698.20

  5. DISCUSSION & DIRECTION TO TOWN MANAGER

    Mayor Glenn Singer: None Requested

    Vice Mayor Bernard Einstein: None Requested

    Page 1 of 2 (Special Town Council Meeting Agenda – 9/15/20)

    Councilmember Judy Lusskin: None Requested

    Councilmember Jaime Mendal: None Requested

    Councilmember Kenneth Bernstein: None Requested

    Town Manager Alexander Diaz None Requested

  6. ADJOURNMENT:

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DECORUM:

ANY PERSON MAKING IMPERTINENT OR SLANDEROUS REMARKS OR WHO BECOMES BOISTEROUS WHILE ADDRESSING THE COUNCIL SHALL BE BARRED FROM THE COUNCIL CHAMBERS BY THE PRESIDING OFFICER.

NO CLAPPING, APPLAUDING, HECKLING OR VERBAL OUTBURSTS IN SUPPORT OR OPPOSITION TO A SPEAKER OR HIS OR HER REMARKS SHALL BE PERMITTED. NO SIGNS OR PLACE CARDS SHALL BE ALLOWED IN THE COUNCIL CHAMBERS. PERSONS EXITING THE COUNCIL CHAMBERS SHALL DO SO QUIETLY.

THE USE OF CELL PHONES IN THE COUNCIL CHAMBERS IS NOT PERMITTED. RINGERS MUST BE SET TO SILENT MODE TO AVOID DISRUPTION OF PROCEEDINGS.

PURSUANT TO FLORIDA STATUTE 286.0105, THE TOWN HEREBY ADVISES THE PUBLIC THAT: IF A PERSON DECIDES TO APPEAL ANY DECISION MADE BY THIS BOARD WITH RESPECT TO ANY MATTER CONSIDERED AT ITS MEETING OR HEARING, HE WILL NEED A RECORD OF THE PROCEEDINGS, AND FOR THAT PURPOSE, AFFECTED PERSONS MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS IS MADE, WHICH RECORD SHALL INCLUDE THE TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED. THIS NOTICE DOES NOT CONSTITUTE CONSENT BY THE TOWN FOR THE INTRODUCTION OR ADMISSION OF OTHER INADMISSIBLE OR IRRELEVANT EVIDENCE, NOR DOES IT AUTHORIZE CHALLENGES OR APPEALS NOT OTHERWISE ALLOWED BY LAW.

IF YOU NEED ASSISTANCE TO ATTEND THIS MEETING AND PARTICIPATE, PLEASE CALL THE TOWN MANAGER AT 305- 932-0744 EXT 224 AT LEAST 24 HOURS PRIOR TO THE MEETING.

RESIDENTS AND MEMBERS OF THE PUBLIC ARE WELCOMED AND INVITED TO ATTEND.

Page 2 of 2 (Special Town Council Meeting Agenda – 9/15/20)

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TOWN OF GOLDEN BEACH

One Golden Beach Drive Golden Beach, FL 33160

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M E M O R A N D U M

Date:

September 15, 2020 Item Number:

To:

Honorable Mayor Glenn Singer &           1          

Town Council Members

From:

Alexander Diaz, Town Manager

Subject:

Resolution No. 2698.20 – A Resolution Awarding Comprehensive Health Insurance for employees and their eligible dependents through AvMed with the Berenguer Group, an Acrisure Partner as the agent of record

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Recommendation:

It is recommended that the Town Council adopt the attached Resolution No. 2698.20 as presented.

Background:

During the March 27, 2020 FMIT Board meeting indicative increases to heath Insurance were projected at 8% and the Administration began to explore our strategy for Insurance renewals and offerings. By May 2020, the Administration grew worried of the possible impact the Global Pandemic would take on the renewal rates of the Town’s Health Insurance. We invited Insurance Brokers to submit their qualifications to serve as the Town’s Insurance Agent of Record. Once selected, the Agent was tasked with presenting the Town with multiple proposals and to design plan offerings that would yield a quality plan and net savings (if possible).

In learning that the Town’s renewal rates came in at 13.80% or $111,505.00 over what the Town currently pays for insurance the need to re-valuate our plan offering, coverage and provider became even more certain.

By late August the selected Agent failed to meet the Town’s expectations and did not achieve the expected objective(s). The Town then asked other Agent(s) to provide us their “best and final” plan design and costs.

Page 1 of 2 Memo Resolution No. 2698.20

In comparing the other quotes the Town received, we found that the proposal (for AvMed Advantage HMO, with a Transamerica Life GAP Plan and a Health Reimbursement Account of $1800 per member), provided competitive and fair coverage to the employees and their eligible dependents, while affording the Town a considerable cost savings from the Town’s current plan offerings (not taking into account the forecasted increases for this coming year).

In addition, we also quoted a buy-up option, which we would like to still offer the employees, at no additional cost to the Town. Employees that elect to choose the buy-up option will pay the difference in the increase in cost.

The renewal premium in comparison to the Town’s current premium has decreased by 29% from $70,017.44 to $49,114.71.

Although it is nerve-racking to think of change during a global pandemic, we also need to look at the possible benefits for all members; the proposed plan offers a premium savings to all members and provides for an out-of-pocket benefit not currently offered.

Employees in the Standard plan will see premium savings of at least $1,300 and a cash contribution (medical debit card) of at least $1,000.

Fiscal Impact:

Because we have not completed our Open Enrollment, it is difficult to provide an exact cost.

Page 2 of 2 Memo Resolution No. 2698.20

TOWN OF GOLDEN BEACH, FLORIDA RESOLUTION NO. 2698.20

A RESOLUTION OF THE TOWN OF GOLDEN BEACH, FLORIDA, AWARDING A COMPREHENSIVE HEALTH INSURANCE PLAN FOR THE BENEFIT OF THE TOWN OF GOLDEN BEACH EMPLOYEES AND ELIGIBLE DEPENDENTS; PROVIDING FOR IMPLEMENTATION; AND PROVIDING FOR AN EFFECTIVE DATE.

WHEREAS, the Town’s wishes to provide comprehensive health insurance to its employees; and

WHEREAS, in April the Administration requested proposals from several different firms to designate an Agent of Record for comprehensive health insurance coverage; and

WHEREAS, the Town received proposals from five different firms; and

WHEREAS, the Town selected a broker to serve as the Agent of Record; the selected broker went out into the market to shop for plans yet failed to deliver as called for by the Town; and

WHEREAS, the Town then asked a second broker to provide what they would recommend as a more competitive ad responsible option; and

WHEREAS, that agent presented the most competitive and responsible proposal from Avmed Advantage HMO (the “PLAN”), with a Transamerica Life GAP Plan and a Health Reimbursement Account of $1800 per member; and

WHEREAS, the Town would like to also offer a buy up option to a higher tier plan (Avmed Advantage POS) at the employee’s own expense, causing no additional cost to the Town; and

Page 1 of 3 Resolution No. 2698.20

WHEREAS, entering into this Contract will provide the Town with a considerable cost savings to the Town from its current comprehensive health insurance offerings; and WHEREAS, the Town Council finds that entering into an Agreement for service is

in the best interest of the Town.

WHEREAS, the Administration understands that with any change there might be some reservations, hesitations and possible disruption to its members, however the Town has taken steps to minimize said heartache; and

WHEREAS, throughout the course of this new transition the Town and the new Agent of Record are committed to facilitate any issues or concerns that may arise, and take any and all necessary steps in making this a seamless and smooth transition.

NOW THEREFORE, BE IT RESOLVED BY THE TOWN COUNCIL OF THE TOWN OF GOLDEN BEACH, FLORIDA, AS FOLLOWS:

Section 1. Recitals Adopted. Each of the above recitals are hereby adopted,

confirmed and incorporated herein.

Section 2. Proposal Accepted. The proposal to go into a Contract with the

Berenguer Group, An Acrisure Partner as described and set forth in the Agenda Item Report attached hereto and incorporated herein, and are hereby accepted.

Section 3. Implementation. The Mayor, Town Manager and Town Attorney

are hereby authorized to take any and all action necessary to implement this Resolution in accordance with its terms and conditions including, but not limited to, the designation of a new agent of record.

Section 4. Effective Date. That this Resolution shall become effective

immediately upon approval of the Town Council. Sponsored by the Town Administration.

Page 2 of 3 Resolution No. 2698.20

The Motion to adopt the foregoing Resolution was offered by                        ,

seconded by                 , and on roll call the following vote ensued:

Mayor Glenn Singer      

Vice Mayor Bernard Einstein      

Councilmember Judy Lusskin      

Councilmember Jaime Mendal       Councilmember Kenneth Bernstein      

PASSED AND ADOPTED by the Town Council of the Town of Golden Beach, Florida, this 15th day of September, 2020.

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ATTEST: MAYOR GLENN SINGER

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LISSETTE PEREZ TOWN CLERK

APPROVED AS TO FORM AND LEGAL SUFFICIENCY:

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STEPHEN J. HELFMAN TOWN ATTORNEY

Page 3 of 3 Resolution No. 2698.20

Town of Golden Beach

Health Insurance Broker & Benefits Review Timeline

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05/01/2020 Request to HR Consultant to Obtain Proposals & Presentations from Multiple Health Insurance Brokers Servicing Municipalities in Miami-Dade County

05/07/2020 HR Consultant Sent List Via Email to Health Insurance Brokers Requesting:

  • 1. About the firm

  • 2. Portfolio on the Management Team and Account Manager

  • 3. All value added services related to customer service, wellness, self-service technology, features, and any other services

  • 4. Relationships with carriers

  • 5. Ideas on how to improve the existing plan with cost savings to the Town

  • 6. Sample cost savings and creative solutions for plan similar in size to the Town

  • 7. List of municipal clients

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05/11/2020 Sapoznik Presentation Received

05/15/2020 Brown & Brown Presentation Received

05/19/2020 Evershore Presentation Received

05/22/2020 ABP Benefits Presentation Received

05/29/2020 Gallagher Presentation Received

06/08/2020 HR Consultant Sent Broker Comparison Report to Town Manager for Review

07/01/2020 HR Consultant Sent Town Manager Sample Savings from the Top 3 Brokers for Review

07/16/2020 Insurance Committee Sent Town Manager Ranking of Top 3 Brokers

08/05/2020 Town Received FMIT UHC Renewal Rates

08/21/2020 Evershore Presents BCBS Medical & Dental Rates

08/26/2020 Evershore Presents Gap Insurance Rates

09/02/2020 Evershore Presents Aetna Decline to Quote

09/03/2020 Evershore Sends Revised BCBS & Gap Insurance Proposal

09/03/2020 Evershore Presents Cigna Decline to Quote

09/04/2020 The Berenguer Group Presents Avmed Insurance Proposal

09/09/2020 Evershore Presents Life Insurance Proposal

09/10/2020 Town Council Held a Virtual Public Workshop to Discuss AvMed Insurance Proposal

Town of Golden Beach Health Insurance Proposed AvMed FY2020-2021

Total Premium

Monthly Cost

Annual Town

Proposed

Premium Rates

Annual Premium Trans $7K & Fee

HRA $1800

Cost

to Employee

Town Monthly Cost Cost

AvMed 7419 31

Employee Only

$498.73

$185,527.56

$87.37

$150.00

$736.10

$0.00

$ 22,819.10

$ 273,829.20

5

Employee Spouse

$1,105.13

$66,307.80

$179 .79

$150.00

$1,434.92

$349.41

$ 5,427.55

$ 65,130.60

9

Employee & Children

$950.93

$102,700.44

$152.28

$150.00

$1,253.21

$258.56

$ 8,951.90

$ 107,422.74

4

Employee & Family

$1,542.07

$74,019.36

$268.46

$150.00

$1,960.53

$612.22

$ 5,393.26

$ 64,719.12

Premium Rates

Trans $3K & Fee

HRA $1800

AvMed Choice 7465 2

Employee Only

$818.99

$19,655 .76

$50.44

$150.00

$1,019.43

$283.33

$ 1,472.20

$ 17,666.40

1

Employee Spouse

$1,814 .80

$21,777.60

$103.99

$150.00

$2,068.79

$983.28

$ 1,085.51

$ 13,026.12

1

Employee & Children

$1,561.57

$18,738.84

$84.41

$150.00

$1,795.98

$801.32

$ 994.66

$ 11,935.92

Employee & Family

$2,532.32

$0.00

$148.34

$150.00

$2,830.66

$1,482.34

$

$

53

$488,727.36

$ 46,144.18 $ 553,730.10

AVMED

Annual Premium

ONLY

$488,727.36

United Health

Cuurent Premium

$678,541.86

Savings

$189,814.50

AVMED

Annual Premium

$553,730.10

United Health

Current Premium

$678,541.86

Savings

$124,811.76

Town of Golden Beach Health Insurance Current United Health Car e

Current FY2 0 19-2020

Monthly Cost to Current Town Cost

Premium Cost Emp lo yee Per Month Annual Town Cost

Plan 3

31

Emplo yee Only

$873.96

$0.00

$27,092.76

$325,113 .12

5

Employee Spouse

$1,879.01

$502.53

$6,882 .43

$82,589.10

9

Employee & Children

$1,616.82

$371.43

$11,208.51

$134,502.12

4

Employee & Family

$2,621.87

$873.96

$6,991.66

$83,899.92

$0.00

Plan 1

2

Employee Only

$967 .83

$93 .87

$1,747.92

$20,975.04

1

Employee Spouse

$2,080.84

$704.35

$1,376.49

$16,517.88

1

Employee & Children

$1,790.49

$545.10

$1,245.39

$14,944.68

Employee & Family

$2,903.50

$1,155.59

$0.00

$0.00

53

$56,545.16

$678,541.86

New Rates FY2020-2021

Plan 3 31

5

9

4

Plan 1 2

1

1

United Health Care NEW Rates FY2020-2021

Monthly Cost to

Monthly Town

Premium Cost

Emp loyee

Cost

Annual Town Cost

Employee Only

$994 .57

$0.00

$30,831.67

$369,980.04

Employee Spouse

$2,138.31

$571.87

$7,832.20

$93,986.40

Employee & Children

$1,839.94

$422.69

$12,755.30

$153,063.54

Employee & Family

$2,983 .69

$994.56

$7,956.52

$95,478.24

$0.00

$0.00

Employee Only

$1 ,101 .39

$106 .82

$1,989.14

$23,869 .68

Employee Spouse

$2,368 .00

$801.56

$1,566.44

$18,797.28

Employee & Children

$2,037.58

$620 .33

$1,417 .26

$17,007.06

Employee & Family

$3,304 .18

$1,315.05

$0.00

$0.00

53 $64,348.52 $772,182.24

Town of Golden Beach Health Insu rance Proposed AvMed FY2020 – 2021

Monthly Cost to

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Proposed

AvMed 7419

31

5

9

4

AvMed Choice 7465

2

1

1

53

Premium Cost Employee Town Monthly Cost Annual Town Cost

Employee Only

$736 .10

$0 .00

$ 22,819.10

$ 273,829.20

Employee Spouse

$1,434.92

$349.41

$ 5,427.55

$ 65,130 .60

Employee & Children

$1, 253.21

$258 .56

$ 8,951.90

$ 107,422.74

Employee & Family

$1,960.53

$612.22

$ 5,393.26

$ 64,719.12

Employee Only

$1 ,019.43

$283.33

$ 1,472.20

$ 17,666.40

Employee Spouse

$2,068 .79

$983 .28

$ 1,085.51

$ 13,026.12

Employee & Children

$1,795.98

$801.32

$ 994.66

$ 11,935.92

Employee & Family

$2,830.66

$1,482.34

$ .

$ .

$ 46,144.18 $ 553,730.10

For: TOWN OF GOLDEN BEACH

Health Insurance Renewal: 10/1/2020

By: The Berenguer Group An Acrisure Partner

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Table of Contents

UHC Current / Renewal vs AvMed Advantage HMO (HRA $1.8K) Page 3 UHC Current / Renewal vs AvMed Advantage POS (HRA $1.8K) Page 4

AvMed HMO Benefits Pages 5 – 10

AvMed Choice Benefits Pages 11 – 18

Transamerica Benefits Pages 19 – 20

Client List Reference Page 21

Prepared for: Town of Golden Beach Effective 10/1/2020 By: The Berenguer Group an Acrisure Partner (HRA $1,800)

↓ HMO Open Access (No Referalls Needed)↓

Page 3

Calendar Year Deductible (CYD)

UHC – Choice Plus Plan 3

$500 / $1,000 In

$1,000 / $2,000 Out

Advantage

AvMed + HRA + Transamerica = $0 Worst Case

versus

AvMed – Achieve 7419

$5,000 / $10,000

Trans pays 1st 100% up to $7,000 per Mem

Copay / Coins Max $2,500 / $5,000 In

$5,000 / $10,000 Out

Hospital Services CYD + 10% In / CYD + 30% Out

Member Worst Case = $2,500

Labs: 100%

$2500 Current Advantage AvMed

AvM + HRA +

Trans = $0 Worst Case

AvM + HRA +

$8,100 / $16,200

Trans pays 1st $7,000 per Mem + HRA $1,800 CYD + 50%

Trans pays 1st $7,000 per Mem + HRA $1,800 Member Worst Case = $0

Labs: 100%

Outpatient Services

Urgent Care

Emergency Room PCP

Specialist

CYD + 10% In / CYD + 30% Out

Member Worst Case = $2,500

$50 In / CYD + 30% Out Member’s Worst Case = $50

$150 In & Out Net Member’s Worst Case = $150

$20 In / CYD + 30% Out

$40 In / CYD + 30% Out

Trans = $0 Worst Case

AvMed Trans pays 100%

AvMed Trans 100%

(True ER Only) AvMed + HRA

AvMed + HRA

$30

$60

CYD + 50%

Trans pays 1st $7,000 per Mem + HRA $1,800 Member Worst Case = $0

$50

Trans pays 1st 100% up to $7,000 per Mem Member’s Worst Case = $0

CYD + 50%

Trans pays 1st $7,000 per Mem + HRA $1,800 Member Worst Case = $0

HRA Visa Card up to $1,800 Per Employee

RX $10-35-60

UHC – Choice Plus Plan 3

AvMed w/ HRA Advantage

Coverage

#

Current

Renewal

EE Only

31

$873.96

$994.57

EE + Spouse

5

$1,879.01

$2,138.31

EE + Children

9

$1,616.82

$1,839.94

EE + Family

4

$2,621.87

$2,983.69

Total

49

$61,526.67

$70,017.44

AvM+Trans+HRA

=

9 to 0 versus Current UHC

$15/$25/$40/$80/50% coinsurance AD

#

31

Rates

$498.73

Trans $7K

$82.67

Fee

$4.70

HRA $1800

$150.00

Total

$736.10

Savings

-25.99%

5

$1,105.13

$175.09

$4.70

$150.00

$1,434.92

-32.89%

9

$950.93

$147.58

$4.70

$150.00

$1,253.21

-31.89%

4

$1,542.07

$263.76

$4.70

$150.00

$1,960.53

-34.29%

49

$35,712.93

$5,821.48

$230.30

$7,350.00

$49,114.71

-29.85%

AvMed – Achieve 7419

Rates and Benefits are for comparison purposes only. This document does not constitute a guarantee of benefits coverage. Final rates and coverage are based on final enrollment.

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P

a g e

4

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Rates and Benefits are for comparison purposes only. This document does not constitute a guarantee of benefits coverage. Final rates and coverage are based on final enrollment.

UHC Network ↓ In AvMed Area↓ ↓Out of AvMed Area Network Only in USA↓

myuhc.com www.avmed.org https://www.multiplan.com/webcenter/portal/ProviderSearch?SiteId=84451

$500 Individual / $1,000 Family – In AvMed Network

Calendar Year

$250 Individual / $500 Family In

AvMed + HRA +

$500 Individual / $1,000 Family – In Net out AvM Area (Multiplan)

Deductible (CYD)

$500 Individual / $1,000 Family Out

Transamerica = $0

$1,500 Individual / $3,000 Family – Out of Network

Worst Case

Trans pays 1st 100% up to $3,000 per Mem

versus

$3500 Individual / $7000 Family – In AvMed Network

Copay / Coins Max

$2,000 Individual / $4,000 Family In

$2,000 Current

$3500 Individual / $7,000 Family – In Net out AvM Area (Multiplan)

$4,000 Individual / $8,000 Family Out

Advantage AvMed

$10,500 Individual / $21,000 Family – Out of Network

Trans pays 1st 100% up to $3,000 per Mem

Hospital Services

CYD + 10% In / CYD + 30% Out

Member Worst Case = $2,000

AvM + HRA +

Trans = $0 Worst Case

CYD + 10% – AvM Net, PHCS (National Out of AvMed Network) CYD + 30% – Out of Net

Trans pays 1st $3,000 per Mem + HRA $1,800

Member Worst Case = $0

Outpatient Services

Labs: 100%

MRI:$100 / Surgery: $100 CYD + 30% Out

Member Worst Case = $2,000

AvM + HRA +

Trans = $0 Worst Case

Labs: 100% AvM Net and PHCS (National Out of AvMed Network) CYD + 10% – AvM Net and PHCS / CYD + 30% Out of Net

Trans pays 1st $3,000 per Mem + HRA $1,800

Member Worst Case = $0

$75 – In AvMed Network

Urgent Care

$50 In / CYD + 30% Out

AvMed Trans pays 100%

$75 – In Multiplan PHCS Network (Out of AvM Network Area Only) CYD + 30% – Out of Network

Trans pays 1st $3,000 per Mem + HRA $1,800

Member’s Worst Case = $50

Member’s Worst Case = $0

$250 – AvM Net, PHCS

Emergency Room

$125 In & Out Net

AvMed Trans 100%

(True ER Only)

(National Out of AvM Network), & Out of Net Trans pays 1st $3,000 per Mem + HRA $1,800

Member’s Worst Case = $125

Member Worst Case = $0

PCP

$15 In / CYD + 30% Out

AvMed w/ HRA

AvMed w/ HRA

$15 – AvM Net & PHCS (Out of AvMed Net)

                                        CYD + 30% – Out of Network

$30 – AvM Net & PHCS (Out of AvMed Net)

                                        CYD + 30% – Out of Network

HRA Visa Card up to

$1,800

Specialist

$30 In / CYD + 30% Out

RX

$10-35-60

AvMed w/ HRA

$15/$25/$40/$80/50% coinsurance AD

Per Employee

Coverage

#

UHC – Choice Plus Plan 1

Current Renewal

Advantage

AvMed – Choice

Rates Trans $3K Fee HRA $1800

Total Savings

EE Only 2 $967.83

$1,101.39

AvM+Trans+HRA = 9 to 0 versus Current UHC

$818.99

$45.74

$4.70

$150.00

$1,019.43

-7.44%

EE + Spouse 1 $2,080.84

$2,368.00

$1,814.80

$99.29

$4.70

$150.00

$2,068.79

-12.64%

EE + Children 1 $1,790.49

$2,037.58

$1,561.57

$79.71

$4.70

$150.00

$1,795.98

-11.86%

EE + Family 0 $2,903.50

$3,304.18

$2,532.32

$143.64

$4.70

$150.00

$2,830.66

-14.33%

Total 4 $5,806.99

$6,608.36

$5,014.35

$270.48

$18.80

$600.00

$5,903.63

-10.66%

Page 5

Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services

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Large Group Achieve LH507-LG20

Coverage Period: Beginning on or after 10/01/2020 Coverage for: Individual or Individual + Family| Plan Type: HMO

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, call 1-800-88-AVMED (1-800-882-8633) or visit www.avmed.org. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other

underlined terms see the Glossary. You can view the Glossary at www.cciio.cms.gov or call 1-800-88-AVMED (1-800-882-8633) to request a copy.

Important Questions

Answers

Why This Matters:

What is the overall deductible?

$5,000 individual / $10,000 family

Generally, you must pay all the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets

the overall family deductible.

Are there services covered before you meet your deductible?

Yes. Preventive care, office visits, certain lab tests, certain prescription drugs, urgent care, and certain recovery services, e.g., habilitation and rehabilitation services, are covered before you

meet your deductible.

This plan covers some items and services if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at

https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific

services?

No.

You don’t have to meet deductibles for specific services.

What is the out-of- pocket limit for this plan?

$8,100 individual / $16,200 family

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has

been met.

What is not included in the out-of-pocket limit?

Premiums, prescription drug brand additional charges and manufacturer assistance, and

services this plan doesn’t cover.

Even though you pay these expenses, they don’t count toward the out-of- pocket limit.

Will you pay less if you use a network provider?

Yes. See www.avmed.org or call 1-800-88- AVMED (1-800-882-8633) for a list of network providers.

This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get

services.

Do you need a referral to see a specialist?

No.

You can see the specialist you choose without a referral.

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Page 6

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Common Medical Event

Services You May Need

What You Will Pay

Limitations, Exceptions, & Other Important

Information

an In-Network Provider (You will pay the least)

an Out of Network Provider

(You will pay the most)

If you visit a health care provider’s office or clinic

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Primary care visit to treat an injury or illness

$30 copay/ visit

Not Covered

Additional charges may apply for non- preventive services performed in the

Physician’s office.

Specialist visit

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$60 copay/ visit

Not Covered

Additional charges may apply for non- preventive services performed in the

Physician’s office.

Preventive care/screening/ immunization

No Charge

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what

your plan will pay for.

If you have a test

Diagnostic test (x-ray, blood work)

50% coinsurance after deductible;

no charge for lab work at

participating labs

Not Covered

Charges for office visits may apply if services are performed in a Physician’s office. Charges for certain other labs and

Specialty labs will be higher.

Imaging (CT/PET scans, MRIs)

50% coinsurance after deductible

Not Covered

Charges for office visits or Physician/professional services may also apply depending where services are

received.

If you need drugs to treat your illness or condition

More information about prescription drug coverage is available at www.avmed.org

Value generic drugs (Tier 1)

$15 copay/ prescription (retail); $37.50 copay/

prescription (mail order)

Not Covered

Retail charge applies per 30-day supply.

Generic & brand drugs: covers up to a 90- day supply at retail pharmacies and a 60-90 day supply via mail order.

Certain drugs in all tiers require prior authorization.

Brand additional charges may apply.

Specialty drugs available in 30-day supply only; not available via mail order.

Generic drugs (Tier 2)

$25 copay/ prescription (retail); $62.50 copay/

prescription (mail order)

Not Covered

Preferred brand drugs (Tier 3)

$40 copay/ prescription (retail); $100 copay/

prescription (mail order)

Not Covered

Non-Preferred brand drugs (Tier 4)

$80 copay/ prescription (retail); $200 copay/

prescription (mail order)

Not Covered

Specialty drugs (Tier 5)

50% coinsurance after deductible (retail only)

Not Covered

AVLG_H_7

419_R6217_0720

Page 7

Common Medical Event

Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

an In-Network Provider (You will pay the least)

an Out of Network Provider (You will pay

the most)

If you have

outpatient surgery

Facility fee (e.g., ambulatory surgery

center)

50% coinsurance after deductible

Not Covered

Prior authorization required.

Physician/surgeon fees

50% coinsurance after deductible

Not Covered

Prior authorization required.

If you need immediate medical attention

Emergency room care

50% coinsurance after deductible

50% coinsurance after deductible

AvMed must be notified within 24-hours of inpatient admission following emergency services, or as soon as reasonably

possible. Charges are waived if admitted.

Emergency medical

transportation

$150 copay/ one way ground transport

$150 copay/ one way ground transport

50% coinsurance after deductible for air and water transportation.

Urgent care

$50 copay/ visit at urgent care facilities; $30 copay/ visit at retail clinics

$50 copay/ visit after deductible at urgent care facilities; $30 copay/ visit after deductible at retail

clinics

———————-None———————-

If you have a hospital stay

Facility fee (e.g.,

hospital room)

50% coinsurance

after deductible

Not Covered

Prior authorization required.

Physician/surgeon fees

50% coinsurance after deductible

Not Covered

Prior authorization required.

If you need mental health, behavioral health, or substance abuse

services

Outpatient services

$30 copay/ visit

Not Covered

Prior authorization may be required.

Inpatient services

50% coinsurance after deductible

Not Covered

Prior authorization may be required.

If you are pregnant

Office visits

Routine OB & midwife:

$30 copay/ 1st visit only; subsequent visits at no

charge

Not Covered

———————-None———————-

Childbirth/delivery professional

services

50% coinsurance after deductible

Not Covered

Maternity care may include tests and services described elsewhere in this SBC (e.g., ultrasound).

Childbirth/delivery facility services

Hospital stay: 50% coinsurance after deductible; Birthing center:

Same as Routine OB

Not Covered

Prior authorization required.

Page 8

Common Medical Event

Services You May Need

What You Will Pay

Limitations, Exceptions, & Other

Important Information

an In-Network Provider (You will pay the least)

an Out of Network Provider (You will pay

the most)

If you need help recovering or have other special health needs

Home health care

$60 copay/ visit after deductible

Not Covered

Limited to 20 skilled visits per calendar year. Approved treatment plan required.

Rehabilitation services

$60 copay/ visit;

$30 copay/ visit for chiropractic services

Not Covered

Limited to 35 visits per calendar year for rehabilitative outpatient PT, OT, ST, cardiac rehab, pulmonary rehab, and chiropractic services combined. Cardiac and pulmonary rehab require prior

authorization.

Habilitation services

$60 copay/ visit

Not Covered

Habilitative PT, OT, and ST, when provided for the treatment of autism spectrum disorder and Down syndrome, are limited to a combined maximum of

100 visits per calendar year.

Skilled nursing care

$250 copay/ day for the first 5 days per admission after

deductible

Not Covered

Limited to 60 days post-hospitalization care per calendar year. Prior

authorization required.

Durable medical equipment

$250 copay/ episode of illness

Not Covered

Excludes vehicle modifications, home modifications, exercise equipment, and bathroom

equipment.

Hospice services

No charge after deductible

Not Covered

Physician certification required.

If your child needs dental or eye care

Children’s eye exam

$35 copay/ exam

Not Covered

Limited to one eye exam per calendar year to determine the need for sight

correction.

Children’s glasses

Not Covered

Not Covered

———————-None———————-

Children’s dental check-up

Not Covered

Not Covered

———————-None———————-

Page 9

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Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Excluded Services & Other Covered Services:

  • Acupuncture

  • Bariatric Surgery

  • Child Dental Check Up

  • Child Glasses

  • Cosmetic Surgery

  • Dental Care (Adult)

  • Hearing Aids

  • Infertility Treatment

  • Long-Term Care

  • Non-Emergency Care When Traveling Outside the U.S.

  • Private-Duty Nursing

  • Routine Eye Care (Adult)

  • Routine Foot Care

  • Weight Loss Programs

  • Chiropractic Care

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: the Florida Office of Insurance Regulation at 1-877-693-5236 or www.floir.com/consumers, the U.S. Department of Labor, Employee Benefits Security Administration, at 1-866-444-3272 or www.dol.gov/ebsa/contactEBSA/consumerassistance.html, or the U.S. Department of Health and Human Services at 1-877-267- 2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.

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Your Grievance and Appeals Rights:There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact AvMed’s Member Engagement Center at 1-800-882-8633. For plans subject to ERISA, you may also contact the U.S. Department of Labor’s Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. Additionally, a consumer assistance program can help you file your appeal. Contact the Florida Department of Financial Services, Division of Consumer Services, at 1-877-693-5236 or www.floir.com/consumers.

Does this plan provide Minimum Essential Coverage? Yes.

If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.

Does this plan meet Minimum Value Standards? YES.

If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help pay for a plan through the Marketplace.

Language Access Services:

Para obtener asistencia en Español, llame al 1-800-882-8633.

To see examples of how this plan might cover costs for a sample medical situation, see the next section.

Page 10

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This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

About these Coverage Examples:

Peg is Having a Baby

(9 months of in-network pre-natal care and a hospital delivery)

Managing Joe’s type 2 Diabetes

(a year of routine in-network care of a well- controlled condition)

Mia’s Simple Fracture

(in-network emergency room visit and follow up care)

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The plan’s overall deductible Specialist copayment Hospital (facility) coinsurance Other coinsurance

This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/delivery professional services Childbirth/delivery facility services

Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

$5,000

$60 50%

50%

The plan’s overall deductible Specialist copayment Hospital (facility) coinsurance Other coinsurance

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This EXAMPLE event includes services like: Primary care physician office visits (including disease education)

Diagnostic tests (blood work) Prescription drugs

Durable medical equipment (glucose meter)

$5,000

$60 50%

50%

The plan’s overall deductible Specialist copayment Hospital (facility) coinsurance Other coinsurance

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This EXAMPLE event includes services like: Emergency room care (including medical supplies)

Diagnostic test (x-ray)

Durable medical equipment (crutches) Rehabilitation services (physical therapy)

$5,000

$60 50%

50%

Total Example Cost

$12,800

Total Example Cost

$1,925

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$7,400

Total Example Cost

Cost Sharing

Deductibles

$630

Copayments

$1,120

Coinsurance

$0

What isn’t covered

Limits or exclusions

$0

The total Mia would pay is

$1,750

In this example, Peg would pay:

In this example, Joe would pay:

In this example, Mia would pay:

Cost Sharing

Deductibles

$5,000

Copayments

$420

Coinsurance

$2,630

What isn’t covered

Limits or exclusions

$60

The total Peg would pay is

$8,160

Cost Sharing

Deductibles

$0

Copayments

$3,930

Coinsurance

$0

What isn’t covered

Limits or exclusions

$60

The total Joe would pay is

$3,990

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The plan would be responsible for the other costs of these EXAMPLE covered services.

AvMed Partial Client List Marriott Hotels

AT&T

State of Florida Employees Miami Dade County City of Sweetwater

City of Miami Garden

Village of Key Biscayne Jackson Hospital

Cable Marine

Boat Owners Warehouse

Coral Gables Fraternal Order of Police

Page 13

Thank you!

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Help with your out-of-pocket medical costs

TransConnect® for Florida Supplemental Medical Expense Insurance | Underwritten by Transamerica Life Insurance Company

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PHOTO: TWENTY20.COM/MAKENAMEDIA

Andrea was 33 weeks along when she was involved in a car accident, immediately putting her into pre-term labor. After the whirlwind of the ambulance ride, ER, emergency c-section, and hospital stay, she’s nervous about how much her major medical insurance will pay. It’s a relief to remember that she signed up for TransConnect® at her employer’s last open enrollment, which can pay for out-of-pocket expenses like deductibles,

co-insurance, and co-payments.

Product highlights

Inpatient Hospital Benefits

$7000 per Member, 3 X per Family

Your policy pays benefits for inpatient hospital stays, inpatient procedures, inpatient physician charges, and even routine nursery care for dependent children. Your employer determines your calendar year maximum benefit (multiplied by three for an insured family).

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Outpatient Hospital Benefits $7000 per Member, 3 X per Family Your policy also pays benefits (separate from the inpatient hospital benefits) for:

  • radiological diagnostic testing performed in a hospital outpatient facility or a magnetic resonance imaging (MRI) facility

  • radiation therapy or chemotherapy authorized by a radiologist, chemotherapist, or an oncologist for outpatient cancer treatment

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    VISIT

    transamericabenefits.com

    CUSTOMER SERVICE

    1-888-763-7474

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    • Guaranteed issue

    • No pre-existing conditions

    • Present a TransConnect® ID card along with your

      group medical ID card to the medical service provider

    • Review claims online

    Contact information

  • outpatient surgery performed in a hospital facility, free-standing surgery center, or physician’s office

  • MRIs, CT scans, PET scans, diagnostic ultrasounds, electrocardiogram (EKG) tests performed in a physician’s office (x-rays and lab fees are not included)

  • cardiac cauterizations and stress tests

  • accident injury or emergency condition treatment in a hospital ER or urgent care center

  • ER charges for illness if admitted to the hospital

Accident-Only Ambulance Benefit

$1000

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This benefit is payable when ambulance transportation (ground or air) is required to a hospital or emergency center for injuries sustained in an accident. Ambulance transportation must be within 72 hours of the accident and must be provided by a licensed professional ambulance company.

Help with your out-of-pocket medical costs | TransConnect® for Florida Supplemental Medical Expense Insurance

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Eligibility

You must be actively employed qualifying as an eligible insured (defined by the employer) and have an employer’s basic, major medical, or comprehensive medical plan.

Important Policy Provisions

Your employer selects benefit amounts, paid only for deductibles, co-insurance, and co-pays incurred when your major medical plan pays for specified treatments and care.

How to Submit a Claim

The ID card you’ll receive after enrollment should be presented at time of service so providers are paid directly after your major medical carrier determines what you owe. If you don’t do so at time of service, simply submit a TransConnect® claim form, UB92 or HCFA (the itemized service provider’s bill), and the Explanation of Benefits (EOB) from the major medical carrier showing what you owe after what they paid.

Exclusions

No benefits are payable under this policy/certificate for any expenses incurred:

  • Late enrollees are subject to a 30 day waiting period.

  • During any period the insured person does not have coverage under another medical plan.

  • As the result of suicide or any attempted suicide, while sane or insane.

  • For any intentionally self-inflicted injury or sickness.

  • For rest care or rehabilitative care and treatment.

  • For voluntary abortion except, with respect to the insured or insured spouse where the insured or the insured’s dependent spouse’s life would be endangered if the fetus were carried to term; or where medical complications have arisen from abortion.

  • As a result of commission of a felony.

  • As a result of participation in a riot, civil commotion, civil disobedience, or unlawful assembly. Excludes loss occurring while acting in a lawful manner within the scope of authority.

  • As a result of participation in a contest of speed in power driven vehicles, parachuting or hang gliding.

  • As a result of air travel, except as a fare-paying passenger on a commercial airline on a regularly scheduled route or as a passenger for transportation only and not as a pilot or crew member.

  • As a result of intoxication as determined and defined by the laws and jurisdiction of the geographical area in which the loss occurred.

  • For alcoholism or drug use, unless such drugs were taken on the advice of a physician and taken as prescribed while hospital confined as an inpatient.

Termination of Insurance

  • For any loss incurred while on active duty status in the armed forces of any country. If you notify us of such active duty, we will refund any premium paid for any period for which no benefits are provided as a result of this exclusion.

  • For pregnancy of a dependent child.

  • For sex changes.

  • For experimental treatment, procedures, devices, drugs or surgery. (Except that bone marrow transplants will not be considered experimental in the treatment of cancer).

  • For accident or sickness arising out of and in the course of any occupation for compensation, wage or profit; (Doesn’t apply to sole proprietors or partners not covered by workers’ compensation.);

  • For mental illness or functional or organic nervous disorders, regardless of the cause if the other medical plan does not cover these conditions.

  • For dental or vision services, including, but not limited to, treatment, surgery, extractions or X-rays, unless resulting from an accident occurring while the insured person’s insurance under this policy is in force and if performed within 12 months of the date of such accident; or due to congenital disease or anomaly of an insured newborn child; and to assure the safe delivery of necessary dental care provided to an insured person meeting certain criteria.

  • For routine physical examinations and rest cures.

    Insurance on an insured will end on the earliest of the following dates:

    Insurance on a dependent will end on

    the earliest of the following dates: The Company may end the insurance if:

    • The end of the last period for which premium has been paid.

    • The policy is terminated.

    • The insured retires.

    • The insured ceases to be on active service.

    • The insured’s coverage in the underlying medical plan ends.

  • The insured’s insurance terminates.

  • The end of the last period for which premium has been paid.

  • The dependent no longer meets the definition of dependent.

  • The dependent’s coverage in the underlying medical plan ends.

  • The policy is modified so as to exclude dependent insurance.

    • Any insured person submits a fraudulent claim.

    • Participation requirements are not met.

    • On any premium due date, if the Company or employer sends written notice 45 days in advance requesting termination.

    • If the underlying medical plan terminates.

      Up-to-date information regarding our compensation practices can be found in the Disclosures section of our website: tebcs.com

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      This is a brief summary of TransConnect® Supplemental medical expense insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa.

      Policy form series CPGAP2FL and CCGAP2FL. Forms and form numbers may vary. This insurance may not be available in all jurisdictions. Limitations and Exclusions apply. Refer to the policy, certificate and riders for complete details.

      23145_CTC01CFL1016

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      Plan Management

      HRA Eligible Expenses

      Health reimbursement account (HRA) eligible expenses.

      Medical services and treatments.

      • Acupuncture

      • Ambulance

      • Artificial limbs

      • Artificial teeth

      • Blood sugar test kits for diabetics

      • Breast pumps and lactation supplies

      • Chiropractor

      • Contact lenses

      • Dental treatments including X-rays, cleanings, fillings, braces and tooth removals

      • Doctor’s office visits and procedures

      • Drug addiction treatment

      • Drug prescriptions

      • Eyeglasses and vision exams

      • Fertility treatment

      • Hearing aids and batteries

      • Hospital services

      • Inpatient alcoholism treatment

  • Insulin

  • Laboratory fees

  • Laser eye surgery

  • Over-the-counter medicines and drugs if prescribed by a doctor (see more information below).

  • Physical therapy

  • Psychiatric care if the expense is for mental health care provided by a psychiatrist, psychologist or other licensed professional

  • Special education services — recommended by a doctor — for learning disabilities

  • Speech therapy

  • Stop-smoking programs (including nicotine gum or patches, if prescribed)

  • Surgery, excluding cosmetic surgery

  • Vasectomy

  • Weight-loss program, if it’s a treatment for a specific disease diagnosed by a physician

    Over-the-counter (OTC) medicines and drugs.

    Examples of OTC medicines and drugs that may be covered if a valid prescription is provided, include:

    • Acid controllers

    • Acne medicine

    • Aids for indigestion

    • Allergy and sinus medicine

    • Antidiarrheal medicine

    • Baby rash ointment

    • Cold and flu medicine

    • Eye drops

    • Feminine antifungal or anti-itch products

    • Hemorrhoid treatment

    • Laxatives or stool softeners

    • Lice treatments

    • Motion sickness medicines

    • Nasal sprays or drops

    • Ointments for cuts, burns or rashes

    • Pain relievers, such as aspirin or ibuprofren

    • Sleep aids

    • Stomach remedies

      CONTINUED

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      OTC supplies.

      Examples of OTC supplies that may be eligible for reumbursement, include:

      NOTE

    • Bandages, adhesive or elastic

    • Braces and supports

    • Catheters

    • Condoms

    • Contact lens solution and supplies

    • Crutches

    • Denture adhesives

    • Diagnostic tests and monitors (such as blood glucose monitors)

  • Elastic bandages and wraps

  • First-aid supplies

  • Insulin

  • Ostomy products

  • Pregnancy tests

  • Reading glasses

  • Walkers, wheelchairs and canes

    Insulin does not require a prescription for reimbursement.

    Common services and expenses not eligible for HRA reimbursement.

    Common services and expenses not eligible for HRA reimbursement, include:

    • Aromatherapy

    • Baby bottles and cups

    • Baby oil

    • Baby wipes

    • Breast enhancements

    • Cosmetics

    • Cotton swabs

    • Dental floss

    • Deodorants

    • Feminine care

    • Hair regrowth

    • Low-calorie foods

    • Mouthwash

    • Petroleum jelly

    • Shampoo and conditioner

    • Skin care

    • Spa salts

    • Sun-tanning products

    • Toothbrushes

For a complete list of eligible expenses,

see your benefit plan documents or visit irs.gov.

These are not complete lists. See your benefit plan documents or visit irs.gov to view all eligible expenses for your HRA.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., or their affiliates.

The UnitedHealthcare plan with Health Reimbursement Account (HRA) combines the flexibility of a medical benefit plan with an employer-funded reimbursement account. A health reimbursement account is not insurance. HRAs are administered by OptumHealth Financial Services and are subject to eligibility and restrictions.

This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment, and restrictions. Federal and state laws and regulations are subject to change.

Facebook.com/UnitedHealthcare Twitter.com/UHC Instagram.com/UnitedHealthcare YouTube.com/UnitedHealthcare MT-1168156.0 3/18 ©2018 United HealthCare Services, Inc. 18-7331

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City ‌

Provider

Aventura

Aetna

Miramar

Aetna

North Miami

Aetna

Coral Gables Fraternal Order of Police

AvMed

Miami Dade County

AvMed

Miami Gardens

AvMed

State of Florida Employees

AvMed

Sunrise

AvMed

Sweetwater

AvMed

Village of Key Biscayne

AvMed

Coconut creek

Cigna

Coral Gables

Cigna

Coral springs

Cigna

Fort Lauderdale

Cigna

Hallendale

Cigna

Margate

Cigna

Miami Beach

Cigna

Miami Lakes

Cigna

Tamarac

Cigna

Hollywood

Closed on Fridays

Lauderhill

Closed on Fridays

Miami Gardens

Closed on Fridays

Pompano Beach

Closed on Fridays

Wilton Manors

Closed on Fridays

Bal Harbour

Florida Blue

Bay Harbor Islands

Florida Blue

North Bay Village

Florida Blue

Miami Shores

Humana

Oakland Park

Humana

Dania Beach

United Health Care (recently went out to bid

they won)

Davie

United Health Care (staying with it for the

new FY)

Hialeah

United Health Care (self funded)

Indian Creek

United Health Care (staying with it for the new FY) however, they didn’t renew their current plan, they issued a new plan with

GAP

North Miami Beach

United Heath Care (Just switched for this FY)

Plantation

United Health Care (staying with it for the

new FY) they are contracted with them for a certain amount of years

Sunny Isles

United Health Care (staying with it for the

new FY)

SurfSide

United Health Care (staying with it for the

new FY) renewed and staying with the same plan they previously had

September 8, 2020‌

The Berenguer Group Juan Berenguer President

12651 S. Dixie Highway., Suite 209

Pinecrest, Florida 33156

Re: AvMed’s Financial Position Dear Mr. Berenguer:

As one of AvMed’s valued partners, I am writing to assure you that we remain committed to providing you, our mutual clients and their members the best Member health experience possible. AvMed’s financial position has not impacted our services to you or our clients. We’d like to underscore the fact that our financial position has not impacted the high quality, professional administration that AvMed provides. We remain financially secure and are confident that AvMed is well positioned for future success. With that said, we did want to provide you with the facts supporting AvMed’s ability to continue to effectively administer its health plans and our very strong capital position.

There are 3 relevant points here:

Capital Adequacy – AvMed’s capital and surplus level is significantly increased from 2016 to YTD 2020. AvMed made significant planned investments in technology and data capabilities to strengthen our ability to deliver a “better Member health experience.” While these investments were dilutive to capital and operating performance, nonetheless, we remain financially secure with capital and surplus over 580% greater than the requirements imposed by the Florida Office of Insurance Regulation. As a community based not-for-profit health plan AvMed uses its capital to drive benefits to its Members and clients as opposed to shareholders.

Liquidity – AvMed’s liquidity position improved in 2019 and continues to improve in 2020. AvMed has sufficient liquidity to meet its commitments and obligations to Members, clients and providers.

Operating Performance – Following four years of financial losses resulting from non-recurring investments made to strengthen AvMed’s technology and data platforms, operating statement performance stabilized and since 2017, AvMed has reported net income.

AvMed’s commitment and ability to serve your clients, employees and their families remains more steadfast than ever.

AvMed remains resolute in our commitment to providing our high quality, high-touch service and our relentless dedication to our mission, to help our Members live healthier. This commitment is demonstrated month after

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month, year after year, as we rank in the top quality, service or satisfaction studies by J.D. Powers of commercial health plans. In addition, AvMed continues to rank “Highest in Overall Satisfaction with Health Plan” among physicians.

2019 saw a 13% increase in our Capital and Surplus level by years end. Also, in 2018 AvMed finalized a $200 million, seven year contract with a leading technology firm to assist AvMed in providing world class service at the local level. The technological enhancements will provide greater self-service for our members, employer clients and The Berenguer Group. We deployed those enhancements on September 8, 2020. AvMed believes that our strong financial position and this transformation of our infrastructure will enhance the legendary service that we provide to our clients.

To provide additional support to our commitment, please find enclosed the Managed Care Report Quarterly Data Summary, as of December 31, 2019 published by Florida Office of Insurance Regulation (FLOIR). Highlighted on page 2, you will see AvMed’s Year to Date Quarterly Statement of Assets, Liabilities Capital and Surplus by Carrier

– as reported by AvMed to FLOIR. While 2nd Quarter has not been published yet, the positive results are continuing in 2020 as you can see from the 1st Quarter Managered Care Report.

AvMed is proud that you continue to entrust their clients’ health plan coverage to us.

We look forward to continuing to effectively serve The Berenguer Group, its clients and their employees and families.

Please do not hesitate to email me at Brian.Brown@AvMed.org or call me at 305-671-6168 if I can be of further assistance.

Sincerely,

Brian Brown

Head of Group Sales & Retention AvMed

Enclosures

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Managed Care Report‌

Quarterly Data Summary as of March 31, 2020

Florida Office of Insurance Regulation Market Research & Technology Unit Data Retrieval Date: August 24, 2020

Data Source: NAIC OLTPPROD and FLOIR DCAM schema

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Quarterly Statement Assets, Liabilities, Capital and Surplus by Carrier

Quarter 1, 2020

Net Admitted Assets

($)

Liabilities

($)

Capital and

Surplus

($)

YTD

Premiums

($)

YTD

Net Income Loss

($)

Aetna Better Health Of Florida Inc.

302,870,331

155,359,294

147,511,037

167,556,706

(2,509,968)

Aetna Health Inc.

550,977,172

376,849,418

174,127,754

354,671,787

(16,570,813)

Aids HF MCO of FL, Inc.

26,337,858

11,687,634

14,650,224

24,009,077

(1,158,700)

Avmed, Inc.

260,517,814

161,295,447

99,222,367

164,500,074

76,397

Baycare Select Health Plans, Inc.

28,255,701

21,586,172

6,669,529

14,635,426

(4,165,923)

Behealthy Florida, Inc.

27,301,256

3,566,973

23,734,283

8,699

2,193,821

Best Care Partners, Inc.

14,345,698

11,639,149

2,706,432

204,031

(110,286)

Capital Health Plan, Inc.

605,078,209

141,820,779

463,257,431

235,663,080

372,587

Careplus Health Plans, Inc.

627,009,767

460,152,171

166,857,596

644,526,775

4,706,354

Centene Venture Company Florida

22,865,043

4,725,703

18,139,340

2,613,779

(2,900,233)

Cigna Healthcare Of Florida, Inc.

2,941,104

515,807

2,425,297

517,311

(49,745)

Coventry Health Plan Of Florida, Inc.

5,838,096

1,308,572

4,529,524

196,054

169,273

Devoted Health Plan Of Florida, Inc.

45,178,673

33,659,777

11,518,896

34,667,402

(6,520,678)

Doctors Healthcare Plans, Inc.

17,910,369

10,707,943

7,202,426

38,673,070

(1,908,646)

Florida Blue Medicare, Inc.

261,867,454

97,489,722

164,377,733

228,304,905

(30,543,875)

Florida Health Care Plan, Inc.

221,858,187

82,634,907

139,223,280

118,295,546

9,488,976

Florida Mhs, Inc

58,827,899

27,723,570

31,104,329

38,348,474

(3,497,400)

Florida True Health, Inc.

85,880,195

54,347,221

31,532,974

73,142,894

(7,973,218)

Freedom Health, Inc.

316,552,977

227,081,645

89,471,332

325,190,431

(4,491,681)

Health First Commercial Plans, Inc.

99,444,253

41,752,975

57,691,278

59,721,170

3,724,421

Health First Health Plans, Inc

160,688,531

53,457,167

107,231,364

119,838,344

3,831,374

Health Options, Inc.

2,440,122,880

1,207,172,686

1,232,950,194

1,329,592,120

70,323,267

Healthspring Of Florida, Inc

147,891,224

85,054,761

62,836,463

242,327,575

(5,230,708)

Healthsun Health Plans, Inc.

285,307,262

158,463,725

126,843,537

302,997,485

(3,971,512)

Humana Medical Plan, Inc.

2,679,976,015

1,834,308,103

845,667,913

2,932,597,497

31,806,231

Longevity Health Plan Of Florida, Inc.

2,907,527

1,327,682

1,579,845

2,057,543

(418,273)

Medica Health Plans Of Florida, Inc.

4,420,221

49,637

4,370,583

0

5,985

Medica Healthcare Plans, Inc.

172,202,560

122,341,325

49,861,235

199,751,590

(218,471)

Mmm Of Florida, Inc.

14,014,456

5,502,998

8,511,458

13,519,724

(2,705,018)

Molina Healthcare Of Florida, Inc.

282,998,173

177,556,820

105,441,353

164,879,011

6,777,846

Neighborhood Health Partnership, Inc.

248,822,459

183,568,440

65,254,019

219,148,886

6,815,395

Optimum Healthcare, Inc.

213,015,775

141,145,517

71,870,259

204,838,669

(5,184,140)

Preferred Care Partners, Inc.

605,206,003

434,689,796

170,516,207

772,640,194

6,640,657

Prominence Healthfirst Of Florida, Inc.

9,756,000

53,694

9,702,307

0

(402,286)

Simply Healthcare Plans, Inc.

655,127,909

416,135,333

238,992,576

878,931,102

(29,362,085)

Solis Health Plans, Inc.

13,851,018

10,373,347

3,477,671

6,047,743

(793,480)

Sunshine Health Community Solutions, Inc.

15,572,581

11,584,551

3,988,030

2,228,486

(2,430,134)

Sunshine State Health Plan, Inc.

788,312,803

454,847,116

333,465,687

937,790,740

(24,862,184)

Ultimate Health Plans, Inc.

23,154,808

13,313,517

9,841,291

22,301,375

3,238,461

Unitedhealthcare Of Florida, Inc.

474,150,664

257,552,326

216,598,338

474,948,936

84,446

Wellcare Of Florida, Inc.

1,470,671,886

1,215,605,107

255,066,779

1,835,775,339

(82,501,315)

14,290,028,811

8,710,008,527

5,580,020,171

13,187,659,050

(90,225,281)

*This information is compiled from financial statement and enrollment data filed by each HMO. It has not been audited or independently verified.

Managed Care Report‌

Quarterly Data Summary as of December 31, 2019

Florida Office of Insurance Regulation Market Research & Technology Unit Data Retrieval Date: June 4, 2020

Data Source: NAIC OLTPPROD and FLOIR DCAM schema

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Quarter 4, 2019

Net Admitted Assets

($)

Liabilities

($)

Capital and

Surplus

($)

YTD

Premiums

($)

YTD

Net Income Loss

($)

Aetna Better Health Of Florida Inc.

299,213,576

150,418,168

148,795,408

559,084,578

77,675,685

Aetna Health Inc.

503,734,495

317,274,030

186,460,465

1,504,350,107

51,219,176

Aids HF MCO of FL, Inc.

27,740,261

11,519,771

16,220,490

101,839,826

947,063

Avmed, Inc.

278,144,497

167,500,297

110,644,200

699,786,590

14,621,696

Baycare Select Health Plans, Inc.

29,329,180

19,208,800

10,120,380

34,865,781

(25,308,176)

Behealthy Florida, Inc.

33,919,687

11,902,790

22,016,897

56,349,173

3,190,859

Capital Health Plan, Inc.

618,097,473

132,029,498

486,067,975

898,354,742

48,321,748

Careplus Health Plans, Inc.

579,338,837

411,547,813

167,791,024

2,138,346,012

93,182,441

Centene Venture Company Florida

21,286,819

80,501

21,206,318

0

241,229

Cigna Healthcare Of Florida, Inc.

2,979,057

537,624

2,441,433

1,515,986

(398,889)

Coventry Health Plan Of Florida, Inc.

6,393,892

2,081,565

4,312,327

39,584

306,700

Devoted Health Plan Of Florida, Inc.

41,701,858

27,816,545

13,885,313

45,215,353

(24,378,481)

Doctors Healthcare Plans, Inc.

20,976,205

12,260,226

8,715,979

78,856,548

(23,337,064)

Florida Blue Medicare, Inc.

201,764,101

130,504

201,633,597

0

1,180,465

Florida Health Care Plan, Inc.

223,677,079

88,832,052

134,845,027

481,210,510

48,713,849

Florida Mhs, Inc

73,692,758

45,422,226

28,270,532

207,163,974

(6,272,298)

Florida True Health, Inc.

82,507,621

40,896,005

41,611,616

330,532,022

(33,992,679)

Freedom Health, Inc.

270,045,016

168,365,158

101,679,858

1,149,007,872

61,540,726

Health First Commercial Plans, Inc.

97,924,716

37,905,174

60,019,542

237,421,619

8,698,657

Health First Health Plans, Inc

158,167,054

49,697,295

108,469,759

443,521,605

13,403,110

Health Options, Inc.

2,227,255,493

918,640,619

1,308,614,874

5,715,620,289

540,570,135

Healthspring Of Florida, Inc

132,422,955

51,004,626

81,418,329

860,431,813

22,310,624

Healthsun Health Plans, Inc.

242,615,229

108,659,715

133,955,514

1,089,763,717

82,105,603

Humana Medical Plan, Inc.

2,305,982,086

1,478,781,798

827,200,288

10,549,741,869

228,065,598

Longevity Health Plan Of Florida, Inc.

1,600,680

2,562

1,598,118

0

(1,462,519)

Medica Health Plans Of Florida, Inc.

4,415,245

50,647

4,364,598

0

(20,283)

Medica Healthcare Plans, Inc.

161,032,034

105,518,213

55,513,821

704,086,476

21,377,539

Mmm Of Florida, Inc.

12,899,469

6,234,852

6,664,617

30,415,151

(11,116,840)

Molina Healthcare Of Florida, Inc.

256,726,282

158,413,747

98,312,535

733,537,669

52,994,702

Neighborhood Health Partnership, Inc.

216,538,031

158,269,723

58,268,308

840,510,970

37,836,623

Optimum Healthcare, Inc.

194,682,117

112,671,585

82,010,532

737,240,984

45,617,159

Preferred Care Partners, Inc.

545,973,473

365,257,761

180,715,712

2,580,102,857

97,667,114

Simply Healthcare Plans, Inc.

642,182,250

374,032,725

268,149,525

3,277,428,736

76,831,212

Solis Health Plans, Inc.

16,974,889

12,625,781

4,349,108

11,240,960

(20,894,564)

Sunshine Health Community Solutions, Inc.

15,416,300

11,459,308

3,956,992

12,237,858

(5,287,268)

Sunshine State Health Plan, Inc.

779,828,236

416,621,465

363,206,772

4,110,955,853

29,582,672

Ultimate Health Plans, Inc.

21,362,032

14,517,970

6,844,062

71,816,081

(6,196,174)

Unitedhealthcare Of Florida, Inc.

453,521,952

239,771,988

213,749,964

2,065,961,468

39,844,872

Wellcare Of Florida, Inc.

1,309,320,498

968,490,037

340,830,461

6,806,003,229

205,093,552

13,111,383,433

7,196,451,164

5,914,932,270

49,164,557,862

1,744,475,574

Quarterly Statement Assets, Liabilities, Capital and Surplus by Carrier

*This information is compiled from financial statement and enrollment data filed by each HMO. It has not been audited or independently verified.