The URL can be used to link to this page

Item 4DItem 4D CITY OF SOUTH LAKE MEMORANDUM July 27, 2021 TO: Shana Yelverton, City Manager FROM: Stacey Black, Director of Human Resources SUBJECT: Approve a contract with Cigna to provide employee health, dental, and vision insurance benefits for the Plan Year October 1, 2021 through September 30, 2022. Action Requested: Approve a contract with Cigna to provide employee health, dental, and vision insurance benefits for Plan Year October 1, 2021 to September 30, 2022. Background Information: Full-time employees are offered health, dental and vision insurance as part of the City's standard benefits package. Aetna is the City's current provider for employee health, dental, and vision insurance and became the City's health insurance provider on October 1, 2016 following a competitive bidding process. Aetna became the provider for dental and vision insurance on October 1, 2019. Aetna offers employees four medical plan options, two dental plan options, and one vision plan. In late May, the City received its health, dental, and vision insurance renewals from Aetna. The renewals proposed a 23.6% increase to the health insurance, a 12.8% increase for dental insurance, and no increase for vision insurance. As a result of the proposed increases, the City issued Requests for Proposals (RFP) for employee health, dental and vision insurance. RFP Process. The City last issued an RFP for medical insurance in 2016 and will typically issue RFPs every four to five years, depending upon renewal proposals. The RFPs were issued in June, and the City received four responses for health insurance, seven for dental insurance, and nine for vision insurance. Each proposal was reviewed and evaluated based on the following criteria: • schedule of benefits and provider network; • rates; Shana Yelverton, City Manager Item 4D July 27, 2021 Page 2 • experience, qualifications, reputation, and references; • reporting, plan administration and ease of billing; and • wellness. Staff carefully analyzed proposals to evaluate each option. Based upon this review, Cigna was selected as the finalist for employee health, dental and vision insurance. Health. Four carriers submitted proposals for health insurance. Aetna's, Cigna's, and United Healthcare's health insurance proposals mirror current plans and offer a comparable provider network. Aetna 9.5% $273,010 Cigna -0.1% -$10,813 Scott & White -4.2% -$119,763 Health Plan United 15.1% $739,103 Healthcare Scott & White Health Plan's proposal includes minor plan changes and incorporates a narrow provider network for all plans. Although it offers a rate reduction, the plan provides a more restrictive provider network and would cause significant disruption for employees and, therefore, is not recommended. Cigna's proposal includes a $150,000 first and second -year premium credit acknowledging the administrative cost to change carriers and a $100,000 first -year credit if dental coverage is also purchased. Cigna also has offered a $30,000 wellness credit that can be applied to Cigna's wellness program. Dental. Seven carriers submitted proposals for dental insurance. In general, the plans offered by the carriers were comparable to the current coverage. Although MetLife offers the lowest rates, Cigna's proposal includes a first -year credit of Carrier Aetna % Increase 12.8% s increase $22,822 Cigna -1.0% -$1,427 MetLife -7.6% -$11,096 Reliance 22.8% $33,020 Standard 29.8% $42,595 Insurance United 18.4% $25,288 Healthcare United 4.5% $6,603 Concordia $100,000 if bundled with medical insurance. Cigna's proposal maintains the current rates on the PPO dental plan and reduces the premiums on the DHMO plan by 12.4%. This equates to an overall premium reduction of 1 %. Shana Yelverton, City Manager July 27, 2021 Page 3 Vision. Nine carriers submitted proposals for vision insurance. Vision insurance is optional, and employees contribute 100% of the cost. There is no direct cost to the City for vision insurance. Cigna's proposed vision plan is similar to the City's current plan and includes an average rate increase of a roximatel 5 A0/ This increase Item 4D Carrier Aetna % Increase 0.0% Avesis -12.4% Blue Cross -9.8% Cigna 5.6% MetLife -6.6% Reliance Standard -5.0% Standard Insurance 0.0% United Healthcare -10.7% VSP 6.2% pp Y o. equates to a rate change of less than one dollar per paycheck for employees. Although Cigna does not offer the lowest rates, it is beneficial and easier for employees to have one medical, dental and vision insurance provider. Recommendation. Based upon a review of all proposals, Cigna was selected as the finalist for employee health, dental and vision insurance. Cigna offers comparable health, dental, and vision plan designs, robust provider networks, a strong wellness partnership, and favorable premiums. In addition, Cigna's proposal includes generous first and second -year premium credits in acknowledgment of the administrative cost to change carriers and a first -year credit if dental coverage is also purchased. Finally, there is added value by having one carrier for all three insurance products through reduced staff time for benefits administration and simplified insurance for employees. The table below compares the proposed rate changes and financial impact to the City from the current provider, Aetna, and the finalist, Cigna. CARRIER 9.5% 12.8% 0% One-time credit: Aetna increase increase increase — $217,000 administration (current - $15,000 wellness provider) $273,010 $22,822 $0 increase increase increase 0.1% 1.0% 5.6% 1st year credits: decrease decrease increase — $150,000 administration — $100,000 dental bundle Cigna $10,813 $1,427 $0 — $30,000 wellness (finalist) decrease decrease increase 2nd year credit: — $150,000 administration Shana Yelverton, City Manager July 27, 2021 Page 4 Financial Considerations: Strategic Link: Citizen Input/ Board Review: Legal Review: Alternatives: Supporting Documents: Item 4D The proposed plan designs, provider networks, and rates, coupled with the credits offered by Cigna, provide the City with the best value for insurance. Staff recommends City Council approve a contract with Cigna for health, dental, and vision insurance. COVERAGE ESTIMATED ANNUAL TOTAL CITY CONTRIBUTION ESTIMATED ANNUAL DECREASE Health Insurance $4,143,878 -$10,813 Dental Insurance $144,073 -$1,427 Vision Insurance $0 $0 The cost estimates reflected above assume current employee enrollment and elections. The City will also receive a premium credit from Cigna of $250,000 on the first month's invoice. The proposed insurance plan costs will be included in the proposed budget for Fiscal Year 2022. Performance Management and Service Delivery: attract, develop and retain a skilled workforce. N/A N/A Deny the contract with Cigna and seek alternative options. The following supporting documents are attached: • RFP Comparisons • Cigna Health Insurance Proposal • Cigna Dental Insurance Proposal • Cigna Vision Insurance Proposal Staff Recommendation: Approve a contract with Cigna to provide employee health insurance, dental insurance, and vision insurance benefits for Plan Year October 1, 2021 through September 30, 2022. City of Southlake 2021 Insurance RFP Health Plan Comparison Rates Effective 10/01/2021 BENEFITS Physician Copay Specialist Copay Urgent Care Copay Emergency Room -Facility Inpatient Hospital Outpatient Surgery Deductible - Individual Deductible - Family Coinsurance Out of Pocket Max - Ind.* Out of Pocket Max - Fam.* Lifetime Maximum Retail Prescriptions PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Change Monthly Premium Annual Premium ComparisonHDHP HSA Cigna United Scott & White Current Plan Aetna (Recommendation) Healthcare Health HDHP HSA HDHP HSA Base HDHP HSA HDHP HSA BSW Plus HMO HDHP In -Network In -Network In -Network In -Network In -Network Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% Ded + 10% Ded + 10% Ded + 10% Ded + 10% Ded + 20% $3,000 $3,000 $3,000 $3,000 $3,000 $6,000 $6,000 $6,000 $6,000 $6,000 90% 90% 90% 90% 80% $6,000 $6,000 $6,000 $6,000 $5,250 $12,000 $12,000 $12,000 $12,000 $10,500 *Deductible included *Deductible included *Deductible included *Deductible included *Deductible included Unlimited Unlimited Unlimited Unlimited Unlimited $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 20% EEs Current Rates Proposed Rates Proposed Rates Proposed Rates Proposed Rates 42 $ 640.40 $ 638.15 $ 701.24 $ 806.85 $ 613.71 7 $ 1,428.09 $ 1,429.12 $ 1,563.76 $ 1,559.04 $ 1,368.58 16 $ 1,261.60 $ 1,261.92 $ 1,381.45 $ 1,496.97 $ 1,209,03 12 $ 2,094.10 $ 2,097.93 $ 2,293.04 $ 2,237.40 $ 2,006.83 77 0.0% 9.5% 16.3% -4.2% $ 82,208 $ 82,172 $ 90,018 $ 95,601 $ 78,782 $ 986,499 $ 986,064 $ 1,080,216 $ 1,147,216 $ 945,388 2021 Health Insurance RFP Page 1 of 1 City of Southlake 2021 Insurance RFP Health Plan Comparison Rates Effective 10/01/2021 BENEFITS Physician Copay Specialist Copay Urgent Care Copay Emergency Room -Facility Inpatient Hospital Outpatient Surgery Deductible - Individual Deductible - Family Coinsurance Out of Pocket Max - Ind.* Out of Pocket Max - Fam.* Lifetime Maximum Retail Prescriptions PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Change Monthly Premium Annual Premium Narrow Network Plan Cigna United Scott & White Current Plan Aetna (Recommendation) Healthcare Health Texas Health Aetna LocalPlus In -Network Texas Health Aetna Charter HMO BSW Plus HMO - LC1HA5E2 In -Network In -Network In -Network In -Network In -Network $30 Copay $30 Copay $30 Copay $25 Copay $25 Copay $50 Copay $50 Copay $50 Copay $75 Copay $50 Copay $75 Copay $75 Copay $75 Copay $100 Copay $50 Copay $300 Copay + 20% $300 Copay + 20% $300 Copay + 20% $500 Copay $500 Copay + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% $1,500 $1,500 $1,500 $1,500 $1,500 $3,000 $3,000 $3,000 $3,000 $3,000 80% 80% 80% 80% 80% $5,000 $5,000 $5,000 $5,000 $5,000 $10,000 $10,000 $10,000 $10,000 $10,000 *Deductible included *Deductible included *Deductible included *Deductible included *Deductible included Unlimited Unlimited Unlimited Unlimited Unlimited $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 $5/$40/$75 $8/$35/$70/$200 EEs Current Rates Proposed Rates Proposed Rates Proposed Rates Proposed Rates 32 $ 679.88 $ 711.50 $ 744.47 $ 748.96 $ 651.55 5 $ 1,516.14 $ 1,586.64 $ 1,660.17 $ 1,447.18 $ 1,452.96 18 $ 1,339.35 $ 1,401.65 $ 1,466.59 $ 1,389.57 $ 1,283,54 24 $ 2,223.19 $ 2,326.61 $ 2,434.39 $ 2,076.87 $ 2,130.54 79 4.7% 9.5% -0.7% -4.2% $ 106,802 $ 111,770 $ 116,948 $ 106,060 $ 102,351 $ 1,281,621 $ 1,341,234 $ 1,403,375 $ 1,272,717 $ 1,228,213 2021 Health Insurance RFP Page 2 of 2 City of Southlake 2021 Insurance RFP Health Plan Comparison Rates Effective 10/01/2021 BENEFITS Physician Copay Specialist Copay Urgent Care Copay Emergency Room -Facility Inpatient Hospital Outpatient Surgery Deductible - Individual Deductible - Family Coinsurance Out of Pocket Max - Ind.* Out of Pocket Max - Fam.* Lifetime Maximum Retail Prescriptions PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Change Monthly Premium Annual Premium -• Buy -Up Plan Cigna United Scott & White Current Plan Aetna (Recommendation) Healthcare Health Open Access Elect Open Access Plus Open Access Elect EPO Premier BDW Plus HMO - Choice EPO OAPIN Buy Up Choice EPO LC1 HA2F2 In -Network In -Network In -Network In -Network In -Network $30 Copay $30 Copay $30 Copay $30 Copay $30 Copay $50 Copay $50 Copay $50 Copay $60 Copay $60 Copay $75 Copay $75 Copay $75 Copay $75 Copay $50 Copay $300 Copay + 20% $300 Copay + 20% $300 Copay + 20% $250 Copay + 20% $500 Copay + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% $2,000 $2,000 $2,000 $2,000 $2,000 $4,000 $4,000 $4,000 $4,000 $4,000 80% 80% 80% 80% 80% $5,500 $5,500 $5,500 $5,500 $5,500 $11,000 $11,000 $11,000 $11,000 $11,000 *Deductible included *Deductible included *Deductible included *Deductible included *Deductible included Unlimited Unlimited Unlimited Unlimited Unlimited $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 $5/$40/$75 $8/$35/$70/$200 EEs Current Rates Proposed Rates Proposed Rates Proposed Rates Proposed Rates 76 $ 737.58 $ 723.52 $ 807.65 $ 966.86 $ 706.84 10 $ 1,644.80 $ 1,613.46 $ 1,801.06 $ 1,868.21 $ 1,576.26 42 $ 1,453.01 $ 1,425.35 $ 1,591.05 $ 1,793.84 $ 1,392,46 20 $ 2,411.86 $ 2,365.93 $ 2,640.99 $ 2,681.10 $ 2,311.35 148 -1.9% 9.5% 21.7% -4.2% $ 181,768 $ 178,305 $ 199,036 $ 221,127 $ 174,193 $ 2,181,212 $ 2,139,665 $ 2,388,428 $ 2,653,521 $ 2,090,313 2021 Health Insurance RFP Page 3 of 3 City of Southlake 2021 Insurance RFP Health Plan Comparison Rates Effective 10/01/2021 BENEFITS Physician Copay Specialist Copay Urgent Care Copay Emergency Room -Facility Inpatient Hospital Outpatient Surgery Deductible - Individual Deductible - Family Coinsurance Out of Pocket Max - Ind.* Out of Pocket Max - Fam.* Lifetime Maximum Retail Prescriptions PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Change Monthly Premium Annual Premium POS Premier Plan Cigna United Scott & White Current Plan Aetna (Recommendation) Healthcare Health Open Access Open Access Plus Open Access BSW Plus HMO - Managed Choice OAP Premium Managed Choice POS Premier LC1SA1E2 POS POS In -Network In -Network In -Network In -Network In -Network $25 Copay $25 Copay $25 Copay $25 Copay $25 Copay $50 Copay $50 Copay $50 Copay $50 Copay $50 Copay $75 Copay $75 Copay $75 Copay $75 Copay $50 Copay $300 Copay + 20% $300 Copay + 20% $300 Copay + 20% $250 Copay + 20% $500 Copay + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% Ded + 20% $1,500 $1,500 $1,500 $1,500 $1,500 $3,000 $3,000 $3,000 $3,000 $3,000 80% 80% 80% 80% 80% $3,500 $3,500 $3,500 $3,500 $4,000 $7,000 $7,000 $7,000 $7,000 $8,000 *Deductible included *Deductible included *Deductible included *Deductible included *Deductible included Unlimited Unlimited Unlimited Unlimited Unlimited $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 $5/$40/$75 $8/$35/$70/$200 EEs Current Rates Proposed Rates Proposed Rates Proposed Rates Proposed Rates 19 $ 827.25 $ 793.47 $ 905.84 $ 1,111.63 $ 792.78 3 $ 1,844.78 $ 1,769.43 $ 2,020.03 $ 2,147.95 $ 1,767.90 6 $ 1,629.70 $ 1,563.14 $ 1,784.52 $ 2,062.44 $ 1,561,79 5 $ 2,705.12 $ 2,594.64 $ 2,962.11 $ 3,082.55 $ 2,592.39 33 4.1 % 9.5% 24.2% 4.2% $ 44,556 $ 42,736 $ 48,789 $ 55,352 $ 42,699 $ 534,671 $ 512,835 $ 585,464 $ 664,227 $ 512,391 2021 Health Insurance RFP Page 4 of 4 City of Southlake 2021 Insurance RFP Dental Plan Comparison Rates Effective 10/01/2021 PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Changel Monthly Premium Annual Premium PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Changel Monthly Premium Annual Premium EEs 34 7 9 15 65 Dental HMO Current Rates $ 14.75 $ 28.03 $ 29.53 $ 45.72 $ 1,649 $ 19,791 Dental HMO Dental HMO Dental HMO Proposed Rates Proposed Rates Proposed Rates $ 12.92 $ 14.75 $ 13.06 $ 24.55 $ 28.03 $ 24.82 $ 25.86 $ 29.53 $ 26.12 $ 40.04 $ 45.72 $ 40.48 UL0.00]/. U F -11.59/6 $ 1,444 $ 1,649 $ 1,460 $ 17,334 $ 19,791 $ 17,521 Dental HMO Current Rates n/a n/a n/a n/a n/a n/a n/a 2021 Dental Insurance RFP Page 1 of 1 City of Southlake 2021 Insurance RFP Dental Plan Comparison Rates Effective 10/01/2021 PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Changel Monthly Premium Annual Premium PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Change Monthly Premium Annual Premium Dental HMO I IF Dental HMO Dental HMO Proposed Rates Proposed Rates Proposed Rates n/a $ 13.30 $ 14.36 n/a $ 26.10 $ 27.27 n/a $ 27.80 $ 28.73 n/a $ 47.20 $ 48.48 n/a]UF -3.4%UL 0.9% n/a $ 1,593 $ 1,665 n/a $ 19,117 $ 19,979 2021 Dental Insurance RFP Page 2 of 2 City of Southlake 2021 Insurance RFP Vision Plan Comparison Rates Effective 10/01/2021 PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Changel Monthly Premium Annual Premium Vision Plan Comparison Rates Effective 10/01/2021 PREMIUMS Employee Employee/Spouse Employee/Child(ren) Employee/Family % Changel Monthly Premium Annual Premium 2021 Vision Insurance RFP Page 1 of 1 4111's r Cigna. Cigna HealthCare Financial Proposal for City of Southlake 1400 Main St Ste 460 Southlake, TX 76092-7645 SIC Code: 9111 Total Eligible Employees: 346 Participating Subscribers: 328 Employer Contributions - Employee: Multiple Employer Contributions - Dependent: Multiple Waiting Period: Eligibility Definition: Active Employees working 30 hrs Effective Date: October 01, 2021 Note: The Quoted rates are subject to final Underwriting approval and, as noted below, are subject to change in the event of changes in benefits selected or changes in the risk factors upon which the Quoted Rates are based. In addition, state law may require regulatory approval of rates. If required regulatory approval has not been obtained on the proposed effective date, the healthplan shall use rates that are consistent with its then currently approved rating methodology and the quoted rates shall be effective immediately on the date for which they are approved for use. The Quoted Rates are guaranteed while the Group Service Agreement remains in effect until the next anniversary date, unless enrollment changes by 10% in which case Cigna HealthCare may change the Quoted Rate. Date: July 07, 2021 Cigna Healthcare Financial Exhibit for: City of Soul Effective Date: October 01, 2021 02 GC [load Ontion Cigna PLAN OFFERED Open Access Plus Open Access Plus LocalPlus In -Network OAP Premium OAPIN Buy Up LocalPlus IN Mid Plan Offering Quadruple Option Quadruple Option Quadruple Option Plan Name OAP Premium (14252730) OAPIN Buy Up (14252732) LocalPlus IN Mid (14252733) Medical Management Model Included Included Included Health Advocacy Excluded Excluded Excluded Situs TX TX TX Funding Fully Insured Fully Insured Fully Insured Cigna MEDICAL B� NO NO NO Collective Deductible Collective OOP NO NO NO Deductible/OOP Max Accumulator No Cross Accumulation NA NA Variable Coinsurance Applies YES YES YES Plan Deductible Order of Applicability Benefit Copay, Plan Benefit Copay, Plan Benefit Copay, Plan Deductible, Deductible, Coinsurance Deductible, Coinsurance Coinsurance In -Network: Telehealth Copay $0 $0 $0 Office Copay - PCP $25 $30 $30 Office Copay - SPC $50 $50 $50 Inpatient Deductible - Per Admit NA NA NA Inpatient Deductible - Per Day NA NA NA Outpatient Facility Copay None None None Emergency Room Copay $300 $300 $300 Urgent Care Copay $75 $75 $75 Deductible - Individual $1,500 $2,000 $1,500 Deductible - Family $3,000 $4,000 $3,000 Out -of -Pocket - Individual $3,500 $5,500 $5,000 Out -of -Pocket - Family $7,000 $11,000 $10,000 Out -of -Pocket - Family - Individual Amount $3,500 $5,500 $5,000 Out -of -Pocket Max Deductibles Ded Accumulates Ded Accumulates Ded Accumulates Out -of -Pocket Max Copays All Copays Accumulate All Copays Accumulate All Copays Accumulate Coinsurance Variable Variable Variable PCP Office Visits 100% 100% 100% Specialist Office Visits 100% 100% 100% Inpatient Hospital Facility 80% 80% 80% Outpatient Hospital Facility 80% 80% 80% Inpatient Professional Services 80% 80% 80% Outpatient Professional Services 80% 80% 80% Emergency Room 80% 80% 80% Urgent Care 100% 100% 100% Laboratory Services at an Outpatient Facility 100% 100% 100% Laboratory Services at an Independent Lab Facility 100% 100% 100% Radiology Services at an Outpatient Facility 100% 100% 100% Medical Specialty Drugs at an Outpatient Facility 80% 80% 80% Medical Specialty Drugs at a Physician's Office 80% 80% 80% Medical Specialty Drugs at Home Setting 80% 80% 80% Out of Network: Deductible - Individual $2,500 NA NA Deductible - Family $7,500 NA NA Out -of -Pocket - Individual $6,500 NA NA Out -of -Pocket - Family $19,500 NA NA Out -of -Pocket - Family - Individual Amount $6,500 NA NA Out -of -Pocket Max Deductibles Ded Accumulates NA NA Out -of -Pocket Max Copays All Copays Accumulate NA NA Coinsurance Variable NA NA PCP Office Visits 50% NA NA Specialist Office Visits 50% NA NA Inpatient Hospital Facility 50% NA NA Outpatient Hospital Facility 50% NA NA Inpatient Professional Services 50% NA NA Outpatient Professional Services 50% NA NA Emergency Room 80% NA NA Urgent Care 100% NA NA Laboratory Services at an Outpatient Facility 50% NA NA Laboratory Services at an Independent Lab Facility 50% NA NA Radiology Services at an Outpatient Facility 50% NA NA Medical Specialty Drugs at an Outpatient Facility 50% NA NA Medical Specialty Drugs at a Physician's Office 50% NA NA Medical Specialty Drugs at Home Setting 50% NA NA Maximum Reimbursable Charge Option 2 NA NA Inpatient Deductible - Per Admit NA NA NA Inpatient Deductible - Per Day NA NA NA Outpatient Facility Deductible None NA NA MRC Fee Schedule Percentage (Professional) 110% NA NA MRC Fee Schedule Percentage (Facility/Ancillary) 110% NA NA Pharmacy Benefl Focused 90 - CVS Focused 90 - CVS Focused 90 - CVS Pharmacy Network Formulary/PDL Performance Performance Performance Retail Copay $10/$35/$70/$150 $10/$35/$70/$150 $10/$35/$70/$150 Retail Copay (90 Days) $25/$88/$175 $25/$88/$175 $25/$88/$175 Home Delivery Drug Copay $25/$88/$175/$150 $25/$88/$175/$150 $25/$88/$175/$150 Deductible None ($0) None ($0) None ($0) Out -of -Pocket Max Combined With Medical Combined With Medical Combined With Medical Mental Health/Substance Use Disorder(Yes/No) Vision Rider (Yes/No) 'High level benefit summary. Please see your plan summary for a more detailed benefit description. If this proposal includes Cigna Care Network, the level of in -network benefits applicable may vary from what is shown above. ieM -iT Cigna. Acct#:3191776/OP-5108474/Q2/2065960 Page 2 of 6 7/22/2021 9:53 AM Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 w,z u . uuaa v [ion Cigna PLAN OFFERED HSA Open Access Plus HSA Base Plan Offering Quadruple Option Plan Name HSA Base (14252731) Medical Management Model Included Health Advocacy Excluded Situs TX Funding Fully Insured Cigna MEDICAL BENEFITS* Collective Deductible NO Collective OOP NO Deductible/OOP Max Accumulator No Cross Accumulation Variable Coinsurance Applies NO Plan Deductible Order of Applicability Plan Deductible, Benefit Copay, Coinsurance In -Network: Office Copay - PCP None Office Copay - SPC None Deductible - Individual $3,000 Deductible - Family $6,000 Individual - In a Family Amount Deductible $3,000 Out -of -Pocket - Individual $6,000 Out -of -Pocket - Family $12,000 Out -of -Pocket - Family - Individual Amount $6,000 Out -of -Pocket Max Deductible Ded Accumulates Out -of -Pocket Max Copays All Copays Accumulate Coinsurance 90% Adult Preventive Care Office Visit 100%, No Ded Out of Network: Deductible - Individual $6,000 Deductible - Family $18,000 Individual - In a Family Amount Deductible $6,000 Out -of -Pocket - Individual $12,500 Out -of -Pocket - Family $37,500 Out -of -Pocket - Family - Individual Amount $12,500 Out -of -Pocket Max Deductibles Ded Accumulates Out -of -Pocket Max Copays All Copays Accumulate Coinsurance 50% MRC Fee Schedule Percentage (Professional) 110% MRC Fee Schedule Percentage (Facility/Ancillary) 110% Pharmacy Benefits Pharmacy Network Focused 90 - CVS Formulary/PDL Performance Retail Copay $10/$35/$70/$150 Retail Copay (90 Days) $25/$88/$175 Home Delivery Drug Copay $25/$88/$175/$150 Deductible Combined With Medical Out -of -Pocket Max Combined With Medical Mental Health/Substance Use Disorder (Yes/No) Yes Vision Rider (Yes/No) No Employer Fund Contribution Fund Amount - Individual $0 Fund Amount - Family $0 Eligible Expense NA summarv. Please see vour plan summary for a more detailed benefit description. If this proposal includes Cigna Care Network, the level of in -network benefits applicable may vary from what is shown above. x',iaas Cigna. Acct#:3191776/OP-5108474/Q2/2065960 Page 3 of 6 7/22/2021 9:53 AM ON Cigna, Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 Q2 GC Quad Option Cigna PLAN OFFERED Open Access Plus HSA Open Access Plus Medical Choice OAP Premium HSA Base Plan Offering Quadruple Option Quadruple Option Plan Name OAP Premium HSA Base Medical Management Model Included Included Situs TX TX Funding Fully Insured Fully Insured Cigna RATES OAP Premium HSA Base #EE Rates #EE Rates Employee 21 $793.47 42 $638.15 Emp + Spouse 3 $1,769.43 6 $1,429.12 Emp + Child(ren) 5 $1,563.14 16 $1,261.92 Emp + Family 5 $2,594.64 13 $2,097.93 Monthly Billed Amount 34 1 $42,760 77 $82,841 Monthly Billed Amount Per Product 1 $42,760 $82,841 Annual Billed Amount Per Product $513,121 $994,090 TOTAL EE's 328 TOTAL Monthly Billed Amount $405,082 TOTAL Annual Billed Amount $4,860,981 Note: The fee associated with the administration of the HRA and/or HSA product is excluded from the Rates. Cigna is offering the below credits to the first bill: $150,000 admin credit $100,000 for dental integration credit Year 2: $150,000 for admin credit Acct#:3191776/OP-5108474/Q2/2065960 Page 4 of 6 7/22/2021 9:53 AM ON I Cigna, Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 Q2 GC Quad Option Cigna PLAN OFFERED Open Access Plus LocalPlus In -Network Medical Choice OAPIN Buy Up LocalPlus IN Mid Plan Offering Quadruple Option Quadruple Option Plan Name OAPIN Buy Up LocalPlus IN Mid Medical Management Model Included Included Situs TX TX Funding Fully Insured Fully Insured Cigna RATES OAPIN Buy Up LocalPlus IN Mid #EE Rates #EE Rates Employee 71 $723.52 30 $711.50 Emp + Spouse 8 $1,613.46 5 $1,586.64 Emp + Child(ren) 42 $1,425.35 18 $1,401.65 Emp + Family 20 $2,365.93 23 $2,326.61 141 1$171,461 76 $108,020 Monthly Billed Amount Monthly Billed Amount Per Product $171,461 $108,020 Annual Billed Amount Per Product $2,057,531 $1,296,239 TOTAL EE's TOTAL Monthly Billed Amount TOTAL Annual Billed Amount Note: The fee associated with the administration of the HRA and/or HSA product is excluded from the Rates. Cigna is offering the below credits to the first bill: $150,000 admin credit $100,000 for dental integration credit Year 2: $150,000 for admin credit Acct#:3191776/OP-5108474/Q2/2065960 Page 5 of 6 7/22/2021 9:53 AM Cigna HeaXM1care Financial fthibit for: City of Southlake Cigna. PROPOSAL TERMS AND CONDITIONS for Proposal: Og GO anal 0,411 A. General Terms mtnls Proposal Cigna HealMCare is pleased b present III PIP ... I for a Fully Insured Non-PadicipatIbD group medical and pharmacy benefit plan Ph,'Phb-) sponsored by Ciy of $outhlake. TNIs proposal Is valid for 80 days from Its original dale M release,0]/0 =1. Any revisions or updates b Ills proposal will rwt renew thl. valld tlmeframe unless expressly rgmmuniboted by Cigna HealMCare. Pr000sal Ca Cigna Health may revise or withdraw this Proposdii: M1ange I.,he ededive date of the quote. 2 M1e policy period II is d1floont Ihan 12 months. 3 he policy will not be ItIod In TX. d enefits are dfierenl than shown In the RFP or benefit motlificabons are requested. 5 "'no— Provided by is deemed Inaccurate. 8 tinge in any law,regulation, or requlretl assessment or tax that changes Cigna HealdhCare's bid b.Raring the pl,n. s by 10%or more, by product or for the total acroun .from the enrollment assumptions used In esMNl.Mng It. robs, fees, antllor feeacmd�s set I M1erelrt 8 he quoted enrollment such Mat II results in a needed change in premium rates. R re based on final enrollment I.--.Inclutlinlgehotal number of enrol es, their age, sex, demographics, locator antl the dbb—ion of enrollees by pr.ducator by customer der. 8 e Cigna Healthcare administered plan is less than 50%of thetolalellglble populatlonitlentlfietlas346 10 any olf thetlnio'_bb upon which these bobs or benefits were based (Including Metllcel HlshorylnformatonJ changes Cris inarourab. 11 vepr do, of Metllcel l PM1armacy.Atka products for all of City of SouWake's employees in all. —too 12 t employerxconhrlbutes less than 50%towaMthetoMlcostolthecoveregeelechetlbyeacM1enrolletlemployee- 13 t employer changes its level of contn..tlon lowaM the cost of the coverage. 14 .—he quoted sites withdraws 'ttht the eb__ date or terminates during the contact term, or at any I —following enrollment. 15 t wabng pedotl is tlifferent than. 18 Federal, Stab or Local action impacts the beneht levels quoted harem or aXeds our ability to me et our obligations to you, to your covered emphyeeslour 1] thoboo any reimbursement arrangement)" Pop "calls etc.)thot subod—I or reduces Me out --pocket obligation of—obr p...... nder the policy. eesl.—o Mons are requested to be Oft —Man 620%, 19 CIIen1 contrmaton of employee counts reveal the group to be a Small Employer,as defined under Me Pabent Probdbn and Afobable Care Act.antl Cigna HealtM1Care's receipt of the following Iniormahion'.-Complehetl metlical history questonnate 3o days Dnor to the policy egedrve date. o Cigna reserves the ngM1l to revise or wimtlrow Intl proposal if the requlretl metlical questionnaire is not received 30 days prior b Me policy egectiva dodo. B. Scope antl Appllcmlon of thls Proposal etl. Mwvereg e e reeedetl In Ihis Proposal: 1 assumes n lhalanyalnsurance polby, cedltcatelbooklet or summary plan d—Option material will be made avanable b 111e pollcyhdder a le 3 or policy may be canceled as of any Premium Due Date if the number of—od Employees fails to meet the minimum re,aired per group p-1,Ition rules; romply with any other material plan provision relating,. Employer conhnbutions or gr.up Dadicipoton rules. 4 Cigna s One Guide tligibl antl customer guidance solution. st apply to pad -lime or seasonal employees far any Dlan. 8 eligibleretrees arenMll_lgetlinthls plan unless mandated by situ, state legislation. reCigna's Network Savings Progrem (NSP) antl other Cost C.....mI" programs tlesignetl b conain wsds with rasped b binge. br oUl.ln—I, ceslsupplies that are covered by the Plan antl reduce the membeYs balance billing exposure. For atlminisbnng Mace programs, Cigna robins I D dlon of the savings or recoveries—ololed- 8 harges for convedingaquofied customer of a group plan to an lntllvitlual plan. 8 sling benefits for out-M-nehvoM health care serviceslsupplies to a Maximum Reimbursable Charge equal M 110%m elopetlnby Cigna balsetl upon a Ob-d logy similar I. Mat used by "Id Io tle,ermine the allowable fee brsimilar services In dhI geographacomarkel, OR, where Mat lee schedule does not provide a value, IM1e eo,h peroentle of the usual antl customary charyes made by providers M wcM1 service/supply or supply In the geographic area where Me servlcelsupply is received determbod by reference I. a Ihlbi P.dy dab base. t0 a employe es are located in the net++oM area, and thot all employees era only ellglble for Ma Cigna Healthcare or any ober aMllabtl company pratlucl offerings specified. 11 requires you notify us wiMin 30 days If any inbrtnation set bdh in this loan changes at any time wfille cevarage is provltletl to you by Cigna Healthcare. 12 may require regulatory approval of rates.lf ell proposed effective date, regulatory approval is not obtained IM1e healthplan shall use rotes consistent rently approvetl rates antl the foregoing rates shall be efiectve auhomatcaIII If a product is new antl has never had approvetl rates, Me .rage llI be postp.netl until regulatory approval Is received. 13 a sal fodM1 mthls document to survive executors of any final contact and/or Issuance by Cigna Health—ofoO, policy antllor roue $ervbe Agreemnenttons 14 a Cigna HeallM1Care's sbndartl lnsurenre policy form approvetl for use In IM1e applicable state by Me state insurance regulabr will be issued. Because Mellnsurance policy antl cediMate terms require regulatory approval,tb very little eexibiliry to change the provisions. The provisions of the Insubonce policy antl cedific to will control In ,he event ofo lbbbb, wllh the terms orl the request for proposal antl the Proposal 15 Isahigh-level summary of the proposed coverage. It ntfy all IM1e categorcare exp ies of health expenses III are covered or excluded. 18 may include state requlretl continuation rates whichwtll maI.h the retoo for the underlying plan. For Nebraska antl New York Over Age Dependents the rates 18 charges ma de by on offliate, -Cmfor bore management progams to contain Me cost of specific health serviceslib— I--Mhobonbo etl guidelines to promote p.P.bt safety antl eXident bore (I e., charges for management of d,bg...I., cardiology, rodobbn Merepy, MI procedures, medical oncology, sleep management antl borne heallb/DMEIHIT) when applicable. 20 M1arges for Embarc Benett ProtectonsM ane,work soluton forcedainh,gh-rosh gene therapy tlrugs arranged by evi — 21 Cigna HealtbCare assumes that Me group beallb plan or hoo th insurance cover age to which lM1iI proposal applies will not boa"goldtolholod health plan' 22 Includes applicable Patient --ton antl AXordable Care Act tees antl assessments Imposed upon health Insurers inducting Me Comparetve EXedlveness 23 n'ppll.....fo......oge form will be provltletl only lollowing untlerwriting approval 24 premium rates for the first month will be reduced by$1 K000 gg br a trb—tonal relief credo. 25 a Improvement Funtl the ntl')in of$300000a for clinicallwellnesalbehavieral programs b—d by Cigna fray the cost oh Cigna Healthcare tlesignahetl antl artangetl health and wellness Improvement programs for emplohyeers (eg , biometslc 1—bblll, F. shots, etc.) an rtl panicipalion In these programs. Tho F.ndmay be accessed during the pedotl from 10/0112021-0913012022 The Funtl may not be accessed following -I of to --ton of the Cigna HealMCare agreement. Unused funds bonnot be rolled 2] assumes that any non-volunbry vision benefit that is lnclutled In IM1e metlical plan and rwl provided through a sop —to policy o sub)ec1 I. ACA requirements. 28 For the producl(s)Open Access Plus, HSA Open Access Plus and LocalPlus ln-Network, Cigna earns financlal Rebates through drug.—fo Nrer rangements on certain tlrugs Mat are Included on Cigna', prescription drug list OW, Formulary). For some of the drugs for which Cigna may earn flnanclal Rebates, Cigna uses some Dodion of the financial Rebate value b adj- IM1e Prescnpdon Drug Charges payable by Cigna antllor Members for Ibse tlrugs. 2 -apply to intlivitlualsunless employed by the policyholder or an entity that padlcipales in on associaton or bust lhatis IM1e potcyholtler. OPOSAL: bo, 3 Propose by Clgne HealtbCare is propdebry antl bigM1ly confitlenhial.lt eing provltletl wllb IM1e untlerslantling Mat li will not tlrbyalM1e employeatllls represenbtves or consultants for any purpose obey than IM1e evaluator of the Proposal.O any of IM1e I I( nblI.b_to____obtsabbov"a.11 thereof) I. any person or enbty other than IM1e employer, Its representatives antl consulMnisbInd Me d respIbbbb employe.who ere directly Involved In IM1e evaluat onnprocess. 1 cM1 Plan presented in Ibis proposal bas an actuarial value, determined by Cigna H.IithCare, of 60% or greater. This tlebrmination was mad' u"do g Cigna Gaatng application which may produce on actuarial value slighlly d—ont than IM1e official HHS calculator. A bough we would expert any l, you will M1ave Io consul, wllb youractuarial consullan, for a more precise dhhe inaton If IM1e oleo's actuarial value. Cigna 1-thCare not provide actuarial ceditcalions. 2 Implement Me requested benefit design, tlifferent funding arrangements (II ,Insured, self-insuretl antllor HMO) involving aRl,.Wd Cigna companies may be required will respect Io plan partpants residing In certain states. 3 Cigna HealtM1Care may have an agreement with your benefit odvisor,u,do, which the benefit advisor may be paid for providing maM1adplace Intelligence or for the performance of administatve services. The qualificabon for antl amount of this payment may be based upon...bolt business g—1 and/.r retention levels. Any such payment is funded Through Cigna HeaIIM1CIII, general overhead. 4 The beneht advisor may qualify for lbbbro.epayment(monetaryor non-boon-IO) from Cigna HealMCare. For example, the benefit advisor may receive payment based upon new sales, new cuntomer growth or retention. This ncent— payment is funded from Cigna HealdM1Care's general overhead. 5 Cigna HealMCare sponwre programs IomIln, beneht advisors about Cigna HealtbCaresplan—bbIge antl servibos(Including producer advisory ceunclls). The cost of these events Is funded through Cigna HealthCare's general ovemeatl. Financial Proposal for City of Southlake Effective Date: October 01, 2021 Date: June 17, 2021 >y Cigna Dental is different. With Cigna, your dental benefits become a powerful extension of your overall benefits portfolio... helping to drive down medical costs while improving health outcomes and increasing employee engagement. It's the reason we're the fastest growing dental carrier', serving over 17 million customers. Cigna Dental brings you focused dental expertise and rich programs, which helps deliver better whole-Derson health outcomes throuah dental solutions. Dental that goes beyond. To help improve people's health. Dental care is an integral component of overall health. Using our whole -person health insights, leamings, and experience, we built dental solutions that help todav's busv emplovees get the most out of their benefits and maximize their overall health. Customer Engagement The key to impacting health and wellbeing is empowering your employees with the right tools in the right places to take action on the dental benefits they have and receive care. It's why we're focused on engaging our customers at every intersection from finding the right plan, to finding the right provider for their unique needs, to connecting with high -risk populations, to understanding their dental health and how it imoacts their overall health. (- O Personalization Our focus is on making it easy for every employee to have the opportunity to make the right choice for what is uniquely important to them. Our tools and service support help customers take control of their health, all while yielding increased engagement results. Customers can find and choose high -value' dentists close to home, work or school, make appointments online, compare /�p�+^([, treatment costs and show what their Dlan will Day. so thev can avoid sumrises. �-tor--' Clinical Expertise and Integration' Getting the right oral health care can improve overall health, especially for those who have certain medical conditions. This clinical focus matters. People who receive preventive dental care have 25 % lower hospital admission rates and 23 % lower emergency room visits. That translates to an average of 6 % lower total medical cost in year one, and 8 % average savings in veartwo. ONetworks We have a large, dedicated dental recruitment team focused on bringing in the dentists that matter most to our clients and those providers who deliver the highest standards of care. Whether choosing the Cigna DPPO or Cigna Dental Care® (DHMO)' plan, your employees will get access to quality providers. And they will find the right provider with ease and confidence using the Cigna Brighter Score®' ratina and transparencv tool on mvCiana®. Product Solutions O We know that choice is important to employees and that everyone has different needs and preferences with their dental plan so we've made it easier to offer options to your employees. We've expanded our DHMO network by 80 % , making it the largest in 37 states and growing'. We've designed a product with predictable costs and a cost-effective benefit program, all without sacrificing quality. For maximum flexibility on provider choice, our DPPO plan offers a quality network of providers and flexibility in plan desians. And. since 77 % of claims are in -network. DPPO not only offers flexibility. but savings. too. t 1 Summary W There's a reason more clients are choosing Cigna Dental. It's because we understand the important decision ahead of you and the responsibility for providing quality benefits to your organization to help your employees lead happier, healthier lives. As your partner, we believe more should be expected of your dental plan. Our products, services and networks help enable our customers to make the best choices and access the best care —meaning they become and stay healthier. Engaging your employees and inspiring them to have better health sits at the forefront of our approach. We set ourselves apart through our connection with our customers as we help them maximize their dental benefits, improve their health, and drive down costs. We team with you, connecting with your employees, to make this happen. This partnership is what makes the difference. 1. Based on Q3 2019 LIMRA for individual membership counts, YOY reporting as of October 2019. 2. High -value dentists are those identified as having top results based on their Brighter Score rating. The Brighter Score is an average rating based on patient experience and professional history. Quality designations are not a guarantee of the quality of care that will be delivered to individual patients. Dentists are solely responsible for any treatment provided. 3. "Preventive Dental Treatment Associated with Lower Medical Utilization and Costs." National study of Cigna customers with dental and medical coverage, July 2019. 4. The ten DHMO ("Dental HM07 is used to refer to product designs that may differ by state of residence of enrollee, including, but not limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care plan is not available in all stales. 5. Brighter features may vary by dentist. These and other dentist directory features are for educational purposes only and should not be the sole basis for decision -making. They are not a guarantee of the quality of care that will be provided to individual patients and patients should consider all relevant factors when selecting a dentist. 6. NetMinder DHMO data as of September 2019, reflecting Cigna Dental Care (DHMO) -Access Plus Network counts of unique DHMO locations. Data is subject to change. The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using. 7. Cigna Internal Data and Reporting, July 2019. Network utilization projected for claims across the DPPO and DPPO Advantage networks for 2020. Product availability may vary by location and plan type and is subject to change. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental Indemnity/ PPO plans are insured or administered by Cigna Health and Life Insurance Company (CH LIC), with network management services provided by Cigna Dental Health, Inc. (CDHI) and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. Cigna Dental Care plans are insured by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NE), Cigna Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are insured by CHLIC or Cigna Healthcare of Connecticut, Inc., and administered by CDHI. CHLIC policy forms: OK— DPPO: HP-POL99/HP- POL388, DHMO: POL115; OR -DPPO: HP-POL68/HP-POL352, DHMO: HP-POL121 04-10; TN—DPPO: HP-POL69/HC-CER2V1/HP- POL389 at al., DHMO: HP-POL134/HC-CER17V1 at al. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Brighter Score is a trademark of Brighter, Inc. a Cigna Company. Oppty #: OP-5108360 7/13/2021 8:31 AM Cigna Healthcare Financial Exhibit for: City of Southlake GC Dentacom Effective Date: October 01, 2021 This is a summary of benefits for your dental plan. All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network. Your DPPO** plan allows you to see any licensed dentist, but using an in -network dentist may minimize your out-of-pocket expenses. TPlan Design Total Cigna DPPO Network Out -of -Network Calendar Year Maximum (Class I, II, III, IX Expenses) $1750, Class I Applies $1750, Class I Applies Calendar Year Deductible Per Individual $50 $50 Per Family $150 $150 Class I Expenses - Preventive & Diagnostic Care Oral Exams 100%, No Deductible 100%, No Deductible Cleanings Routine X-rays Fluoride Application Sealants Space Maintainers (limited to non -orthodontic treatment) Non -Routine X-rays Emergency Care to Relieve Pain Class II Expenses - Basic Restorative Care Fillings 80%, After Deductible 80%, After Deductible Oral Surgery - Simple Extractions Oral Surgery - All Except Simple Extraction Surgical Extraction of Impacted Teeth Anesthetics Minor Periodontics Major Periodontics Root Canal Therapy / Endodontics Brush Biopsy Class III Expenses - Major Restorative Care Relines, Rebases, and Adjustments 50%, After Deductible 50%, After Deductible Repairs - Bridges, Crowns, and Inlays Repairs - Dentures Crowns/Inlays/O n l ays Stainless Steel/Resin Crowns Dentures Bridges Class IV Expenses - Orthodontia Coverage for Eligible Children and Adults 50%, No Ortho Deductible 50%, No Ortho Deductible Lifetime Maximum $1500 $1500 Class IX Expenses - Implants 50%, After Deductible 50%, After Deductible Plan Calendar Year Max $1750 $1750 Dental Plan Reimbursement Levels Based on Contracted Fees 90th Percentile of Allowed Charges*** Additional Member Responsibility in Yes, the difference between the excess of Coinsurance None member's dentist's billed charges and the dental plan reimbursement level*** Student/Dependent Age 26/26 P0010 Network. Prepared by Underwriting. 06/17/2021 09:37 AM Cigna. Oppty #: OP-5108360 7/13/2021 8:31 AM Cigna Healthcare Financial Exhibit for: City of Southlake GC Dentacom Effective Date: October 01, 2021 Cigna Dental Choice/indemnity Exclusions and Limitations: Procedure Exclusions & Limitations Exams Two per calendar year Prophylaxis (cleanings) Two per calendar year Fluoride 1 per calendar year for people under 19 X-Rays (routine) Bitewings: 2 per calendar year X-Rays (non -routine) Full mouth: 1 every 3 calendar years. Panorex: 1 every 3 calendar years Cone Beams Not covered Model Payable only when in conjunction with Ortho workup Minor Perio (non -surgical) Various limitations depending on the service Patio Surgery Various limitations depending on the service Crowns and Inlays Replacement every 5 years Prosthesis over Implants 1 per 5 years if unserviceable and cannot be repaired. Benefits are based on the amount payable for non -precious metals. No porcelain or white/tooth colored material on molar crowns or bridges. Bridges Replacement every 5 years Dentures and Partials Replacement every 5 years Relines, Rebases Covered if more than 6 months after installation Adjustments Covered if more than 6 months after installation Repairs - Bridges Reviewed if more than once Repairs - Dentures Reviewed if more than once Sealants Limited to posterior tooth. One treatment per tooth every three years up to age 14 Space Maintainers Limited to non -Orthodontic treatment. No frequency limit for participants under age 19. Alternate Benefit When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna Healthcare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses. Missing Tooth Provision The amount payable is 50% of the amount otherwise payable until insured for a specified time period; thereafter, considered a Class III expense Late Entrant Limit 50% coverage on Class III, IV (if applicable), and IX for 12 months Pre -Treatment Review Available on a voluntary basis when extensive work in excess of $200 is proposed Benefit Exclusions: * Services performed primarily for cosmetic reasons Replacement of a lost or stolen appliance * Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according to accepted dental standards * Procedures, appliances or restorations, other than full dentures, whose main purpose is to change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or restore occlusion * Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars * Bite registrations; precision or semi -precision attachments; splinting * Instruction for plaque control, oral hygiene and diet * Dental services that do not meet common dental standards * Services that are deemed to be medical services * Services and supplies received from a hospital * Charges which the person is not legally required to pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related to a condition connected to a military service * Experimental or investigational procedures and treatments * Any injury resulting from, or in the course of, any employment for wage or profit * Any sickness covered under any workers' compensation or similar law * Charges in excess of the reasonable and customary allowances * To the extent that payment is unlawful where the person resides when the expenses are incurred; * Procedures performed by a Dentist who is a member of the covered person's family (covered person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents); * For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; * To the extent that you or any of your Dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid; * To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a "no-fault" insurance law or an uninsured motorist insurance law. Cigna HealthCare will take into account any adjustment option chosen under such part by you or any one of your Dependents. * In addition, these benefits will be reduced so that the total payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer. **In Texas, the insured dental product offered by CGL/C and CHLIC is referred to as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. ***Charges are based upon an independent third party organization that is the industry standard. Percentile data is based upon the third party organtzavon's aggregated industry -wide claims data This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance cer0cate or plan description. Benefits are insured and/oradministered by Cigna HealthCare. Did you know that most of Cigna's dental plans include the Cigna Dental Oral Health Integration Program? This program was designed to address research that supports the association of oral health to overall health and provides reimbursement of copays or coinsurance for customers with qualifying medical conditions for program eligible procedures. Additionally, registered program members can access articles on behavioral conditions that impact oral health. Cigna is a registered service mark, and the "Tree of Life" logo is a service mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Prepared by Underwriting. Cigna DPPO Network (P0010) 06/17/2021 09:37 AM Cigna. Oppty #: OP-5108360 7/13/2021 8:31 AM Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 Cigna PLAN OFFERED Cigna Dental Care Access Product Choice Plan Name GC Dentacom K1-V9 Situs TX TX Funding Fully Insured Fully Insured Cigna RATES GC Dentacom DHMO #EE Rates #EE Rates Employee 124 $40.99 37 $12.92 Emp + Spouse 28 $81.99 7 $24.55 Emp + Child(ren) 45 $91.20 9 $25.86 Emp + Family 60 $138.87 14 $40.04 257 $19,814.68 67 $1,443.07 Monthly Billed Amount Monthly Billed Amount Per Product $19,814.68 $1,443.07 Annual Billed Amount Per Product $237,776.16 $17,316.86 TOTAL EE's 324 TOTAL Monthly Billed Amount $21,257.75 TOTAL Annual Billed Amount $255,093.02 The above DPPO rates are guaranteed for 2 years, valid for 10/01/2021 and 10/01/2022 effective dates The above DHMO rates are guaranteed for 2 years, valid for 10/01/2021 and 10/01/2022 effective dates The quoted Dental rates are valid only when packaged and sold along side Cigna Medical and/or New York Life Group Insurance. If sold standalone, an increment of 1.35% would apply to the rates illustrated above. This quote assumes the proposed DPPO benefits will be administered on Dentacom. This quote assumes the proposed DHMO benefits will be administered on WEBSTER T Cigna. Oppty #: OP-5108360 7/13/2021 8:31 AM Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 PROPOSAL TERMS AND CONDITIONS for Dental A. General Terms of this Proposal Cigna HealthCare is pleased to present this Proposal for a Fully Insured Non -Participating group Dental benefit plan (the "Plan") sponsored by City of Southlake. This proposal is valid for 60 days from its original date of release, 06/17/2021. Any revisions or updates to this proposal will not renew this valid timeframe unless expressly communicated by Cigna HealthCare. The information contained in this Proposal by Cigna HealthCare is proprietary and highly confidential. It is being provided with the understanding that it will not be used by the employer, its representatives or consultants for any purpose other than the evaluation of the Proposal. Under no circumstances is any of the information contained herein (including excerpts, summaries, extracts, and evaluations thereof) to be used, disseminated, disclosed or otherwise communicated to any person or entity other than the employer, its representatives and consultants, and their respective employees who are directly involved in the evaluation process. Proposal Caveats Cigna HealthCare may revise or withdraw this Proposal if: 1 there is a change to the effective date of the quote. 2 benefits and any applicable experience do NOT match benefits with incumbent carrier; a review of the SPD may be required prior to implementation. 3 participation is below 94%. This will be based on the total eligible employees, identified as 346. 4 enrollment increases or decreases by 10% or more, by product or for the total account, from the enrollment assumptions used in establishing the rates and/or fees set forth herein. 5 it is not the exclusive provider of Dental for all of City of Southlake's employees in all worksites. 6 there is a change in law, regulation, tax rates, or the application of any of these that affects Cigna HealthCare's costs B. Scope and Application of this Proposal Unless otherwise indicated, this Proposal: 1 assumes the quoted Dental rates are valid only when Dental is packaged and sold alongside Cigna Medical and/or CGI. 2 assumes employer contribution levels match what is shown in the RFP. 3 assumes the premium rates proposed by Cigna Healthcare are subject to final Underwriting approval and may be changed due to differences in selection of benefits, changes in census data, or any other changes in risk determined by Cigna Healthcare. 4 includes rates which are subject to regulatory approval. If, as of their proposed effective date, regulatory approval is not obtained, Cigna shall use rates consistent with its then currently approved rates and the foregoing rates shall be effective automatically upon approval. 5 assumes that Cigna HealthCare's standard insurance policy form approved for use in the applicable state by the state insurance regulator will be issued. Because the insurance policy and certificate terms require regulatory approval, there is very little flexibility to change the provisions. The provisions of the insurance policy and certificate will supersede the Proposal in the event of a conflict. 6 includes Dental rates which are guaranteed for a period of 24 months while the contract remains inforce. The guarantee is valid only if medical and/or CGI renews with dental in subsequent period. 7 assumes the rates contain sufficient commission load for Dental of 10%. 8 assumes only a passive DPPO plan may be offered to TX or MS employees due to regulatory requirements. 9 assumes the plan will be implemented using Cigna's standard policy provisions, limitations, and contract language as reflected in Cigna's summary plan description unless specific modifications have been approved and rated appropriately. These standards are summarized in the Underwriting benefit summary. Any benefit modifications must be communicated in writing from Underwriting. 10 contains rates which include costs for Health Insurance Assessment fees (PPACA) for 2020. Rates for 2021 and later do not include Health Insurance Assessment fees (PPACA). 11 Cigna's Dental and/or Vision products are "excepted benefits" and not subject to Essential Health Benefit requirements. 12 Cigna HealthCare may have an agreement with your benefit advisor, under which the benefit advisor may be paid for providing marketplace intelligence or for the performance of administrative services. The qualification for and amount of this payment may be based upon overall business growth and/or retention levels. Any such payment is funded through Cigna HealthCare's general overhead. 13 The benefit advisor may qualify for incentive payment (monetary or non -monetary) from Cigna HealthCare. For example, the benefit advisor may receive payment based upon new sales, new customer growth or retention. This incentive payment is funded from Cigna HealthCare's general overhead. 14 Cigna HealthCare sponsors programs to inform benefit advisors about Cigna HealthCare's plan coverage and services (including producer advisory councils). The cost of these events is funded through Cigna HealthCare's general overhead. Oppty #: OP-5108360 7/13/2021 8:31 AM Cigna Healthcare Financial Exhibit for: City of Southlake Effective Date: October 01, 2021 PROPOSAL TERMS AND CONDITIONS for Cigna Dental Care Rates are valid for a 10/01/2021 effective date. Rates contain sufficient load for a 10% flat commission. Rates are guaranteed for 24 months. Rates include costs for standard eligibility, standard enrollment materials, and standard administration. Rates are valid only where there is an existing CDC network in place. CDC copayments are subject to change on the anniversary date. There must be a section 125 plan in effect. Subscribers must be enrolled in the CDC plan for at least 1 year. Rates are dependent upon eligibility being effective on the first of the month. Rates may be sold on a 4-tier basis only. Rates assume ID cards will be mailed to employee homes. These rates are subject to regulatory approval. The dental insurance coverage shall be provided under a standalone group insurance policy and is an "excepted benefit" as defined in Public Health Service Act Section 2721(c) and (d) and not subject to the requirement of the Patient Protection and Affordable Care Act. The information contained in this Proposal by Cigna HealthCare is proprietary and highly confidential. It is being provided with the understanding that it will not be used by the employer, its representatives or consultants for any purpose other than the evaluation of the Proposal. Under no circumstances is any of the information contained herein (including excerpts, summaries, extracts, and evaluations thereof) to be used, disseminated, disclosed or otherwise communicated to any person or entity other than the employer, its representatives and consultants, and their respective employees who are directly involved in the evaluation process. Cigna HealthCare may have an agreement with your benefit advisor, under which the benefit advisor may be paid for providing marketplace intelligence or for the performance of administrative services. The qualification for and amount of this payment may be based upon overall business growth and/or retention levels. Any such payment is funded through Cigna HealthCare's general overhead. The benefit advisor may qualify for incentive payment (monetary or non -monetary) from Cigna HealthCare. For example, the benefit advisor may receive payment based upon new sales, new customer growth or retention. This incentive payment is funded from Cigna HealthCare's general overhead. Cigna HealthCare sponsors programs to inform benefit advisors about Cigna HealthCare's plan coverage and services (including producer advisory councils). The cost of these events is funded through Cigna HealthCare's general overhead. The term "DHMO" is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna DHMO is not available in the following states: AK, ID, ME, MT, NH, NM, ND, PR, SD, VI, VT, WV, and WY. Rates for 2020 effective dates include costs for Health Insurance Assessment fees (PPACA). Rates for 2021 effective dates and later do not include Health Insurance Assessment fees (PPACA). Cigna reserves the right to modify quoted rates, as necessary, consistent with any future changes in regulation or cost. AR and RI law requires a carrier to offer a point of service option. CDC standalone is not available and must be sold as part of a dual choice option. For new business, employees residing in Idaho may not be offered CIGNA Dental Care. Employees selecting a provider in North Carolina, network availability must be verified prior to selling CIGNA Dental Care. TX law requires a carrier to offer a point of service option to employer paid groups who have 25 or more employees when a closed panel plan is the only plan offered. CDC standalone is only available when another Indemnity/PPO plan is in place. This Cigna Dental Care ("DHMO") proposal assumes covered services will be provided by the Cigna Dental Care Access Plus network of contracted general and specialty dentists Oppty #: OP-5108360 7/13/2021 8:31 AM PROPRIETARY & CONFIDENTIAL �T- Cigna Cigna Vision Solution for City of Southlake Effective Date : 10/112021 Plan Code: 2925 Voluntary FI Quote (Per Employee Per Month) *15% Minimum Participation Required* Premium Rate Employee Only $5.96 Employee + Spouse $11.92 Employee + Child(ren) $12.04 Employee + Family $19.22 *Please note that multiple plans may not be installed for groups with 500EE or fewer or on the Facets platform; if multiple plans were quoted for your review, you may choose only one vision plan. *Broker commissions of 10% are included in this quote. *Voluntary: Medical and/or dental subscribers can elect to not enroll in vision. Does not refer to contribution levels. *Quote is valid for 90 days and includes claim processing, network access, customer service, policy reporting. Does not include SPD. The fee also includes two vision specific ID cards, mailed directly to the member's home address (unless other arrangements are made in advance). *Our Cigna Vision proposal is contingent upon selecting Cigna for your dental and/or medical coverage. *This quote assumes the Cigna Vision will be administered on the Cigna East platforms. *Rates are guaranteed for two years. *Cigna Healthcare's vision products are "excepted benefits"and not subject to Essential Health Benefit requirements. The above quoted rates include Health Insurance Assessment fees (PPACA) for 2020 months, but not for 2021 and beyond. Cigna reserves the right to modify quoted rates, as necessary, should there be any changes in future regulation or costs. Cigna Vision Network offers one of the largest specialty routine vision networks, with optometrists and ophthalmologists, at full service locations nationwide, including private practice and national and regional retail locations. Please be aware that the Cigna Vision Network is different from the Cigna medical networks. Proposed Plan Design - (Cl) PPO - Scheduled Frequency is 12 months for exams, 12 months for lenses, 12 months for contact lenses, and 24 months for frames. Benefit In -Network** Out -of -Network Examination Copay $10 copay n/a Materials Copay $25 copay n/a Exam Covered in Full $45 allowance Single Vision Lenses Covered in Full $40 allowance Lined Bifocal Lenses Covered in Full $65 allowance Lined Trifocal/Progressive Lenses Covered in Full $75 allowance Lenticular Lenses Covered in Full $100 allowance Contact Lenses Materials (retail allowance) Elective $110 allowance $98 allowance Therapeutic Covered in Full $210 allowance Frame (retail allowance) $130 allowance $71 allowance In -Network Benefits Include**: • One vision and eye health evaluation including but not limited to eye health examination, dilation, refraction, and prescription for glasses • One pair of standard prescription plastic or glass lenses, all ranges of prescriptions (powers and prisms) • Additional services, minimum 20% savings* including but not limited to: Plan Pays Customer Cost Retinal Screening $0 up to $39 Lens Enhancements (minimum 20% savings)*: Oversize Lenses Covered In Full $0 Rose Tint: #1 and #2 Covered In Full $0 Standard Polycarbonate Covered -19 years of age up to $40 for Adults All Plastic Dye Tints $0 up to $17 Standard Photochromic - Glass or Plastic $0 up to $82 Standard Scratch Coating $0 up to $17 Standard Ultraviolet Coating $0 up to $17 Progressives Covered In Full $0 Standard Anti -Reflective Coating $0 up to $45 Hi -Index $0 20% off retail All Other Add -On Services, Incl. Premium Services $0 20% off retail • One frame of choice covered up to retail plan allowance, plus a 20% savings on amount that exceeds frame allowance. • One pair or a single purchase supply of contact lenses - in lieu of lenses and frame benefit, (may not receive contact lenses and frames in same benefit year). Allowance applied towards cost of supplemental contact lenses professional services (including the fitting and evaluation), and contact lens materials. • Healthy Rewards® - Vision Network Savings Program: n Minimum 20% savings* on additional purchases of frames and/or lenses, including lens options, with a valid prescription; offered savings does not apply to contact lens materials. Check with your Cigna Vision Network Provider for details. PROPRIETARY & CONFIDENTIAL 'Provider participation is 100 % voluntary, please check with your Eye Care Professional for any offered discounts; stated Customer Cost, up to maximums, are subject to change without notice. "coverage may vary at participating discount retail and membership club optical locations, please contact Customer Service for specific coverage information. Benefits are underwritten or administered by Cigna. This information is intended as a summary of benefits only. It does not describe all the terms, provisions and limitations of your plan. Network providers are independent contractors solely responsible for your routine vision examination and products. Healthy Rewards® -Vision Network Savings Program powered by Cigna Vision is a discount program, not an insured benefit. 6/17/2021 11:08 Aimee Staack (Dallas - 329) Underwriter: