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Item 4D - MemoItem 4D M E M O R A N D U M TO: FROM: July 27, 2022 Shana Yelverton, City Manager Stacey Black, Senior Director of Human Resources SUBJECT: Approve a contract renewal with Cigna to provide employee health, dental, and vision insurance benefits for Plan Year October 1, 2022 through September 30, 2023. Action Requested: Approve a contract with Cigna to provide employee health, dental, and vision insurance benefits for Plan Year October 1, 2022 to September 30, 2023. Background Information: Full-time employees are offered health, dental and vision insurance as part of the City's standard benefits package. Cigna is the City's current provider and became the provider on October 1, 2021 following a competitive bidding process. Cigna offers employees four medical plan options, two dental plan options, and one vision plan. In early June, the City received its health, dental, and vision insurance proposed renewals from Cigna. Health Insurance. Since October 1, 2021, Cigna reports the City has experienced an approximate 90% loss ratio for medical and prescription claims. In June 2022, the loss ratio spiked to 115%. In addition, Cigna also reports the City is currently experiencing 18 large, ongoing claims. In light of the high claims experience, Cigna's initial renewal offer proposed a 13.81% rate increase. Following negotiations, Cigna reduced its renewal offer to an overall average 9.4% rate increase with no plan design changes. The rate increase varies by plan option due to differences in usage for each plan. In addition, based on the City's feedback and identified challenges, Cigna has agreed to remove the prior authorization requirement for high-tech imaging without an additional premium increase. Staff is optimistic that the benefit plan change will reduce some of the challenges we have experienced. Shana Yelverton, City Manager Item 4D July 27, 2022 Page 2 The estimated cost of the original 13.81% premium increase is $388,059; however, the final negotiated 9.4% premium increase reduces the estimated cost increase to $262,224. In addition, Cigna's original 2021 proposal included a $150,000 second-year premium credit upon renewal in acknowledgment of the administrative cost to the City to change carriers. The illustration below shows the estimated cost of the original proposal, the estimated cost of the final negotiated proposal, and the estimated savings from the renewal incentive. Based upon a review of the claims history and the ongoing large claims, staff believes the final proposed renewal is fair. Dental Insurance. In 2021, Cigna provided the City with a two-year rate guarantee for dental insurance. This is the second year of the rate guarantee; therefore, there are no proposed rate or benefit changes to the dental plans. Both the City and employees share the cost of dental insurance. Vision Insurance. In 2021, Cigna provided the City with a two-year rate guarantee for vision insurance. This is the second year of the rate guarantee; therefore, there are no proposed rate or benefit changes. Vision insurance is optional, and employees contribute 100% of the cost. The proposed renewal for health, dental, and vision insurance is financially favorable given the City's ongoing claims experience. Staff recommends City Council approve the proposed renewals for health, dental, and vision insurance. Shana Yelverton, City Manager Item 4D July 27, 2022 Page 3 Financial Considerations: The cost estimates reflected above assume current employee enrollment and elections. The proposed insurance plan costs will be included in the proposed budget for FY 2023. Strategic Link: Performance Management and Service Delivery: attract, develop and retain a skilled workforce. Citizen Input/ Board Review: N/A Legal Review: N/A Alternatives: Deny the contract with Cigna and seek alternative options. Supporting Documents: The following supporting documents are attached: • Cigna Health Insurance Renewal • Cigna Dental & Vision Renewal Rate Sheet • 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, 2022 through September 30, 2023. COVERAGE ESTIMATED ANNUAL TOTAL CITY CONTRIBUTION ESTIMATED ANNUAL INCREASE PREMIUM CREDIT Health Insurance $4,584,941 $262,224 $150,000 Dental Insurance $141,900 $0 $0 Vision Insurance $0 $0 $0 Total Eligible Employees:374 Participating Subscribers:337 Waiting Period: Eligibility Definition: SIC Code: 9111 Active Employees working 30 hrs Account Number: 3344509 Effective Date: October 01, 2022 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: June 13, 2022 for Cigna HealthCare Financial Proposal City of Southlake Insurance Trust Fund 1400 Main St., Suite 210 Southlake, TX 76092-7645 Cigna Healthcare Financial Exhibit for: City of Southlake Insurance Trust Fund Effective Date: October 01, 2022 Renew - +9.40% Sold Cigna PLAN OFFERED Open Access Plus Open Access Plus In- Network Plan Offering Plan Name Medical Management Model Health Advocacy Situs Funding OAP Premium Quadruple Option OAP Premium - HMCM Basic Standard (15975833) Basic Care Standard Excluded TX Fully Insured OAPIN Buy Up Quadruple Option OAPIN Buy Up - HMCM Basic Standard (15975835) Basic Care Standard Excluded TX Fully Insured Cigna MEDICAL BENEFITS* Collective Deductible Collective OOP Combined Medical/Pharmacy Ded/OOP Deductible/ OOP Max Accumulator Variable Coinsurance Applies Plan Deductible Order of Applicability In-Network: Office Copay - PCP Office Copay - SPC Inpatient Deductible - Per Admit Inpatient Deductible - Per Day Outpatient Facility Copay Emergency Room Copay Urgent Care Copay Advanced Radiology Imaging Copay - Office Advanced Radiology Imaging Copay - Outpatient Deductible - Individual Deductible - Family Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductibles Out-of-Pocket Max Copays Coinsurance PCP Office Visits Specialist Office Visits Inpatient Hospital Facility Outpatient Hospital Facility Inpatient Professional Services Outpatient Professional Services Emergency Room Urgent Care Laboratory Services at an Outpatient Facility Laboratory Services at an Independent Lab Facility Radiology Services at an Outpatient Facility Medical Specialty Drugs at an Outpatient Facility Medical Specialty Drugs at a Physician's Office Medical Specialty Drugs at Home Setting Out of Network: Deductible - Individual Deductible - Family Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductibles Out-of-Pocket Max Copays Coinsurance PCP Office Visits Specialist Office Visits Inpatient Hospital Facility Outpatient Hospital Facility Inpatient Professional Services Outpatient Professional Services Emergency Room Urgent Care Laboratory Services at an Outpatient Facility Laboratory Services at an Independent Lab Facility Radiology Services at an Outpatient Facility Medical Specialty Drugs at an Outpatient Facility Medical Specialty Drugs at a Physician's Office Medical Specialty Drugs at Home Setting Maximum Reimbursable Charge Inpatient Deductible - Per Admit Inpatient Deductible - Per Day Outpatient Facility Deductible MRC Fee Schedule Percentage (Professional) NO NO Combined OOP Only No Cross Accumulation YES Benefit Copay, Plan Deductible, Coinsurance $25 $50 NA NA None $300 $75 None None $1,500 $3,000 $3,500 $7,000 $3,500 Ded Accumulates All Copays Accumulate Variable 100% 100% 80% 80% 80% 80% 80% 100% 100% 100% 100% 80% 80% 80% $2,500 $7,500 $6,500 $19,500 $6,500 Ded Accumulates All Copays Accumulate Variable 50% 50% 50% 50% 50% 50% 80% 100% 50% 50% 50% 50% 50% 50% Option 2 NA NA None 110% NO NO Combined OOP Only NA YES Benefit Copay, Plan Deductible, Coinsurance $30 $50 NA NA None $300 $75 None None $2,000 $4,000 $5,500 $11,000 $5,500 Ded Accumulates All Copays Accumulate Variable 100% 100% 80% 80% 80% 80% 80% 100% 100% 100% 100% 80% 80% 80% NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA MRC Fee Schedule Percentage (Facility/Ancillary) 110%NA Pharmacy Benefits (G/B/NPB/4th Tier) Focused 90 - CVS Focused 90 - CVS Standard Standard $10/$35/$70/$150 $10/$35/$70/$150 $25/$88/$175 $25/$88/$175 $25/$88/$175/$150 $25/$88/$175/$150 Pharmacy Network Formulary/PDL Retail Copay Retail Copay (90 Days) Home Delivery Drug Copay Deductible None ($0)None ($0) Out-of-Pocket Max Combined With Medical Combined With Medical Mental Health/Substance Use Disorder (Yes/No)Yes Yes Vision Rider (Yes/No)No 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. Acct#:3344509/OP-5167205/Q1/3056463 6/17/2022 11:49 AM ndCigna Healthcare Financial Exhibit for: City of Southlake Insurance Trust Fund Effective Date: October 01, 2022 Renew - +9.40% Sold Cigna PLAN OFFERED Plan Offering Plan Name Medical Management Model Health Advocacy Situs Funding Cigna MEDICAL BENEFITS* Collective Deductible Collective OOP Combined Medical/Pharmacy Ded/OOP Deductible/ OOP Max Accumulator Variable Coinsurance Applies Plan Deductible Order of Applicability In-Network: Office Copay - PCP Office Copay - SPC Inpatient Deductible - Per Admit Inpatient Deductible - Per Day Outpatient Facility Copay Emergency Room Copay Urgent Care Copay Advanced Radiology Imaging Copay - Office Advanced Radiology Imaging Copay - Outpatient Deductible - Individual Deductible - Family Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductibles Out-of-Pocket Max Copays Coinsurance PCP Office Visits Specialist Office Visits Inpatient Hospital Facility Outpatient Hospital Facility Inpatient Professional Services Outpatient Professional Services Emergency Room Urgent Care Laboratory Services at an Outpatient Facility Laboratory Services at an Independent Lab Facility Radiology Services at an Outpatient Facility Medical Specialty Drugs at an Outpatient Facility Medical Specialty Drugs at a Physician's Office Medical Specialty Drugs at Home Setting Out of Network: Deductible - Individual Deductible - Family Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductibles Out-of-Pocket Max Copays Coinsurance PCP Office Visits Specialist Office Visits Inpatient Hospital Facility Outpatient Hospital Facility Inpatient Professional Services Outpatient Professional Services Emergency Room Urgent Care Laboratory Services at an Outpatient Facility Laboratory Services at an Independent Lab Facility Radiology Services at an Outpatient Facility Medical Specialty Drugs at an Outpatient Facility Medical Specialty Drugs at a Physician's Office Medical Specialty Drugs at Home Setting Maximum Reimbursable Charge Inpatient Deductible - Per Admit Inpatient Deductible - Per Day Outpatient Facility Deductible MRC Fee Schedule Percentage (Professional) MRC Fee Schedule Percentage (Facility/Ancillary) Pharmacy Benefits (G/B/NPB/4th Tier) Pharmacy Network Formulary/PDL Retail Copay Retail Copay (90 Days) Home Delivery Drug Copay Deductible Out-of-Pocket Max 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. LocalPlus In-Network LCPIN MId Quadruple Option LCPIN Mid - HMCM Basic Standard (15975836) Basic Care Standard Excluded TX Fully Insured NO NO Combined OOP Only NA YES Benefit Copay, Plan Deductible, Coinsurance $30 $50 NA NA None $300 $75 None None $1,500 $3,000 $5,000 $10,000 $5,000 Ded Accumulates All Copays Accumulate Variable 100% 100% 80% 80% 80% 80% 80% 100% 100% 100% 100% 80% 80% 80% NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Focused 90 - CVS Standard $10/$35/$70/$150 $25/$88/$175 $25/$88/$175/$150 None ($0) Combined With Medical Yes No Acct#:3344509/OP-5167205/Q1/3056463 6/17/2022 11:49 AM Cigna Healthcare Financial Exhibit for: City of Southlake Insurance Trust Fund Effective Date: October 01, 2022 Renew - +9.40% Sold Cigna PLAN OFFERED CIGNA HealthCare - Choice Fund HSA Open Access Plus Plan Offering Plan Name Medical Management Model Health Advocacy Situs Funding HSA Base Quadruple Option HSA Base - HMCM Basic Standard (15975834) Basic Care Standard Excluded TX Fully Insured Cigna MEDICAL BENEFITS* Collective Deductible Collective OOP Combined Medical / Pharmacy Ded / OOP Deductible/OOP Max Accumulator Variable Coinsurance Applies Plan Deductible Order of Applicability In-Network: Office Copay - PCP Office Copay - SPC Deductible - Individual Deductible - Family Individual - In a Family Amount Deductible Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductible Out-of-Pocket Max Copays Coinsurance Adult Preventive Care Out of Network: Deductible - Individual Deductible - Family Individual - In a Family Amount Deductible Out-of-Pocket - Individual Out-of-Pocket - Family Out-of-Pocket - Family - Individual Amount Out-of-Pocket Max Deductibles Out-of-Pocket Max Copays Coinsurance MRC Fee Schedule Percentage (Professional) MRC Fee Schedule Percentage (Facility/Ancillary) NO NO Combined Ded & OOP No Cross Accumulation NO Plan Deductible, Benefit Copay, Coinsurance None None $3,000 $6,000 $3,000 $6,000 $12,000 $6,000 Ded Accumulates All Copays Accumulate 90% 100%, No Ded $6,000 $18,000 $6,000 $12,500 $37,500 $12,500 Ded Accumulates All Copays Accumulate 50% 110% 110% Pharmacy Benefits (G/B/NPB/4th Tier) Pharmacy Network Formulary/PDL Retail Copay Retail Copay (90 Days) Home Delivery Drug Copay Deductible Out-of-Pocket Max Focused 90 - CVS Standard $10/$35/$70/$150 $25/$88/$175 $25/$88/$175/$150 Combined With Medical Combined With Medical Yes No Mental Health/Substance Use Disorder (Yes/No) Vision Rider (Yes/No) Employer Fund Contribution $0 $0 Fund Amount - Individual Fund Amount - Family Eligible Expense Included *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. Acct#:3344509/OP-5167205/Q1/3056463 6/17/2022 11:49 AM Cigna Healthcare Financial Exhibit for: City of Southlake Insurance Trust Fund Effective Date: October 01, 2022 Renew - +9.40% Sold Cigna PLAN OFFERED Plan Offering Plan Name Situs Subscribers Members Current Rate Renewal Rate Monthly Billed Amount Change 30 $793.47 $853.95 $25,618.47 7.62% 6 $1,769.43 $1,904.31 $11,425.85 7.62% 5 $1,563.14 $1,682.29 $8,411.47 7.62% Employee Emp + Spouse Emp + Child(ren) Emp + Family 4 $2,594.64 $2,792.42 $11,169.68 7.62% Monthly Billed Amount 45 94 $56,625.47 Cigna PLAN OFFERED Plan Offering Plan Name Situs Subscribers Members Current Rate Renewal Rate Monthly Billed Amount Change 49 $638.15 $673.81 $33,016.86 5.59% 6 $1,429.12 $1,509.01 $9,054.06 5.59% 21 $1,261.92 $1,332.46 $27,981.58 5.59% Employee Emp + Spouse Emp + Child(ren) Emp + Family 16 $2,097.93 $2,215.22 $35,443.46 5.59% Monthly Billed Amount 92 192 $105,495.96 Cigna PLAN OFFERED Plan Offering Plan Name Situs Subscribers Members Current Rate Renewal Rate Monthly Billed Amount Change 61 $723.52 $782.49 $47,732.16 8.15% 7 $1,613.46 $1,744.99 $12,214.90 8.15% 31 $1,425.35 $1,541.54 $47,787.70 8.15% Employee Emp + Spouse Emp + Child(ren) Emp + Family 19 $2,365.93 $2,558.79 $48,617.01 8.15% Monthly Billed Amount 118 249 $156,351.77 Cigna PLAN OFFERED Plan Offering Plan Name Situs Subscribers Members Current Rate Renewal Rate Monthly Billed Amount Change 30 $711.50 $819.93 $24,597.90 15.24% 7 $1,586.64 $1,828.43 $12,798.98 15.24% 20 $1,401.65 $1,615.25 $32,305.08 15.24% Employee Emp + Spouse Emp + Child(ren) Emp + Family 25 $2,326.61 $2,681.16 $67,029.11 15.24% Monthly Billed Amount 82 170 $136,731.07 LCPIN Mid (TXLCPD, TXLCPF, TXLCPX) OAPIN Buy Up (TXOAPD, TXOAPF, TXOAPN, TXOAPW, TXOAPX) LocalPlus In-Network LCPIN MId Quadruple Option LCPIN Mid - HMCM Basic Standard TX Quadruple Option HSA Base - HMCM Basic Standard TX OAP HSA Base (TXOAPD, TXOAPF, TXOAPN, TXOAPW, TXOAPX) Open Access Plus In- Network OAPIN Buy Up Quadruple Option OAPIN Buy Up - HMCM Basic Standard TX Open Access Plus OAP Premium Quadruple Option OAP Premium - HMCM Basic Standard TX OAP Premium (TXOAPD, TXOAPF, TXOAPN, TXOAPW, TXOAPX) CIGNA HealthCare - Choice Fund HSA Open Access Plus HSA Base Acct#:3344509/OP-5167205/Q1/3056463 6/17/2022 11:49 AM Note: The fee associated with the administration of the HRA and/or HSA product is excluded from the Rates. Above rates do not reflect employer liability for fund contributions Included in the proposed Monthly Billed Amount is the Benefit Advisor Fee which is not part of the monthly premium. Acct#:3344509/OP-5167205/Q1/3056463 6/17/2022 11:49 AM Employee Emp+Spouse Emp+Child Emp+Family Premium Rates $40.99 $81.99 $91.20 $138.87 Employee Emp+Spouse Emp+Child Emp+Family Premium Rates $12.92 $24.55 $25.86 $40.04 Employee Emp+Spouse Emp+Child Emp+Family Premium Rates $5.96 $11.92 $12.04 $19.22 City of Southlake Insurance Trust Fund Plan No. 3344509 Rates Effective October 1, 2022 Dental Care Plan (K1-V9 PCS) Signature________________________________________________________ Title:___________________________________________________________ Vision PPO Plan Dental Choice Plan Approved and Accepted this_______Day of_________________________2022 Dental and Vision Date: June 17, 2021 0 Effective Date: October 01, 2021 Financial Proposal for City of Southlake Whole-person health. Dental focused. 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 carrier1, serving over 17 million customers. Cigna Dental brings you focused dental expertise and rich programs, which helps deliver better whole-person health outcomes through 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, learnings, and experience, we built dental solutions that help today’s busy employees 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 impacts their overall health. 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-value2 dentists close to home, work or school, make appointments online, compare treatment costs and show what their plan will pay, so they can avoid surprises. Clinical Expertise and Integration3 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 year two. Networks 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)4 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®5 rating and transparency tool on myCigna®. Product Solutions 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 growing6. 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 designs. And, since 77% of claims are in-network7, DPPO not only offers flexibility, but savings, too. Summary 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 term DHMO (“Dental HMO”) 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 states. 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 (CHLIC), 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 et al., DHMO: HP-POL134/HC-CER17V1 et 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 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. Plan 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/Onlays 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 Plan Calendar Year Max $1750 Dental Plan Reimbursement Levels Based on Contracted Fees 90th Percentile of Allowed Charges*** None Yes, the difference between the 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 Additional Member Responsibility in excess of Coinsurance 50%, After Deductible $1750 Oppty #: OP-5108360 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 Perio 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 CGLIC 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 organization'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 certificate or plan description. Benefits are insured and/or administered by Cigna HealthCare. 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) 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. 06/17/2021 09:37 AM Oppty #: OP-5108360 Cigna Healthcare Financial Exhibit for:City of Southlake Effective Date: October 01, 2021 Cigna PLAN OFFERED Product Plan Name Situs Funding Cigna RATES #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 Monthly Billed Amount 257 $19,814.68 67 $1,443.07 Monthly Billed Amount Per Product Annual Billed Amount Per Product TOTAL EE's TOTAL Monthly Billed Amount TOTAL Annual Billed Amount 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. If sold packaged with two or more Cigna Supplemental Health lines of coverage (AI/CI/HC), an additional decrement of 1% 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 Choice Cigna Dental Care Access Plus GC Dentacom K1-V9 TX TX Fully Insured Fully Insured $1,443.07 $237,776.16 $17,316.86 $19,814.68 GC Dentacom DHMO $255,093.02 324 $21,257.75 Oppty #: OP-5108360 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 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. 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. 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. 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. 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. 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 Effective Date : 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 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 - (C1) 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: ¤ 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. *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 Solution for City of Southlake 10/1/2021 *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.18 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: