City Commission - Special Meeting

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All right, Madam Clerk, good to go. Mr. Attorney, good to go. Mr. Mayor, good to go.

Yes, sir.

Colleagues on the commission, good to go. Yes, sir. Staff. All right. Carmen, let me get an agenda, if you don't mind. Pass that this way. You don't gotta get up, just pass it this way. Thank you. Thank you very much. All right. Meeting date, Wednesday, August 26th, 2026 at 5 p.m., Cochise Chambers, 500 Southwest 109 Avenue. Roll call, Madam Clerk. Thank you. Please stand for the invocation. Would anybody like to give the invocation? All right? Let's bow our heads. In Jesus' name I pray. Dear Heavenly Father, thank you for granting us the gift of life, the gift of family, the gift of friendship, and the gift you bestowed upon us, the gift of service. Please continue to bless us with the wisdom necessary to make the decisions for the betterment of our residents, our employee, and the great city of Sweetwater. Please continue to bless our police officers, our firefighters, and the greatest military in the world. In Jesus' name I pray, amen. Please remain standing for the Pledge of Allegiance.

I pledge allegiance to the flag of the United States of America and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all.

Please be seated.

Thank you all for coming. Item four, public comments. Madam Clerk? Seeing no public comments, item five. A resolution of the City Commission of the City of Sweetwater selecting employee benefits insurance policies for fiscal year 2026-27, providing for authorization and providing for an effective date. Mayor Diaz, you have the floor.

Thank you, Mr. President. And let me start out by saying to all three companies, thank you so much for your way of participating and taking your rates to the level And if it's not the race the benefits or in some cases a combination of so thank you for that I want to thank straight out. Brown and Brown for an excellent. Brokership and the work that's done. Thank you that we got this unfortunately we got a last minute, but there was a lot of negotiations happening since Friday tool. about five minutes ago, so it's all in here to a point, but there's still some adjustments I heard that we gotta state, am I correct? Okay, and Yoli, thank you for stepping up and analyzing everything and making sure that it's the very best, not only for our employees, but our commissioners and our families, so that everybody has a say. The companies, The 3 them are good companies by analyzing what we've come through and look that we were looking at certain benefits that they came and competed and brought down even further. I want to be real clear of the descriptions in place because money wise it's it's pretty intact and and pretty much there between everybody everybody benefits some have a different style than the other and some have become more competitive and drop the race. The copayments there deductibles and also on their copayment on the on the medicines themselves. Drastically so if I can I'm going as brown and brown and Jolie to come up please. And by the way, I'm not asking the companies to come up because the companies already went up in the last meeting and I think everything was pretty much said. Now we're going to get a broker along with our HR person to specify what's happened through this whole day and this weekend, but specifically what we have before us at this moment between each company. I started with... United last time. I'll start this time with curative and then with admit and then with United. If you want to go ahead and start. Is that okay with you guys? You have the floor, sir. Thank you.

Yeah, I think it's really important to highlight what has changed from the meeting that we had to now and all the recent negotiations. So I'll let Evelyn cover some of the differences. Go ahead, Evelyn.

Good evening, Council. So Curative has come back and given us an implementation fee credit of an additional $10,000. So it's a total of $60,000 where they started at $50,000 before. We also received a quote. as you want it for the PPO max for all employees. So we have the rates for what was presented originally, which was the three plans. And then we have one for just the PPO for the entire demographics for the city of Sweetwater. So that's the only change that Curative had.

That's it?

Yeah, that's it. That's it? Any questions on Curative?

Any questions on Curative?

Okay, admin.

Admin has come back with some enhancements on their plans. They have modified their plans, still has a $500 deductible, but they have improved ER co-payments. They have also modified their percentage on the guarantee based off your MLR for next year. So you have two different alternates, 2A and 2B, that you'll see on your summary sheet there. They have also proposed on the bottom, where you see ER co-payments changing, whether we decide to go from 250 to $100, or the deductible that currently they proposed of 500, moving that to a $250 co-payment, and that would increase by 2.5%.

Anybody have any questions on admin?

Yes, I do.

Commissioner Saul, do you have the floor? Yeah, what would be the auto pocket for employee for admin?

On admin's modified plan. It's the same $3,500 that you have today.

Same thing? Mm-hmm. Okay, thank you.

The mechanics of the plan is not apples to apples to what you have right now. So what you'll see on your spreadsheet, you'll have some green and some show red. Those are decrements, whether it's a little bit more or a little bit less.

What page are you looking at?

I'm pulling it up now.

Are you looking at this? No, she's looking at this.

No, no, no. At the big packet. At the big packet. What page is the Aetna one? I mean the Aetna, the admin one. 38. 38. Thank you.

You guys can do the smaller.

Yeah, really? Need a good eye.

Take a picture of it. Magnifier right here.

Is it 38?

which is here, the three, the nine, the 25. Right, so AVMED did a difference on the prescription medications where they did multiple tiers, where the first tier for value generic is a $3 copay, generic is a $9 copay, preferred medication is $25 copay, non-preferred is $50 copay, and then specialty medication is a 50% coinsurance.

Okay, hold on. on specific sorry did you say okay it's hard to read this it really is i took a picture and i blew it up on my phone okay um max what is that uh preferred and then non-preferred it's 50 am i correct correct and then specialty is 50 percent of whatever the cost of the drug is i'm sorry 50 of the contracted amount And the contracted amount would be?

It depends on what the specialty medication cost is. So whether it's $1,000, then the coinsurance is 50% of the $1,000.

For $500 out of pocket. Correct. And that is built out or every incident?

Every incident. Every incident. Until you reach your out-of-pocket maximum.

Which is $3,500. $3,500. Okay. Sorry, I just wanted to get that clear.

Do me a favor, explain that again as if I was my six-year-old child.

On the specialty pharmacy? So it's a 50% coinsurance of the contracted amount. So to make it math simple, let's say that that specialty pharmacy is $1,000, you're paying 50% of that. So you're going to pay a $500 copay, if you want to call it that. And that $500, everything you pay in your medical plan, all those copayments or coinsurance, they all accumulate towards your out-of-pocket maximum. which on your core plan is $3,500. So every time I go for a specialty pharmacy, if I'm taking it, every month I'm going to pay $500.

Got it. So my question is, because you said prescription, so I want to make sure we're on the same page. If I take a monthly medication on diabetes, And that prescription is normally a hundred dollars. I don't know how much diabetes medication is. If anybody knows, let me know. Just give a number. You're saying the employee is going to pay $50.

50%. If it's a, if it's considered to be a specialty medication, but, um, diabetes medication is not considered. So for example, cancer treatment, that could be a specialty medication, rheumatoid arthritis. hiv um got it any other and ms so you're either getting that medication infused at the doctor's offices or the pharmaceutical is sending it directly to your home in a cooler i understand so uh chemo radiation anything like that right not no not chemo chemo falls under medical not pharmacy

But if there is a special medication, for instance, I was told that somebody, when I got a medication, it was $3,000. That could be a specialty medicine for cancer treatment.

It could be.

Okay. So at that point in this plan falls under that, it would be $1,500. Correct. And if you had to do it X amount, it will be 1500 until you meet the $3,500 stop loss is what it used to be.

Probably going to have two and a half months of out of pocket in that particular example.

Got it.

And after that is a hundred percent covered for the remainder of the calendar year.

Okay.

And that is, how many options is that offering? Or is that just the option?

That is the option for specialty pharmacy.

Got it. Now, we requested that you present us with, what did you say, max?

The out-of-pocket maximum? The out-of-pocket max?

No, I said PBO max. That's on curative.

Curative.

Okay.

So we'll be on curative. Let's go back to curative for one second. The PPO Max is the one that you were able to go to CVS or Walgreens. Got it. Which was asked by. Got it.

No, it wasn't my question. My question was, I asked you to present us with options to give the employees the same benefits that we had.

Right. That's on curative.

So curative is the only one that did that. Correct.

Nobody else did that. On admin, do you still have your core plan and you have your buy-up options? So employees do have the option to buy up to the other plan.

And what does that look like? For admin, what does that look like?

So if we look at the marketing sheet.

Is that the same page? 38? Yeah.

What do you want to see here? I guess. So right now the single rate on the core plan is 800. Sorry, I'm having trouble myself. 884. 884.72. Mm-hmm. And the buy-up option is $1,182.49. Okay. Now, on the core plan with AFMED, that is under their AIM network. So that is just Tri-County. So that is Miami-Dade, Broward, and Palm Beach County. Your buy-up plan, right, where employees can buy up to, that one is Florida. the in-network of Florida, and you have out-of-network benefits as well.

Got it. All right.

And going back to the curative, that one is a signal. Let me ask a question.

I keep saying it right. Let me just throw in a question so I don't lose my frame of mind here. So Abbott's proposing, just so I understand, because I have alternate 2A, alternate 2B. Alternate 2A is 2.926968 gross annual cost. It says minus 7.4%. What does that mean? Minus 7.4% of all the other bids?

Compared to current. Compared to your current rates.

Got it. And then alternate B is $3 million. What is the difference between 2A and 2B, please?

So it's just the pharmacy.

Office visit copay and pharmacy. co-pays are different office i'm sorry say it again please office visit co-pays were reduced because originally athmet quoted 50 co-pay and then they modified their plans and in the modified plans it went to 20 20 co-pay got it so uh can you explain the modifications to us Modification is they no longer have the plan that the city of Sweetwater was on prior to going to United Healthcare. So they try to modify the plans to get as close as they could to your current plan with United Healthcare. That's what they call modified.

No, I understand that. Forgive me, I should have asked a more direct question. The modification specifications are, what are they? What do they change?

Changing co-pays in primary.

From what to what?

From $50 to $20.

Okay, so when you go to a doctor, when you go to your primary care physician, instead of $50, it's $20.

No, the primary care physician is $10 copayment and specialist is $20.

Because you said primary, what does that mean?

Primary is internal medicine or a family practice doctor that you go to. That is a $10 copayment. Anytime you go to any specialist, whether it's a GI doctor, a dermatologist, a gastrologist, you're going to pay the higher copayment.

Good, so your primary care physician is $10. Correct. And a specialist is $20. Correct. Good, so they lowered it. And prescription drugs were what, and what are they now?

Okay, so they went from $10, $25, $40, $80.

And what does that mean, $10, $25, $40, $80?

So they have value generic. They have a list of medications where they all fall under a $10 copayment. That's what they call value generic. Then they have another tier. So theirs works a little bit different than others. They have generic at, it was originally $25, preferred brand name drugs at 40, and non-preferred drugs at $80 copayment. That's why I said 10, 25, 40, and 80. So depending on the tiers. Correct. So the modified plan reduced that to starting at value generic at $3. So $3 for that, generic $9, preferred brand 25, and non-preferred 50. Sorry, do you need me to repeat that again? No, I heard you, I heard you. I tend to have a loud mouth sometimes, so it's okay.

I've never heard you be loud. Okay. Does anybody want to step in? Because I'm going to keep firing. Does anybody need to step in? If you do, let me know. No, go ahead. I'm going to keep cranking away.

I'm going to try to follow her on this one, but go ahead.

Okay, so if an employee goes to the urgent care, how much is it?

They're going to pay a $20 copayment at an individual urgent care facility or a $20 copay at the hospital.

Okay, and if an employee has to stay in the hospital overnight?

they are going to have their deductible, which is $500. And since the coinsurance is 100%, there is no cost share after the $500.

I'm sorry, can I jump in? You have the floor, go ahead. What about the ER?

Emergency room is a flat $250 copayment.

Is this for HMO or both? Or PPO?

For just the HMO. The PPO remains at $100 copayment.

So, okay. All right.

Now, Ahmed has also offered if we wanted to reduce the $250,000 to $100,000, then that will add an additional 1.5% to the premium that they proposed. An additional 1.5% to the $2.9 million? To the $3 million we have here.

To the $3 million, sure.

$3,022,000? Yes. We would add a point and a half to it.

Okay.

So the difference between the 2A and the 2B, the 2A is what they originally proposed and 2B is what they're proposing today? Correct. And to lower that cost, it would be an additional 1% on the $3,022,000? Between both programs.

If we wanted to enhance the emergency room copayment.

Does that mean that all other deductibles lower as well, you know, it's still it's still a $500 deductible correct just the year. So from 2.50 to 100. All right, so that's going to cost us an additional $30,000 a year is a 1% or 1.5% so 1.5. So it's going to be a 40 so it's going to be 45 so it's going to be Hold on, hold on. I know you guys are helping, but just hold what you got. So we're talking about an additional $45,000 a year, more or less.

Maximum for reducing those benefits.

Got it. Just an out of the head. Is that accurate? Good. You're doing great. Okay. That's interesting. Does anybody have any questions pertaining to that? No? Does anybody have any other questions pertaining to admin? Is there anything you want to say about admin?

no i think we have everything that's proposed here okay all right mr mayor united let's go to united what page is it united is one page 24. So UnitedHealthcare came back and gave you a rate pass. So on current benefits, what that means is that there is no increase in your premiums for the 2026-2027 plan year. That is current program like you have today, continuing your healthy rewards, which pays your employees the monies that they've earned so far. Everything remains the same, including your wellness dollars. So there is no change. They have also proposed, based off our request, if we change the diagnostics, which used to be deductible and a coinsurance, if we go to a flat dollar copayments, I have different scenarios, and they also gave us where we made the prescription drug, the three tiers, a little bit better. So I'll tell you what those are. So your, let me go to prescriptions first. So prescriptions were 10, 35, 70. What does that mean? Tier one is $10 tier two is 35 and tier three is 70. Okay. They gave us an option where we can add a $200 copayment to the diagnostics so that members don't have to pay deductible plus the 10%. And we change the RX three tier to 10, 35, 60, and they're coming in at 0.7%. if we still leave it at two hundred dollars but make the prescriptions a little bit even better it would be 10 35 50 and that is a two percent increase which is equivalent to sixty two thousand dollars correct yeah now explain that part because there's a three-tier system compared to a six seven tier So going back to the question on specialty, for example, United's is a little bit different. They have three tiers. So the specialty pharmacy, depending on where it falls, it would be the applicable cost share of that copayment. So more than likely, a specialty pharmacy probably falls either at 35 or at $50 copayment, if we were to change it to that.

So let's take the same scenario that we had before we use the diabetic, um, one for a hundred dollars. And we, we discussed that that will fall probably in the first ranks. Am I correct? Correct.

The first tier, second tier, depending on the medication, depending on the diabetic, but to that point, mayor, I actually, I want to add something very important. So we have some top drugs utilization for United healthcare. So under tier one, You have 68.8% currently being used as tier one currently today, meaning your employees are picking up their prescriptions and they're falling under a tier one. You have under tier two, you have 25.2% of your employees filling prescriptions under a tier two. Your tier three, which surprisingly, surprised me actually, only 6% of your medications fall under a tier three.

So that's where we would have the cancer medicine that we were talking earlier about the other one when we were talking about admit. Now you get the same $3,000. How much would that be? They have to pay in that.

Depending on the tier, it could be $35 or it could be $50. It depends on which one of those.

Would it be more than that? No. Would it be the 50% coinsurance?

No.

So instead of the $1,500, the most that's going to be out of your pocket is going to be $50. Am I correct?

If we go with a 1035.50, yes.

Correct. That would be the best scenario.

Or if we stay with 1035.60, it would be no more than $60.

Okay. Would that be the same on both sides of the program?

Yes. Same prescription.

So you're telling me that the employees out there that have been hit with 150, $200 that we heard some of the complaints about the most that's going to be is $50. Correct.

If it falls under tier three. Yes.

Yeah.

Uh, question. If I can interject the other floor, go ahead. So Does United currently offer that? Yes. In our current plan?

Yes. No.

No.

No, it was negotiated down. Yes, but the three tiers they do.

Let me explain what I mean. We currently have employees that are going through some stuff and they gotta pay a lot of money. What you're explaining right now is that they wouldn't have to pay that money. My question again.

what united is offering right now is it different than what we currently have it is the same thing the only thing that's different is that now we would have lower co-payments if we go to the 10 35 60 or 10 35 50. and specifically in this conversation about the specialty medication right now they're probably paying either 35 or 70 dollars that would be reduced to either $50 or $60, depending which one we go through.

I guess what the president is asking, if we use the same scenario on the heavy-duty one that, you know, it's a lot more money and so on.

It's still the same. The mechanics of it works exactly the same.

So it's going to be a maximum for the employees that are there now that are paying a large amount of money for their specialized medication. The most out of their pocket is going to be $50 compared to, it could have been 250, 500, whatever it could be.

So let me ask this question. Um, if an employee goes to have a surgery right now with the current plan that we'd have, what is the total out of pocket for the employee for United?

You have a two 50 deductible. Plus they have to pay 10% coinsurance up to a maximum of $3,500.

So I would assume that any surgical procedure will be more than $3,500, right? Because an ER visit could be $3,500. So an outpatient procedure could very well result in an out of pocket maximum of $3,500.

Right, and go ahead. So I've been, not corrected, but for a reminder, there is one thing that may be why some employees pay more than those tiers, because some of those medications, if they run them through the medical side, right, then they have their regular 250 deductible plus 10% up to their out-of-pocket of 3,500. So we were talking prescriptions, right, and there is a lot of medications, specialty medications, that fall under those tiers, but there are specialty medications that if they're administered in the doctor's offices, those would be subject to the deductible and would be ran through the medical side, not pharmacy.

What that means is also some of the employees are now, or some of the people that are taking fusion-type medicines, that they have the procedures, a medical procedure, Yeah, okay. So I wanted to make sure because that is the same when it goes through that to any insurance.

Correct.

But the difference here is, let's just say it's the same scenario that... your no more doctor says you have to take this type of fusion for iron, which is the most common one, especially in women when they're about to give birth or whatever. From what I understand, that's like the new thing now. So by doing that, what will be the cost of that employee at that point?

Well, in that particular case, I don't know exactly right now where that falls, but if it falls under one of the tiers, they would be just have those copayments. If it falls under the medical side, then it'll be subject to the 250 deductible plus the 10% coinsurance.

You have the floor, Commissioner Diaz, go ahead.

I'm gonna, let's talk to this credit, because that was the last experience, right? And with the current United Hand, the process of my kid, my daughter, was from the second month Thank you. You know how it is. It's like we did like 50 on the whole process ultrasounds, right? After the 15, 20 ultrasounds, that was C. We met the deductible, 3,500, right? I'm trying to explain it to you guys, not to you. You guys know what it is. So we paid the visit, this, this, this, by the third month. we were already made the deductible, right? So what that means is like from the 20 something week of the pregnancy on my wife, on us, we didn't have to pay anything else, not even the iron infusion. Everything was paid. Then it came the time that we did the C-section, the tubes ligation, ligation, whatever the name is, all that thing, and it was $250. because we already met the deductibles. So that's how United works. At least it worked for me. It was gonna work for everybody else. But that's what it is.

And that's very similar. Even though the amounts could be different, it's very similar amongst all the carriers.

Yes, the un-united what would be the out-of-pocket right now for employee $3,500. Okay, it was that's what it was before or it's been like dozens.

It's been like that for since day one.

Okay.

Yes.

Thank you. And that would be applied to the HMO on the to your HMO plan.

The $3,500 to your national flex plan, which is your PPO, and your maximum out-of-pocket is $1,500. $1,500.

It would be for the PPO, what they call it.

Correct. And that's the same as what it is today.

Okay. Now, my other question that I have, if any employee is going to have an MRI, how much do they have to pay, the copayment?

They're going to have, for major radiology, it's going to also be 10%. after their 250 deductible if they haven't satisfied it.

But that's current.

That's current.

So one of the proposals is to change that to a $200 copay. To a flat. A flat. That would be great. So before, or the current is 250 for the deductible plus 10% coinsurance. So let's say, I don't know, throw out a number, 500 something. This offer here of a 2% increase would be a $200 copay.

Flat. No cost share, no nothing. A flat $200.

So basically a pet imaging, which is probably the more expensive of the MRIs, if I'm not mistaken. I could be wrong. What is, if I could just ask, what is the normal for a pet? which is being done more and more every day because of, unfortunately, cancer.

It depends on the part of the body of the actual scan.

Oh, it's the whole body.

I don't know. Maybe, Brian. It's several thousand dollars.

I thought it was like $3,000 to $4,000.

It depends on where you're doing it, you know, the contractor rate.

So with United, we're going to be paying $200. Yeah. Right? No, for part two. Yeah.

Correct. All right. All right.

Anything else to add?

No, sir.

Any other commission you'd add anything? Commissioner Hidalgo, area four. I want to ask a question. You asked earlier the buy-up for United. What's the difference on there?

So that's the flex plan. So the flex plan means you get the benefit of being under a neighborhood health partnership from a pricing standpoint, but you have national presence. So neighborhood health is the entire state of Florida, but the minute you step outside the state of Florida, you're able to tap into the UnitedHealthcare network. So that's the flexibility that you have on the national POS plan currently today.

So let's say right now someone has HMO, they want to bump themselves up. What's the cost of one and the other? What's the difference, like the buy-up difference?

149 monthly monthly all right so I have a I have a few questions give me the difference between just to be fair United, ABMED, Curative, give me your professional recommendations as our consultant to the city of Sweetwater, go. Don't look at the mayor, look at me, go.

I'm thinking, I'm thinking.

Oh, she was actually thinking when I looked at her.

I think you have a good renewal on the table with UnitedHealthcare. I think they've been fair. I think they've showed their commitment in trying to retain your business by giving you a flat renewal. They've given us the two enhancements that we asked for for minimum. I think that would be the least amount of disruption on your employees. You don't have to go through prior authorizations. Because whenever we changed carriers, as we saw changing to United, the first 120 days, I will tell you, because we were very involved, it was not pretty. It was not at all. We had a lot of service issues because we had to deal with doctors' offices. And it wasn't in United's defense. It was providers' offices not providing the correct information so that we would have an ease of transition for those employees. They did work with us through all of those, and we got those all settled. So all the prior authorizations right now are in play. The other thing is the health rewards. We don't have health rewards with AFMIT or Curative. They do have other things that they can offer as well, but not the health rewards. Where health rewards, that's actual money going into your employees' pockets. So some of the complaints that some of the copayments may have been a little bit higher, that is true, but they've also been getting from doing, whether it's getting their Apple Watch connected, having a physical, having a mammogram, whatever it may be, they're earning dollars. And some of your employees have earned $400, $500, $600. So you are the highest that UnitedHealthcare has paid out. as far as health rewards, which is, correct me if I'm wrong, $32,000 or $34,000? $39,000. We all have great companies here, all three of them are. Curative is a completely different concept. They have a new platform, which as you heard Stacy earlier last week, you do your baseline within the first 120 days, all your employees get zero out of pocket, or they pay for prescription drugs, either a $50 copayment, or 250 for specialty pharmacy. But employees do have to make that call during the first 120 days. The first 120 days, automatically everybody receives zero dollars regardless. But on that 121st day, if they do not make that call, it automatically defaults to a standard $5,000 deductible. AFMID is a great company, too. You have Florida Network. You have the PPO Network as well. You all have history with AFMID. The plan, I do want to clear, even though there are modifications and they have tried to match as much as possible, it is not apples to apples to what you had previously. So I don't want anybody coming back saying this is not what I was paying when I was under AFMID because the plan design is very different.

What does that mean?

The out of pocket so there's different parts of the plan that's very different you could have been paying maybe $10 for something before that now today under the new admin plan maybe $15 I'm just using that as an example not that the plan is that way. So you have great offers on the table. I've been providing a very nice savings as well as curative. Um, so you do have all three great companies that are, so it's really up to the council as far as what exactly is the goal, um, and what you're looking for for your employees.

So you punted, you didn't give the recommendation, right? Oh, she did. She did. I did. She did. What's your recommendation? United.

United.

Are you recommending United?

I'm saying that that's probably the best choice for your employees at this time.

So here's my question. I personally haven't had any issues with United. By the way, to Curative, that's an amazing concept. I think you guys are a disruptor. I'm not gonna go with you guys only because it's too new for me and I'm not willing to risk the employee's health benefits on something that's new and interesting and I'm just not sure about. I wish you all the best. I'm just very transparent. I'm not afraid to give people the truth. I've never had an issue with United. A lot of our employees have had issues with United because they come to me and they tell me. I don't know what they told anybody else. I had a conversation with the mayor. The mayor says he hasn't heard any complaints and I respect that. But I have. So I'm hesitant. My business mind says, you know, United is a safe bet. But my heart with the employees says go with admin. So that's where I'm at right now. Does anybody else wish to speak? Mr. Mayor, you have the floor.

Thank you. I've tried to modify everything as much as possible. And once again, I want to thank all three companies for the professionalism and everything, the way they came to us and what they've done. So that to me is important. I've also sat with those two ladies over the phone over the weekend and in present. We analyzed everything on the disruptive side, with the studies that you did, which at the end of the day, I know it came a little late, but it was just because we were getting better offers and situations, which is part of your package, your 60 pages here. What I understood in the past was exactly what Commissioner Iagno and myself had a conversation with, was the issue with the difference in cost on the medicine and the higher cost with some employees. That was the most important thing. that was modified and united stepped up to the plate and really came in for a marginal fee and really brought it in to the points that were just explained if that wouldn't have happened it would have been even a probably harder decision okay but the most important decision here And the reason why I'm gonna go and specify that we go with United is for the following reason. A lot of people have already worked out the differences in employees, which I'm not gonna bring them out, but at least three or four that are here that were having issues with their doctors, okay, and the payments and stuff like that. That's been cleared. Some had issues with certain medicines. Those medicines have been cleared too. And that, you know, Brown and Brown could specify to what I just said. This is the least of the disruptive situation, which I'll be honest with you, I don't want to go back to where we lived in the beginning of this last year, going through all the phases with the employees. As far as the city is concerned, okay, we're not paying the least of the three, but it's not about the money, as we said before, so much as the benefit that they get and that they're happy with what they get. I think based on everything we've said and analyzed, I don't see there is a choice. I know it's a business side and then an emotional side, but I've tried to look at both. And both of them are showing to me that they're gonna win, win, win. Another thing that has not been brought up, and there's two things. One is the extra coverage that the city pays for. for the, yeah, go ahead.

So the city right now, in addition to paying 100% of the medical premium for the employees and 50% towards their families, the city also pays 100% and 50% towards the family for a hospital indemnity plan. Now, that is only for the employees on the HMO plan. Anybody who's on the PPO plan, they don't get that plan paid by the city, but it's only $35 a month. So if they want it, they're paying 17-something a paycheck.

What does that mean, indemnity plan?

So the hospital indemnity plan means that if you get hospitalized, if you are staying overnight at the hospital, Colonial, you have to submit a claim to Colonial showing that you stayed at the hospital. Colonial sends you either a check or direct deposit into your account, $3,000. for being at the hospital. You can use that money for whatever you want. You can use it for going on vacation after being in the hospital. You could use it towards covering your deductible, whatever you want. And if it's an outpatient surgery, meaning same day, in and out, right, you're not staying overnight, outpatient surgery, then it's $1,500. And it's one time per calendar year. So the city pays that policy 100% for the employee and 50% for the family. So in addition to all of these extremely rich benefits, you're paying for a supplemental insurance for the employees. And that money goes straight to their pocket.

Which is helping them pay for those out-of-pocket expenses.

So those benefits are the reason why I'm saying what I'm saying. And I'm going to be looking at something in the future, but I'm going to talk to you individually. There's another type of program out there that is I've asked Jody to give me some numbers and we're not going to get into it now because it's not fair that we don't have all the information, but it's separate and above something like the one that we just mentioned and is to deal with cancer. So we're going to look at that because right now I think the city with what we're just proposing and what we're looking at plus what we're giving, we're probably ahead of almost any city out there and coverage. for our employees. So I think based on everything that's been said and it's not like we haven't looked at everything and you guys could see the hard work that's been done and this is why I'm asking you to please support at this time with United and I think United has their own vision in dental. So I think that if we just get the whole package, we'll hold on. I did tell one commissioner, and I want to keep my word, that there was one company still left that did not participate in that.

Correct.

I would like if you give me the authority on that based on what comes in and what kind of rate they do for me to allow to move forward either with them which is a company that was here before, and it's just so you could get another angle, or we just go with United for Vision and Dental. So that's where I'm asking you, Mr. Mayor.

Commissioner Reynaldo Rey, yes, please. So one question, I heard something just to clear it up, because I've also had the same complaints and stuff like that, I've heard it as well. When I make a decision, I want to make sure that, let's say I do choose United, I don't get over it, I wanted to go back to AFMED. You explained something there, which is a key. Even if we do go back to AFMED, like you said, it's not the same AFMED they had two years ago.

Well, it's the same company, but the plan design, there's some variations to it.

Correct.

It's not apples to apples to what the city had previously.

Correct. It's not like if I'm here trying to make the, or we're trying to make the decision and saying, hey, you know what? We've heard complaints and they like to admit. If we get off, but again, it's not going to be the same app that they had before. Correct.

They could in some cases in the most of the complaints have been prescription drugs. Correct. So it will be different tiers. So it can be the same thing that happened with United healthcare can happen back to, you can be paying a third tier with, uh, AFMED that maybe was a tier two with United or tier two with United. Now it's a tier three with Ahmed. That can vary.

I'm trying to clear the air on that because then we make a decision and then you have others saying, oh, should have gone back. But if we still go back, it doesn't mean it's back to what we were. Correct. That year. Correct. Or those years, two years ago.

Commissioner?

Commissioner Young, you have the floor.

No. I only have one question to ask. If we're going to accept United, it's going to be the same plan, the last one, after they did all the discounts and deductibles and the flat fee for $200 for the employees. So that's what we're going to be voting on.

So you have three different options with United. But the current plan design is no changes. Everything remains the same. You have an option on the table where it is improving the major radiology to a $200 copayment. And then it depends what prescription tier we want to go with.

And I want to go with what we stated up here to the commission.

Okay. The 10, the 10 35 50.

Am I correct?

Which would represent a 2% increase.

Yes.

Okay. Can we, uh, can we specify which one is that one a one B one C one D that would be one C at a 2% increase. a two percent increase okay yes okay so just with all those benefits that we're targeting that's one seat that that'll be the one if i belong united it's one seat all right okay commissioner yes yeah i'm um you know i'm a little bit um

i wanted to get up in it that's going to be my vote right now uh based on the the decrease that we got and all the benefits that we got um now i know the mayor wants to get united and and this is just i mean i didn't have all this information that we got now i wish i would have it three or four days before i know i know but you know to make that decision because my decision right now was for amni um what will be the um the copay between you know tier one tier two three or three omit versus united to make a decision

Well, you have six tiers with United, and you have three with the other ones. So this is why she mentioned that they're different. So you don't know where one particular falls in one or another. So it's not fair to Admin or United that we sit here to try to compare it that way. So what we did is said this is a maximum L.A. in tier one, two, three. And the most important one was the one that the employees were complaining about, which was the one with the specialty drugs. And that one is a total of $50. Whether it's one type of drug or any type of specialty drug. Or it could be 30. Or it could be a 10.

Now, that change, they just did it now, right? This change here, we just did it right now. This is why we wanted them to. Okay.

Yeah, everybody make sure.

Commissioner is here, who is he for? This is really quick, and it's not even a question, it's a recommendation. United, right, if we decided to go with United, right, is there any way you guys can do like kind of a workshop when it comes to this?

UNITED REPRESENTATIVE, PLEASE STAND UP TO THE PODIUM. PLEASE STATE YOUR NAME FOR THE RECORD.

MY NAME IS BRIAN GARRISON, VICE PRESIDENT OF SALES AND ACCOUNT MANAGER FOR UNITE HEALTHCARE. WE'VE ACTUALLY BEEN WORKING WITH YOUR HR TEAM AT BROWN & BROWN, AND WE'VE HAD HEALTH FAIRS AND THINGS LIKE THAT. that the app or anything else that we have the vital medications at zero dollar co-pays that's why i think you guys have had amazing success as it relates to uhc rewards and the 35 000 that have been paid out to your employees which if you change you know you can have some employees that probably won't be happy losing 35 000 But yes, we could educate however you want. We can come out here and do that education, and we've been doing that all throughout the year.

That's what I'm trying to get you. If we decided to go with you, if you can do as quick as you can. Joel is more than capable to do it, but he's just one person.

Yes.

And I would love if we pick you guys. to help the residents, I'm sorry, the employees to go through this. There's $1,000 right here on everybody's pocket, and wife's, or husband's. And they don't know how to use it.

You have a lot of people that do.

There's money right here. $39,000. There's $2,000 per family in your pocket. Absolutely. Through a Visa gift card. I've got it.

Yeah, we can certainly come out and educate again. We're happy to do that.

And that helps a lot. It's $2,000 per family.

To finish your question, I will set it up with them. Thank you, sir. I will set it up with them as soon as we move forward. God willing. And at that point, we'll have it. And if you can't, we could have it in a couple of sessions to make it easier for the whole city to be able to move around.

Whatever it is, it's really helpful.

From the PD to everybody else and make it happen.

Let me ask you, Jolly.

You're on the floor, Commissioner Zaldeus. Thank you.

Jolly, on the medicines for the diabetics. is that how much that would be for an employee that they have to pay?

It depends on the medication. It depends on the medication and what tier it would fall under.

Stand by, Commissioner Yano. Commissioner Ian Biasio has grace of the Lord's presence. Go ahead, Commissioner.

All right, so my position on this is like, so i haven't had a bad experience with uh with that with sorry with united i like it i have it's been great been very straightforward i love the app by the way it's very easy to use and when i need to find a doctor on it it's great so what i do is i download a pdf of all the doctors that in the area of what i need i drop it in ai and i put in the parameters of what exactly and it tells me it ranks what are the best doctors for me so then i call from there so it makes it very streamlined so i like that um so and also i i also don't like this every year that we go through that every year we switch insurance carriers and i don't like doing that because it's a headache for everybody because everybody's got their specialized doctors for everything and then you switch insurance and then everybody's got to switch everything again and i don't like that disruption of service and i don't like going through it i know nobody likes going through that so i rather stay with what we have especially if the price is the same thank you guys for for doing that for making it the same i don't think we really lose out on anything by going the same and then when we've gone with with avmed then we go with them and then the next year they raise the price and then we're forced to go with somebody else and we play this same game every year but you know admin's been good too with all the benefits there i didn't have a problem when we had admin either i just don't like that going back and forth every year. So I'd rather stay with what we have. But I also had another question pertaining to somebody asked it last week, but nobody I don't think an answer was given about the GLP ones. I know they're only covered for diabetes, but how much would it cost additionally to the city to add it for weight loss? And my reasoning for that is like, yeah, you're treating diabetes, you're treating the symptom, right? You're treating that. But I think it's very important to treat obesity because if you don't treat that, then that's how you end up with high blood pressure, diabetes, and all these other problems that happen. So I think it's more beneficial to everyone if that is covered. That way people lose weight and then nobody gets these issues later and they have to depend on it. So how much would it cost to add that?

The range is approximately between 5% and 7.5% additional to what the rates are today. to add GLP-1s for weight loss.

Okay, and what would that look like in a monetary amount in that range?

Daniel?

That's about $200,000. Okay, so that's a big increase then. We don't want to increase too much then.

Commissioner Yano, you want the floor? I want to make it abundantly clear, Commissioner Yano is my favorite. Go ahead.

No, no, I had a quick question about Colonial. Is Colonial going to be offered now when we start on the open enrollment?

Colonial? Colonial is currently offered. We offer the hospital indemnity. We offer a critical illness policy that covers cancer, heart attack, stroke. We have an accident policy. for any injuries off the job?

I'm very familiar with Colonial. I had it for 25 years when I worked with the state. Okay. And I love the company. It's great. I know it works, and believe me, when you submit the papers and they pay you right away, there's no waiting time. So if anybody wants to do it, now is the time, October 1st, to get one of those covers, right?

Correct. We have a very high participation rate with Colonial. Again, every employee on the HMO plan The city pays 100% for them for the hospital and 50%. And then anyone who wants to, anyone who's on the PPO plan can do a buy-up to include the hospital indemnity plan as well. And we have a lot of employees that choose to be on the PPO plan or they're at the executive level where they're already on the PPO plan automatically and they choose to pay for that plan, the hospital plan.

Okay, I just want to make sure, so when I start, anybody who will be interested in can join. I will be enjoying for sure.

Do you want to say something? Okay, thank you. I'm still waiting for the numbers. The what? For the numbers, yes. What numbers? Can you ask for the monetary? No, I just said.

No.

200.

Commissioner Saldeas, you're on the floor.

Yes.

No, I was just going by, excuse me, to answer your question, Commissioner.

Yes.

The thing is, I was just looking at the rate. If it's 5% and we have 2% and we went up to that much money, the 5% will put us somewhere along there. And I was just looking at Scott to see if I was correct. But you guys are the pros at that if you want to give them a fixed number now. Or we could work at that on the side.

We have a ballpark number.

What is it?

Your current premium is about 3 million. It would be about 3.5 to add the GLP-1s for weight loss.

35? Roughly. 1,000 a month.

No, 3.5 million. You're paying gross roughly 3 million. It would be about $3.5 million. to add the GLP-1s for weight loss.

Okay, there's other weight loss procedures that work really good, too. You know what's good? Jogging.

Going through our parks.

Closing the mouth.

Going through our parks.

But thank you. Yeah. No pastelitos.

Let me ask you on the GLP-1, how much do they have to pay now with United?

It depends on the tier that it falls under.

Absentee, just to give you an example.

That's a tier three. So currently they would be paying two-day $70 copayment.

How much they're used to doing the other payment that we have?

No, no, no, now we have a new plan.

Yeah, yeah, the new one now it's seven.

It would be $50.

It would be $50 now?

Yeah. On the new one.

What was the other one?

$70.

Okay. I only pay $25 right now.

Yep.

For the same thing. We're united?

We're united. Because it falls under a different tier, that's why.

Yes, it's probably in combination with a coupon.

Yeah.

I'm telling you because that's what I'm paying. I have to do it because I'm diabetic type two, I have to use it every month. And I'm paying, they only give me once a month, but it's $25.

I have a question. Do rewards for the United carry over into the new plan?

No, they do not.

No, you have to earn it every plan year. Every plan year, so you don't cash it out, you don't roll it over, all right. I'm gonna make a quick statement, then I'm gonna make a recommendation. I liked admin, I still like admin. But I feel like admin betrayed us. You don't put a face. You guys raised the rates 35%. That's why I feel like you guys betrayed us. If it wasn't for, in my opinion, these two ladies standing up here, specifically Yoli, if I'm not mistaken, to basically get us back into shape and make us more attractive to companies like admin and united and curative and blue when we became more attractive when we lost weight and we took the glp1 and we did the tummy tuck and the breast lift now you guys want us back um that's how i feel now that's just me i don't speak for anybody else but i'm going to make a recommendation to my colleagues um just a simple yes or no do we want to give Ahmed and United, two minutes, give us their best pitch, and then we decide. If you guys are interested in that, we do it. If not, we decide right now.

I decide already. Huh? No. I made my decision already.

You want to give them an opportunity? Yeah. Commissioner, just a quick straw vote. Commissioner Yana, would you like to give them two minutes? It's a yes or no. That's a no. Commissioner Isidro Ruiz? It's a no. No. Saul Diaz? Yes. Yes. Reynaldo Ray? Yes. Ian Baisio?

Yeah.

Okay. Okay. So, yes. So, if you can, ladies, you can indulge us.

That puts them in a bad position.

I don't think it puts them in a bad position. We're here to make informed decisions. Abmed, we'd like you guys to go first. You got two minutes. And by the way, if you want to go ahead and lower rates right now, I'm not going to say no. Say your name for the record.

and you have two minutes sure um lily guzman and i am the director of sales and retention for avmed lord lord is abraham manager of strategic accounts um so AFMED's been, we're here, we're local, we're in their backyard. I understand what you're saying, and you looked straight at me when you said you felt betrayed. Unfortunately, at the end of the day, insurance is still a business. You still have to have the money to be able to pay the claims. And I think that's what happened, right? In general, I think today you do look like a much better group. a much healthier group, and it's shown through our proposal. We're not only local, we cover nationwide pharmacies, we cover all the hospitals in Florida. We improved our benefits, and the Rx, we dropped significantly. I think in the areas where your employees will need them most, We're offering the added value package of Smart Shopper, where you get rewards, ComHealth, which is an $80 value to all the employees, RX Saving Solutions, Omada Health, These are all things that are continued to keep the group healthy and manage their health. We're also added a $20,000 annual wellness for Sweetwater, which can be used towards either providing a wellness app or something of that nature that we can help to enhance the wellness today for incentives and so forth. 10 seconds. 10 seconds. We are also we also are here to handhold if you do decide to come without me to handhold each member, make sure that the transition is smooth for both prescription and any services.

Thank you very much. United step right up. The price is right.

Good evening, again, Brian Garrison, Vice President of Sales and Account Management for UnitedHealthcare and Shar Schwartz, who's your strategic account executive. I MEAN, THE PLAIN AND SIMPLE REASON WHY I THINK UNITED IS WE PROVIDED YOU STABILITY, PREDICTABILITY. LAST YEAR YOU WERE GETTING A 35% INCREASE. WE CAME IN WITH A SINGLE DIGIT NUMBER AND WE CAME BACK OUT THIS YEAR AND GETTING A 2.5% AND NOW A RATE PASS. YOUR EMPLOYEES ARE FAMILIAR WITH OUR PROGRAMS. THEY'VE GOTTEN $35,000 IN UHC We've done a lot of things to help the members, 90-day access to Walgreens, CVS. It doesn't just have to be at OptumRx. We also have vital medications where your employees can get medications at $0 copay. And we're continuing to evolve and provide more and more benefits to your employees to stay healthy and provide the predictability that we've been able to provide from a financial perspective. We're local, too. We may not be right here in Miami, but we're up the road at Plantation. I live down here in Miami. And we're dedicated and committed to coming out and doing health fairs. Again, I think of what we've done in nine months in working with your HR and Yoli and Brown and Brown, the results are there. UHC rewards and the payouts. Your employees and the prescription drugs has quieted down, and now we've offered an enhancement to that. We can't go chasing our competitors below current and have that sustainability that you're looking for from a financial perspective. So we've done the best we can to show our commitment and our partnership to you by going from our initial increase down to a pass. And we hope you make the right decision based on everything we've been able to, how we've been able to perform and how we partner with you, your consultant, and your HR team.

Thank you very much. Thank you. I'd like to give, does any commission wish to speak before I say anything? No. No? I'd like to give the mayor the final word, but before that, Mr. Mayor, you're the leader of this city, you're the CEO of this city. You're not a normal mayor in most cities to those watching on TV. You have a city manager who's the administrator, and the city manager has staff upon staff upon staff. The mayor... is our mayor and our city manager. So he's gotta play the political hat and the administrative hat, and sometimes they don't jive. It's not an easy job to do. That office is most certainly difficult. I think you know that I am most critical. On this dais, I am the most critical of you because we are Sweetwater. You and I are most certainly Sweetwater. um we may not always agree but when you and your staff do a good job i always like to piss people off by saying a bad word and saying kick ass job good job sir so i'd like to give you the floor

Thank you, Mr. President. And I will tell you straight up, I think I said it earlier, we have looked at every the four corners of the document, per se, every angle that we could see. And we tried. And once again, I can't thank the companies enough. Each one of them stated very clearly by putting their money where their mouth is. So we thank you. Unfortunately, there's got to be one. And with that, the best benefits for the money and looking at situations that we might be facing in the future, I don't think that United will disappear. I think they really have proven it by doing what they've done this year, and they will continue to do it and work with us in every angle. So the best benefit for not only the employees, the commissioners, and when I mean employee, I mean the guys in blue and every single employee that we have. I think the best benefit is gonna be the combination of United, Colonial, and maybe some other stuff that we could get in the future, where I'll talk to you guys separately on, and going that route. Based on everything, I think what we could afford properly, Um, and I think that it will be all around the best solution.

Mr. Mayor, I, um, I was coming into this meeting voting for Abbott. I'm very transparent. I don't, I'm not concerned with hurting people's feelings with the truth. If you get your feelings hurt with the truth, I don't know what to tell you. Um, after hearing everything, I'm going to be choosing United, not based on the mayor's recommendation, although that does carry a lot of weight. Definitely with the recommendation of our consultants with Brown and Brown and with Yoli. You know what's funny is we never refer to her company name. It's just her name, Yoli. That's funny. One word. That's funny. Do you have a Yoli in your city? I can market that, by the way. So I'm going to be choosing United. I... I hope to have a long-lasting relationship. If you notice, Commissioner, I see he was a man of few words, but when he speaks, he speaks well. And what he said was true. We do not want to have a flim-flam relationship and this toxicity that keeps going back and forth. Unfortunately, the employees' health is one of the most important commodities, in my opinion. I think our residents are number one, and our employees are right under that. As far as I'm concerned, the people on this dais and the mayor, we're at the bottom of the barrel. We're the least important in the city. Our greatest assets are our residents and our employees. That's just my personal opinion. I ask if United is chosen, Please take care of those employees with those specialty scenarios. Don't treat us like just another number, because you will lose my respect. And I will most certainly go in the media and bash you if you notice I have no filter. I could care less. So does anybody else want to speak before we vote and make a motion? Commissioner Yanyu.

One quick question. Yoli, are we gonna have sort of like we had in the past? Like it was open enrollment where everybody was sitting face to face. I think I miss that a lot because we had the companies in front of us and we can ask anything like we had in the future. Are we gonna be able to have this time the same thing?

You're asking about the open enrollment meeting that takes place every year?

We used to have it face-to-face with the companies and they can explain to us.

Since I've been with you, we've been hosting an open enrollment meeting. I happen to love it. It's a wonderful opportunity for me to reconnect with the employees, make sure that they're using the United Healthcare Rewards app that Commissioner Reeves was talking about. And then I'm really big on all of the supplemental plans that the city offers. and I really try, not that I'm pushing people, no, I don't want you to think that, but I'm highly encouraging and educating people about my own experiences, not that I'm on your insurance, but I have a similar supplemental insurance through Aflac, and I'm constantly telling them, hey, look, I have three kids, look how much they've paid me over the years, so it's really an education session for the employees, so I happen to love those meetings a lot, and then we invite people our carrier to come and participate and then after that we do the health fair that was very successful last year as well and it's another opportunity to re-engage with the carriers everybody who's a vendor within the city so yes i would love to do that again okay do we have a motion for a company

Do we have a motion for a company?

We have to say the company.

I move for United.

Commissioner, invite a CO's motion for United. Do we have a second? Second. We have a second by Commissioner Saudia. No, no, not me. No. I'm sorry. Isidro Ruiz.

Roll call, Madam Clerk. Hold what you got. Commissioner Aldo Ray. Before, I know you said United. Make sure you say United alternate one seat. Yes.

Okay, so I amend my motion to United 1C.

That was not going anywhere else but that. Second as amended. Good catch.

United alternate 1C is the motion by Commissioner Baezio, second by Commissioner Isidro Ruiz, roll call, Madam Clerk. Commissioner Navarro. Yes. Commissioner Torres. Yes, thank you, United. Commissioner Diaz.

Yes. Commissioner Reyes. Yes.

Commissioner Baezio.

Yes. Yes. Congratulations, United. I want to thank Curative. I want to thank AVMED for being so aggressive. We really appreciate you guys coming out. But we've got to make the decisions best for our employees. So it is what it is. Thank you so much. Do we have a motion to adjourn? No. All in favor say aye. Aye.