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Resolution No. 23-47
RESOLUTION NO. 23-47 A RESOLUTION OF THE CITY OF ATLANTIC BEACH, FLORIDA, APPROVING EMPLOYEE HEALTH INSURANCE BENEFITS DELINEATED IN EXHIBIT A FOR THE PLAN YEAR BEGINNING JANUARY 1, 2024, INCLUDING THE FOLLOWING: BENEFITS PROVIDED TO CITY EMPLOYEES AND THEIR FAMILIES THROUGH CIGNA, LIFE INSURANCE AND EMPLOYEE ASSISTANCE PLAN BENEFITS PROVIDED BY THE CITY AT NO COST TO EMPLOYEES, AND OTHER INSURANCE COVERAGE OFFERED TO EMPLOYEES AT THEIR EXPENSE;AUTHORIZING THE CITY MANAGER TO EXECUTE CONTRACTS AND PURCHASE ORDERS IN ACCORDANCE WITH AND AS NECESSARY TO EFFECTUATE THE PROVISIONS OF THIS RESOLUTION; AND PROVIDING AN EFFECTIVE DATE. WHEREAS, the City of Atlantic Beach seeks to provide the most cost-efficient and effective health benefits for employees and their families; WHEREAS, the City of Atlantic Beach pays for a substantial portion of the health insurance for employees; and WHEREAS, the City of Atlantic Beach desires to continue to utilize CIGNA as its health care provider as delineated in Exhibit A; and WHEREAS, the City also desires to provide life insurance and employee assistance plan benefits at no cost to employees as delineated in Exhibit A; and; WHEREAS,the City also desires to provide employees the option of participating in other insurance coverage, to include dental, vision, short-term and long-term disability, supplemental life, as well as several supplemental policies, all at their own expense, as delineated in Exhibit A; and NOW THEREFORE,be it resolved by the City Commission of the City of Atlantic Beach as follows: SECTION 1. The City Commission hereby approves health care insurance benefits delineated in Exhibit A for the plan year beginning January 1, 2024, including the following: Benefits provided to City employees and their families through CIGNA; life insurance and employee benefits provided by the city at no cost to employees; and other insurance coverage offered to employees at their expense. SECTION 2. The City Commission hereby authorizes the City Manager to execute contracts and purchase orders in accordance with and as necessary to effectuate the provisions of this Resolution. SECTION 3. This Resolution shall take effect immediately upon its passage and adoption. Resolution No. 23-47 Page 1 of 2 PASSED AND ADOPTED by the City of Atlantic Beach,this 23rd day of October,2023. Curtis Ford, ayor Attest: plan VAa •eZe, Donna L. Bartle, City Clerk Approved as to form and correctness: Jason Ga riel,City Attorney Page 2 of 2 Exi-ts_R ( r P ...- \ -------- ..--- _;;;••••• ••1_ ,-- ....---- _------ .. _____....------------ -11-40 _>_, -_---., _ -;----'•-° - -----j..----- \ (v-•(, V- -,-,..,-;:-_- \ \\ , - . - d ,\ ,,,i,1(.>\ . .. ."- 1.--.......- ...- .,_ - \ I\ ) N ., ,....._ . „.- \ - / ti 1 1 ml 1 . . , , • . ... . .,$, dr _ . ; . .. • -.. . N. .. _ . . Selected Rates and PLans for: IO A an lc -- eac .._, .. ... ... . -- . . ‘ 11: Effective Date: 01/01/2024 Gallagher Insurance Risk Management Consulting CITY OF ATLANTIC BEACH-EFFECTIVE 01/01/2024 Gallagher Renewal Summary Effective:01/01/2024 Medical, Stop Loss, Dental,Vision & EAP _ `tion :tion Medical CIGNA A 7%:8.7%if adding weight loss meds Consultant Fee Dental Sun Life A+ Flat Consultant Fee Vision Humana A- Flat Consultant Fee EAP Health Advocate * 3.8%Increase Consultant Fee 'While Gallagher does not guarantee the financial viability of any health insurance carrier or market,it is an area we recommend that clients closely scrutinize when selecting a health insurance carrier There are a number of rating agencies that can be referred to including,A.M.Best,Fitch.Moody's.Standard&Poor's,and Weiss Ratings(The Street.com).Generally,agencies that provide ratings of Health Insurers,including traditional insurance companies and other managed care organizations,reflect their opinion based on a comprehensive quantitative and qualitative evaluation of a company's financial strength.operating performance and market profile.However,these ratings are not a warranty of an insurer's current or future ability to meet its contractual obligations Ancillary AM Best • Rating 12,. '•••-'.,-' '.ction Gallas : "'t- , . 1,ation Life/AD&D Standard • A Flat Consultant Fee Vol Life/AD&D Standard A Flat Consultant Fee STD Sun Life A+ 13.8%Increase Consultant Fee LTD Sun Life A+ 8.8%Increase Consultant Fee Vol.Worksite AFLAC Plans Changing-Pending _ 1 ,1I 1 l i.?..I I 1 1 ,..,i1 Hi.i .. -. Hui A. M. Best's Rating Scale Level Category Level Category Level Category A•• A• SuPv.a b b , ; _ I,t A.A Excellent G•.(,• r E Uncle Regl/atory Supaksron B•• B. Very Good C.C. . F h h0udanm s.. _ ttcial Size Categories �i i Up to 1000 ;SC IX 250.000 to 500.000 FSCII 1.000 to 2.000 FSC X 500,000 to 750.000 FSC IN 2000 to 5,000 FSC XI 750.000 to 1,000,000 I FSC IV 5.000 to 10.000 FSX)II 1000000 to 1.250.000 FSCV 10000 to 25.000 FSXXI 1.250.000 to 1.900.000 FSC VI 25 000 to 50.000 FSC XV1500.000 to 2.000,000 FSC VII 50000 to 100.000 FSC XV 2.000000 a mae FSC VI 100 000 to 250 000 In 5000 U Reported Pohcylalders'Supe s Plus Condecnai Reserve Funds) ,i-Best's Insurance Recall ptdshed annually by A 1.1 Best Ca pany.Inc preceyts canad'e151Ye fepals On tle Inencrl peseta',hstcry, and transxhons of tnsuance corrpams vett rg a the Unted States and Canada Comrenies licensed coda flatness in the United Stales are assignee a Best's Rating whdt attempts to meas ire the conperatne posdan of the canparry or association aganst e'dtstry The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 2 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM O 0 0 e Q )..r Q.) 4 c v P r rl rl l.7 . d vi vi N c C C co co co Q fl d a) a) a) a) mc C C z, O O O co -D V V C a) U a) 7 0) 0) 0) O C C C N > L L C C 0 0 0 O 0 m U p C C C C c m a a (6 "0 m a) a) a) E co c c c c o a E E E CD r m a) a) (7 E O) >, 0) 0) p C_ C C E To a) a) a) 0 N a) 2Z 1) 0 N co co U 7 a) _m E. _co CcCDcoco a n 3 U C C C a) a. o a) a)) > N7 7 7 N @ o 0 0 0 N ci a g Q g 0 0 N u_ CO Q Q Q 0) Cl) N O O O Q N C co ca O 0 a) a) a a) p O >o a) N 2 2 2 I c 0 E co U N C. a) N N ` m - N a) a) a) a) a) a •WU ca C (6 ca co E E 1 @ a.) a 0 2 2 co i — U cd CO 0 U a) C I N I c C I I I N N -c) 7 i 3 0) o 0 o co C) m N /R C r co a) r) Woci C C C O �V p C co co C v C d •8=,' M 0 0 U cn v c C' CO N N O .5 N 0 a a O C y U a) Wc0 a) 2 2 a) a) ca E E o 2 -2 y N O > COQ ca ca c o o > ca m ca 0> U U C0 c C C c C E 0 0 < C C co — C W 7 N co 7 7 7 a) a) Y UJ LL ^+ U U) U) Cl) I 2 2 U) U) U) a) _ W W co a) U N 0 0 J C W W N N ca 0 CO N • U N N Y • p F O co C C U Z a) o _ II 0 a) E i c J o c °6 a c a c4 H F- () O p p C a < cu > d p Q Q U @ o Q 5_ • H O �' u U is Q = C CC U NO • d d C _1 p O o Q m dwH N U) O Q_1 > u_ U w CITY OF ATLANTIC BEACH-EFFECTIVE 01/01/2024 Clid Medical Financial Comparison Gallagher Insurance Risk Management Consulting Current Renewal SELECTED-Proposal 1 Current Plans w/Weight Loss Meds CIGNA CIGNA High Plan OAP Advantage A Plan OAP Advanta,e A Plan Deductible(Individual/Family) $2,000/$4,000 $2,000/$4,000 Coinsurance(Carrier/Member) 70%/30% 70%/30% Out of Pocket Maximum(Individual/Family) $6,000/$12.000 $6.000/$12,000 PCP/Specialist $30/$60 $30/$60 Inpatient Hospital CYD+30% CYD+30% Rx(Retail 30-day supply) $10/$35/$60 $10/$35/$60 EE Tiers/Headcounts/Rates EEs Employee Only 4 $777.11 $831.48 $844.75 Employee+Spouse 1 $1,853.88 $1,983.59 $2,015.24 Employee+Child(ren) 0 $1,432.53 $1,532.76 $1,557.22 Employee+Family 0 $2.431.30 $2,601.41 $2.642.92 Monthly Premium 5 $4,962 mow $5,310 $5,394 • Yearly Premium $59,548 =.,,,$63,714 $64,731 Yearly Difference($) • $4,166 $5,183 Yearly Difference(%) 7.0% 8.7% Mid Plan - 'all ' ' ` OAPIN Advantage A Plan 500 OAPIN Advanta,e A Plan 500 Deductible(Individual/Family) $500/$1,000 $500/$1,000 Coinsurance(Carrier/Member) 90%/10% 90%/10% Out of Pocket Maximum(Individual/Family) $4,000/$8,000 S4,000/$8,000 PCP/Specialist $25/$50 $25/$50 Inpatient Hospital CYD+ 10% CYD+ 10% Rx(Retail 30-day supply) $10/$35/$70 $10/$35/$70 Rates EEs Employee Only 31 $880.50 $942.13 $957.22 Employee+Spouse 9 $2,099.96 $2.246.98 $2.282.94 Employee+Child(ren) 6 $1.622.79 $1.736.40 $1.764.19 Employee+Family 5 $2.753.87 $2,946.67 $2.993.83 Monthly Premium 51 $69,701 $74,581 ` $75,775 ,` Yearly Premium $836,415 $894,967 _ $909,295 Yearly Difference($) $58,552 _ $72,880; ' Yearly Difference(°/a) 7.0% 8.7. Core Plan OAPIN Advantage A Plan 2000 OAPIN Advanta s e A Plan 2000 Deductible(Individual/Family) $2,000/$4,000 $2,000/$4,000 Coinsurance(Carrier/Member) 80%/20% 80%/20% Out of Pocket Maximum(Individual/Family) $5,500/$11,000 $5.500/$11,000 PCP/Specialist $30/$60 $30/$60 Inpatient Hospital CYD+20% CYD+20% Rx(Retail 30-day supply) $10/$35/$70 $10/$35/$70 Rates EEs Employee Only 35 $782.11 $836.84 $850.15 Employee+Spouse 8 $1,865.73 $1,996.29 $2.028.04 Employee+Child(ren) 8 $1,441.68 $1,542.57 $1.567.10 Employee+Family 1 $2,446.83 $2,618.06 $2.659.69 Monthly Premium $56,280 $60,218 $61,176 Yearly Premium $675,360 $722,620 $734,113 Yearly Difference($) ' $47,261 $58,753 Yearly Difference(%) . „ 't- E. 7.0% 8.7% ALL PLANS TOTAL _ Current` _ Pro.osal 1 Total Monthly Premium $130,944 $140,108 $142,345 Total Yearly Premium ' '. $1,571,322 $1,681,301 A $1,708,138 Total Yearly Difference($) $136,816 Total Yearly Difference(%) ',11.IIIIII I ,. _ 8.7% Wellness Subsidy $5,000 $5,000 All rates sub to change based on final enrollment,contribution and underwriting. This is a summary of in-network benefits only and is not intended to be a complete outline of the illustrated plan's/plans'contractual provisions. Headcounts per 1/1/24 Renewal. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 4 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM a co 2 O € v o d _ to g o 0 10 y o 0 0 0 a Y.d e e 0 0 0 0 0 c = d p, C o O 0 01 ; T 0 0 0 0 n 0 o O 0 V T C? 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U oN V E v N N Ti, NN N N (V IN N N IA MN tp fA A t0 IA N w E W C y c G \ yN I O W ( o ®co CO S \L L V r O o b ; t = 7 F og I o a U 1.w �. Q a N d o d0 = E E _e = g � � U 111 c in o o C J W W O a, - r N r CO j U V ,— V oa c c c m 1 fw o c v e m o c til o d o c w _ y = p o IFY- v/ `a �a) i '7 o a1 m ''�s o c, d § T s o m m � m m Y J_ we o3 v'E a t V V op� v E 4 g u a op»'E a 2 u c° o Ny Fi c•� •� �. g.L m a c c T a L o .oc c >. G L m a c c m n N oC 41 U LL C `1 `1 C N U a C d d C cn U LL C ` y U 6 T N _/0.) qOq/1y+a�1 +a1 +yy V o Oy +yy +yy cu V o O ++ a+ ++ V O aLL /�♦ 41 N a/ a1 T V a1 N G7 v T U D 4 0 N N N T O % dNNE O H p QV/ o T T o — T T T T— T T T T T T T } } } W O c NO 0 0 o L T T T o 0 0 o C T`` 0 0 0 0 .E a n a c ,� ,� ,� nE n a c A ,a ,a o.E a n c ,O ,C CO o 2 a 2 m y NI o CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 Gallagher Insurance Risk Management I Consulting Medical HMO Copay Plans - Core and Mid Plans Current I Selected Renewal Current/Selected Renewal CIGNA Core Plan CIGNA-Mid Plan CORE AND MID HMO PLANS _, ,_..r - _ OAPIN Adv �, .._'.,n 200! OAPIN • , n 500. In-Network Only In-Network Only Plan/Calendar Year Deductible(PYD/CYD) Individual $2,000 $500 Family Aggregate $4,000 $1,000 Coinsurance(Carrier/Member) 80%/20% 90%/ 10% Out-of-Pocket Maximum(includes Deductible, Coinsurance, Rx and Copays) Individual $5,500 $4,000 Family Aggregate $11,000 $8,000 Office Services Telemedicine 1 $10 $10 Primary Care Physician(PCP) $30 $25 Specialist $60 $50 Hospital/Surgical/Emergency Care Urgent Care $50 $50 Emergency Room & Facilities $300 $150 Outpatient Hospital(per visit) CYD +20% CYD + 10% Inpatient Hospital(per admission) CYD+20% CYD+ 10% Prescriptions(Tiered Program) Weight I Meds(' IncIufied Weight toss Meds Included Retail(30-day supply) $10/$35/$70 $10/$35/$70 Specialty(30-day supply) $10/$35/$70 $10/$35/$70 Mail Order(90-day supply) $25/$88/$175 $25/$88/$175 Preventive Health` Well Child PCP: $0 PCP: $0 Routine Adult Physical Exams Specialist: $0 Specialist: $0 Well Woman Exam (e.g.. annual GYN) Mammogram Covered 100% Covered 100% Colonoscopy Covered 100% Covered 100% Services at Independent Diagnostic Facilities Independent Clinical Lab(e.g., Blood Work) Covered 100% Covered 100% Including if physician sends it out to a lab Diagnostic Services(e.g., X-rays, EKGs) $250 $250 Advanced Imaging Services(e.g., MRI, CAT. PET) Covered 100% Covered 100% Mental Health/Substance Abuse Outpatient Office Visit $60 $50 Inpatient Admission CYD +20% CYD+ 10% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. Telemedicine refers to telehealth calls or video calls with a telehealth provider(e.g.. Teladoc, MDNow, AmWell. Doctor on Demand, HealthiestYou). This differs from Virtual Visits, which is s remote visit with a member's PCP or specialist and the cost for Virtual Visits can vary by physician. Virtual Visits to out of network providers are typically not covered. 2 Frequency limitations. age restrictions and preventive medical coding apply for it to be considered routine coverage. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 6 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 G_i Gallagher Medical PPO - High Plan Insurance Risk Management I Consulting Current/Renewal CIGNA • OAP Advanta•e A Plan In-Network Out-of-Network Plan/Calendar Year Deductible(PYD/CYD) Individual $2,000 $4,500 Family Aggregate $4,000 $9,000 Coinsurance(Carrier/Member) 70%/30% 50%/50% Out-of-Pocket Maximum(includes Deductible, Coinsurance, Rx and Copays) Individual $6,000 $6,250 Family Aggregate $12,000 $12,500 Office Services Telemedicine 1 $10 N/A Primary Care Physician(PCP) $30 CYD + 50% Specialist $60 CYD+50% Hospital/Surgical/Emergency Care Urgent Care $75 CYD +50% Emergency Room & Facilities $350 $350 Outpatient Hospital(per visit) CYD+ 30% CYD + 50% Inpatient Hospital (per admission) CYD + 30% CYD +50% Prescriptions(Tiered Program) Weight Loss Medications Included Retail(30-day supply) $10/$35/$60 50% Specialty(30-day supply) $10/$35/$60 50% Mail Order(90-day supply) $25/$88/$150 50% Preventive Health 2111111111011111 Well Child Routine Adult Physical Exams PCP or Spec ° Well Woman Exam (e.g., annual GYN) Covered 100%Well -Age 15: 50/° Age 16 and older: CYD Mammogram + 50% Colonoscopy Services at Independent Diagnostic Facilities Independent Clinical Lab(e.g., Blood Work) Covered 100% CYD+ 50% Including if physician sends it out to a lab Diagnostic Services(e.g.,X-rays, EKGs) $200 CYD + 50% Advanced Imaging Services(e.g., MRI, CAT, PET) Covered 100% CYD + 50% Mental Health/Substance Abuse Outpatient Office Visit $60 CYD+50% Inpatient Admission CYD + 30% CYD+ 50% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans'contractual provisions. Telemedicine refers to telehealth calls or video calls with a telehealth provider(e.g.. Teladoc, MDNow, AmWell, Doctor on Demand, HealthiestYou). This differs from Virtual Visits, which is s remote visit with a member's PCP or specialist and the cost for Virtual Visits can vary by physician. Virtual Visits to out of network providers are typically not covered. Frequency limitations. age restrictions and preventive medical coding apply for it to be considered routine coverage. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 7 ©2022 ARTHUR J. GALLAGHER CO. AJG COM a CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 rir_ Gallagher Dental Financial Comparative Insurance Risk Management (.o., unmc, Current Selected Renewal I Sun Life High Emp# Dental PPO Employee 20 $26.29 $26.29 Employee+ One 11 $50.63 $50.63 Employee+Two or More 7 $83.21 $83.21 Monthly Premium 38 $1,665 $1,665 Yearly Premium $19,982 $19,982 Yearly Difference($) $0 Yearly Difference(%) 0.0% Employee 37 $9.97 $9.97 Employee+ One 15 $16.86 $16.86 Vol_ Worksite 9 $28.57 $28.57 Monthly Premium61 $879 $879 Yearly Premium $10,547 $10,547 Yearly Difference ($) $0 Yearly Difference(%) 0.0% Emp# ..Curren . Initial Renewal Total Monthly Premium99 $2,544 $2,544 Total Yearly Premium $30,529 $30,529 Total Yearly Difference($) $0 Total Yearly Difference(%) 0.0% Headcounts 1/1/24 Renewal. All rates subject to change based on final enrollment, contribution and underwriting. I The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 8 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM i CITY OF ATLANTIC BEACH -EFFECTIVE 01/0112024 Dental PPO Gallagher Insurance i Risk Management Consulting Current/Selected Renewal Deductible In-Network Out-of-Network Class I: Preventive Individual/Family Waived Waived Class II: Basic Individual/Family $50/$100 $50/$100 Class III: Major Individual/Family $50/$100 $50/$100 Class IV: Orthodontic Individual/Family Not Covered Not Covered Coinsurance Class I: Preventive 100% 100% Class II: Basic 80% 80% Class III: Major 50% 50% Class IV: Orthodontic Not Covered Not Covered Benefit Maximums Yearly Benefit Maximum (Per Member) $1,500 $1,000 Plan Maximum Enhancement No Orthodontic Lifetime Max(Per Member) Not Covered Additional Benefit Provisions Non-Surgical Endodontics(Basic/Major) Major Surgical Endodontics(Basic/Major) Major Non-Surgical Periodontics(Basic/Major) Basic Surgical Periodontics(Basic/Major) Major Implant Parts Covered(Fixture/Abutment/Prosthesis) No (Child/Adult)Orthodontic Coverage Not Covered Additional Contract Provisions Contributory or Non-Contributory Plan (EE/ER %) 100% Employee Paid Rate Guarantee 1 year until 1/1/25 Minimum Participation for Coverage 65% Timely Applicant Waiting Period 6/12 Basic/Major Dependent Age Limit 26 Out-of-Network is% UCR or MAC MAC Rates Employees Current Renewal Employee 20 $26.29 $26.29 Employee+ One 11 $50.63 $50.63 Employee+Two or More 7 $83.21 $83.21 Monthly Premium38 $1,665 $1,665 Yearly Premium $19,982 $19,982 Yearly Difference($) $0 Yearly Difference(%) 0.00% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans'contractual provisions. Headcounts as of 5/1/23 invoice. All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 9 ©2022 ARTHUR J. GALLAGHER CO. AJG,COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 V'= Gallagher DH M O / Pre-Paid Dental Insurance Risk Management Consulting Current/Selected Renewal Common Services Code Member Pays Office Visit Copay 9430 $10 Bitewings-Four Films 0274 $0 X-Ray/Panoramic Film 0330 $0 Routine Cleaning 1110 $0 Filling (Silver/ 1 Surface) 2140 $10 Filling(Silver/3 Surfaces) 2160 $35 Anterior Filling (Resin/ 1 Surface) 2330 $35 Anterior Filling (Resin/3 Surfaces) 2332 $55 Posterior Filling (Resin/ 1 Surface) 2391 $60 Posterior Filling(Resin/3 Surfaces) 2393 $80 Crown- Porcelain Fused to Metal 2750 265* Root Canal-Molar 3330 $245 Gingivectomy- Per Quadrant 4210 $120 Prosthodontics-Complete Upper 5110 $295* Partial Dentures(Upper or Lower) 5211 $350* Placement of Endosteal Implant 6010 Not Covered Custom Abutment 6057 Not Covered Abutment-Supported Porcelain Crown 6061 Not Covered Partial Bony Impaction 7230 $65 Orthodontic Benefit Schedule Code Member Pays Evaluation 8660 $100 Comprehensive Adolescent Dentition 8080 $2,000 Comprehensive Adult Dentition 8090 $2,000 Specialist Self-Referral Permitted No Referral Needed for Copay Schedule Yes Discount on Services, or Copay Schedule Copay Additional Contract Provisions Contributory or Non-Contributory Plan (EE/ER %) 100% Employee Paid Rate Guarantee 1 year to 1/1/25 Minimum Participation for Coverage 1 employee Timely Applicant Waiting Period None Dependent Age Limit 19, 26 of FT Student Rates Employees Current Renewal Employee 37 $9.97 $9.97 Employee+ One 15 $16.86 $16.86 Employee + Family 9 $28.57 $28.57 Monthly Premium61 $879 $879 Yearly Premium $10,547 $10,547 Yearly Difference($) $0 Yearly Difference(%) 0.0% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans'contractual provisions. Headcounts per 1/1/24 renewal. All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 10 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 tiT Gallagher Insurance Insurance I Risk Management I Consulting Current/Selected Renewal Humana 1 isipn.. Copayments In-Network Out-of-Network Reimbursement Vision Exam $10 Up to$30 Retinal Imaging Up to$39 Not Covered Materials $15 See below Frequency Limitations Vision Exam 12 months Lenses(Within Frames or Contacts) 12 months Frames 24 months Limited to Frame Lenses or Contact Lenses within Yes the same year?(Yes/No) Maximum Allowances Allowance Reimbursed up to$ Single Vision Lenses $25 Bifocal Lenses Covered 100/o $40 Trifocal Lenses after applicable $60 Lenticular Lenses materials Copay $80 Frames $130 Retail, then $65 20%Discount Contact Lenses(Elective) Up to$130, then $104 15% Discount Disposal Contact Lenses(Elective) Up to$130 Up to$104 Standard Contact Lens Fit& Follow Up Up to$55 Not Covered Premium Contact Lens Fit& Follow Up 10%off Retail Not Covered Diabetic Eye Care (Up to 2/yr each) -Examination-2 per year $0 Copay Up to$77 - Retinal Imaging-2 per year $0 Copay Up to$50 - Extended Ophthalmoscopy-2 per year $0 Copay Up to$15 -Gonioscopy-2 per year $0 Copay Up to$15 -Scanning Laser-2 per year $0 Copay Up to$33 Laser Correction Discount Discount N/A Additional Contract Provisions Contributory or Non-Contributory Plan (EE/ER %) 100% Employee Paid Rate Guarantee 2 years until 1/1/25 Dependent Age Limit 26 Rates Employees Current Renewal Employee 48 $5.93 $5.93 Employee +Spouse 16 $11.87 $11.87 Employee+ Child(ren) 10 $11.27 $11.27 Employee + Family 6 $17.71 $17.71 Monthly Premium 80 $694 $694 Yearly Premium $8,322 $8,322 Yearly Difference($) $0 Yearly Difference(%) 0.0% This is a summary of benefits only and is not intended to be a complete outline of the illustrated •Ian's/•lans'contractual •rovisions. Headcounts as of 5/01/23 invoice. All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 11 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 161*i Gallagher Basic Life and A D&D Insurance I Risk Management I Consulting (Accidental Death & Dismemberment) Current Renewal Selected Rev. Renewal Benefit Specifications Employee Basic Life 1 x BAE to$50,000 Employee Basic AD&D 1 x BAE to$50,000 Guarantee Issue $50,000 Waiver of Premium (Yes/No) Yes Conversion Privilege(Yes/No) Yes Portable Privilege at Term Rates(Yes/No) Yes Acceleration Benefit(Yes/No) Yes Reduction Schedule Attained Age/Employee: Benefit Reduced To: 65 65% 70 50% 75 35% 80 Rates Current Renewal Revised Renewal Volume $4,722,600 $4,722,600 $4,722,600 Life Ins. Rate/$1,000 $0.190 $0.190 $0.175 AD&D Rate/$1.000 $0.030 $0.030 $0.030 Monthly Premium $1,039 $1,039 $968 Yearly Premium $12,468 $12,468 $11,618 Yearly Difference($) ($850) Yearly Difference(%) -6.8% Rate Guarantee 2 years to 1/1/25 Minimum Participation for Coverage 100% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. 411 71M1.11111.10 SE Volume as of 1/1/24 Renewal; 117 employees All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 12 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM CITY OF ATLANTIC BEACH-EFFECTIVE 01/01/2024 Voluntary Life and AD&D Gallagher • t k Management Consultor; Current Selected Renewal Benefit Specifications Employee Voluntary Life/AD&D $10k increments to$200,000(not to exceed 5xBAE) rounded to next$10,000 Spouse Voluntary Life/AD&D $5k increments to$100,000(not to exceed 50% of employee amount) Child Voluntary Life/AD&D $10,000 Dependent Age Limit To Age 21,25 if FT student AD&D Applies to(Employee/Spouse/Child) Yes Guarantee Issue Employee$70,000;Spouse$10,000 Waiver of Premium(Yes/No) Yes Conversion Privilege(Yes/No) Yes Portable Privilege(Yes/No) Yes Acceleration Benefit(Yes/No) Yes Suicide Exclustion(Yes/No) Yes Open Enrollment Provisions True Open Enrollment(up to GI without EOI) No Reduction Schedule Attained Age/Employee: Benefit Reduced To: 65 65% 70 50% 75+ 35% Rates(Per$1,000/Month) EE SP Child EE SP Child Age: 0-24 $0.067 $0.067 $0.067 $0.067 25-29 $0.067 $0.067 $0.067 $0.067 30-34 $0.086 $0.086 $0.086 $0.086 35-39 $0.133 $0.133 $0.133 $0.133 40-44 $0.247 $0.247 $0.247 $0.247 45-49 $0.418 $0.418 $0.418 $0.418 50-54 $0.703 $0.703 $0.703 $0.703 55-59 $1.083 $1.083 $1.00 per $1.083 $1.083 $1.00 per 60-64 $1.700 $1.700 member $1.700 $1.700 member 65-69 $3.050 $3.050 $3.050 $3.050 70-74 $5.463 $5.463 $5.463 $5.463 75-79 $5.463 $5.463 $5.463 $5.463 80-84 $5.463 $5.463 $5.463 $5.463 85-89 $5.463 $5.463 $5.463 $5.463 90-94 $5.463 $5.463 $5.463 $5.463 95-99 $5.463 $5.463 $5.463 $5.463 AD&D $0.040 $0.040 $0.040 $0.040 $0.040 $0.040 Rate Example EE SP Child EE SP Child Current Volume $1,139,500 $1,139,500 Additional Contract Provisions Rate Guarantee 2 years until 1/1/25 This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. Volume as of 4/1/23 Invoice; 18 EE $6,115.80/yr; 5 Sp$622.20/yr; 6 Ch 72/yr. All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 13 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 Voluntary Short Term Disability Gallagher Insurance I Risk Management I Consulting Current Selected Renewal Benefit Specifications Elimination Period (Accident/Sickness) 14 days/ 14 days Earnings reported by the Employer immediately prior to the first date of disability. Includes deductions made for pre-tax contributions to a Definition of Earnings qualified deferred compensation plan, Sec 125 plan or FSA acount. Does not include commissions, bonuses. overtime or any other compensation. of Weekly Salary Covered 60% Weekly Benefit Amount $1,500 Annual Salary covered by Weekly Benefit $130,000 Benefit Duration 11 weeks after elimination period Conversion Privilege (Yes/No) No Portability Privilege(Yes/No) No Evidence of Insurability Required (Yes/No) No Pre-Existing Condition Limitations(Yes/No) 3/ 12 Waiver of Premium (Yes/No) No Rates Current Renewal Volume(covered weekly benefit) $9,460 $9,460 Premium Rate (per$10 of covered weekly benefits) $0.412 $0.469 Monthly Premium $390 $444 Yearly Premium $4,677 $5,324 Yearly Difference ($) • $647 Yearly Difference(%) 13.8% Rate Guarantee 1 year to 1/1/25 Minimum Participation for Coverage 25% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. Volume per 1/1/24 Renewal. 14 Employees All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 14 ©2022 ARTHUR J. GALLAGHER CO. AJG COM CITY OF ATLANTIC BEACH-EFFECTIVE 01/01/2024 V'- Gallagher Voluntary Long Term Disability Insurance Risk Management I Consulting Current Selected Renewal Benefit Specifications Elimination Period 90 Days Earnings reported by the Employer immediately prior to the first date of disability. Includes deductions made for pre-tax Definition of Earnings contributions to a qualified deferred compensation plan, Sec 125 plan or FSA acount. Does not include commissions. bonuses, overtime or any other compensation. %of Monthly Salary Covered 60% Monthly Benefit Amount $6,000 Annual Salary covered by Monthly Benefit $120,000 Benefit Duration SSNRA Loss of duties and loss of earnings required; 80%earnings test Definition of Disability during own occ period and 60%during any occ period. Own Occupation Period 24 months Self Reported Symptom Limitation(Yes/No) Yes,24 months Waiver of Premium(Yes/No) Yes Conversion Privilege(Yes/No) No Portability Privilege(Yes/No) No Evidence of Insurability Required(Yes/No) No Pre-Existing Condition Limitations(Yes/No) Yes, 3/12 Mandatory Rehab Requirements(Yes/No) Yes Mental/Nervous/Alcohol/Drug Limitations 24 months Age/Rate% Covered Monthly Payroll or Current Renewal Benefit 0-24 $0.185 $0.202 25-29 $0.185 $0.202 30-34 $0.276 $0.301 35-39 $0.461 $0.502 40-44 $0.704 $0.767 45-49 $0.980 $1.068 50-54 $1.268 $1.382 55-59 $1.602 $1.746 60-64 $1.338 $1.458 65-69 $1.060 $1.155 70-99 $0.922 $1.005 Rate Example Current Renewal Covered Benefit $110,780 $110,780 Monthly Premium $1,088 $1,184 Yearly Premium $13,056 $14,208 Yearly Difference(Increase) $1,152 Percentage Difference 8.8% Additional Contract Provisions Volume&Rate Based on: Covered Monthly Payroll OR Covered Monthly Benefit Covered Monthly Payroll Rate Guarantee 1 year to 1/1/25 Minimum Participation for Coverage 25% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. Volume per 1/1/24 Renewal. 20 Employees. All rates subject to change based on final enrollment, contribution and underwriting. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 15 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM City of Atlantic Beach-Effective 1/1/24 Employee Assistance Pro• ram Current/Selected Renewal Benefits #of Face to Face Sessions 6 per issue per year Worklife Support Included Telephonic Assistance Unlimited, 24/7 Educational Resources Included Promotional Outreach Standard Communication Materials Crisis Response Services $275/hour plus travel/exp Included, free 30 min. consultation per unique issue. 25% Legal Services discount on standard legal fees if retained Included, free 30 minute consultation per unique issue. Online Financial Services financial portal: Financial Fitness Center Identity Theft Services 1 hour consultation with a fraud resolution specialist Included, unlimited telephonic support and specific Critical Incident Stress Management communication materials. On-Site Grief Group Counseling $275/hour plus travel/exp On-Site Training Training Seminars$250/hour plus travel Management&Supervisor Consultation Included. Unlimited telephonic manager/supervisory consultations and mandatory referrals SAP/DOT Case rate$300-$550 only for employees subject to DOT regulations. Utilization Reports Included Dependent Coverage Included Mobile App Yes Web Address www.healthadvocate.com/members Other Health Advocacy(+$2 PEPM) 108 providers within Providers 10 miles; 1 in 32233 zip RATES Curren! Renewal Number of Members 123 123 Price per Employee Per Month $1.30 $1.35 Total Monthly Cost $159.90 $166.05 Annual Total Cost $1,918.80 $1,992.60 Rate Guarantee 1 year until 1/1125 This is a summary of benefits proposed only. It is not intended to be a complete outline of the illustrated plans'contractual provisions. FT Member Count as of 10/5/23 Navigator. 199 including PT and Retirees. 0 G < \ _ E c5 { - { / I li cii ti ■ - 63 6- ® @ / 0 \ \ .. » aLn 8 9 r zal — \ \ } \ ( ° < = j § « - 0 !• \ \ } a / a ! a....V j \ \\ \ \ \ \ \ \ \ \ \ a - » $ 2 \ § ) { $ i { # - 6 D D « % \ ,..'7,` \ U. > >- ` E 0 RS 0,0 E . C • ce % «- } 3 i co \ \ ) ! _00 r. to 7 G 2 I co L., i E , « 76 } ! / u ! - ® - - - © - \ oi0 ± 1wtoa I tocc \ 0 ■ 0 1 0 Gallagher M✓txa ..P4S.r.t CMWHno r. Accident Insurance e ,�sstar,dart Group Accident-Mid-Leve Group Accident-Plan 3 Situs State:FL SELECTED RENEWAL Employee:Actively at Work;Ages 18+ Employee:Actively at Work;Ages 18-99 1. Issue Ages Spouse:Ages 18+ Spouse:Ages 18-99 Child:Under Age 26 Child:Birth to ARe 26 2. Participation Requirement Inforce 10 Enrolled Employees 3. Guaranteed Issue Yes Yes 4. 24 Hour/Off Job 24 Hour 24 Hour 5. Hospital Admission $750 $1,000 6. Hospital ICU Admission Payable Under Hospital Admission $1,000 7. Admission Benefit Payments Either Admission or ICU Admission Admission and ICU Admission Benefits Can Be Benefit is Payable lx Per Calendar Year Paid Simultaneously lx Per Covered Accident 8. Hospital Confinement Per Day $150(Up to 365 Days) $250(Up to 365 Days) 9. Hospital ICU Confinement Per Day $300(Up to 30 Days) $250(Up to 31 Days) Confinement and ICU Confinement Confinement and ICU Confinement Benefits Can 10. Confinement Benefit Payments Benefits Can Be Paid Simultaneously Per Be Paid Simultaneously Per Covered Accident Covered Accident $125 11. Emergency Room Benefit (Additional$75 Observation Benefit $400 Availahle if HPId in an FR Fnr 74+Hnurcl 12. Non-Emergency Room Care $75 Physician's Office/Urgent Care $400 Physician's Office/Urgent Care 13. Physician Follow-Up $20(Up to 6 Visits) $250(Up to 3 Visits) 14. X-Ray $75 $200 15. Ambulance Ground/Air $150/$750 $200/$600 16. Physical Therapy $20(Up to 6 Visits) $250(Up to 6 Visits) 17. Single Fractures/Dislocations Up to$5,000/Up to$6,000 Up to$5,500/Up to$3,000 18. Lacerations Up to$300 Up to$400 19. Employee Accidental Death,Dismemberment &Catastrophic Benefits Up to$40,000 Up to$100,000 20. Organized Sport Benefit None 25%Youth Organized Sports Benefit 21. Wellness $25 Per Insured Per Calendar Year $50 Per Insured Per Calendar Year (After 12 Month Waiting Period) (Includes COVID-19 Testing) 22. Miscellaneous None None Active Employees Can Port Coverage Active Employees Can Port Coverage Until Until Group Master Policy Terminates or Group Master Policy Terminates or is Replaced; 23. Portability is Replaced; Ported Policies Remain Active Until Policyholder Ported Policies Remain Active Until Terminates Coverage or No Longer Pays Policyholder Terminates Coverage or No Premiums;Ported Policies Terminate When Longer Pays Premium Group Policy is Terminated 24. Value-Add None Auto-Pay Available For Health Screening Benefit if Completed at ER's Health Fair RATE GUARANTEE 1 ear until 1/1 25 25. Employee Only $7.18 $6.47 26. Employee&Spouse $10.72 $10.25 27. Employee&Children $12.54 $12.06 28. Family $16.08 $19.00 0 2023 GALLAGHER BENEFIT SERVICES,INC. Page 18 of 24 AJG.COM Gallagher Mw o ah Mfl,..,w, CQ%Rf,.,9 Critical Illness Insurance Affac. . i.it Group Specified Critical Illness Group Critical Illness-Premier Plan 2 Situs State:FL SELECTED RENEWAL Employee:Actively at Work;Ages 18+ Employee:Actively at Work;Ages 18-99 1. Issue Ages Spouse:Ages 18+ Spouse:Ages 18-99 Child:Under Age 26 Child:Birth to Age 26 2. Participation Requirement Inforce 10 Enrolled Employees Employee:Up to$50,000($5K Increments) 3. Guaranteed Issue Maximum Spouse:Up to$25,000 Employee:Up to$20,000($lOK Increments) Child:50%of Employee Coverage Amount Spouse/Child:50%of Employee Coverage Amount 4. Children Coverage Included Included 5. Pre-Existing Condition limitations* 12/12 None 6. Covered Critical Illnesses Cancer,Heart Attack,Stroke,Major Organ Cancer,Heart Attack,Stroke,Major Organ Failure, Transplant,End-Stage Renal Failure End-Stage Renal Failure Covered At 100% Benign Brain Tumor,Coma,Loss of Hearing/Sight/ Speech,Paralysis,Occupational Hepatitis&HIV, Advanced Alzheimer's Disease,Advanced MS, 7. Other Covered Critical Illnesses Covered At 25% Advanced Parkinson's Disease,ALS,Bone Marrow Coronary Artery Bypass Surgery,Carcinoma In Situ Transplant 21 Additional Conditions For Children Covered At 25% Severe Coronary Artery Disease With Recommendation of Bypass,Carcinoma in Situ 100%Recurrence 100%Recurrence 8. Same Illness Diagnosis(Recurrence) (6 Month Separation Period;6 Months Treatment- (90 Day Separation Period) Free) 9. Different Illness Diagnosis 1 x Each Illness 1 x Each Illness (30 Day Separation Period) (No Separation Period) 10. Maximum Benefit lx Each Illness,lx Recurrence Each Illness lx Each Illness,lx Recurrence Each Illness 11. Benefit Reduction 50%At Age 70 None 12. Wellness $50 Per Insured Per Calendar Year(EE/SP Only) $50 Per Insured Per Calendar Year (Includes COVID-19 Testing) 13. Miscellaneous None None Active Employees Can Port Coverage Until Group Active Employees Can Port Coverage Even if Group Master Policy Terminates or is Replaced;Must be Master Policy Terminates or is Replaced; 14. Portability Covered For at Least 12 Months and Under Age 70; Ported Policies Remain Active Until Policyholder Ported Policies Remain Active Until Policyholder Terminates Coverage or No Longer Pays Premiums Terminates Coverage or No Longer Pays Premiums 15. Value-Add None Health Advocate,Auto-Pay Available For Health Screening Benefit if Completed at ER's Health Fair RATE GUARANTEE 1 year until 1/1/25 Monthly Premium API Monthly Premium $20,000 Employee Only $20,000 Employee Only ates Spouse&Dependent Rates Are Included in the Proposal Spouse&Dependent Rates Are Included in the Proposal Non-Tobacco Uni-Tobacco Issue Age Attained Age • 7 Total Age Bands 6 Total Age Bands 16. Age 35 $8.56 $8.20 17. Age 45 $16.66 $17.00 18. Age 55 $32.70 $35.20 *Diagnosis Look-Back Periods,Treatment/Symptom Free Duration Requirements,Waived Pre-Ex Definitions and Other Restrictions May Apply.The Policy and Certificate Provide Complete Definitions Regarding Eligibility of Any Claim. ®2023 GALLAGHER BENEFIT SERVICES,INC. Page 19 of 24 AJG.COM Gallagher ImaCt a,,Manwpms, CbwMh •TANDARD AGE BANDED RATES/SELECTED Age Monthly Premium-Employee/$10,000 18-29 $2.70 30-39 $4.10 40-49 $8.50 50-59 $17.60 60-69 $32.70 70+ $83.20 Age Monthly Premium-Employee/520,000 18-29 $5.40 30-39 $8.20 40-49 $17.00 50-59 $35.20 60-69 $65.40 70+ $166.40 Age Monthly Premium-Spouse/55,000 • 18-29 $1.35 30-39 $2.05 40-49 $4.25 50-59 $8.80 60-69 $16.35 70+ $41.60 Age Monthly Premium-Spouse/510,000 18-29 $2.70 30-39 $4.10 40-49 $8.50 50-59 $17.60 60-69 $32.70 70+ $83.20 ®2023 GALLAGHER BENEFIT SERVICES,INC. Page 20 of 24 AJG.COM 41) Gallagher mance YµWn.me.a [awJ+q Hospital Indemnity Insurance Afac. I Group Hospital Indemnity-Plan 2 Group Hospital Indemnity-Plan 2 Situs State:FL SELECTED RENEWAL Employee:Actively at Work;Ages 18+ Employee:Actively at Work;Ages 18-99 1. Issue Ages Spouse:Ages 18-64 Spouse:Ages 18-99 Child:Under Age 26 Child:Birth to Age 26 2. Participation Requirement Inforce 10 Enrolled Employees 3. Guaranteed Issue Yes Yes 4. Pre-Existing Condition Limitations' 6/12 None S. Hospital Admission $500 $1,000 6. Hospital ICU Admission Payable Under Hospital Admission Payable Under Hospital Admission 7. Admission Benefit Payments Either Admission or ICU Admission Benefit is Either Admission or ICU Admission Benefit is Payable lx Per Calendar Year Payable lx Per Calendar Year 8. Hospital Confinement Per Day $200(Up to 180 Days) $100(Up to 31 Days) 9. Hospital ICU Confinement Per Day $200(Up to 30 Days) Payable Under Hospital Confinement Either Confinement or ICU Confinement Either Confinement or ICU Confinement 10. Confinement Benefit Payments Benefit is Payable Per Covered Accident/ Benefit is Payable Per Covered Accident/ Illness Illness 11. Pregnancy Covered With 9 Month Waiting Period Covered 12. Newborn Benefits Well Baby Care Benefit:$25(Age 12 Months None or Younger,Up to 4 Visits Per Calendar Year) 13. Mental Wellness&Addiction Recovery None None 14. Wellness None None Surgical and Anesthesia Benefits;Out-of- 15. Miscellaneous Hospital Prescription Drug Benefit;Hospital None ER/p iv4ician Benefit:Intermediate Active Employees Can ort Coverage Until Active Employees Can Port Coverage Even if Group Master Policy Terminates or is Group Master Policy Terminates or is 16. Portability Replaced; Replaced; Ported Policies Remain Active Until Ported Policies Remain Active Until Policyholder Terminates Coverage or No Policyholder Terminates Coverage or No Langer Pays Premiums to Age.70 I orwer Pays Premiums 17. Value-Add None None RATE GUARANTEE 2 ears until 1 1 26 18. Employee Only $18.99 $7.37 19. Employee&Spouse $38.94 $12.49 20. Employee&Children $31.15 $10.29 21. Family $51.10 $18.43 *Diagnosis Look-Back Periods,Treatment/Symptom Free Duration Requirements,Waived Pre-Ex Definitions and Other Restrictions May Apply.The Policy and Certificate Provide Complete Definitions Regarding Eligibility of Any Claim. 0 2023 GALLAGHER BENEFIT SERVICES,INC. Page 21 of 24 AJG.COM CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 oka._J Gallagher Flexible Spending Account (FSA) Administrati0rragement Consulting Current/Selected Renewal MedCom Set Up Basic Plan Set-Up Waived Enrollment Processing Fee Per Participant (IF there is an enrollment fee per participant) $0 $0 Enrollment Processing Cost (Enrollment Fee x #Participating) $0.00 $0.00 Additional Services(and Fees) Summary Plan Description (New) Included Included Discrimination Testing (1st Year) Included First Year Only Included First Year Only Paper Enrollment Kits Per Kit N/A N/A Initial Debit Card Fee(1 card) Included Included Replacement/Additional Debit Card Fee Administration Fees: Participants Current Renewal Annual Renewal Fee Waived Waived Minimum Monthly Admin Fee $50.00 $50.00 37 Monthly Administration Fee Per Participant $4.50 $4.50 Total Monthly Admin Fee $167 $167 (Monthly Fee x #participating) Monthly Premium (Not Including Set Up Fees) $167 $167 Yearly Premium (Including Set Up and Renewal Fees) $1,998 $1,998 Yearly Difference($) $0 Yearly Difference(%) 0.0% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's contractual provisions. All rates subject to change based on final enrollment, contribution and underwriting. Employee Count from EN 10-5-23. The information contained herein is subject to the disclosures and disclaimers on the final page of this review. 22 ©2022 ARTHUR J. GALLAGHER CO. AJG.COM a CITY OF ATLANTIC BEACH -EFFECTIVE 01/01/2024 46) Gallagher COBRA Administration Insurance j Risk Management I Consulting Current/Selected Renewal Im•lementation Costs MedCom Set Up Waived #Occurrences on Takeover 0 0 Basic Plan Set Up $0 $0 Take Over Fee(Cost Per Current Participant) $0.00 $0.00 Total Set Up $0 $0 Yearly Difference($) $0 Yearly Difference(%) 0.0% Additional Services(and Fees) Annual Renewal Fee Waived New Hire Initial Notice $3.00 $3.00 Per COBRA Notification Per Eli!ible Em.lo ee O.tion Admin Eligible Employees 123 123 Minimum Monthly Admin Fee $40 $40 Monthly Admin Fee Per Eligible Employee $0.60 $0.60 Monthly Admin Fee (Monthly Fee x #participating) $74 $74 Monthly Premium (Not Including Set Up Fees) $74 $74 Yearly Premium(Including Set Up Fees) $886 $886 Yearly Difference($) $0 Yearly Difference(%) 0.0% This is a summary of benefits only and is not intended to be a complete outline of the illustrated plan's/plans' contractual provisions. 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