Explanation
BACKGROUND:
Funding for the medical insurance program is necessary to ensure continuation of the city’s medical program. Included within the medical program are COBRA and tobacco cessation services. Insurance programs must be maintained in accordance with the negotiated labor contracts. The Department of Human Resources requests to contract with Community Insurance Company dba Anthem Blue Cross and Blue Shield and to provide funding from February 1, 2026 through December 31, 2026 for this program. This ordinance represents the first year of this contract. This contract has an initial term of 11 months and will continue, with approved appropriations until December 31, 2028 with the option of two one-year renewals.
In April of 2025, the Department of Human Resources, with assistance from Marsh & McLennan Agency, our employee benefits and wellness consultant, went out to bid for a medical and pharmacy third party administrator via RFP030095.
The RFP team interviewed 3 medical program finalists. After careful consideration and evaluation, Community Insurance Company dba Anthem Blue Cross and Blue Shield was selected as being the lowest and best bid for medical third-party administrator services for the city.
Cost estimates for 2026 are based on weighted 2023, 2024 and 2025 benefit fund expenditures, using a weighted average of actual city utilization, expected changes due to union negotiations, as well as input from the City's employee benefits and wellness consultant. The Department of Human Resources requests to contract with Community Insurance Company dba Anthem Blue Cross and Blue Shield and to provide for funding February 1, 2026 through December 31, 2026.
Outside of the Community Insurance Company dba Anthem Blue Cross and Blue Shield contract, but included in the medical program appropriations, are the annual Patient-Centered Outcomes Research Institute (PCORI) fee appropriations at $85,000.00. PCORI fees were initiated as part of the Affordable ...
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