Satellite Beach presentation recommends Cigna after RFP; plan year to shift to fiscal year

Sean Fleming, a senior benefits consultant with the Pickering Group, told the Satellite Beach City Council on Aug. 20 that an RFP for the city’s employee health insurance produced a recommended renewal with Cigna.

Fleming said the market has shown sharp increases driven by medical inflation and a small number of very large claims. He reported the plan’s typical deductible and out-of-pocket structure under the current schedule: a single deductible of $500, a family deductible of $1,000, and out-of-pocket maximums of $3,000 for individuals and $6,000 for families. He said the city’s loss ratio had moved from 73% last year to roughly 116% so far this year, largely because five claims over $50,000 accounted for about 55% of plan costs; three of those five claims are no longer ongoing.

Fleming summarized proposals he received after the RFP: FMIT’s renewal at 31.4% (about $632,000), Cigna’s medical proposal at 12.4% (the consultant’s recommended option), and negotiated dental renewal at about 8.7% when packaged with vision. He told the council that Cigna’s pharmacy formulary could move some drugs to lower tiers for employees, which might reduce out-of-pocket pharmacy costs for some members. "Ultimately, the 12.4% with Cigna was the best medical offer," Fleming said.

The presentation also recommended changing plan accumulators so deductibles and out-of-pocket maximums run Oct. 1 to Sept. 30 to align with the city fiscal year. Fleming and a council member said that change should prevent employees from repeatedly resetting a deductible within short calendar-year spans if the city changes carriers or plan features.

Fleming gave utilization data for the city’s employer health clinic: 45% employee engagement, 78 unique patients and 261 visits over a 13-month period, with 87% of visits in person and an internal net promoter score reported as 100%.

Council members asked clarifying questions about the timing change and utilization; no formal vote was recorded on the presentation itself. Fleming said he would take questions and proceed with next steps for implementing the recommended renewal if the council directed staff accordingly.

This presentation followed an RFP process and a year in which carriers narrowed options; Fleming noted Humana exited the group commercial market and that fewer carriers reduces leverage in negotiations.