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Item E BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: September 5. 2001 Division: Public Works Bulk Item: Yes No -1L- Department: Engineering AGENDA ITEM WORDING: Discussion and approval of proposed Capital Improvement Plan for FY2002. ITEM BACKGROUND: The capital improvement plan is presented to the BOCC on an annual basis and included as part of the budget process. PREVIOUS REVELANT BOCC ACTION: On June 12,2001, the BOCC began preliminary discussions of the projects to be included in the FY2002 capital improvement plan. The proposed capital plan was presented to the BOCC on August 16,2001, for their review. CONTRACT/AGREEMENT CHANGES: n/a .' STAFF RECOMMENDATIONS: Approval of Capital Plan for FY2002. TOTAL COST: BUDGETED: Yes No COST TO COUNTY: REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year APPROVED BY: County Atty. _ ~/?.8'~ ( ITEM PREPARED BY: DIVISION DIRECTOR APPROVAL: DOCUMENTATION: Included -1L- To Follow_ Not Required_ e/ DISPOSITION: AGENDA ITEM # en I- Z W ~ 0 z w Ol ~ c: ~ ~ Q) Q) Z ~ ~ () ..J () a.. 0 I- III Z .- W 0 0 ~ N W ..0 > .- 0 en 0::: ::J Ol a.. ::J ~ <( ..J ~ I- a.. ~ () 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ,..: cD CD- N en N ,..: .- co I'- I'- ll) I'- ll) C1l ..- '<t '<t C1l ..- C1l N .- cD ~ ~ ~ ~ ~ ~ ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 cD cD cD M cD N 0 CD CD CD C') CD C') ..... 0 '<t '<t C1l '<t C1l cD ~ ~ ~ ~ ~ ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Ol N ,..: ,..: ,..: .0 .0 cD '<t '<t ll) ll) ..- N ..- 0 N C1l ~ '<t C1l C1l ~ .0 ~ ~ ~ ~ ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CO N ci as ci as as ,..: I'- 0 C1l C') '<t '<t C1l 0 N I'- ..- CO '<t '<t CO ~ ~ ~ .0 ~ ~ ~ ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I'- ci as ci cD en en en 0 CD 0 r:: C') C') I'- 0 C') ;.; I'- '<t '<t CO .... ~ ~ .0 ~ ~ ~ CO ~ Q) >- 0 0 0 0 0 0 ro 0 0 0 0 0 0 0 0 0 C!- O. 0 t) ci ci -.i N l/) M M u: to 0 0 0 CD ll) CD CD '<t '<t CO 0 N ~ .0 ~ ~ ~ Ifl ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ci ci ci -.i N N .0 LO 0 0 ll) C1l N N C1l 0 o. 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N CO 0) V ~ o 0 o 0 o 0 0) aD C<') CO ~ 0) N" ~ o 0 o 0 o 0 cD 0) ~ ~~ ~ ~ ~ o 0 o 0 o 0 cD~ C<') .... 10 V~ ~ ~ ~ o 0 o 0 o 0 aD as N <Xl 10 ~ o 0 o 0 o 0 aDo) .... CO 10 0) o ~ ~ o 0 o 0 o 0 aD aD o 10 10 ,.... o .... ~ o 0 o 0 o 0 aDri ~ ~ o ~ 2 U Q) -e- o. .c U ~Cii ;,e -- .... c: CD e =c;l o o o o 0) ~ ~ ~ o o o 0) ~ ~ o o o cD ~ ~ o o o ri ~ ~ o o o ri ~ ~ ~ ~ ~ o o q ~ ..... ~ o o o o .... ~ o o o o ~ ~ ~ - ~ Cl Cl 'I'"' - Q) > +- eu "5 E ::l U en e o ~ ca 'C Q, e Q, i' ~ t- - '0 c;: Q) e ~ e. ::l (J) ~ o o ~ ~ ii3 III X M ~ ~ 2 ~ CO) - Q) 0) "0 ::l CD olJ - c: Q) E Q) 0) ctI c: ctI :2 - o Q) U ~ BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: September 5.2001 Division: Management Services Bulk Item: Yes Services No XX Department: Administrative AGENDA ITEM WORDING: Discussion and approval of proposed changes to the Group Insurance Program in order to reduce ad valorem costs. ITEM BACKGROUND: During the budget workshop of July 20, 2001, the Board of County Commissioners suggested we readdress the group insurance proposals recommended on March 13,2001 as a means to reduce the impact on taxpayers. This was done at the August 15,2001, BOCC meeting and at that time, it was recommended we agenda for the September 5, 2001, meeting. PREVIOUS REVELANT BOCC ACTION: The last major presentation on Group Insurance was on March 13, 2001. CONTRACT/AGREEMENT CHANGES: Not applicable STAFF RECOMMENDATIONS: TOT AL COST: ,:.. BUDGET.ED: Yes No --- COST TO COUNTY: REVENUE PRODUCING: Yes No AMOUNTPERMONTH_ Year APPROVED BY: CountyAtty_ OMBIP~_ ~agement_ DIVISION DIRECTOR APPROV AL:jt/)/ ~~ , James L. Roberts DOCUMENTATION: Included To Follow_ Not Required AGENDA ITEM #~ DISPOSITION: September 5, 2001 At the July 20,2001, budget workshop, the Board of County Commissioners asked that we readdress our March 13,2001, proposals. On August 15, 2001, we were asked to agenda for September 5, 2001. As of July 2001, we have a total of 2,607 individuals covered under our group insurance program. Recommendations - Note 70% of cost savings will impact ad valorem funds and 30% will impact other revenue sources. (Item 3 from March 13,2001 Proposals) Implement a charge for all current retirees and all employees employed by the county prior to October 1,2001, upon their satisfying all retirement requirements. The charge should be $100 per month for their insurance. Group Insurance will assist all retirees who do not claim their Retiree Health Insurance Subsidy fonn the FRS with the process to obtain it. Implementation date of January 1,2002 (originally recommended 10/1/01). The amount of the subsidy is based on service credit at retirement, $5 for each year of service, with a minimum monthly subsidy of$50 and a maximum of$150. The County pays FRS for Insurance Subsidy. This item was recommended by the Task Force during 2000. The administration concurs but is willing to consider a different amount commensurate with the amount received by retirees to assist with the provision of health insurance. . Savings 191 retirees (255 retirees x 75%) x 100lmo x 9 months $171,900 Medical savings not projected because we should be secondary for those individuals who drop coverage. 2 (Item 13 from March 13,2001 Proposals) At present, covered individuals are responsible for 20% ofheaIth care costs on a total cost of$10,000. Thereafter the plan pays 100%. Recommendation is to change the base limit to $20,000. On March 13,2001, the amount was raised from $10,000 to $11,000 with direction to raise amount by 10% a year until it reaches $20,000. Recommend we go immediately to $20,000. Claims between $10,000 and $20,000: ,::tJ. Year Emnloyees SavinlZs - Sept 1999 130 $165,150 Sept. 2000 137 $190,900 June 2001 (9 months) 125 $160,000 -"" Projected Savings (Effective January 1, 2002) $120,000 3. Monroe County has one of the most economical pricing structures for dependant care in the County. We have looked at alternative pricing structures to shift more of the cost of dependant. 80th of these options are detailed on the attached sheet: Dependant Coverage: Option A: Spouse Children Family Savings Option 8: One Child Spouse Only Children Family Savings (Effective January 1,2002, after open enrollment) ---- $290 $218 $508 $491,634 $238 $281 $346 $202,500 ...::W ...' "0 n a c: "0 =t o ,CD en 3. ~ ::0 ::0 ,!a' 0) 'CD , ii. I' n'~ w w'~: "'~~:'I'~~1 O,::T '"0"0 ; n: < -, 0 0 ::T' ClI (II c: c:: _.1 "'0:-0' "'l "tl en en e:i CD 1 CD I' ~"'l CD CD I '::l:::l ClI ,.g QO O:~I ifirifir' C' 0 ---- C') 2. 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C') ~ ~^ I\):E ""'" ""'" (J) n ::T o Q. III a C') o c: l .::1 ~"< I\) . W CXl W "0 o c: en CD Ci) a c 'tI 5' (II C "'l m = n CD o "E. o' ::l , )> ,~ I\) co o C') ::T 0) ::l to ~CD C1I I\) m 3 '"0 5' '< I\) CD ....CD CXlen FKAA Current monthly- dependent coverage rates (FKAA SUBSIDIZES 1/3- DEPENDENT COVERAGE RATE PER UNION CONTRACT) : PREMIUM: $179.46 - spouse only $133.83 - child only $366.55 - family coverage - Recent RFP done by FKAA (July 2001) - only two fully-funded proposals were received, all others were self-funded proposals. FKAA union employees had their union find an insurance carrier just for union employees and their dependents. " FKAA does not anticipate going self-funded due to funding co~t. Their recommendation at this time is to split their employees coverage (union and non-union). Union employees would be insured by the union plan and their non-union employees (80) would remain insured with League of Cities. Union Plan - $100. Deductible/90% reimbursement UCR/no PPO or network/Medical/Dental/Vision/RX coverage. PREMIUMS 10/01/01: $365.00 - employee $183.35 - 1 dependent $267.63 - 2 or more dependents League of Cities - Plan changes - increase co-pay from $20 to $30/out of network reimbursement only 50%. ....~.. PREMIUMS 10/01/01: $522.20 $247.51 $331.90 $632.67 ....' - employee (paid by FKAA) - chirciren only (employee paid). - spouse only (employee paid) - family coverage (spouse and children) (employee paid) *NOTE: ABOVE DEPENDENT COVERAGE PREMIUMS SUBSIDIZED 1/3 BY FKAA. *NOTE: only. Above premiums are for Medical and Prescription coverage Dental and Vision additional premiums. CITY ELECTRIC SYSTEM 51% increase last year with League of Cities. Current monthly dependent coverage rates: $240.66 - spouse only $185.14 - children only $425.80 - family coverage *NOTE: CES does not subsidize any of the dependent coverage ?remiums. Currently CES has 154 active employees and 120 retirees. - <.. Recent RFP done by CES (July 2001) - will recommend to continue with League of Cities with an increase of 21%. CES does not anticipate going self-funded at this time due to funding cost. PREMIUMS 10/01/01: $465.93 $291. 20 $224.01 $515.33 - employee (CES pays) - spouse only (employee paid) children only (employee paid) family (spouse and children) (employee paid) *NOTE: CES does not subsidize any of the dependent coverage premiums . ~ *Note: Above premiums are for Medical and Preseription coverage only. Dental and vision additional prem:i:ums. CITY OF KEY WEST Ci ty expects go have RFP's out by the first or second week of August. They are currently insured with League of Cities, Silver Plan. : $313.58 - employee (CES pays) $277.03 - spouse only (employee paid) $205.59 - children only (employee paid) $482.62 - family coverage (spouse and children) (employee paid) Current Premiums: *Note: Above premiums are for Medical and Prescription cover~qe '. only. Dental and vision additional premiums. *Total coverage including (medical/dental/vision/prescription) for family would be $545.09 ($482.62 med/RX, $43.30 dental, $19.17 vision) ,..r ,...' ~ MONROE COUNTY SCHOOL BOARD Actual percentage increases not available. Current monthly rates (based on 10 months): *NOTE: Increased February 2001 - first increase in nine years $93.55 to $111.31 - employee pays (board subsidizes 78%) $250.67 to $314.79 - family (one or more) employee pays (board subsidizes 22%) Other plan changes made February: Deductible $300 to $400 (two per family); Beechstreet network 85% to 80%; out-of-network 80% to 70%; added 3rd tier to RX plan *NOTE: only. Above premiums are for Medical and Prescription co~~rage Dental and Vision additional premiums. At this time the Monroe County School Board is unsure of whether they will be going out for RFP this year. They do not anticipate a rate increase in October as their rates were just adjusted February 2001. ""... 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III ~ 0 ? ::I (") cr =- cr ::I III (") &r III It -< III 0 III < 0 ::I tT 0" tT iil ~ It iil ; AUC-31-01 12,40 FROM,MONROE COUNTY AT TV OFFICE 10,3052923516 PACE 1/4 Board of County Commissioners RESOLUTION NO. -2001 A RESOLUTION CANCELLING RESOLUTION NO. 104-1999 AND 119-2001 AND AMENDING RETIREMENT ELIGIBILITY REQUIREMENTS FOR GROUP HEALTH INSURANCE COVERAGE FOR MONROE COUNTY EMPLOYEES. WHEREAS, group health insurance expenses have been steadily increasing; and WHEREAS, the number of retired County employees continues to increase dramatically each year; and WHEREAS, it is the intent of the Monroe County Board of County Commissioners to allow COWtty employees, including employees of the Constitutional Officers and the Mosquito Control Board, who meet the criteria established in this resolution to retire through the Florida Retirement System and maintain their group health insurance benefits with Monroe County as provided herein; now, therefore, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA: Section 1. A. Employees in FRS Regular and Special Risk Classes with a minimum of ten (10) years of full-time service with Monroe County, who retire on, or after, their nonnal retirement date as described in Sec. 121.021(29), F.S., and who are covered under the group health insurance coverage provided by Monroe County upon retirement, employees in other FRS Classes who complete the number of years of creditable service required by the Florida Statutes to be eligible for a benefit Wtder FRS, who retire on, or after, their nonnal retirement date under Sec. 121.021(29) F.S., and who are covered under the group health insurance coverage provided by Monroe County upon retirement, including those who have retired or will retire in accordance with these provisions, and all other retirees who as of October 1,2001 are participating in the County's group insurance program at no cost, may maintain their group health insurance benefits.,_ with Monroe County following their retirement., provided such retirees pay to Monroe County the following monthly premium: (i) One hundred dollars ($100.00), or such other amount as detennined by the Board of County Commissioners. Page 1 HUu-~l-~j l~'~l ~KUM'MUNKUC ~UUN1Y HllY U~~l~~ ID'~052S2~516 PACE 2/4 (ii) The payment of the initial premium under this subsection I.A. for those employees who retired prior to October 1, 2001, is due on January I, 2002 and the first day of each month thereafter. For employees who retire on or after October I, 200 I, their initial premium will be due the latter of January 1, 2002, or on the first day of the month following the month in which they retire and the first day of every month thereafter. B.) Employees with ten (10) years of full-time service with Monroe COWlty who are covered Wlder the group health insurance coverage provided by Monroe County upon rerirement and retire on their early retirement date, as described in Sec. 121.021(30) F.S., may maintain their group health insurance benefits with Monroe County following their early retirement, provided such early retirees pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premium will be payable on the first day of every month commencing with the month following the month in which the employee retires. Notwithstanding the foregoing, early retirees required to pay the premiums described in this subsection I.B. will become subject to the premium set forth in subsection 1.A. above upon meeting one of the following requirements: (i) Sixty (60) years of age for Regular Class employees or fifty-five (55) years of age for Special Risk Class; or (ii) Qualification Wlder the Rule of 70 wherein the combined years of service with Monroe County and the retiree's age equal a total of seventy (70). C.) Employees with at least ten (10) years of full-time service with Monroe COWlty who are covered Wlder the group health insurance coverage provided by Monroe County upon termination of employment and are fully vested under FRS who elect not to retire under FRS upon termination of employment with Monroe COWlty, may elect to re-enroll Wlder the group health insurance coverage provided by Monroe County upon retirement under FRS, provided that Monroe County was their last FRS employer. Fonner employees electing this option, may maintain their group health insurance benefits with Monroe County following such election, provided such former employees pay to Page 2 ~U~-~J-~J J~'~J ~KUM'MUNKU~ ~UUN~Y AITY U~~I~~ ID.3052823516 PAGE 3/4 Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premiwn will be payable on the first day of every month beginning with the first of the month following the month in which the employee elects to re-enroll under the group health insurance coverage provided by Monroe County upon retirement from FRS. Employees electing this option must, notify Monroe County of their intent within thirty-one (31) days of retirement to re-enroll in the County's group health insurance program. If Employee does not notify Monroe County within thiny-one (31) days of retirement of their intent to re-enroll, they will have to wait until open enrollment. Employees who elect to re-enroll under this option are not eligible for premiwn adjustments under subsection 1.A. or I.B. of this resolution. D.) Employees with less than ten (10) years of full-time service with Monroe County who are covered under the group health insurance coverage provided by Monroe County upon termination of employment and are fully vested under FRS, upon retirement under FRS, including those employees retired prior to October I, 2001 in accordance with these provisions, may maintain their group health insurance benefits with Monroe County following their termination of employment, provided such terminated employees pay to Monroe County a monthly premium in an amount established annually by the Board of County Commissioners. The premiwn will equal, but not exceed, Monroe County's monthly departmental cost for active employees. Such premium will be payable on the first day of every month beginning with the first of the month following the month in which the c:mployee terminates employment with Monroe County_ Employees with less than ten (10) years of full-time service with the County are not eligible for premium adjustments under subsection I.A. or I.B. of this resolution. E.) Notwithstanding the foregoing, employees with a hire date on or after October 1,2001 may, upon their retirement under FRS, maintain their group health insurance benefits with Monroe COWlty following such retirement, provided such former employees pay to Monroe County a monthly premiwn in an amount established annually by the Board of County Conunissioners. The premium will equal, but not exceed, Monroe County's monthly departmental cost for active employees and will be payable on the first day of every month beginning with the first of the month following the month in which the employee retires under FRS. Employees with a hire date on or after October I, 200 I are not eligible for premium adjustments under subsection 1.A. or I.B. of this resolution. Page 3 AUG-31-01 12,41 FROM,MONROE COUNTY ATTY OFFICE 10,3052823516 PAGE 4/4 Section 2. This resolution shall be effective as of October 1, 2001. Section 3. This resolution does not affect any requirement of eligibility with the Florida Retirement System; it affects only eligibility to receive health insurance benefits under the Monroe County Group Employee Benefit Plan. Section 4. For purposes of this resolution, full-time service shall have the meaning provided in the County's policies and procedures governing determination of service. For purposes of this resolution, the definition of date of hire is the date an employee first begins work for Monroe County determined in accordance with the County's procedures governing fringe benefits. Any break in employment offony-eight (48) hours or more will result in a new date of hire if the employee returns to County service. Section 5, The Monroe County Board of County Commissioners formally reserves the right to any and all future changes and modifications of this resolution, the group insurance contract providing health benefits described herein and/or the required premium. contributions. Section 6. The Monroe COWlty Board of COWlty Commissioners cancels Resolution No. 104- 1999. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the day of , 200 I. Mayor George Neugent Mayor Pro Tern Nora Williams Commissioner Dixie Spehar Commissioner Charles "Soooy" McCoy Commissioner Munay Nelson (SEAL) ATTEST: DANNY L. KOLHAGE) CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By By Page 4 Deputy Clerk REQUEST FOR PROPOSAL THE UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA, hereinafter called UTILITY BOARD, operator of the City Electric System, hereby gives notice to prospective bidders that sealed proposals will be received by said UTILITY BOARD, at the Finance Department, 1001 James Street, Key West, Florida 33040, until 1 :30 p.m. on FRIDAY, JUNE 22,2001 for: CES RFP NO. 20-01 SPECIFICATIONS FOR EMPLOYEE BENEFITS PROGRAM The Utility Board has instituted the DemandStar.com system to provide current information to potential bidders. This system allows you to receive bid information quickly and at your convenience 24 hours a day, seven days a week. Specifications may be obtained from their website at (www.demandstar.com) DemandStar website or phone: (954) 577-3915. Registered vendors will be notified automatically of all Request for Proposals. All Bidders are required to submit: One (1) original and seven (7) copies of each proposal are to be enclosed in a sealed envelope marked on the outside: Attn: Letisia Powell CES RFP NO. 20-01 SPECIFICATIONS FOR EMPLOYEE BENEFITS PROGRAM Failure to submit one (1) original and seven (7) copies of the proposal may result in non- compliance and the bid may be rejected. Each proposal shall constitute an offer to the UTILITY BOARD, as outlined therein, and shall be irrevocable after the time announced for the opening thereof. At a meeting of the BID OPENING COMMITTEE to be held in the Louis Carbonell Board Room at the William Arnold Service Building, 1001 James Street, Key West, Florida on Friday, June 22, 2001 at 1 :30 p.m. proposals will be opened and publicly read aloud. Any proposals received after the time announced herewith for the opening will not be considered. THE UTILITY BOARD reserves the right to reject any or all proposals, to waive irregularities and informalities in any or all proposals, and to separately accept or reject any item, items, bid schedule or bid schedules of the proposal which the UTILITY BOARD deems to be in the best interest of the UTILITY BOARD. Patrick Cates, Materials Service Supervisor Utility Board-City of Key West ~.3 J... ~ CES RFP #20-01 Utility Board of the City of Key West, Florida REQUEST FOR PROPOSALS EMPLOYEE BENEFITS PROGRAM HEALTH PRESCRIPTION DENTAL LONG TERM DISABILITY AND ALTERNATE SELF INSURANCE HEALTH PLAN CLAIMS ADMINISTRATION MEDICAL BENEFITS EXCESSSTOP-LossINSURANCE PRESCRIPTION MANAGEMENT PLAN OCTOBER 1, 2001 EFFECTIVE DATE GENERAL SECTION General Information The following items are desired in arranging the Utility Board of the City of Key West, Florida's (AKA City Electric System (CES)) employee benefits program. In some instances, all items may not be available or may require modification. CES solicits modified proposals to the extent that they provide adequate coverage in view of the overall program objectives. Proposers are not required to submit quotations on all coverages requested. However, the proposal should clearly indicate which coverages or services, if any must be purchased together. CES also wishes to explore a Self-Insured plan (Self-Insured with Stop Loss). This will include Third Party Administration, Specific and Aggregate Stop-loss insurance, Claim and Reporting Service as well as needed actuarial evaluations. CES and its representatives have exercised due care in preparing this Request for Proposals (RFP). All information contained herein is believed to be substantially correct. However, Proposers should verify information independently if desired. CES and its representatives do not warrant the accuracy of information contained herein. 2 CES RFP #20-01 Background Information The Utility Board was initially created by the City Council and subsequently was established by an Act of the Florida Legislature in 1945 to operate and maintain the System. The present form of the Utility Board was created in 1969 by the Florida Legislature and was given control of the System. The Board is composed of a Chairman who is elected for a term of two years and four members who are elected for a term of four years by the voters of the City. The Utility Board exercises exclusive control and management of the System and appoints its Vice-Chairman. The General Manager of the System serves as the Secretary of the Utility Board and is also responsible for the day-to-day operations of the System, including the hiring of employees. Neither the City nor any other board, officer or agency of the City has any control over the operation or management of the System or of the Utility Board. The City must approve the issuance of bonds by the Utility Board. The System's assets are protected through the Risk Management Program developed and managed by the Risk Management Section. The System currently owns, operates, and maintains nine generating units with total maximum net continuous capability of 50.4MW. This includes units at Stock Island, Big Pine Key and Cudjoe Key. Coverages Requested CES pays the full cost of Health coverage for employees. Employees pay the full cost of coverage for eligible dependents on the health insurance and all dental benefits. CES pays the premium for the long-term disability. Health Insurance CES currently offers employees a POS plan with the Florida League of Cities, which includes prescription drugs. The current drug co-pay is $10.00 generic, $20.00 preferred brand, and $35.00 non-preferred brand. Dental Coveraae Dental coverage is provided for employees and dependents by Florida League of Cities. Prescriotion A separate stand-alone prescription management program is solicited for evaluation and a possible separate purchase outside the medical plan Lona Term Disabilitv CES is currently offering income protection insurance to its employees. Premiums are paid by CES. It wishes to continue offering long-term disability. The current program provides up to fifty percent (50%) salary replacement. Details of the plan and rating information are included in the Exhibit Section of this RFP. 3 .... 'I Effective Date of Coverage The effective date of coverage is to be October 1, 2001. Proposals are requested to be effective until November 15, 2001 in the event that a continuation of the current coverages is necessary. Proposals must be returned on or before June 22,2001 at 1 :30 PM. Firm Proposals Any proposal may be withdrawn until the date and time set for the return of the proposals. Any proposal not so withdrawn shall constitute an irrevocable offer until November 1, 2001 to provide the services set forth in these specifications, or until one or more of the other proposals have been awarded. It is currently anticipated that an award will be made by August 22 ,2001. CES will make its decision regarding proposal award(s) based upon the determination of what is in the best interest of CES. Such award may be all or part to one or more vendors. CES reserves the right to reject any or all proposals and to waive any technicalities or informalities in proposals received. CES reserves the right for any reason to withdraw this RFP prior to the date/time proposals are due and/or to make no award should circumstances change. Requests for Additional Information Every effort has been made to provide complete and accurate information. Should proposers need additional information, requests should be made in writing to CES' independent Risk Management and Benefit consultants: 4 Sharon M. Jakobi CPCU, ARM or Lawton Swan III, CPCU, ARM Interisk Corporation 1111 No. Westshore Blvd. Tampa, FL 33511 8132871040 8131871041 (Fax) Reauests must be submitted "rior to June 1.2001.3:00 PM. If warranted, an addendum to the RFP will be issued providing available requested information. Such an addendum, if issued, will be sent to all registered proposers. Clarifications & Right to Negotiate CES reserves the right to request clarifications of information submitted and to request additional information of one or more Proposers if necessary. CES reserves the right to negotiate with, or not negotiate with, any individual Proposer. Proposals should indicate a contact representative who has the authority to negotiate. Authority of Proposers and Agent Involvement In order to be accepted, Proposals must be signed by an authorized representative of the insurance company(ies) or other organizations underwriting/administering the program. If the submitted agent/broker does not have the authority to sign the proposal, it must be signed by an authorized representative of the company. Proposals submitted without binding authority will not be considered. All proposers must be currently licensed in the State of Florida to transact business of the types proposed. Verification of proper licensing may be requested. Any insurer/provider contacted directly by CES shall not be available for agent/broker participation. In these instances, no commissions or finders fees shall be paid. No agent of record letters will be given by CES. Any agent or agency submitting a proposal must be properly licensed by the Insurance Department of the State of Florida to represent the Company that is submitting the proposal. References Proposers must supply references, preferably Florida governmental employers, who currently contract with the Proposer. References must include the name and phone number of a contact person. 5 " Renewal Terms It is the intent of CES that the coverages and contracts, as awarded, shall be renewable at CES' option for successive periods, not less than annually. However, if meaningful and unsatisfactory changes in premium, coverage or service occur, CES may exercise an option to obtain competitive quotations. Please include the formula or method in which premium changes will occur on annual renewals. Sample Forms and Policies Sample employee handbooks and other complete and accurate coverage and contractual information are required as part of the proposal. Sample Claim reports must be included. Rate Change/Policy Modification Rates must be guaranteed for at least one (1) year, preferably longer if possible. The insurer/provider must provide one hundred and twenty (120) days written notice to CES prior to any increase in rates or modification resulting in restriction of existing policy terms, limits, or provisions. Termination/Non-Renewal Notice One hundred and twenty (120) days written notice to CES is requested for termination or non- renewal, except when the reason for termination is for non-payment of premium. Enrollment It is anticipated that Open Enrollment meetings for all coverages will occur beginning September 17, 2001. It is the Proposer's responsibility to provide sufficient forms, brochures, and personnel to accomplish enrollment. Please be advised that CES is geographically spread from Key West to Marathon Key. Employee/Retiree Eligibility CES currently has 154 employees, 5 Utility Board Members, 1 Utility Board Attorney, 99 retirees and 1 person on COBRA who are eligible for insurance benefits. Insurer definitions of eligible participants must include appointed Board Members, Retirees and Domestic Partners. Currently CES has 11 domestic partner dependents. Only eligible full-time employees and retirees are included in the plan. CES employees are eligible for benefit participation on the first day of the month following their 30th day of employment. The Board of Directors are eligible for participation as of the first day of employment. 6 Retirees are eligible for continued coverage after 20 years of service or 10 years of service and attained age of 55. . All presently insured employees and their dependents are to be covered by proposed plans whether at work or disabled on the effective date of coverage. Any COBRA participants, their dependents or anyone eligible to elect COBRA prior to such election must be eligible for coverage. No Activelv-at- Work Exclusion Employees and their dependents who are absent from work due to health problems and retirees and their dependents who are disabled on the date of plan inception are to be automatically covered as any other employee except for conditions provided by the previous insurer or applicable State or Federal Laws. Notice of Claim The procedure for reporting a claim should be included along with a description of how claims are handled and the average time required to pay claims (claim turn around time). The claim paying location should be indicated. Claim Consultation and Statistical Reports CES requests that the successful Proposer(s) submit monthly experience reports. Reports should be completed in plain English and received by CES within twenty (20) days following the end of the month. As a minimum, reports must include premium, claims paid and enrollment. More detailed utilization data will be required on a quarterly basis. Copies of reports must be included for review. Reports should continue in the event of termination of the benefit program or changing to another insurer or service provider. If the benefit program is terminated, reports should continue to be provided on a monthly basis for at least 6 months. Stability of Insurers It is preferred that insurers furnishing coverage be stable and have a current A.M. Best Company rating of "A" or better and be of sufficient financial size to provide stability and security for the successful operation of the benefits program of CES. Non-insurance company proposers which are not rated by A.M. Best must submit a financial statement showing results for at least the past three years and current financial status. 7 .a , Provider Organizations CES is interested in utilizing Preferred Provider Networks if available. Proposers must include copies of the network provider listing that can be made available to the employees and dependents of CES. A significant portion of the evaluation process will include the extent and quality of available provider networks. Premium/Billing Reports The successful Proposer shall accept a self.administered monthly billing report created by CES. CES would prefer to pay a one month's deposit at the effective date and pay the monthly premium at the end of each covered month so that staff can reconcile the census data with their Finance Department. Employee Handbooks & Provider Directories Proposals must include the cost of employee handbooks. These documents must be distributed at the open enrollment in September. Exceptions to Specifications To be considered by CES, any specific exceptions by the vendor to these specifications and conditions must be listed and fully explained on the proposal forms or on a separate letterhead (if additional space is needed.) The vendor's standard form will not be acceptable for this purpose. Use of Proposal Forms Proposers must complete the proposal forms included and made part of this request. It is important that the proposal form be signed by an authorized representative of the insurer/service provider in order to receive consideration. Additional information or proposal forms may be submitted as a supplement to the enclosed forms. 8 Utility Board of the City of Key West, Florida REQUEST FOR PROPOSALS EMPLOYEE BENEFITS PROGRAM OCTOBER 1, 2001 EFFECTIVE DATE Medical Benefits Current Coverage/Plan Details CES currently provides employees a POS program through the Florida League of Cities. CES contributes 100% of the Employee's cost for coverage. Employees can elect to cover their dependents with only one dependent tier option and full family. CES wishes to provide a Medicare Supplement alternative for retired or active employees who are 65 years old or older and eligible to receive medical benefits. Please include a rate and benefit schedule for this option. A summary of benefits is included within the Exhibits. Coverage structured in a similar manner is preferred. It is recognized that there may be some slight coverage variations and, therefore, Proposers must provide copies of sample policies. booklets. forms and riders. Employee Enrollment Successful Proposers will be expected to provide adequate materials and personnel for an open enrollment. Proposers will be expected to attend enrollment meetings with employees and should anticipate three full days of meetings. Coverage Desired The major medical lifetime limit must be at least $1,000,000. The current deductible is $0 in network per individual and $500 individual $1,500 per family out of network. The coinsurance percentage for payment is 60%. CES wishes to better their present plan if applicable. Alternative proposals are desired. All proposals must conform to applicable federal and state legislation. Plans similar to the current plans are desired for ease of transition. However, alternatives will be considered. 9 ., \ Family and Other Approved Leaves of Absence Insured employees are to be eligible for continued individual and family coverage during official leaves of absence. Permissible leaves include, but are not limited to family, those for medical and maternity conditions, and other personal reasons qualifying under CES. Insured employees who elect not to continue benefits for dependents during an approved family/medical leave must be eligible for full benefits upon their return to work with no waiting period and no pre-existing condition period. Actively At Work Provision Proposers must waive the "Active Iv At Work" provision. subiect to applicable Federal and State laws. included in standard policy wording for all currently enrolled employees, retirees, dependents and others. This provision should apply to new enrollees. Proposals, which exclude coverage for any current enrollees, will not be considered. Pre-Existing Condition Clauses All proposals should specify the terms of pre-existing conditions coverage. Prooosers must fullv "accept the status of all" currentlv enrolled emplovees. Census A complete census is included in the Exhibits. Continued Network Access Current Monthly Rates EMPLOYEE ONL Y $385.07 Plus Spouse $240.66 Plus Children $185.13 FULL FAMIL Y $810.86 RETIREE WITHOUT MEDICABLE SUPPLEMENT Same as above RETIREE WITH MEDICAL SUPPLEMENT $161.00 Rates are to be guaranteed for at least a twelve (12) month period. Please indicate if a longer rate guarantee applies. 10 Preferred Providers If a plan, which favors or requires specific providers, is proposed, include a listing and count of providers in Monroe County. Please specify the total number of providers within Monroe County in the following categories: CJ Family Physicians CJ Pediatric Physicians CJ Obstetrics/Gynecology Physicians CJ Other Specialists CJ Hospitals Plans should specify any residency requirements, and if applicable, what type of coverage is provided out of the service area. Usual, Customary & Reasonable Charges The method of calculation of the prevailing rates must be disclosed. Prescription Benefits Proposals must detail available prescription benefits. Plans are preferred which include retail and mail order prescriptions benefits. Plans are preferred which include Diabetes test strips and birth control pills as covered prescriptions. Cost Containment Provisions Please outline what cost-containment provisions are included in the proposed plans. Who will perform pre-certifications, what procedures require pre-certification and other similar details must be included. Plans are preferred which do not require pre-certification of Physical Therapy services relating to a surgical procedure. Current Enrollment Data See Exhibit 4 Experience Data The exhibits to this RFP include copies of available experience data. The following is a summary: See Exhibit 6 11 At ' Utility Board of the City of Key West, Florida REQUEST FOR PROPOSALS EMPLOYEE BENEFITS PROGRAM OCTOBER 1, 2001 EFFECTIVE DATE Dental Benefit Desired Benefits/Deductibles Plans similar in structure to the current plan are preferred. An alternate more comprehensive plan is solicited. A plan summary is provided in the Exhibits. Current dental coverage includes a $1,000 annual maximum. Plans which include periodontal procedures and replacement and repair of crowns at 80% reimbursement are preferred. It is further preferred that charges for replacement of crowns, bridges, partial or full dentures, inlays, on lays or crowns be covered at 80% if within 60 months. Orthodontic benefits for dependents under age 19 must be included. Current Enrollment Data See Exhibit A Current Rates $19.55 28.75 48.30 Rates shown are monthly. Rates are to be guaranteed for at least a twelve (12) month period. A 24 month rate is preferred. Please indicate if a longer rate guarantee applies. Preferred Providers If a plan, which favors or requires specific providers, is proposed, include a listing and count of providers in Monroe County. 12 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA DISABILITY BENEFITS LONG-TERM NEED CURRENT INFO CES is currently offering income protection insurance to all its employees. Premiums are paid by CES. It wishes to continue long-term disability. The current program provides up to fifty percent (50%) salary replacement up to $3,000 per month - 90 day elimination. Details of the plan are included in Exhibit 3 of this RFP. Desired Coverage & Limits Lona Term Disabilitv Long Term Disability providing benefits up to age 65. Limited "own occupation" language is acceptable. CES will consider alternate plans and varying terms consistent with insurance industry products. CES wishes to consider an optional proposal with a sixty (60) day elimination period. Please attach details of benefit amounts, terms and costs. A take-over basis, while not required, will assist in reducing CES' administrative burden. Portability is an important consideration. Policyholders should be able to continue coverage individually in the event of termination with CES. The current plan is rated on a percentage of salary basis. If rates are proposed in dollar amounts increments of $50 per bi-weekly pay period are requested subject to individual employee validation at time of application. The definition of disability should be as broad as possible. Please include underwriting criteria including a statement on any guaranteed issue limits or whether all applications are individually underwritten. 13 It \ CLAIM REPORTING LOCATIONS AND PROCEDURES All proposals should indicate the address, telephone number and names of individuals who will be contacts in reference to claims as well as any specific claim reporting requirements relating to time periods, documentation and other items. 14 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR HEALTH PLAN CLAIMS ADMINISTRATION UTILIZATION REVIEW LARGE CASE MANAGEMENT SERVICES DENTAL INSURANCE GENERAL INFORMATION Utility Board of the City of Key West, Florida desires to obtain proposals for Third Party Administration Services (TPA) and Utilization Review Services (UR) for its Self-Insured Health Plan. CES is currently insured with the Florida League of Cities and wishes to consider a Self Insured Plan with Stop Loss Insurance. CURRENT PROGRAM CES currently provides employees with a POS plan for Health insurance. CES contributes the Employee's cost for coverage. CES wishes to provide a Medicare Supplement alternative for retired or active employees who are 65 years old or older. Please include a rate and benefit schedule for this option. A benefits booklet is included within the Exhibits. Similar coverage is preferred. CES will consider reasonable coverage variations. CES currently uses the Beech Street Provider Network, but will consider alternative networks or other options. 15 .. The following cost containment provisions are desired in the Self Insured plan: o Coordination of Benefits o Subrogation/Right of Reimbursement o Pre-Admission Certification for non-PPC providers (25% penalty for non-compliance) o Managed Second Surgical Opinion for non-PPC providers (25% penalty for non- compliance) o Medical Case Management o Reduced benefits for out-of-network services Claim processing is to be handled on a direct submission basis. Claims will sent directly to the TPA to review them for eligibility and processes them for payment along with the Explanation of Benefits (EOB's). The TPA should print claim checks for CES on its local checking account and forward the checks directly to the employee or provider. The TPA should perform periodic claim audits and a maximum thirty (30) day claim turn around. DESIRED PROGRAM CES wishes to provide essentially the same level of benefits as the current plans. However, alternatives will be considered subject to acceptable level of benefits, financial stability and cost. One alternative desired would be an 80%/20% plan with a $200 deductible. CES desires the successful TPA and Utilization Review, (UR), provider to assist in the implementation of the following: o Automation connections among TPA, CES and UR provider, o Claim options, including electronic submission, if possible, o Monitoring (on-line, if possible) capabilities of claim status, eligibility status, UR performance, and; o Plan Document revisions and distribution to employees. TP A SERVICES DESIRED The coordination of the TPA and the UR process is considered a critical area of evaluation. The following services are requested of each TPA proposer and should be included in their quoted fee structure: o Adjusting all claims submitted to conclusion of the claims o Reporting of potential specific claims to the excess insurer o Automated ability to check the usual charge for each claim o Assistance in writing plan document o Continuous maintenance for compliance with state & federal laws and regulations o Assistance in Printing and distribution of plan booklet to employees o Monthly reporting to CES o Participating in periodic meetings with CES to discuss plan performance o Answering employee questions regarding coverage 16 o Checking eligibility of claim and claimants o Coordinating all UR services and performance o Filing assistance for state and federal filings o Assisting with negotiation of managed care network availability o Coordinating benefits o Managing subrogation & Right of Reimbursement o HIPAA and/or COBRA administration o Provide an on-site service representative to assist in administration Resumes of key staff should be included for review. References, preferably of other governmental entities, must be included for review. TPA ERROR RATIOS A description should be included of how the TPA internally audits and verifies the accuracy of their claim paying. The acceptable error ratio should be included. MANAGED CARE Utility Board of the City of Key West, Florida is interested in fee reductions typical of a Managed Care Network. TPA's should indicate past experience in developing or assisting in the creation of such networks. The successful TPA will be expected to assist in this process. Proposed networks are expected to remain in effect for one full year from the October 1, 2001. Any reduction in the network size or change in participants should guarantee continued access to all County members for the remainder of the year. UTILIZATION REVIEW (UR) AND LARGE CASE MANAGEMENT SERVICES DESIRED CES is interested in controlling the cost of medical claims. The UR provider(s) will be evaluated on their ability to coordinate with the TPA for the best control of costs. The following services are included in the plan description. Others can be considered. o Mandatory Pre-Admission Certification o Managed Second Surgical Opinion o Medical Case Management o Pre-certification of Diagnostic procedures Resumes of key staff should be included for review. References, preferably of governmental entities, must be included. 17 .. PAYMENT TERMS The preferred method for all TPA, UR and Large Case Management is monthly payment. If other terms are proposed, please be specific regarding amounts and time schedules. CLAIM REPORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals to whom to report claims. CLAIM CONSULTATION AND STATISTICAL REPORTS Utility Board of the City of Key West, Florida will require that the successful proposer submit monthly loss reports. Reports should be completed in plain English and received by CES within twenty (20) days following the end of the month. The reports should include a detailed description of individual claims and the amounts paid for each claim. Individual allocations by operating location may be necessary. Other management reports may be required by CES. Please indicate any additional charges that may apply for special reports beyond the standard reports included in the TPA, UR and Large Case Management fee. !Ail proposals must contain samples of all reports that will be provided.1 OWNERSHIP OF INFORMATION All information and files are required to be returned to CES within thirty (30) days upon termination or request by CES. All files are to be the property of CES. The TPA will be responsible for transfer of data to another TPA or to CES in the event the TPA contract is not continued. The TPA must provide that all prior claim history in electronic or hard-copy form will be available. Any additional charges or fees must be specifically identified at the time the proposal is accepted. 18 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR EXCESS/STOP-Loss INSURANCE FOR GROUP SELF-INSURED MEDICAL BENEFITS GENERAL INFORMATION Utility Board of the City of Key West, Florida requests proposals for Excess and Aggregate/Stop-loss Insurance for proposed Self-Insured Medical Benefits Program. Eligible expenses include both medical and prescription charges. DESIRED PROGRAM CES requests alternative proposals for: SPECIFIC STop-Loss INSURANCE Contract basis: Covers: Effective Dates: Insurer Rating: Limit: Per Claim Attachment level: 12/15 Medical and RX as per plan October 1, 2001-2002 A- or higher $1,000,000 Option 1 Option 2 Option 3 Option 4 $15,000 $20,000 $25,000 Insurer Option 19 ANNUAL AGGREGATE STop-Loss INSURANCE Contract basis: Covers: Effective Dates: Insurer Rating: limit: Aggregate Attachment Point: 12/15 Medical and RX as per plan October 1, 2001-2002 A- or higher $1,000,000 Insurer Option Preferred attachment point is 115% of projected claims. Other attachment levels may be proposed. Please provide dollar attachment point. While a paid-basis contract may be proposed, CES recognizes the need for a claim run-off provision even with current statutes and take-over provisions. Please state any claim run-off provision available, the terms, length of coverage and cost. Critical in CES' decision process will be the insurer's willingness to waive all actively at work limitations and fully accept all currently enrolled and covered participants and plan eligibility rules. 20 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR PRESCRIPTION MANAGEMENT PLAN OCTOBER 1, 2001 - OCTOBER 1, 2002 Utility Board of the City of Key West, Florida desires to obtain alternate proposals for a stand- alone Prescription Plan as part of its self-insured Medical Benefits Plan. Currently, prescription benefits are provided as part of the Florida League Medical Benefits Plan. The cost of prescriptions is included in CES' overall medical costs. It is not necessary to propose a stand-alone Prescription Management Plan if the benefit is included in a medical benefit plan proposal. However, CES wishes to determine if removing the prescription benefits will reduce the cost of the medical plan. CURRENT PROGRAM The current prescription plan is handled under the Florida League Plan. Prescriptions are filled through participating pharmacies. The employee co-pay amount is $10 per generic prescription, $20 for preferred and $35 for non-preferred. Mail order prescriptions are available at the same copays. DESIRED PROGRAM CES will continue to include prescription medications in its self-insured Medical Benefits Plan if it is cost efficient. However, prescription costs have been rising faster than other medical costs. CES desires to reduce and contain these prescription costs. It will consider alternate plans both within the self-insured Medical Benefits Plan and as separate, stand-alone prescription plan that will aid in reducing the overall cost. Formularies and other discount programs will be considered. 2] CES desires the successful Prescription Management Plan provider to provide the following: => Prescription Card benefits for employees and dependents participating in the health plan, => A generous selection of participating retail pharmacies throughout CES and the United States, => Retail and Mail-order coordination, if possible, and => Significant discounts in the costs of prescriptions, including incentives for the use of generics. => Adequate monthly management reports to determine employee utilization and track provider activity as well as display number of dispenses by pharmacy location. CES will consider proposals that may also include the use of formularies or other alternative programs to reduce and contain prescription costs. CES also wishes to be able to determine prescription usage and patterns and will cooperate with proposers to develop a reporting system that can analyze needs, costs and usage. References must be included. QUALIFICATIONS OF PROPOSER Experience with Government Entities will be a major factor in the evaluation of the proposals. All proposers should furnish a summary of all such experience. References, including client name, contact person and telephone number, should also be included. PARTICIPATING PHARMACIES A complete listing, by city, of all participating pharmacies in Monroe County must be included. Proposals will be considered for countywide service or for service to a significant portion of CES. CES reserves the right to select more than one proposal if in CES' sole discretion such selection is in the best interest of CES. CLAIM REPORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals who will be contacts in reference to claims. QUARTERLY MEETINGS WITH CES The proposer will be required to attend quarterly meeting at CES location to discuss plan utilization, cost analysis, changes in regulation, trend analysis and others. 22 STATISTICAL MANAGEMENT REPORTS Utility Board of the City of Key West, Florida will require the successful proposer to submit utilization and cost reports on a monthly basis. Reports should be completed in plain English and received by CES within twenty (20) days following the end of the month. The reports should include: => Generic vs. name brands dispensed, => Employee vs. dependent utilization, ~ Retiree utilization => Program savings, ~ Value of discounts and, => Other reports requested by CES !Ail proposals must contain a sample of the reports that will be provided.1 23 Utility Board of the City of Key West, Florida EMPLOYEE BENEFITS PROGRAM HEALTH PRESCRIPTION DENTAL LONG TERM DISABILITY AND ALTERNATE SELF INSURANCE HEALTH PLAN CLAIMS ADMINISTRATION MEDICAL BENEFITS EXCESSSTOP-LossINSURANCE PRESCRIPTION MANAGEMENT PLAN PROPOSAL FORM - GENERAL INFORMATION Use of the proposal forms will enable a faster, more complete analysis of the proposal(s) submitted. This General Information Proposal Form must be completed for each separate proposal submitted. For example, if a separate insurer is proposed for dental and vision coverage, two separate General Information Proposal forms must be completed. Please complete this general proposal form in addition to a separate proposal form for each coverage proposed. Additional information can be attached to the forms. Name of Insurer/Service Provider Address Current AM. Best Rating If not rated by A M. Best, are financial statements attached? Is insurer/provider authorized by the Florida Insurance Department? Insurer contact, location, phone Name of Agent/Broker 24 Address Please indicate who is authorized to negotiate. Type(s) of plan(s) proposed? Proposal valid until November 15, 2001 Sample forms, policies, riders, employee handbooks, etc. included? Length of rate guarantee? One Hundred and Twenty (120) days termination notice provided? Renewal terms as requested? Method of premium payment described? Employee/Retiree eligibility as requested? Enrollment procedure and involvement described? Claims office location, telephone? Will there be a toll-free number for employee questions? Average claim turn around time? Monthly claims summary with year to date premium/loss summary provided? Premium/loss summary provided within 20 days of end of month? Will loss reports continue to be furnished beyond termination for six months? State any participation requirements. Insurer/provider references provided? 25 Is this an authorized offer? Has proposal been signed by an authorized person? Please state any exceptions to specifications. I have read the Utility Board of the City of Key West's Request for Proposals for Employee Benefits Program. I understand the specifications. I realize that the General Information section applies to each coverage and I am either complying with the specifications or indicating which specific items I cannot comply with. The below signed Proposer has not divulged to, discussed with or compared his/her proposal with other Proposers and has not colluded with any other Proposer or parties to a proposal whatsoever, provided however, this does not preclude discussions, for the sole purpose of obtaining information or pricing or materials, equipment and/or services the Proposer intends to include as a part or sub contract to Proposer's overall proposal. Date Firm, Telephone Authorized Representative 26 Utility Board of the City of Key West, Florida EMPLOYEE BENEFITS PROGRAM PROPOSAL FORM - MEDICAL BENEFITS Insurer/Provider Name Address, Telephone Number Current AM. Best Rating Can this coverage be purchased independent of other coverages? Does Proposal match desired benefits? Please state any exceptions Does proposal match current deductibles? Please state any exceptions. Is a Medicare Supplement alternative provided? Will "Actively At Work" provision be waived for all currently enrolled employees? Will Conversion coverage be offered? Will Proposer take over all enrolled employees? Are rates guaranteed for twelve (12) months? Is full policy form/endorsements/riders, included? 27 Can Proposer accomplish scheduled Open Enrollment? Does plan favor preferred providers? How many providers are in Monroe County? (Please do not respond "refer to directory." However, network directory must be included.) Family Physicians? Pediatrics? OB/GYN Physicians? Specialist Physicians? Hospitals (Please note names of hospitals participating in network) What is maximum lifetime medical benefit? POS Employee Only Spouse Dependent only Children Full Family Medicare Supplement RA TES: PPO Option 28 Please indicate which plans (if multiple plan options are offered) are available in which geographic regions Please indicate what method of calculating prevailing rates is utilized by each plan offered. (If a PPO type plan is offered, please indicate method both in and out of network.) Please state any exceptions to specifications. Are premiums loss sensitive in any manner? (if so, please detail.) Are prescription benefits provided as requested? Are birth control pills a covered prescription? What are the prescription copays? Are cost-containment provisions clearly outlined? Please attach all details. Is this an authorized offer? Has proposal been signed by an authorized person? Please state any exceptions to specifications. The below signed Proposer has not divulged to, discussed with or compared his/her proposal with other Proposers and has not colluded with any other Proposer or parties to a proposal whatsoever, provided however, this does not preclude discussions, for the sole purpose of obtaining information or pricing or materials, equipment and/or services the Proposer intends to include as a part or sub contract to Proposer's overall proposal. Date Firm, Telephone Authorized Representative 29 Utility Board of the City of Key West, Florida EMPLOYEE BENEFITS PROGRAM PROPOSAL FORM - DENTAL COVERAGE Insurer/Provider Name Address, Telephone Number Current AM. Best Rating Can this coverage be purchased independent of other coverages? Does Proposal match desired benefits? Please state any exceptions Does proposal match current deductibles? Please state any exceptions. Are rates guaranteed for twelve (12) months? Does plan favor preferred providers? How many providers are in Monroe County? (Network directory must be enclosed if applicable.) Is plan offered an indemnity, pre-paid or scheduled plan? Does the plan reimburse based upon usual and customary or based upon a schedule of benefits? This must be very clear in proposal and on any attached description of benefits. Are periodontal procedures and replacement and repair of crowns covered as requested at 80%? 30 Are charges for replacement of crowns, bridges, partial or full dentures, inlays, onlays or crowns covered if within 60 months? RA TES: Single Employee Only Dependents Full Family (other tier arrangements are acceptable. Make sure proposal clearly states the tiers.) Is this an authorized offer? Has proposal been signed by an authorized person? Please state any exceptions to specifications. The below signed Proposer has not divulged to, discussed with or compared his/her proposal with other Proposers and has not colluded with any other Proposer or parties to a proposal whatsoever, provided however, this does not preclude discussions, for the sole purpose of obtaining information or pricing or materials, equipment and/or services the Proposer intends to include as a part or sub contract to Proposer's overall proposal. Date Firm, Telephone Authorized Representative 31 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA DISABILITY INCOME PROTECTION COVERAGE IPROPOSAL FORMI Insurer/Provider Name Address, Telephone Number Current AM. Best Rating Can this coverage be purchased independent of other coverage? Are Long-term Disability benefits proposed? Please state details Is a sample policy attached? What is the definition of disability? Is partial disability covered? What is the definition of partial disability? How are benefits paid? How often? Are rates guaranteed for twelve (12) months? IRATES:I MONTHLY RATE Long Term Disability (attach schedule) Is this an authorized offer? Will you assist CES in take-over and/or enrollment? 32 Describe the process Has proposal been signed by an authorized person? Please state any exceptions to the current plan. The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by CES. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date Firm, Telephone Authorized Representative 33 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR HEALTH PLAN CLAIMS ADMINISTRATION SERVICES IPROPOSAL FORMI Please complete a separate proposal form for each option offered. Name of Third Party Administrator Address: Telephone Number: Name of Account Representative assigned to CES Telephone of Account Representative What services are included in the quoted price? (Attach separate sheet if needed) Are you proposing a network? Is a network directory included? List the total number of providers in Utility Board of the City of Key West, Florida for each of the categories listed here: Allergists Chiropractors Cardiologists Dermatolog ists 34 Family Practice Gastrologists General Practitioners General Surgery Gynecologists Internal Medicine OBGYNs Oncologists Optomologists Pediatricians Radiologists Urologists Network Hospitals List by name What is the average turn-around time for claims? What is the average error ratio performance for the administration of medical claims? How was this figure calculated? Will you agree to penalties if an agreed upon error ratio is exceeded? Are resumes of adjusters attached? Are references attached? What is the current case load for the adjusters who will be assigned to CES' account? Will the proposer charge any initial or set-up fees? If so, please explain Are samples of all claims and statistical reports included? Is a sample contract or agreement included? 35 jauoted Price:1 Employee Spouse dependent only Child(ren) only Family Other Other State any enrollment requirements? Will you assist with the enrollment process? Will you provide for an annual open enrollment process? Are there any exceptions to specifications? Is proposed network guarantee access for one year from 10/1/01 for all providers listed as of 10/1/01? Please provide the In-Network Negotiated Fees and Out-of-Network Allowable for the following CPT codes: 111 00 Biopsy of Skin 17261 Destruction, Malignant Lesion 29870 Diagnostic Arthroscopy 42820 Adenoidectomy and/or Tonsillectomy 43200 Esphaogastroudenscopy 58120 Dilation and Curettage 70450 CT and MRI of Head/Brain, w/o contrast 36 70460 71020 72146 90782 92004 92014 92226 99201 99215 99223 99283 Tomography Head or Brain, with contrast Radiologic Exam, Chest Magnetic Resonance Imaging Therapeutic/Diagnostic Injection OPHTH Serv: Exam; Compre New Pt OPHTH Serv: Exam; Compre, Est. PT Ophthalmoscopy w/min Psychotherapy Office Visit / New PT Office Visit / Est. PT; Comprehensive Subsequent Hsp Visit; Intermediate ER Exam; New PT; Intermediate The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by Utility Board of the City of Key West, Florida. Deviations from the requested program have been stated. Signature of Authorized Representative Date 37 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR EXCESS/STOP-Loss INSURANCE FOR GROUP SELF-INSURED MEDICAL BENEFITS IProposal Forml Use of the proposal forms will enable a faster, more complete analysis of the proposal(s) submitted. Please complete this proposal form for each insurer and/or option proposed. Additional information can be attached to the forms. Agent/Agency submitting proposal: Address: Telephone Number: Does agent have binding authority? If not, state procedure to bind. Insurer Proposed. A.M. Best Rating. Is an intermediary utilized to access the insurer? 38 If so, please provide name, address, etc. Will insurer waive all active at work limitations and fully accept all currently enrolled and covered participants in CES' employee benefits plan? If no, please specify details (this will be considered critical in the evaluation process). Will premium payments be monthly based upon enrollment? If no, please specify details (this will be considered critical in the evaluation process). Will insurer provide at least 90 days notice of Any policy modification? Will insurer provide at least 90 days notice of any Rate changes for renewal? If no, please specify details (this will be considered critical in the evaluation process). Will insurer provide at least 90 days notice? of termination or non-renewal? If no, please specify details (this will be considered critical in the evaluation process). Effective date of coverage. Proposal valid until (date) Is a 12/15 coverage basis proposed for stop-loss? If no, please specify details (this will be considered critical in the evaluation process). What specific limit of liability is proposed? Has the stop-loss insurer approved CES' 39 Plan Document? (include written confirmation from the stop-loss insurer). What specific retention is proposed? What aggregate limit of liability is proposed? What is the aggregate calculation method proposed? What is the monthly aggregate attachment point? What are the specific rates? What are the aggregate rates? Will the aggregate accumulation include prescription claims? Sample forms and policies included? Will you require a signed disclosure form? Is this proposal firm? The Representative stated below is the authorized agent of the Proposer (company or companies proposed), and is authorized to bind coverage upon acceptance by CES. Deviations from the requested program have been stated. Coverage will be issued as proposed. The insurer agrees to be bound by the information contained in this proposal form and all separate coverage proposal forms attached. The insurer agrees to deliver a policy to the insured within forty-five (45) days after inception of coverage. Signature of Authorized Representative Date 40 UTILITY BOARD OF THE CITY OF KEY WEST, FLORIDA REQUEST FOR PROPOSALS FOR PRESCRIPTION MANAGEMENT PLAN !PROPOSAL FORMI Please complete a separate proposal form for each option offered. Name of Prescription Management Plan Address: Telephone Number: Does Plan include retail and mail order? What are retail co-pays? Generic Preferred Non-Preferred What are mail-order participant co-pays? Will the proposer charge any initial or set-up fees? If so, please explain 41 Are alternate approaches available such as the use of Formularies or other arrangements? If so, include Specifics. Are samples of all management and statistical reports included? Is a sample contract or agreement included? lauoted Price/Fees or Discount Arrangement:1 (attach separate page if necessary) Will a minimum fee apply to the contract? If so, please specify How many participating pharmacies are located in the Florida Keys? Locations: How many participating pharmacies are in the U.S.? Is sample participant information/communication materials included? Are there any exceptions to specifications? Will you agree to quarterly meetings at CES' location To provide utilization review, cost analysis, changes in Regulation, trend analysis and others? 42 The representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by CES. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Signature of Authorized Representative Date 43 Exhibit 1 Florida LeaQue - Silver Plan 44 Florida Municipal Insurance Trust Major Plan Benefit In Network Out of Network Calendar year Deductible: Individual Family Maximum Out of Pocket: Individual Family Lifetime Maximum . Inpatient . Outpatient Services deductible . Emergency Room Services Preventative Care Routine Services Well Child Care Specialty Care OB/GYN Care Allergy Injections Surgical Expense Maternity Care P.O.S. Silver Plan o o $ 500 $1,500 $2,500 $1,500 $3,000 $5,000 Unlimited Hospital Services $250.00 Co-Pay, then 80% of covered expenses $1,000,000 80% of covered expenses $500.00 Deductible, then 60% of covered expenses 60% of covered expense after $100.00 Co-Pay, then 100% of covered expenses $100.00 Co-Pay, then 1 00% of covered expenses Physician Services $25.00 Co-Pay Not Covered $25.00 Co-Pay 60% of reasonable charges $25.00 Co-Pay 60% of reasonable charges $25.00 Co-Pay 60% of reasonable charges $25.00 Co-Pay 60% of reasonable charges $25.00 Co-Pay 60% of reasonable charges 80% 60% of reasonable charges $25.00 Co-Pay, 60% of reasonable charges 1 st Visit, then 100% 45 Florida Municipal Insurance Trust Other Health Care Services In Network Out of Network . Prescription Drugs $10.00 Generic Wholesale Price, less 10%, (RX Net) $20.00 Preferred Brand less In Network Co-Pay $35.00 Non-Preferred Brand · Mental & Nervous Disorder Inpatient Services $250.00 Co-Pay, (30 days per calendar year maximum) then 80% Outpatient Services $25.00 Co-Pay, (20 visits per year limit) then 100% $500.00 Deductible then 60% of covered charges 60% of covered charges $50.00 per visit maximum . Alcohol and Drug Dependency Individual Visit charges . Hospice Care 80% (6 month maximum care) $6,000 lifetime maximum . Home Health Care 80% (60 visits per year maximum) . Physical Therapy 80% 60% of covered charges (40 visits per year maximum) $2,000 calendar year maximum . Skilled Nursing Facility 80% 60% of covered charges (75 days per year maximum) $10,000 lifetime maximum . Chiropractic Services $25.00 Co-Pay charges (26 visits per calendar year) . Routine X-Rays, Lab Tests, Diagnostic Services $25.00 Co-Pay 60% of covered 60% of covered charges 60% of covered charges 60% of covered 80% $40.00 per visit maximum 60% of covered charges . . . All surgical procedures must be pre-certified. All non-emerQency hospital stays must be pre-certified. All Out of NefworK Benefits are covered 60% of reasonable and customary charges, after the calendar year deductible has been met. All deductibles do not apply toward the annual maximum out-pocket expenses. Allin Network Co-Pays apply toward the annual maximum out-of-pocket expenses. The hospital deductiljle for Out of Network confinement due to an emergency does not apply. (This is intended as a Summary of Benefits and does not include all Of the benefits, Limitations and exclusions of the plan. Complete terms of the plan are contained in the Master Plan of Benefits.) . . . 46 Exhibit 2 Florida League - Dental Plan 47 FLORIDA MUNICIPAL INSURANCE TRUST DENTAL BENEFIT PLAN SUMMARY CITY OF KEY WEST UTILITY BOARD EFFECTUATE DATE: 10/01/97 UNIT# 380 FMIT# 303 Reasonable and customary limits will apply to all covered eligible expenses. GENERAL DENTAL CARE Calendar Year Maximum Deductible $1,000 $50 calendar year ($100 family) After the deductible has been met unless otherwise stated, the following coinsurance will apply: This plan will pay 100% preventive services, not subject to the calendar year deductible, as follows: I. Oral examinations 2. Dental X-rays (Bitewings twice per calendar year, Full Mouth or panoramic once every 2 yearn) 3. Fluoride application (for dependents under age 15) 4. Prophylaxis This plan will pay 80% for basic dental services as follows: 1. Emergency treatment for pain 2. Space maintainers 3. Dental X-rays 4. Biopsies of oral tissue 5. Pulp vitality tests 6. Filings 7. Extraction 8. Oral Surgery 9. Endodontics 10. Periodontics This plan will pay 50% for dental restorations and specialty services as follows: 1. Inlays, onlays 2. Crowns 3. Bridges, dentures SCHEDULE OF ORTHODONTIC BENEFIT (applies only to eligible dependents under age 19). Lifetime maximum (per person) $1,000 Lifetime deductible $50 per person Covered eligible expenses are payable after the deductible at 50%. 1. Diagnostic procedures. 2. Appliances for tooth guidance and control of harmful habits. 3. Retention Appliances. 4. Comprehensive treatment with fixed and removable appliances for correction of malocclusion In permanent, primary and mixed dentition. These summaries are designed only to give you a brief description of the benefits provided and does not 48 include all the provisions, limitations or exclusions in the policies. In an actual claim situation, the policy provisions, limitations, exclusions will apply. If this outline disagrees with the Plan Document in any way, the Plan Document will govern. CLAIM ADMINISTRATOR: Florida League Of Cities, Inc. Claims Center PO Box 025457 Orlando, FL 32853-8135 (407) 245-0725 (800) 756-3042 49 Exhibit 3 Long-term Disability Plan 50 Group Long Term Disability insurance Income Protection for The Utility Board of the City of Key West, Florida Continent Casualty Company For all the Commitments you make* 51 Certificate Table of Contents Eligibility Effective Date Schedule of Benefits Definitions Disability Benefits Extension of Maximum Period Payable Recurrent Disability Waiver of Premium Exclusions and limitations Termination of Your Insurance Uniform Provisions General Provisions Additional Benefits B B1 C E F G G G H H J K 52 Dear Employee: Your greatest asset is your ability to earn an income. Practically everything you have, or would ever nope to have, depends on it. Just stop and think what would happen if you were disabled - and your income stopped. Where would the money come from to pay your rent or mortgage, food, clothing, utilities and the man,r other expenses of day-to-day living? What about your family? How would they manage. If you were disabled and could not work, you would probably draw upon your savings-at least for a short period-to pay the mounting bills and expenses. But what if you were prevented from working for a prolongea period of time? Obviously, few of us can afford to support ourselves for extended periods from our savings. Borrowing the large sums of money often required when you are not drawing a paycheck is practically out of the question. That's why your Group Long Term Disability Insurance Plan can help-it provides you and your family with the monthly income benefits you may need when you become disabled and can't work. Your company, aware of this very vital need, has not only endorsed such a plan of insurance protection for you-it is paying tne full premium as well. This plan will help assure you a continuing income benefit In the event you are ever disabled by covered accident or sickness and prevented from performing your regular duties-at absolutely no cost to you. Please take the time to look over this booklet carefully. Note how this insurance coverage can help provide financial protection. After all, your future-and your family's -may very well depend on It. 53 Continental Casualty Company CNA Plaza Chicago, Illinois 60685 CNA For All the Commitments You Make A Stock Company Having issued Policy No. SR-83094193 to The Utility Board of the City of Key West, Florida (Herein called the Employer) Policy Date: October 1, 1995 CERTIFIES that You are insured provided that You qualify under the ELIGIBILITY provision stated below, become insured and remain insured in accordance with the terms of the policy. Your insurance is subject to all the definitions, limitations and conditions of the policy it takes effect on the effective date indicated in the EFFECTIVE DATE provision stated below. This certificate, however, is not the policy. It is merely evidence of insurance provided under the policy. The policy can be amenaed by mutual consent between the Employer and Us. This certificate re p laces and cancels any other certificate previously issued to You under the policy. Eligibility All active, full-time employees with a minimum of 30 days of continuous service with the Employer. "Active, full-time" means an employee who works at least 30 hours per week. Part-time, temporary or seasonal employees are not eligible. 54 Effective Date If You am eligible before the policy takes effect, You insurance will take effect on the Effective Date of the policy. If You become eligible alter the Effective Date of the policy, Your insurance will take effect on the first day of the month that falls on or next follows the date You are eligible for this insurance. If, because of Injury or Sickness, You are not working full-time on the date Your insurance woulcf otherwise take effect, You will be insured effective on the date You return to full-time work 60 Schedule of Benefits Monthly Benefit Your Monthly Benefit payable hereunder shall be 50% of Your Salary (1) or $3,000, whichever is the lesser amount minus the reductions in (2) below. Maximum Period Payable Age on the Date Disability Commenced 61 years or younger 62 years 63 years 64 years 65 years 66 years 67 years 68 years 69 years or older To Your 65th birthday 42 months 36 months 30 months 24 months 21 months 18 months 15 months 12 months Elimination Period 90 days Features: Survivor Income Benefit Period: 6 Months Your Occupation Period: 24 months (1) "Salary" means the monthly wage or salary that You were receiving from Your Employer on the date the Disability began. If excludes commissions, overtime earnings. incentive pay, bonuses or other compensation. 61 (2) The Monthly Benefit under the policy shall be reduced by: Disability benefits paid, payable, or for which there is a right under: a. The Social Security Act. including any amounts for which Your dependents may qualify because of Your Disability, b. Any Worker's Compensation or Occupational Disease Act or Law, or any other law which provides compensation for an occupational injury or sickness, or c. Any State Disability Benefit Law; Disability benefits paid under: a. Any group insurance plan provided by or through Your Em ploy or, b. Any formal sick leave plan provided by Your Employer, or c. Any Retirement Plan provided by Your Employer; Retirement benefits paid under the Social Security Act, including any amounts for which Your dependents may qualify bec8use of Your retirement; Retirement benefits paid under a Retirement Plan provided by the Employer except for amounts attributable to Your contributions. If any benefit described above is paid in a single sum through compromise settlement or as an advance on future liability, the amount which pertains to Your Disability will be divided by the number of months from the date of its receipt to the end of the benefit period applicable to You. The result shall be deducted from Your Monthly Benefit. 1. 2. 3. 4. 62 Your Monthly Benefit, after the reductions stated above, if any, will not be further reduced for subsequent cost-of-living increases which are paid, payable, or for which there is a right under any other benefit descriBed above. "Retirement Plan" means a plan which provides retirement benefits to employees and is not funded wholly by employee contributions. It does not include: 1) a profit sharing plan, a thrift or savings plan; 2) an Individual retirement account (IRA). 3) a tax sheltered annuity (TSA); 4) a stock ownership plan; or 5) a deferred compensation plan. In no event will Your Monthly Benefit payable for Total Disability (but not for Residual Disability) be reduced to less than $100. 63 Definitions "Adjusted Pre-Disability Salary" means Your monthly salary in effect on the date Your Disability began. On the first anniversary of Your continuing Disability and on each subsequent anniversary1 the predisability salary will be increased by. 7 % until 5 annual adjustments have been made. "Application"" means the Employer's application attached to the policy. "Disability" means Total Disability or Residual Disability. "Injury" means bodily injury caused by an accident which results, directly and independently of all other causes, in loss which begins while Your coverage is in force. "Loss of Salary Ratio" is equal to: A - B/A where A = Adjusted Pre-Disability Salary B =Monthly Income from Residual Disability "Monthly Benefit", "Elimination Period", "Maximum Period Payable" and "Your Occupation Period" mean that benefit and those periods shown in the Schedule of Benefits which apply to You. "Pre-existing Condition" means a condition for which medical treatment or advice was rendered, prescribed or recommended within 3 months prior to Your effective date of insurance. A condition shall no longer be considered pre-existing if it causes loss which begins after You have been insured unaer the policy for a period of 12 consecutive months. "Residual Disability" means that You, because of Injury or Sickness, are: (1) gainfully employed on a full-time or part-time basis; and (2) aisableo to the extent that the Loss of Salary Ratio is 20% or more. "Salary" means as defined in the Schedule of Benefits. "Schedule of Benefits" means the schedule which is a part of this certificate. "Sickness" means sickness or disease causing loss which begins while Your coverage is in 40rce. Sickness shall not include any loss caused by or resulting from a pre-existing condition. "Total Disability" means that because of Injury or Sickness, You are: (1) continuously unable to perform the substantial and material duties of Your regular occupation; (2) under the care of a licensed physician other than Yourself; and (3) not gainfully employed in any occupation for which You are or become qualified by education, training or experience. 64 After the Monthly Benetit has been payable for Your Occupation Period, "Total Disability means that, because of Injury or Sickness. You are: (1) continuously unable to engage in any occupation for which You are or become qualified by education, training or experience; and (2) under the regular care of a licensed physician other than Yourself. "We", "Our" and "Us" mean the Continental Casualty Company. Chicago, Illinois. "You", "Your", and "Yours" mean the employee to whom this certificate is issued and whose insurance is in force under the terms of the policy. TQI- 55332-A99 Res Dis, < Age 65 Own occ, pre-X 65 Disability Benefits Total Disability Benefit-We will pay the Monthly Benefit for each month of Total Disability, which continues after the Elimination Period. The Monthly Benefit will not be payable during the Elimination Period nor beyond the Maximum Period Payable. Residual Disability Benefit-We will pay a Residual Disability Benefit for each month of Residual Disability wl1ich follows: (1) the Elimination Period; or (2) a period for which Total Disability Benefits were payable. The Residual Disability Benefit will not be payable during the Elimination Period. The amount payable will be equal to the Monthly Benefit times the Loss of Salary Ratio. If the Loss of Salary Ratio is 80% or more1 it will be considered 100%. Disability Benefits will cease on the earliest of the following to occur. (1) the date the Loss of Salary Ratio is less than 20%; or (2) the end of the Maximum Period Payable. General-Total benefits payable for Total Disability and Residual Disability shall not exceed the Maximum Period Payable. If a benefit is payable for a period less than 1 month, it will be paid on the basis of 1/30th of the Monthly Benefit for each day of Disability T1-55330-A Res Dis. 24 + mo own OOC, LG 66 Extension of Maximum Period Payable The Maximum Period Payable will extend beyond the age at which the Monthly Benefit otherwise ceases If, while disabled, You reach that agelJut have not received 12 Monthly Benefit payments during the current period 01 Disability. In that event, the Maximum period Payable shalloe extended during the continuance of the Disability until a total of 12 monthly payments have been made. TQl-67976-A Recurrent Disability If Disability for which benefits were payable ends but recurs due to the same or related causes less than 6 months after the end of a prior Disability, it will be considered a resumption of the prior Disability. Such recurrent Disability shall be subject to the provisions of the policy that were in effect at the time the prior Disability began. Disability which recurs more than 6 months after the end of a prior Disability shall be subject to: 1) a new Elimination Period; 2) a new Maximum Period Payable; and 3) the other provisions of the policy that are in effect on the date the Disability recurs. Disability must recur while Your coverage is in force under the policy. TQ1-679n.B Waiver of Premium We will waive premium for You during the period of Disability for which the Monthly Benefit is payable under the policy. During this period, Your Insurance will remain In force. This provision is subject to the Termination of Your Insurance provision, except for payment of premium. TQ1-67979.B G 67 Exclusions and Limitations The policy does not cover any loss caused by or resulting from: (1) Declared or undeclared war or an act of either; (2) Disability beyond 24 months after the Elimination Period if it is due to mental or emotional disorders of any type. Confinement in a hospital or institution licensed to provide care and treatment for mental or emotional disorders will not be counted as part of the 24-month limit; or (3)a Pre-existing Condition. TQl-68081-A99 LM, Pre-X Termination of Your insurance Your coverage will terminate on the earliest on the following dates: 1. the date the policy is terminated; 2. the premium due date if the Employer fails to pay the required premium for You, except for an inadvertent error; or 3. the date You !aj are no longer a member of a class eligible for this insurance; b withdrawn lrom the program; c are retired or pensioned or d cease work because of a leave of absence, furlough, layoff or temporary work stoppage due to a labor dispute, unless We and the employer have agreed in writing to continue insurance during such period. Termination will not affect a covered loss, which began before the date of termination. TQ1-67978-A H 68 Uniform Provisions Entire Contract; Changes. The policy the Application, Your evidence of insurability (if any), and any attached papers are the entire contract between the parties. Any statement made by the Employer or You shall, In the absence of fraud, be a representation and not a warranty. No such statement shall void the insurance1 reduce the benefits or be used In defense to a claim unless it is in writing and a copy furnished to the Employer or You, whoever made the statement. No statement of the Employer will be used to void the Rolicy after it has been in force for two years. No statement of Yours will be used in defense to a claim for loss incurred or Disability which begins after You have been insured for 2 years. No change in the policy is valid unless approved in writing on the policy by one of Our officers. No agent has the right to change the policy or to waive any of its provisions. Grace Period. A grace period of 31 days is allowed for the payment of each premium due after the first Premium. Your coverage will remain in force during the grace period. A grace period will not apply if We have sent written notice to the Employer of Our intent not to renew the policy at least 31 days before the premium due date. Such notice will be sent to the Employer's last address as shown in Our records. If the Employer gives Us written notice of his intent not to renew the policy, the grace period will not apply. The policy will terminate on the date stated on the notice or on the date, We receive such notice, whichever is later. The Employer will be liable for all premiums due for the period the policy remains in force including the grace period, if it applies. Notice of Claim. Written notice of claim must be given to Us within 30 days after the loss begins or as soon as reasonably possible. The notice will suffice if it identifies You and the policy. It must be sent to Us at Our Home Office, CNA Plaza, Chicago, Illinois 80685 or given to Our agent. Claim Forms. After We receive the written notice of claim, We will furnish claim forms within 15 days. If We do not, the claimant will be considered to have met the requirements for written proof of loss if We receive written proof, which describes the occurrence, extent and nature of the loss. Written Proof of loss. Written proof of loss must be furnished to Us within 90 days after the end of a period for which we are liable. If it is not possible to give the proof within 90 days, the claim is not affected if the proof is given as soon as reasonably possible. Unless You are legally incapacitated, written proof must be given within 1 year of the time It is otherwise aue. 69 Time of Payment of Claim. Benefits will be paid monthly immediately after We receive due written proof of loss. Payment of Claim. All Disability benefits are paid to You. An accrued Disability or Survivor Income benefits unpaid at Your death will be paid to the named beneficiary, if any. If there is no surviving named beneficiary, payment may be made, at Our option. to the surviving person or persons in the first of the following classes of successive preference beneficiaries: Your (a) spouse; (b) children including regally adopted children; (c) parents, or (d) estate. If any benefit is payable to an estate, a minor or a person not comRetent to give a valid release, We may pay up to $1,000 to any relative or beneficiary of Yours wliom We deem to be entitled to this amount. We will be discharged to the extent of such payment made by Us in good faith. Physical examination. At Our expense, We have the right to have a physician examine You as often as reasonably necessary while the claim is pending. Legal Action. No action at law or in equity can be brought until after 60 days following the date written proof of loss was given. No action can 6e brought after the applicable statute of limitations from the time written proof of loss is required to be given. Conformity with State Statutes. If any provision of the policy conflicts with the statutes of the state in which the policy was delivered or issued, it is automatically changed to meet the minimum requirements of the statute. General Provisions The policy is in the Employer's possession and may be inspected by You at any time during business hours at the Employer's office. The policy is not in lieu of and does not affect any requirements for coverage by Workers' Compensation Insurance. TQ1-67980-B09 FL 70 Survivor Income Benefit If You die after having received the Disability benefits provided by the policy for at least 12 successive months and during a period for which benefits are payable, We will pay a Survivor Income Benefit. This benefit is equal to the amount You were last entitled to receive for the month preceding Your death. The Survivor Income Benefit shall be payable on a monthly basis immediately after We receive written proof of Your death. It IS payable for the period stated in the Schedule of Benefits. The benefit shall accrue from Your date of death. This benefit is payable to the beneficiary, if y, named by You under the y. If no such beneficiary exists, the benefit will be payable in accordance with the PAYMENT OF CLAIMS provision. TQ1 -67981-8 71 Continental Casualty Company CNA CNA Plaza Chicag01 Illinois 60685 For all the Commitments you Make A Stock Company IMPORTANT NOTICE To present inquiries or obtain information about Your coverage1 You may contact Us at: 1 (800) 282-7084 Southern Region Should You need assistance in resolving a dispute about a claim, You may contact Us at: 1 (800) 327-2430 Orlando Claims Office BG-110097-ASR 72 ERISA YOUR RIGHTS UNDER ERISA The following section contains information provided to you by the Plan Administrator of your Plan to meet the requirements of the Employee Retirement Income Security Act of 1974. It does not constitute a part of the Plan or of any insurance policy issued in connection with the Plan. All inquiries relating to the following material should be referred directly to your Plan Administrator. SUMMARY PLAN DESCRIPTION Table of Contents Heading Name of Plan Maintenance of Plan Employ:er Identification Number and Plan Number Type of Welfare Plan Administration of Plan Plan Administrator Agent for Service of Legal Process Eligibility and Benefits Circumstances Which May Affect Benefits Sources of Plan Contributions Medium for Providing Benefits Date of End of Plan's Fiscal Year Claim Procedures Statement of ERISA Rights 73 Page II II II II II II III III III Iv Iv Iv Iv SUMMARY PLAN DESCRIPTION Name of Plan The Plan for which this Summary Plan Description is provided is known as the: The Utility Board of the City of Key West, Florida Maintenance of Plan The Plan is maintained by: The Utility Board of the City of Key West, Florida 1001 James Street Key West, FL 33040 (305) 295-1066 Employer Identification Number and Plan Number The employer identification number (EIN) assigned by the Internal Revenue Service to the plan sponsor is: 59-6000347 The plan number assigned by the plan sponsor is: 510 Type of Welfare Plan The Plan is a Long Term Disability Plan Administration of Plan The Plan is administered by the Plan Administrator through an insurance contract purchased from Continental Casualty Company. Plan Administrator Human Resources Department 1001 James Street Key West, FL 33040 (305) 295-1066 Hereinafter referred to as the Administrator. II 74 Agent for Service of Legal Process The person designated as agent for service of legal process upon the Plan is : Human Resources Department 1001 James Street Key West1 FL 33040 (305) 295-1066 In additlon1 service of process may be made upon the Administrator. Eligibility and Benefit The Plan's requirements respecting eligibility for participation, the conditions pertaining to eligibility to receive benefits, and description or summary of the benefits are listed in the certificate portion of this booklet. Circumstances Which May Affect Benefits Circumstances which may result in disql,Jalification. ineligibility. or denial, loss, forfeiture or suspension of any benefits are listed In the certificate portion of this booklet. IN 75 Sources of Plan Contributions Contributions to the Plan are made by the employer. Medium for Providing Benefits Benefits under the Plan are provided in accordance with the pro-visions of Group Insurance Policy Number SR-83094193 issued by Continental Casualty Company, CNA Plaza, Chicago, illinoIs, 60685. Date of End of Plan's Fiscal Year The date of the end of each year for purposes of maintaining the Plan's fiscal records is September 30 Claim Procedures 1. Presenting Claims for Benefits Claim forms may be obtained from: the Employer Please see your insurance certificate or booklet for the requirements of the Group insurance Policy as to notice of claims. 2. Claims Denial Procedure Any denial of a claim for benefits will be provided by the insurance company and consist of a written explanation which will include (i) the specific reasons for the denial, (ii) reference to the pertinent plan provisions upon which the denial is based, (iii) a description of any additional information you might be re~uired to provide with an explanation of why it is needed, and (iv) an explanation of the Plan's claim review procedure. You, your Beneficiary (when an appropriate claimant), or a duly authorized representative may appeal any denial of a claim for benefits by filing a written request for a full and fair review to the insurance company. In connection with such a request, documents pertinent to the administration of the Plan may be reviewed, and comments and issues outlining the basis of the appeal may be submitted in writing. You may have representation throughout the review procedure. A request for a review must be filed by 60 days after receipt of the written notice of denial of a claim. The full and fair review will be held and a decision rendered by the insurance company no longer than 60 days after receipt of the request for review. 76 If there are special circumstances, the decision will be made as soon as possible, but not later than 120 days after receipt of the request for review. If such an extension of time is needed, you will be notified in writing prior to the beginning of the time extension period. The decision after your review will be in writing and will Include specific reasons for the decision as well as specific references to the pertinent plan provisions on which the decision is based. Statement of ERISA Rights The Statement of ERISA Rights is required by federal low and regulation. As a participant in this plan, you are entitled to certain rights arid protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to: Examine, without chargel at the Administrator's office and at other specified locations, such as worksites and union halls, all plan documents filed by the Plan Administrator with the U.S. Department of Labor, such as detailed annual reports and plan descriptions. Obtain copies of all plan documents and other plan Information upon written request to the Administrator. The Administrator may make a reasonable charge for the copies. Receive a summary of the Plan's annual financial report. The Administrator is required by law to furnish each participant with a copy of this summary annual report. In addition to creating rights for plan participants, ERISA imposes duties upon the people who ore responsible for tne operation of the employee benefit plan. The people who operate your plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including your employer, your union, or any other personl may fire you or otherwise discriminate against you in an\{ way to prevent you from obtaining a welfare benefit or exercising your rights under ERISA. If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to nave the Plan Administrator review and reconsider your claim. 77 Under ERISA, there are steps you can take to enforce the above rights. For instance it you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Administrator to provide the materials and pay up to $100 a day until you receive materials, unless the materials were not sent because of reasons beyond tfle control of the Administrator. If you have a claim f for benefits which is denied or ignored, in whole or in part, you ma,'t file suit in a state or federal court. If it should happen that plan fiduciaries misuse tile Plan s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of [abor, or you may file suit In a federal court. The court will decide who should pay court costs and legar fees. rt you are successful, the court may order the person you have sued to pay the cost and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds claim is frivolous. If you have any questions about your plan, you should contact the Administrator. If you have any questions about this statement or about your rights under ERISA, you should contact the nearest Area Office of the U.S. Labor-Management Service Administration, Department of Labor. 78 Exhibit 4 Employee Census, Life Insurance Amount Census, and Disability Insurance 79 M 6/27/43 T&D Substation 3/23/92 Emp. only $64,000 Supervisor/Engine er M 5/20/65 Line Leader 3/13/85 Opt-Out Emp. plus $48,000 $48,000 $21,500 familv F 3/9/66 Director of Human 3/28/85 Emp. plus Emp. plus $59,000 $59,000 Resources familv familv F 9/4/72 Department Staff 8/7/00 Emp. only $26,000 Asst. F 7/18/58 Accountant 8/24/88 Emp. plus $39,000 $39,000 $20,000 $5,000 familv F 7/30/75 Customer Service 3/15/99 Emp. plus Emp. only $30,000 Rep children F 9/21/43 Executive 7/23/75 Emp. only Emp. only $47,000 Assistant M 9/6/62 Sr. Customer 6/14/85 Emp. plus Emp. only $42,000 $42,000 ProQrams Rep. children F 2/9/68 Customer 12/10/90 Emp. only $42,000 $42,000 Services Leader M 02/29/194 Utility Board 1 0/9/97 Emp. only Emp. only $50,000 2 Member M 6/7/63 Electrician 1/9/85 Emp. plus Emp. plus $44,000 familv familv M 2/20/66 IT Analyst 10/12/84 Emp. plus Emp. plus $47,000 familv familv M 4/6/44 Asst. General 4/15/91 Emp. only Emp. only $95,000 ManaQer F 8/21/54 Buyer 6/5/89 Emp. only Emp. only $42,000 M 1/3/49 Meter Reader 1/16/78 Emp. plus Emp. plus $44,000 Leader familv familv M 8/12/67 Meter Service 10/21/87 Emp. only $34,000 Technician M 3/1/71 Electrician 1/8/90 Emp.lchild Emp. only $44,000 $44,000 M 8/26/39 Utility Board 11/7/91 Emp. only $50,000 Member F 11/4/52 Customer Service 5/23/82 Emp. only Emp. plus $30,000 $30,000 Rep familv M 5/19/42 Welder/Mechanic 5/22/79 Emp. plus $43,000 spouse F 11/23/63 IT Analyst 6/2/97 Emp. only Emp. only $48,000 M 3/9/47 Power Plan 9/28/78 Emp. plus $43,000 $43,000 Mechanic familv M 10/28/47 Maintenance 12/26/79 Emp. only Emp. only $45,000 Leader M 3/29/50 Control Room 9/2/82 Emp. plus $37,000 Operator familv M 5/28/55 Electrician 10/13/83 Emp. plus Emp. plus $44,000 $44,000 children familv M 1/17/56 Electrician 1/29/96 Emp. plus Emp. plus $39,000 children familv M 5/6/69 Auto Mechanic 8/8/88 Emp. only Emp. only $43,000 $43,000 M 10/28/44 Meter Reader 11/18/96 Emp. only Emp. only $31,000 M 5/15/61 Apprentice Line 8/17/00 Emp. plus Emp. only $25,000 $25,000 Person children F 2/11/72 Branch Office 8/9/99 Opt-Out $32,000 $32,000 Supervisor-Cust. Servo M 11/1/67 Meter Reader 12/15/97 Emp. plus Emp. plus $30,000 $30,000 children familv M 1/28/53 General Helper 1 0/28/83 Emp. plus $25,000 $25,000 familv 82 M 6/24/49 Machinist 9/19/83 Emp. only Emp. only $43,000 $43,000 Mechanic F 11/18/71 Customer Service 10/27/99 Emp. only Emp. only $30,000 $30,000 Rep M 9/7/52 Power System 2/17/82 Emp. plus $45,000 Coordinator family M 10/16/56 Line Leader 8/4/82 Emp. plus Emp. plus $49,000 $49,000 familv familv M 6/10/49 Pipefitter/Mechani 12/5/74 Emp. plus Emp. plus $43,000 c familv familv M 5/4/63 Meter Service 1 0/6/83 Emp. only Emp. only $55,000 $55,000 Supervisor F 11/6/41 Delinq. Accts. 6/1/92 Emp. only Emp. only $30,000 Rep. "Final Accounts" M 1/19/39 Utility Board 6/16/61 Emp. plus Emp. plus $50,000 Chairman spouse familv M 5/5/74 Tree Trimmer 2/17/98 Emp. plus Emp. plus $39,000 $39,000 $10,000 children familv M 9/9/62 Control Room 10/18/83 Emp. only Emp. only $37,000 Operator M 1/15/57 Load Dispatcher 5/13/96 Emp. only Emp. only $38,000 M 12/19/74 Apprentice Line 9/20/99 Emp. plus Emp. only $29,000 $29,000 Person children M 8/10/62 Maintenance 2/15/84 Emp. plus Emp. plus $45,000 $45,000 Leader children familv F 7/6/45 Training 7/10/91 Emp. plus Emp. only $49,000 $49,000 Coordinator spouse M 9/25/50 Chief Auto 6/20/88 Emp. only $45,000 Mechanic M 9/11/58 Delinq. Accts. 9/6/83 Emp. only Emp. only $35,000 Field Rep. M 9/19/62 Lineman 6/8/83 Emp. plus Emp. plus $46,000 $46,000 $5,000 children familv F 2/4/59 Records Mgmt. 12/17/79 Emp. only Emp. only $45,000 Liaison Officer M 1/8/42 Customer 3/18/85 Emp. only $68,000 Services Manaaer F 11/30/49 Executive 6/20/83 Emp. only $43,000 Assistant F 6/11/61 StoreKeeper 4/24/89 Opt-Out $39,000 $39,000 F 1/14/75 Contract Clerk 11/12/98 Emp. plus Emp. only $32,000 spouse M 1 0/22/62 Engineering 1/1/83 Opt-Out Emp. plus $55,000 $55,000 $40,000 5000 Suoervisor familv F 11/23/63 Custodian 1 0/2/00 Emp. only Emp. plus $19,000 familv F 2/27/69 Customer Service 1/24/96 Emp. only Emp. only $30,000 Rep F 8/17/50 Accounting Rep 1/28/90 Emp. plus Emp. plus $34,000 $10,000 spouse familv M 7/27/48 T&D Director 4/3/78 Emp. only $68,000 M 9/8/58 Meter Service 8/21/81 Emp. only Emp. only $34,000 $34,000 Technician M 11/15/61 Fleet/Facilities 3/16/87 Emp. plus Emp. plus $50,000 Suoervisor family familv M 11/3/47 General Manager 7/14/71 Emp. only Emp. only $103,000 M 6/21/58 Power System 9/14/80 Emp. plus Emp. plus $45,000 Coordinator familv familv M 3/12/41 Meter Reader 9/23/96 Emp. only Emp. only $31,000 M 1 0/2/56 Electrician 10/22/91 Emp. plus $44,000 $44,000 familv 83 M 11/12/63 Electrician 7/18/84 Emp. plus $44,000 $44,000 children M 8/31/54 Meter Service 10/10/72 Emp. only $43,000 Leader M 7/10/44 Finance Manager 1/7/91 Emp. only Emp. plus $83,000 family M 8/16/58 Painter/Insulator 6/20/91 Emp. plus Emp. plus $39,000 family family F 7/8/64 Customer Service 3/12/01 $22,000 Rep M 6/2/47 Courier 5/21/90 Emp. only Emp. only $27,000 M 9/16/66 Power System 2/16/88 Emp. plus $45,000 Coordinator family M 1/10/61 Drafter/Auto Cad 10/12/93 Emp. plus $39,000 Operator spouse M 5/13/65 Engineering Field 8/5/85 Emp. plus Emp. plus $42,000 Rep familv familv M 7/13/46 Electrical 4/20/88 Emp. only Emp. only $62,000 Enaineer F 11/14/57 Engineering Field 12/17/90 Emp. plus Emp. plus $42,000 $42,000 Rep family family M 11/27/63 Meter Service 7/6/88 Emp. plus Emp. plus $35,000 $35,000 Technician family family M 12/12/45 Environmental 4/25/88 Emp. only $52,000 Service Supervisor M 7/6/54 Auto Mechanic 1/29/79 Emp. only $43,000 M 7/25/56 Lineman 1 0/28/83 Emp. plus Emp. plus $46,000 children familv M 12/29/32 Utility Board 1 0/9/97 Emp. only Emp. plus $50,000 Member family M 5/6/60 Customer 6/11/82 Emp. plus Emp. plus $59,000 Services children family Suoerintendent F 9/19/67 Communications 1/20/89 Emp. only $59,000 Director F 11/10/46 Superintendent's 4/23/84 Emp. only Emp. only $33,000 Secretarv M 4/13/67 Customer 7/27/92 Emp. plus Emp. plus $34,000 $34,000 Proarams Rep. family family M 1 0/1/69 Lineman 2/1/91 Emp. plus Emp. plus $46,000 familv familv M 2/13/49 T&D Line 9/15/87 Emp.ldomestic Emp. only $52,000 Supervisor partner F 11/21/57 Accountant 11/13/97 Emp. plus Emp. only $43,000 spouse M 12/12/55 I&E Tech 10/17/88 Emp. plus $44,000 children M 8/25/61 General Helper 10/21/87 Emp. only $25,000 M 6/30/58 Customer 5/8/95 Emp. only $48,000 $48,000 Services Supervisor M 5/16/50 Finance 4/6/92 Emp. plus Emp. only $62,000 Superintendent spouse M 8/27/50 Buyer 9/6/84 Emp. only $42,000 $42,000 M 9/17/57 Control Room 12/15/80 Emp. plus $37,000 $37,000 Operator family M 2/21/43 Risk Mgmt. 4/10/00 Emp. plus Emp. plus $48,000 Specialist spouse family F 11/20/73 Customer Service 3/15/99 Emp. only Emp. only $30,000 Rep 84 Apprentice Mechanic 85 $39,000 COBRA PARTICIPANTS F spouse Cobra expires on 9/30/2001 NOTE: Employer Pays Premiums for Emp. & Emp. pays premium for Dependents 86 ~ Retiree Census Information City Electric System (Utility Board of the City of Key West, Florida) SEX DOB EMP RETIRE MEDICAL COVG TYPE DENTAL COVG LIFE INS AMT DATE DATE TYPE F 3/6/50 11/12/68 1/31/89 Emp. only Emp. only $11,000 M 12/27/23 5/24/54 06/01/84 Emp. medicare supplement $11,000 M 2/3/42 4/20/63 5/1/92 Emp. only $20,000 M 12/9/28 4/30/68 4/30/95 Emp. plus spouse (both Emp. plus spouse $18,000 medicare suoo) F 5/8/21 1/19[73 6/01/81 Emp. medicare supplement $8,000 F 2/3/46 4/14/69 1/31/95 Emp. only Emp. only $14,000 M 7/30/42 11 /09/64 1/31/95 Emp. only Emp. only $18,000 M 9/5/49 11/17/77 12/01/97 Emp. only Emp. only $25,000 M 1 2/7/37 9/15/69 3/01/99 Emp. plus spouse $25,000 M 5/21/39 12/20/63 3/01/84 Emp. only $10,000 M 1/21/36 01/03/84 4/01/97 Emp. (medicare supplement) $19,000 plus spouse M 7/26/32 1 0/25/54 1 0/30/87 Emp. medicare supplement Emp. only $16,000 M 1 0/28/39 6/09/59 5/31/88 Emp. only $16,000 M 12/22/32 6/26/72 01/01/93 Emp. medicare supplement Emp. only $14,000 F 12/3/23 09/16/57 12/15/78 Emp. medicare supplement $8,000 M 12/12/35 9/13/62 8/31 /96 Emp. only $44,000 M 10/29/59 3/08/78 4/01/98 Emp. plus family Emp. plus family $21,000 M 6/20/36 11 /19/64 12/31/87 Emp. plus spouse $17,000 M 7/10/24 12/31/68 12/31/87 Emp. medicare supplement $13,000 M 3/3/55 6/30/71 5/01/92 Emp. plus spouse $21,000 M 4/13/24 03/05/53 11/01/95 Emp. medicare supplement $13,000 M 10/25/31 09/20/50 03/31/78 Emp. medicare supplement $11,000 F 12/22/38 5/11/67 7/29/88 Emp. only $13,000 F 4/16/44 4/30/69 6/01/90 Emp. only $12,000 M 11/28/29 11 /16/59 11/13/81 Emp. only $9,000 M 3/10/39 3/22/65 1/31/95 Emp. only $29,000 F 10/16/67 2/27/89 12/01/94 Emp. only Emp. only $16,000 M 12/17/38 2/28/57 1/31/95 Emp. plus spouse $23,000 M 7/16/38 5/17/62 1/31/95 Emp. only $18,000 F 1/13/42 9/9/85 2/01/99 Emp. only Emp. only $26,000 M 6/1/40 10/17/60 7/01/95 Emp. only $22,000 M 1 0/6/22 5/18/72 1/28/87 Emp. medicare supplement $13,000 M 3/14/38 6/12/70 9/01/87 Emp. plus spouse $16,000 M 1 2/3/32 1/11/65 1/1/93 Emp. medicare supplement $19,000 M 8/20/25 7/14/65 6/24/88 Emp. medicare supplement $10,000 M 5/1/28 6/01/70 1/1/94 Emp. plus spouse (both $16,000 medicare SUDD) F 7/1 8/20 4/23/57 4/23/88 Emp. only $9,000 87 M 2/8/33 7/1 0/72 1/1/96 Emp. (medicare supplement) $18,000 plus spouse M 12/15/33 10/01/57 12/31/87 Emp. plus spouse $17,000 M 4/7/31 4/24/54 4/30/93 Emp. (medicare supplement) $18,000 plus spouse M 5/7/32 5/03/62 6/01 /92 Emp. (medicare supplement) Emp. plus spouse $17,000 plus spouse M 8/29/31 4/23/79 4/30/99 Emp. medicare supplement $22,000 M 3/3/21 1 0/26/53 1 /3/84 Emp. plus spouse (both $10,000 medicare supp) M 1/26/41 5/31/61 1/31/95 Emp. only $21,000 M 9/8/28 1 0/26/65 1/26/91 Emp. medicare supplement Emp. plus spouse $16,000 M 6/28/37 7/31/72 8/01/97 Emp. plus family Emp. plus family $15,000 M 12/14/17 9/01/78 6/21/83 Emp. medicare supplement $9,000 M 10/30/47 2/09/70 Emp. plus spouse Emp. plus spouse $28,000 M 7/9/35 7/28/80 7/28/95 Emp. plus spouse (both $14,000 medicare suoo) M 3/5/21 3/03/58 12/22/81 Emp. medicare supplement $9,000 M 11/22/21 1 0/26/53 1/03/84 Emp. plus spouse (both $13,000 medicare suoo) M 6/25/53 6/04/73 4/26/97 Emp. plus children $22,000 M 5/10/49 9/10/79 7/30/99 Emp. plus family $18,000 M 12/6/31 2/23/57 6/19/80 Emp. medicare supplement $9,000 M 8/15/56 7/20/76 11 /29/96 Emp. only $19,000 M 7/28/37 2/8/60 6/29/90 Emp. only $15,000 M 10/11/28 3/04/48 3/15/ Emp. plus spouse (both $20,000 medicare suoo) M 12/6/38 1 0/02/68 10/02/98 Emp. plus spouse $21,000 M 8/19/25 10/23/61 08/09/82 Emp. medicare supplement Emp. only $9,000 M 4/1 0/29 06/19/53 1/12/90 Emp. plus spouse (both $19,000 medicare supp) M 7/15/50 1/12/65 2/27/81 Emp. medicare supplement $12,000 M 2/3/25 6/11/46 7/03/73 Emp. medicare supplement $8,000 M 9/10/21 5/21/56 1/31/86 Emp. medicare supplement $8,000 M 7/6/15 9/17/62 4/29/88 Emp. medicare supplement Emp. only $8,000 F 4/25/45 2/1 7/70 11/01/86 Emp. only Emp. only $15,000 M 8/14/24 1/15/90 3/01/00 Emp. plus spouse (both $28,000 medicare supp). M 3/27/14 8/04/65 10/31/80 Emp. medicare supplement $9,000 M 1/31/27 12/06/61 1/31/89 Emp. medicare supplement $14,000 M 4/24/35 2/07/62 5/30/86 Emp. (medicare supplement) $13,000 plus spouse M 4/8/46 6/22/68 6/26/98 Emp. plus spouse $19,000 M 8/17/37 9/04/59 9/30/87 Emp. only $13,000 M 10/31/41 9/30/68 4/01/92 Emp. only $17,000 M 2/5/55 6/17/74 6/30/99 Emp. only Emp. only $15,000 M 8/9/46 12/18/67 1/01/96 Emp. only $18,000 M 1/17/39 1 0/04/62 5/10/84 Emp. plus spouse $11,000 M 10/7/51 9/13/88 7/01/92 Emp. only Emp. only $12,000 M 1/7/40 3/04/68 6/01/00 Emp. only $25,000 88 . , M 11/22/20 9/04/68 4/01/82 Emp. medicare supplement $10,000 M 8/25/25 6/23/43 8/24/73 Emp. medicare supplement Emp. only $9,000 M 5/1/39 3/1 0/58 1/31/95 Emp. only $15,000 M 5/3/45 8/24/64 1/04/91 Emp. only $16,000 M 12/10/30 11/13/87 11/01/97 Emp. medicare supplement Emp. only $25,000 M 2/8/47 10/01/65 3/31/95 Emp. only $17,000 M 10/31/48 4/20/67 6/30/87 Emp. only Emp. plus spouse $9,000 M 7/1/46 1 0/24/66 4/26/93 Emp. plus spouse $17,000 F 1/7/26 11/05/79 1/11/91 Emp. medicare supplement Emp. only $9,000 F 1 /20/20 5/25/59 4/15/75 Emp. medicare supplement $8,000 M 11/10/35 3/25/88 8/07/98 Emp. only $18,000 M 1 0/28/41 7/13/64 7/13/99 Emp. only $49,000 F 7/15/39 9/30/81 12/01/94 Emp. only Emp. only $13,000 M 11 /8/27 8/28/52 1/04/83 Emp. only $11,000 M 5/6/57 12/22/78 3/31 /99 Emp. plus family $16,000 F 10/15/26 6/05/62 5/31/90 Emp. medicare supplement $11,000 M 6/19/36 1 0/1 0/59 1/31/92 Emp. (medicare supplement) $21,000 plus SDouse F 8/31 /34 1/17/66 1/31/95 Emp. medicare supplement $13,000 M 5/17/44 8/13/64 1 /15/93 Emp. only $19,000 M 6/23/39 9/18/61 1/01/92 Emp. plus spouse $24,000 89 Exhibit 5 Rx Formulary And FLC Express Scripts 90 ':. _ . .... .. J3~.... ~9.rrn.~J.~r~.....,o."o,~v,uuu""..,,<uur.geQwnenapp"opnale 0 <\irer.ted 10 ao exp".. Scrlpls.lne, reprose"IaUoe at 1.8OO-233-S065 (TOO 1-800.899,2114). .Than" you lor youF<ooperaliQn. . t m,.y be ANTIBACTERIAl DRUGS ANGIOTENSIN CONVERTING ANTIPSYCHOTIC DRUGS OSTEOPOROSIS DRUGS SUSPEJIISIDNS/LlQUJOS ENZYME ItlHISITORS CONVENTIONAl. (TYPJCAI.) SSS EVlSTA ~ AMDXIL 2OOI1l~5m1. S genetic CAPOTl'N S _ic HAlOOl SSS MIACAlClN 400mgISml $USlI SS ACCUPflII.. $ ~ MtllAAIl SSSS FOSAMAX S ge...ic AMOXlll25mg15ml SS MAVlK S generic AAVAHE 250mg/Smf $USlI SSS LOIENSIN SS generie PROUXlN ANTIUlCER DRUGS s generic MCTRIM.PEDlATlllC SSS ZESTRlL' SS genetic THOAAZINE Antacids.... 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OOAVP WAR) sssss J".JlES! 55.55 COAEG $SSS$ PROlAC !IIII ST1MATE (PAR) SSSSS MtCRONOR , 91 EXPRESS SCRIPTS FLORIDA MUNICIPAL INSURANCE TRUST 6625 West 78th Street Bloomington, MN 55439 1-800-233-8065 FLORIDA LEAGUE OF CITIES. Ine Prescription Benefit Program Dear Participant: This brochure outlines the benefits of your prescription drug benefit program. It provides you with an explanation of how to use the program. The program was designed to provide you with flexibility and convenience, while maximizing your savings. You should use the EXPRESS SCRIPTS card for short-term prescription medications (medication used for 30 days or less). EXPRESS SCRIPTS, mail-service pharmacy program, should be used for those medications that you will be taking for more than 30 days (such as heart medication, insulin, and thyroid medications). If you have any questions regarding your benefits or provider locations in your area, please feel free to contact our office at 1-800-233-8065. Prescription benefits are very important component in your medical health benefit and we look forward to providing you with the very best in quality service and products. HOW TO USE THE PLAN: 1. GO TO A PARTICIPATING PHARMACY. For your convenience, a listing of participating pharmacies is located on the back of this brochure. 2. PRESENT YOUR ID CARD and your prescription to the pharmacist. 3. PA Y THE COPA YMENT as identified on the identification card. GENERIC USE: Generic equivalents of prescription drugs are required if an equivalent is available. unless the physician specifically excludes the generic equivalent in the issuance of that prescription. If a generic is available, and the Insured elects a 92 brand name drug ii) lien of its generic equivalent, benefits provided will be based on the lesser price and the Insured may be required to pay the difference in addition to the required copayment. UTILIZATION REVIEW: Drug Utilization Review programs will be used to monitor the dosage and treatment patterns for the Insured under this plan. All prescriptions, which exceed $500, will be required to receive authorizations. DISPENSING LIMITATIONS: The quantity of medication dispensed shall be limited to a 30 day supply from a retail pharmacy and a 90 day supply from the mail service pharmacy. WHA T YOU SHOULD ASK YOUR PHYSICIAN AND PHARMACIST WHEN YOU RECEIVE A PRESCRIPTION AND REMINDERS FOR THEIR PROPER USE: 1. Should you expect side effects from this medication? If so, what might they be? 2. Is there a generically equivalent medication, which can be used to produce the same therapeutic benefit? 3. If the medication is being tested, ask to have prescribed a limited supply until the correct medication is found. 4. Always confirm the amount of prescription to be taken daily and whether it should be taken with food or without, etc. 5. Always finish your medication therapy Incomplete therapy may result in continued illness. IMPO RT ANT: if you are taking other medications, make sure that the prescribing physician is aware of these medications. Drug interaction. misuse and abuse have been found to be a major contributor to prolonged or newly acquired illnesses. FREQUENTLY ASKED QUESTIONS AND ANSWERS: Q Can I fill my prescription at a nonparticipating pharmacy? A If you have prescriptions filled at a non-participating pharmacy, you will be reimbursed according to the contract terms of participating pharmacies. Q What are 'maintenance medications"? A Maintenance medication arc used to treat chronic conditions such as arthritis, diabetes, high blood pressure and ulcers. They are taken on a long-term basis and are available in economic quantities through the mail service program. Q What do I do if I need a prescription filled when I am out of town? A If you are traveling and need a prescription filled, call the toll-free number on your ID card. EXPRESS SCRIPTS representative will locate the nearest participating retail pharmacy to fill your prescription. If a participating pharmacy is not available, your benefit plan may allow you to use a non-participating pharmacy. Q Is my co-payment applied to my deductible? A No. Co-payments do not apply toward your annual deductible or coinsurance Q Could lever pay less than the $10, $20 or $35 co-payment? A Yes. Always ask the pharmacist if the price is less than the co-payment. If so. pay the least amount without 93 using the drug card program and save your receipt for tax purposes. SUMMARY OF BENEFITS Retail Copayment $10 Generic $20 Preferred Brand $35 Non-Preferred Bran Mail Order Service Copayment: $20 Generic $4Q Preferred Brand $70 Non-Preferred Bran Included. Items: . Legend Drugs which require. a prescription under federal or state law unless specifically excluded; . Insulin, syringes and needles for the injection of insulin; . Compounded medications, which include least one legend, drug unless specifically excluded; . Oral contraceptives. Excluded Items: .. Non-Legend Drugs, except insulin; . Charges for drug .administration, and injectable items; .. Charges for prescriptions, which are covered by Workers' Compensation laws, or other county, state or federal programs; . Immunization agents, sera blood or plasma; . Drugs labeled investigational or experimental; . Medication taken by or administered while patient is in a licensed hospital; . Devices, appliances and medical supplies . Nicorette and all smoking deterrents; . Medication to promote hair growth; . Vitamins and prenatal vitamins; . Medication for cosmetic purposes; . Dietary supplements, anorexieants, diet and liquid diets; . Fertility/Infertility drugs . Viagra 94 . Albertson's · Drug Emporium . Eckerds · KashN'Karry · Medicine Shoppe International · K-Mart . Publix . Target · Thrift Drugs . Walgreens · Wal-Mart . WinnDixie \ ,'- PARTICIPA TING PHARMACIES · Other independently owned pharmacies see your benefits department for listing. FlORIDA LEAGUE OF CITIES, INC. 95 Exhibit 6 Loss History Utility Board of the City of Key West 96 MonthlYear Med Claims Drua Claims Total Med Claims Premium Loss Ratio Jun-97 80,742.34 11,497.60 92,239.94 62,226.00 148.23% Jul-97 53,713.19 12,541.67 66,254.86 60,692.00 109.17% Aua-97 197,748.04 9,368.03 207,116.07 62,919.00 329.18% 5eo-97 183,572.41 11,929.21 195,501.62 58,403.00 334.75% Oct-97 78,507.58 13,981.71 92,489.29 65,869.22 140.41% Nov-97 52,403.19 10,056.46 62,459.65 68,074.08 91.75% Dec-97 115,232.55 14,139.50 129,372.05 60,295.30 214.56% Jan-98 65,578.53 14,886.63 80,465.16 63,965.10 125.80% Feb-98 71,607.90 14,445.61 86,053.51 65,896.08 130.59% Mar-98 83,398.51 12,515.41 95,913.92 64,127.78 149.57% Aor-98 88,768.06 17,362.87 106,130.93 65,054.38 163.14% Mav-98 67,397.04 9,330.10 76,727.14 65,066.18 117.92% Sub Total 1,138,669.34 152,054.80 1 ,290,724.14 762,588.12 169.26% Jun-98 99,024.80 14,391.10 113,415.90 65,545.66 173.03% Jul-98 153,243.04 15,393.04 168,636.08 62,964.70 267.83% Aua-98 166,482.29 15,090.91 181,573.20 65,115.50 278.85% 5eo-98 122,872.74 12,823.14 135,695.88 64,685.34 209.78% Oct-98 58,769.96 14,037.75 72,807.71 64,894.24 112.19% Nov-98 77,482.87 15,183.08 92,665.95 67,015.92 138.27% Dec-98 82,527.58 17,872.22 100,399.80 66,012.68 152.09% Jan-99 94,101.26 16,202.61 110,303.87 67,311.34 163.87% Feb-99 107,650.14 13,377.16 121,027.30 88,345.09 136.99% Mar-99 99,085.65 20,977.07 120,062.72 71,512.67 167.89% Aor-99 56,791.89 14,727.83 71,519.72 72,577.34 98.54% Mav-99 103,124.99 14,697.60 117,822.59 73,202.98 160.95% Sub Total 1,221,157.21 184,773.51 1,405,930.72 829,183.46 169.56% June-99 119,028.29 17,098.65 136,126.94 71,791.56 189.61% Julv-99 138,807.01 19,602.47 158,409.48 73,165.16 216.51% Auaust-99 92,858.24 17,622.01 110,480.25 73,397.48 150.52% Seotember-99 160,553.77 21,284.56 181,838.33 74,512.13 244.04% October-99 97,806.39 18,548.08 116,354.47 79,203.96 146.90% November-99 94,817.17 20,290.26 115,107.43 80,836.36 142.40% December-99 59,825.56 24,097.84 83,923.40 82,227.29 102.06% Januarv-OO 67,844.38 22,168.22 90,012.60 80,465.53 111.86% Februarv-OO 144,087.41 21,726.72 165,814.13 80,318.16 206.45% March-OO 93,370.95 21,323.84 114,694.79 81,641.41 140.49% Aoril-OO 59,976.45 21,348.01 81,324.46 81,834.59 99.38% Mav-OO 88,058.25 29,584.69 117,642.94 82,284.12 142.97% SubTotal 1 217,033.87 254,695.35 1,471,729.22 941,677.75 156.29% June-OO 76,315.24 23,557.36 99,872.60 81,900.83 121.94% Julv-OO 75,516.46 20,239.80 95,756.26 79,863.88 119.90% Auaust-OO 178,670.98 29,689.30 208,360.28 82,355.52 253.00% Seotember-OO 124,624.35 28,311.55 152,935.90 81,556.90 187.52% October-OO 214,386.97 11,188.49 225,575.46 116,901.25 192.96% November-OO 130,126.98 21,336.01 151,462.99 119,110.84 127.16% December-OO 118,517.59 16,042.88 134,560.47 115,955.93 , 116.04% Januarv-01 47,740.30 19,906.86 67,647.16 117,851.66 57.40% Februarv-01 66,052.58 18,349.33 84,401.91 111,875.82 75.44% March-01 88,258.54 20,507.74 108,766.28 116,459.60 93.39% Subtotal 1,120,209.99 209,129.32 1,329,339.31 1,023,832.23 129.84% Total 4,697,070.41 800,652.98 5,497,723.39 3,557,281.56 154.55% Claims VS. Premium 06/01/97 - 03/31/01 97 Monroe County Board of County Commissioners Request for Proposals For Implementation in 2002 for Health Benefit Plan Claims Administration & Utilization Review Services Excess/Stop-Loss Insurance for Group Self-Insured Medical Benefits Prescription Benefits Plan Group Life Insurance and Accidental Death & Dismemberment Group Employee Voluntary Supplemental Life Insurance Group Voluntary Dependent Life Insurance Group Voluntary Short Term and Long Term Disability Employee Assistance Plan Nationwide Provider Network Flexible Spending Account Program // Proposal Return Date: see official advertisement [,3 Monroe County Board of County Commissioners Request for Proposals for Implementation 2002 for Health Benefit Plan Claims Administration & Utilization Review Services Excess/Stop-Loss Insurance for Group Self-Insured Medical Benefits Prescription Benefits Plan Group Life Insurance and Accidental Death & Dismemberment Group Employee Voluntary Supplemental Life Insurance Group Voluntary Dependent Life Insurance Group Voluntary Short Term and Long Term Disability Employee Assistance Plan National Provider Network Flexible Spending Account Program SCOPE OF REQUEST FOR PROPOSALS The Monroe County Board of County Commissioners wishes to combine its benefit Plans where possible and to utilize one common plan date. The County currently self-insures its medical benefits, including dental and vision benefits and will consider additional self-insurance of other benefits from time to time as may be in its best interests. It is not necessary that all of the benefits listed in this RFP be provided by one proposer. Proposers may submit proposals for individual benefits plans (i.e., vision or dental, etc.), and may utilize different providers (i.e. insurers or plans). PURPOSE The purpose of this RFP is to consolidate, where possible, the County's benefit plans and to reduce costs where possible. Explore creative proposals utilizing fully funded traditional insurance plans and/or self-funded plans or a combination of both. Consideration will be given to any proposal that recommends modifications in current offerings that will give greater flexibility to employees and allow the County to contain costs. 2 GOAL The goal is to provide responsive and modem benefits to the county employees and their dependents while containing costs. OBJECTIVE The objective is to shift as many of the benefit plans to a common plan year, October 15t through September 30th as practical and reduce the number of providers where possible. GENERAL ORGANIZATION OF RFP DOCUMENT This RFP contains eight (8) separate sections. Each benefit plan is treated individually and separate sections are included for each. The Life Insurance benefits and the Disability benefits are combined in the RFP package, but separate Proposal Response Forms are included where possible, each section contains information for that section including required proposal response forms for that section. Separate proposal responseforms must be completedfor each benefit section proposed and a separate responseform must be submittedfor each proposal madefor each section. The General Proposal Response Form must be completed in all instances to accompany the specific response forms for each benefit. Current providers may either reaffirm their current contracts with rate adjustments as necessary or submit new proposals. Information applicable to more than one section such as census information and loss history data is presented as an exhibit at the back of this RFP. The exhibit information can be photocopied and utilized as the basis for more than one benefit plan. The County realizes that all information to provide a proposal may not be included in this RFP package. Attempts will be made to provide additional information requested to the extent that the information is available and reasonable. Information provided in such request will be available to all proposers. The County intends to rely upon proposals made and proposers and providers must be aware that all items of each proposal will be enforced by the County and specifically to any performance guarantees for service or rates. Subsequent changes from the proposal(s) will not be permitted. The County reserves the right to reject any proposal or part of any proposal for whatever reason and to negotiate or not negotiate with any proposer individually to the exclusion of others, or to waive technicalities. This is in addition to any rights the County may have under normal circumstances. The County requests an annual proposal with the provision for two (2) one-year renewals at the County's option. Any rate guarantees for multiple years should be specifically stated. 3 Section 1 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR HEALTH PLAN CLAIMS ADMINISTRATION AND UTILIZATION REVIEW SERVICES GENERAL INFORMATION The Monroe County Board of County Commissioners desires to obtain proposals for Third Party Administration Services (TPA) and Utilization Review Services (DR) for its Self-Insured Health Plan. Currently, Acordia National, Inc. is serving as Monroe County's TP A and the Keys Physicians Health Alliance, (KPHA), is serving as the UR provider. In-county services and large case management are provided by KPHA and its network. Out-of-county services are provided through the Dimension Health PPO network. Large case management is provided by KPHA. Monthly meetings between KPHA and the County are held to review the status of the self-insured benefits. CURRENT PROGRAM The Health Plan currently provides benefits for the employees of The Board of County Commissioners, the Clerk of the Circuit Court, the Tax Collector, the Property Appraiser, the Supervisor of Elections, the Sheriffs Department, the Mosquito Control District, and the Land Authority. Employees do not contribute to the cost of the Health Plan. Contributions for dependents are made through payroll deductions of $2 I 7 per month for one dependent and $260 per month for two or more dependents. (increasing to $238 and $282 respectively on January 1, 2002). Domestic Partners are considered by County Resolution to be included as dependents subject to the criteria in the resolution. Medical benefits are self insured by the County and provide indemnity benefits. There is an individual lifetime maximum of $1,000,000. Specific types of treatment have other limitations, such as Chemical Dependency and MentaIJNervous treatment. The calendar year deductible is $200 per individual and $400 for a family increasing to $300 and $600 respectively on January 1, 2002. There is a separate per illness hospital confinement deductible of $150. There is a per visit emergency room deductible of $75 effective October 1, 2001. Coinsurance payment percentages are 80% of the first $10,000 (going to $11,000 on January 1,2002 and increasing by 10% each year until we reach $20,000) and 100% thereafter for in-network services. Out of network services are paid at 70% of the first $10,000 and 90% thereafter. The KPHA and Dimension networks are believed to provide adequate coverage throughout the county and into the South Florida area. County retirees reside throughout the United States. Section 7 is seeking a Nationwide Provider Network. Dental coverage is provided for all participants of the health plan. The annual benefit maximum for dental benefits is $2,000 per year. There is a $1,500 lifetime maximum for orthodontia. Calendar year deductibles are $50 for an individual and $150 for a family. Coinsurance payment percentages are 100% for Preventative Services, 80% for Basic Services and 50% for Major Services. There is a $1,000 annual benefit for TMJ. Vision benefits are also included on the Health Plan. Vision exams are allowed once every two calendar years and provide a complete visual exam ($50 maximum), Prescription Glasses - Lenses & Frames ($150) or contacts !$150) are permitted once every two calendar years. Health benefits currently include the following cost containment provisions: 4 . Coordination of Benefits . SubrogationlRight of Reimbursement . Mandatory Pre-Admission Certification . Mandatory Diagnostic Certification . Managed Second Surgical Opinion . Medical Case Management . Reduced benefits for out-of-network services Claim processing is currently handled on a direct submission basis. Claims are sent directly to Acordia National, (the TP A), which reviews them for eligibility and processes them for payment along with the Explanation of Benefits (EOB's). Acordia prints claim checks for the County on its local checking account and forwards the checks directly to the employee or provider. The claim registers are then forwarded to the County for monitoring. Periodic claim audits are performed by the County and separately by the TPA. Acordia maintains a maximum thirty (30) day claim turn around. DESIRED PROGRAM The County desires the successful TPA and UR provider to assist in the implementation of the following changes to the Plan: . Improved Automation connections among TPA, the County and UR provider, . Direct Submission of Claims to TPA, including electronic submission, if possible, . Improved Monitoring (on-line, if possible) capabilities of claim status, eligibility status, UR performance, and; . Plan Document revisions and distribution to employees. RATING DATA Current census information and historical enrollment counts are included as exhibits. EFFECTIVE DATE OF CONTRACT The preferred effective date of the contract will be coordinated with the County's fiscal year - October 1 - September 30. Alternatively, the County may need to enter into a contract initially for a shorter period of time, the County will adjust the anniversary date to October 151 for subsequent years. PROPOSAL SUBMITTAL Questions relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 facsimile: 1-813-287-1041 All Questions seekinl! additional information must be received no later than 5:00 pm twentv (20) davs precedinl! the bid openinl! date. An addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. 5 Sealed proposals includinl!: two (2) oril!:inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSALS HEALTH PLAN CLAIMS ADMINISTR"-TION, DENTAL, VISION, MANAGED CARE AND UTILIZATION REVIEW AND LARGE CASE MANAGEMENT SERVICES RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will service it best. NOTICE OF POSSIBLE INTERVIEW The County may wish to interview fmalists either at their operating location, or at the Monroe County offices in Key West. Interviews conducted on-site at the TPA location should include all key personnel who will be involved with the Monroe County account. If interviews are conducted in Key West, appropriate information for key personnel and operations of the TPA should be provided. ACCEPTANCE BY MONROE COUNTY'S EXCESS INSURER No proposal can be accepted unless the TPA and UR provider are acceptable to the County's Excess Insurer. AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company or organization that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. QUALIFICATIONS OF PROPOSER Experience with Government Entities will be a major factor in the evaluation of the proposals. All proposers should furnish a summary of such experience. References, including client name, contact pe;:son and telephone number, should also be provided for review. 6 TP A SERVICES DESIRED The coordination of the TP A and the UR process is considered a critical area of evaluation. The following services are requested of each TP A proposer and should be included in their quoted fee structure: . Adjusting all claims submitted to conclusion of the claims · Reporting of potential specific claims to the excess insurer . Automated ability to check the usual charge for each claim . Assistance in re-writing plan document · Continuous maintenance for compliance with state & federal laws and regulations . Printing and distribution of plan booklet to employees . Monthly reporting to the County . Participating in periodic meetings with the County to discuss plan performance . Answering employee questions regarding coverage . Checking eligibility of claim and claimants . Coordinating all UR services and performance . Filing assistance for state and federal filings . Assisting with negotiation of managed care network availability . Coordinating benefits . Managing subrogation & Right of Reimbursement . HIP AA andlor COBRA administration . Providing an on-site service representative to assist in administration Resumes of key staff should be included for review. References, preferably of other governmental entities, must be included for review. TPA ERROR RATIOS A description should be included of how the TPA internally audits and verifies the accuracy of their claim paying. The error ratio should be included. Monroe County is interested in negotiating contractual terms that include a commitment from the TP A to remain within a certain error ratio or be penalized. Please address in proposal if such terms would be acceptable. MANAGED CARE Monroe County is interested in fee reductions typical of a Managed Care Network. TPA's should indicate past experience in developing or assisting in the creation of such networks. The successful TP A will be expected to assist in this process. Proposed networks are expected to remain in effect for one full year from October 1, 2001. Any reduction in the network size or change in participants should be guarantee continued access to all County members for the remainder of the year. UTILIZATION REVIEW (DR) AND LARGE CASE MANAGEMENT SERVICES D~SIRED The County is interested in controlling the cost of medical claims. The UR provider(s) will be evaluated on their ability to coordinate with the TPA for the best control of costs. The following services are included in the plan description. Others can be considered. 7 · Mandatory Pre-Admission Certification . Managed Second Surgical Opinion . Medical Case Management · Pre-certification of Diagnostic procedures Resumes of key staff should be included for review. References, preferably of governmental entities, must be included. PAYMENT TERMS The preferred method of payment is monthly. The preferred method for all TP A, UR, and Large Case Management is monthly payment. If other terms are proposed, please be specific regarding amounts and time schedules. SAMPLE CONTRACT OR AGREEMENT Each proposal must contain a sample contract or agreement that would be used between the successful proposer and Monroe County. TERMINA TION/N ON-RENEWAL NOTICE Ninety, (90), days written notice is requested by the service provider for termination or non-renewal of the contract or agreement. CLAIM REpORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals to report claims to. CLAIM CONSULTATION AND STATISTICAL REpORTS Monroe County will require that the successful proposer submit monthly loss reports. Reports should be completed in plain English and received by the County within seven (7) days following the end of the month. The reports should include a detailed description of individual claims and the amounts paid for each claim. Individual allocations by operating location may be necessary. Other management reports may be required by Monroe County. Please indicate any additional charges that may apply for special reports beyond the standard reports included in the TPA, UR, and Large Case Management fee. A copy of all loss reports should be forwarded to Interisk Corporation, which is acting as Monroe County's risk management consultant. All proposals must contain samples of all reports that will be provided. OWNERSHIP OF INFOMIA TION All information and files are required to be returned to the County within thirty (30) days upon termination or request by the County. All files are to be the property of the County. The TPA will be responsible for transfer of data to another TPA or to the County in the event the TPA contract is not continued. The TPA must provide that all prior claim history in electronic or hard-copy form will be available. Any additional charges or fees must be 8 specifically identified at the time the proposal is accepted. Old records may not be destroyed without specific written approval by the County. USE OF PROPOSALS FORMS Proposers are required to submit their proposal(s) on the forms included in this Request For Proposals package. It is important that the proposal be signed by an authorized representative of the insurer/ service provider in order to receive consideration. Additional information or proposals may be submitted in addition to the initial proposal. INSURANCE REQUIREMENT The successful proposer(s), throughout the term of the contract, shall purchase and maintain insurance as set forth in Attachment A. ADDITIONAL REQUIRED FORMS The following forms, included as Attachments B, C, D and E must be signed by an authorized representative and included with the proposals: I. Public Entity Crime Form -Attachment B 2. Drug Free Workplace Form - Attachment C 3. Non-Collusion Affidavit - Attachment D 4. Ethics Clause - Attachment E 9 MONROE COUNTY BOARD OF COUNTY COMJl1ISSIONERS REQUEST FOR PROPOSALS FOR SECTION 1 HEALTH PLAN CLAIMS ADMINISTRATION SERVICES PROPOSAL FORM Please complete a separate proposal form for each option offered. Name of Third Party Administrator Address: Telephone Number: Account Representative assigned to County Phone Number What services are included in the quoted price? (attach separate sheet if needed) Are you proposing a network? Is a network directory included? list the total number of providers in Monroe County, Florida for each of the categories listed here: Allergists Chiropractors Cardiologists Dermatologists Family Practice Gastrologists General Practitioners General Surgery Gynecologists 10 Internal Medicine OB-GYNs Oncologists Optomologists Pediatricians Radiologists Urologists Network Hospitals List by name What is the average turn-around time for claims? What is the average error ratio performance for the administration of medical claims? How was this figure calculated? Will you agree to penalties if an agreed upon error ratio is exceeded? Are resumes of adjusters attached? Are references attached? What is the current case load for the adjusters who will be assigned to the County's account? 11 Are you agreeable to establishing a monetary penalty for excessive error ratio or non-performance standards? Will the proposer charge any initial or set-up fees? Ifso, please explain Are samples of all claims and statistical reports included? Is a sample contract or agreement included? State payment scale used (HIAA, Medicode, etc.) Quoted Price: Employee Spouse Dependent only Family Other State enrollment requirements Will you provide for an open enrollment process? Will a minimum fee apply to the contract? If so, please specify Are there any exceptions to specifications? Please provide the In-Network Negotiated Fees and Out-of-Network Allowable for the following CPT codes: 11100 Biopsy of Skin 17261 Destruction, Malignant Lesion 29870 Diagnostic Arthroscopy 42820 Adenoidectomy and/or Tonsillectomy 43200 Esphaogastroudenscopy 58120 Dilation and Curettage 70450 CT and MRI of Head/Brain, w/o contrast 12 70460 71020 72146 90782 92004 92014 92226 99201 99215 99223 ~ 99283 Tomography Head or Brain, with contrast Radiologic Exam, Chest Magnetic Resonance Imaging Therapeutic/Diagnostic Injection OPHTH Serv: Exam; Compre New Pt OPHTH Serv: Exam; Compre, Est. PT Ophthalmoscopy w/min Psychotherapy Office Visit I New PT Office Visit I Est. PT; Comprehensive Subsequent Hsp Visit; Intermediate ER Exam; New PT; Intermediate Describe your utilization review process . How do you set your diagnosis threshold? What is your dollar amount threshold? What are your staffmg qualifications? Does your firm comply with all state and federal regulatory And licensing requirements? Is a sample contract included? The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptanCt by The County. Deviations from the requested program have been stated. Signature of Authorized Representative Date 13 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR SECTION 1 UTILIZATION REvIEW SERVICES PROPOSAL FORM Please complete a separate proposal form for each option offered. Name ofUR provider Address: Telephone Number: Are the requested services included within the price quoted? Are resumes of personnel attached? Are references included? Quoted Price: Will a minimum fee apply to the contract? Are there any exceptions to specifications? Please provide the In-Network Negotiated Fees and Out-of-Network Allowable for the following CPT codes: III 00 Biopsy of Skin 17261 Destruction, Malignant Lesion 29870 Diagnostic Arthroscopy 42820 Adenoidectomy and/or Tonsillectomy 43200 Esphaogastroudenscopy 58120 Dilation and Curettage 70450 CT and MRI of HeadlBrain, wlo contrast 70460 Tomography Head or Brain, with contrast 14 71020 Radiologic Exam, Chest 72146 Magnetic Resonance Imaging 90782 TherapeuticlDiagnostic Injection 92004 OPHTH Serv: Exam; Compre New Pt 92014 OPHTH Serv: Exam; Compre, Est. PT 92226 Ophthalmoscopy w/min Psychotherapy 99201 Office Visit I New PT 99215 Office Visit I Est. PT; Comprehensive 99223 Subsequent Hsp Visit; Intermediate 99283 ER Exam; New PT; Intermediate What is your average fee reduction achieved for DR cases? The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by The County. Deviations from the requested program have been stated. Signature of Authorized Representative Date 15 Section 2 MONROE COUNTY BOARD OF COUNTY COil/MISSIONERS REQUEST FOR PROPOSALS FOR EXCESS/STOP-Loss INSURANCE FOR GROUP SELF-INSURED MEDICAL BENEFITS GENERAL INFORMATION The Monroe County Board of County Commissioners desires to obtain proposals for Excess/Stop-Loss Insurance for its Group Self-Insured Medical Benefits Program. Eligible expenses include both medical and prescription charges. Currently, John Alden is providing the County's Stop Loss coverage. CURRENT PROGRAM Following is a summary of the County's current program. Insurer John Alden Specific Retention $100,000 Specific Limit $900,000 Eligible Expenses Medical and Prescription Aggregate Attachment Point $ 10,380,053 Aggregate Limit $1 Million Contract Type Paid DESIRED PROGRAM The County desires coverage comparable to its current program. Alternative proposals will be considered based on the ability to meet Monroe's overall objectives. Critical in the County's decision process will be the insurer's willingness to waive all active at work limitations and fully accept all currently enrolled and covered participants. A 90 day claim payment extension is desired in the event the County elects to terminate its self-funded plan. RATING DATA Current census information, historical enrollment count~ and loss information are included as exhibits. -, A copy of the County's Plan Document is included as an exhibit. Proposers are encouraged to obtain the insurer's approval of the document prior to submitting its proposal. 16 EFFECTIVE DATE OF CONTRACT The initial effective date may be for less than 12 months in the event that the program is implemented after the beginning of the fiscal year (Oct. 1 - Sept. 30). Future contracts will be for the full 12 months. REQUEST FOR ADDITIONAL INFORMATION Request for additional information relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 Facsimile: 1-813-287-1041 All reQuests must be received no later than 5:00pm twenty (20) days precedinl! the bid openinl! date. If necessary, an addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. PROPOSAL SUBMITTAL Sealed proposals includinl! two (2) ori!:!:inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL EXCESS/STOP-Loss INSURANCE FOR GROUP SELF-INSURED MEDICAL, PRESCRIPTION Please note that many express mail companies will not guarantee that overnight deliveries to Monroe County will be delivered by 3:00 p.m.. It is the sole responsibility oftlte proposers to ensure their submission is received by the County as specified above. RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriates. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will service it best. AUTHORITY OF PROPOSERS 17 Proposals must be signed by an authorized representative ofthe insurer. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. REQUIRED LICENSE All agents submitting proposals are required to be currently licensed in the State of Florida to transact business within the State. The County reserves the right to request verification of such licensing. The agent should be licensed with the insurer submitting a proposal and have the authority to bind coverage or provide evidence that the insurer has authorized the proposal. STABILITY OF INSURERS Insurers furnishing coverage should be stable and have a current A. M. Best Company rating of "A" or better and be of sufficient financial size to provide security. Insurers must be currently authorized to transact insurance business in the State of Florida. PAYMENT TERMS The preferred method of payment is monthly. If other terms are proposed, please be specific regarding amounts and time schedule. SAMPLE CONTRACT OR AGREEMENT Each proposal must contain a sample contract or agreement tltat would be used between the successful proposer and i'YJollroe County. TERMINATION/NON-RENEWAL NOTICE Ninety, (90) days written notice is requested before the policy can be terminated or non-renewed for any reason other than non-payment of premium. USE OF PROPOSALS FORMS Proposers are required to submit their proposal(s) on the forms included in this Request for Proposals package. It is important that the proposal be signed by an authorized representative of the insurer/service provider in order to receive consideration. Additional information or proposals may be submitted in addition to the initial proposal. ADDITIONAL REQUIRED FORMS The following forms, included as Attachments B, C, D and E must be signed by an authorized representative and included with the proposals: 1. Public Entity Crime Form - Attachment B 2. Drug Free Workplace Form - Attachment C 3. Non-Collusion Affidavit - Attachment D 4. Ethics Clause - Attachment E 18 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR SECTION 2 EXCESS/STOP-Loss INSURANCE FOR GROUP SELF-INSURED MEDICAL BENEFITS Proposal Form Use of the proposal forms will enable a faster, more complete analysis of the proposal(s) submitted. Please complete this proposal form for each insurer and/or option proposed. Additional information can be attached to the forms. Agent/Agency submitting proposal: Address: Telephone Number: Is this proposal authorized by the Insurer? Does agent have binding authority? If not, state procedure to bind. Insurer Proposed. A.M. Best Rating. 19 Is an intermediary utilized to access the insurer? If so, please provide name, address, etc. Will insurer waive all active at work limitations and fully accept all currently enrolled and covered participants in the County's employee benefits plan? If no, please specify details (this will be considered critical in the evaluation process). Will premium payments be monthly based upon enrollment? If no, please specify details (this will be considered critical in the evaluation process). Will insurer provide at least 90 days notice of Any policy modification? Will insurer provide at least 90 days notice of any Rate changes for renewal? If no, please specify details (this will be considered critical in the evaluation process). Will insurer provide at least 90 days notice? of termination or non-renewal? If no, please specify details (this will be considered critical in the evaluation process). Effective date of coverage. Proposal valid until (date) Is a "Paid" coverage basis proposed for stop-loss? If no, please specify details (this will be considered critical in the evaluation process). 20 Can insurer provide access to Conversion coverage? If yes, please include conversion privilege information. What specific limit of liability is proposed? Has the stop-loss insurer approved the County's Plan Document? (include written confirmation from the stop-loss insurer). What specific retention is proposed? What aggregate limit of liability is proposed? Is this an annual limit? If not, state term limit applies to. What is the aggregate calculation method proposed? What is the monthly aggregate attachment point? What are the specific rates? What are the aggregate rates? Will the aggregate accumulation include prescription and dental claims? If not, state benefits included. Sample forms and policies included? Will you require a signed disclosure form? Is this proposal firm? The Representative stated below is the authorized agent of the Proposer (company or companies proposed), and is authorized to bind coverages upon acceptance by the County. Deviations from the requested program have been stated. Coverage will be issued as proposed. The insurer agrees to be 21 bound by the information contained in this proposal form and all separate coverage proposal forms attached The insurer agrees to deliver a policy to the insured within forty-five (45) days after inception of coverage. Signature of Authorized Representative Date 22 Section 3 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR PRESCRIPTION MANAGEMENT PLAN GENERAL INFORMATION The Monroe County Board of County Commissioners desires to obtain proposals for a stand-alone Prescription Plan as part of its self-insured Medical Benefits Plan. Currently, prescription benefits are provided by a prescription card program. The cost of the prescription card is included in the County's overall medical costs. CURRENT PROGRAM The current prescription plan is provided by Walgreens Health Plan, (WHP). Prescriptions are fiUed through participating pharmacies. The employee co-pay amount is $6 per generic prescription and $12 for non-generic. Mail order prescriptions are $12 for generic (3 months) and $30 for non-generic (3 months). Beginning October 1,2001, the plan changes to: Retail - $10 for generic, $20 brand, $35 for non-preferred brands (usually up to 30 day supply. Via mail - $25 for generic, $ 50 brand, and $87.50 for non-preferred brands (90 day supply). The Health Plan currently provides benefits for the employees of The Board of County Commissioners, the Clerk of the Circuit Court, the Tax Collector, the Property Appraiser, the Supervisor of Elections, the Sheriffs Department, the Mosquito Control District and Land Authority. DESIRED PROGRAM The County desires the successful Prescription Management Plan provider to provide the following: => Prescription Card benefits for employees and dependents participating in the health plan, => A generous selection of participating retail pharmacies throughout the County and the United States, => Retail and Mail-order coordination, if possible, and => Significant discounts in the costs of prescriptions, including incentives for the use of generics. => Adequate monthly management reports to determine employee utilization and track provider activity as well as display number of dispenses by pharmacy location The County will consider proposals that may also include the use of formularies or other alternative programs to reduce and contain prescription costs. The County also wishes to be able to determine prescription usage and patterns and will cooperate with proposers to develop a reporting system that can analyze needs, costs and usage. References must be included. RATING DATA Current census information and historical enrollment counts are included as exhibits. 23 EFFECTIVE DATE OF CONTRACT The contract will be Implemented sometime during the 10/1/2001-9/30/2002 Fiscal Year and may be initially be for less than 12 months. Subsequent contract terms will coincide with the County's fiscal year. PROPOSAL SUBMITTAL Questions relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 facsimile: 1-813-287-1041 All Questions seekinl! additional information must be received no later than 5:00pm twenty (20) davs precedin!! the bid openinl! date If needed, an. addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. Sealed proposals includinl! two (2) oril!inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and'must be received no later than 3:00 p.m. on the date specified in the legal notice.. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL PRESCRIPTION MANAGEMENT PLAN RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will serve its best interests. AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. 24 QUALIFICATIONS OF PROPOSER Experience with Governrnent Entities will be a major factor in the evaluation of the proposals. All proposers should furnish a summary of all such experience. References, including client name, contact person and telephone number, should also be included. PARTICIPATING PHARMACIES A complete listing, by city, of all participating pharmacies in Monroe County, must be included. Proposals will be considered for County-wide service or for service to a significant portion of the County. The County reserves the right to select more than one proposal if in the County's sole discretion such selection is in the best interest of the County. PAYMENT TERMS The preferred method of payment is monthly. Proposers must fully explain fees, rates and negotiated discounts. If other terms are proposed, please be specific regarding amounts and time schedule. SAMPLE CONTRACT OR AGREEMENT Each proposal must contain a sample contract or agreement that will be used between the successful proposer and Monroe County. TERMINA TION/N ON-RENEWAL NOTICE Ninety, (90), days written notice is requested by the service provider for termination or non-renewal of the contract or agreement. CLAIM REpORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals who will be contacts in reference to claims and management reports. QUARTERLY MEETING WITH THE COUNTY The proposer will be required to attend quarterly meeting at the County location to discuss plan utilization, cost analysis, changes in regulation, trend analysis and others. STATISTICAL MANAGEMENT REpORTS Monroe County will require the successful proposer to submit utilization and cost reports on a monthly basis. Reports should be completed in plain English and received by the County within seven (7) days following the end of the month. The reports should include: => Generic vs. name brands dispensed, => Employee vs. dependent utilization, => Retiree utilization 25 ~ Program savings, ::::> Value of discounts and, ~ Other reports requested by the County All proposals must contain a sample of the reports that will be provided. USE OF PROPOSALS FORMS Proposers are required to submit their proposal on the forms included in this request. It is important that the proposal be signed by an authorized representative of the insurer/service provider in order to receive consideration. Additional information or proposals may be submitted in addition to the initial proposal. INSURANCE REQUIREMENT The successful proposer(s), throughout the term of the contract, shall purchase and maintain insurance as set forth in Attachment A. ADDITIONAL REQUIRED FORMS The following forms, included as Attachments B, C, D and E must be signed by an authorized representative and included with the proposals: 1. Public Entity Crime Form - Attachment B 2. Drug Free Workplace Form - Attachment C 3. Non-Collusion Affidavit - Attachment D 4. Ethics Clause - Attachment E 26 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR SECTION 3 PRESCRIPTION MANAGEMENT PLAN PROPOSAL FORM Please complete a separate proposal form for each option offered. Name of Prescription Management Plan Address: Telephone Number: Does Plan include retail and mail-order? What are retail co-pays? Generic? Preferred? Non-Preferred? What are mail-order participant co-pays? Will the proposer charge any initial or set-up fees? If so, please explain 27 Are alternate approaches available such as the use of Formularies or other arrangements? If so, include specifics. Are samples of all management and statistical reports included? Is a sample contract or agreement included? Quoted PriceIFees or Discount Arrangement: (attach separate page if necessary) Is there a dispensing fee? If so, state amount. Will a minimum fee apply to the contract? I f so, please specify How many participating pharmacies are located in Monroe County? Locations: How many participating pharmacies are in the U.S.? Is sample participant information/communication materials included? Are there any exceptions to specifications? Will you agree to quarterly meetings at the County's location To provide utilization review, cost analysis, changes in Regulation, trend analysis and others? The representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by The County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Signature of Authorized Representative Date 28 Section 4 LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT; VOLUNTARY EMPLOYEE SUPPLEMENTAL LIFE; VOLUNTARY DEPENDENT LIFE The County currently provides group term life insurance and accidental death and dismemberment insurance for all employees. The Basic Life amounts are non-contributory. INSURANCE AMOUNTS The basic amount of group term life and accidental death and dismemberment insurance provided by the County is: Under al!e 70 Age 70-74 Age 75 & older Active $20,000 $13 ,400 $10,000 Employees with 10 years $20,000 $10,000 $10,000 or more of service who retired on or after Oct. 1, 1987 Any retired Employee insured on Sept. 30, 1987 will on Oct. 1, 1987 be insured for the amount of Employee Life Insurance in force on Sept. 1, 1987. Any Employee retired prior to Oct. I, 1987 who subsequently elects to continue Employee Life Insurance will be insured for the lesser of 50% of the amount of insurance in force prior to Oct. I, 1987 or $5,000. REDUCTIONS DUE TO AGE The amount of term life and AD&D coverages provided are reduced due to age as shown in the chart above. ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS Accidental Death & Dismemberment benefits are included at an amount equal to the life insurance amount for active employees only. CONVERSION PROVISIONS Coverage is to be available for conversion to an individual policy at termination of employment. The County currently pays a per person per month rate but would prefer a flat rate per conversion to the insurer. 29 WAIVER OF PREMIUM Group term life insurance and accidental death and dismemberment insurance is to continue upon employee total disability with waiver of premium. Proposals must provide for continued coverage for any employees not identified as being on waiver of premium status. ACCELERATION OF BENEFITS Plans offering acceleration of benefit provisions in case of near-death disease situations are preferred. Please include details. RETIREE INSURANCE Retirees are included for life insurance in accordance with the Florida State Retirement System rules and are shown in the chart above. RATES Current rates are included in the Exhibits. VOLUNTARY SUPPLEMENTAL LIFE AND VOLUNTARY DEPENDENT LIFE The County does not currently offer supplemental or dependent life, but is interested in receiving proposals for both types of programs. Proposers are encouraged to provide products and rates for these benefits. Copies of all life insurance policies to be used should accompany the proposals along with underwriting requirements and administrative responsibilities of the County. EFFECTIVE DATE OF CONTRACT The effective date of the contract will be sometime during the 10/1/2001 - 9/30/2002 fiscal year and may be for less than 12 months. Subsequent contract terms will coincide with the County fiscal year. PROPOSAL SUBMITTAL Questions relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 facsimile: 1-813-287-1041 30 All Questions seekinl! additional information must be received no later than 5:00pm twentv (20) davs precedinl! the bid openinl! date An addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. 31 Sealed proposals includinl! two (2) ori!!inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT; VOLUNTARY EMPLOYEE SUPPLEMENTAL LIFE; VOLUNTARY DEPENDENT LIFE RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will serve its best interests. AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. QUALIFICATIONS OF PROPOSER Experience with Government Entities will be a major factor in the evaluation of the proposals. All proposers should furnish a summary of all such experience. References, including client name, contact person and telephone number, should also be included. PAYMENT TERMS The preferred method of payment is monthly. Proposers must fully explain fees, rates and negotiated discounts. If other terms are prepared, please be specific regarding amounts and time schedules. 32 SAMPLE CONTRACT OR AGREEMENT Each proposal must contain a sample contract or agreement that will be used between the successful proposer and Monroe County. TERMINATION/NON-RENEWAL NOTICE Ninety, (90), days written notice is requested by the service provider for termination or non-renewal of the contract or agreement. CLAIM REpORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals who will be contacts in reference to claims. USE OF PROPOSALS FORMS Proposers are required to submit their proposal on the forms included in this request. It is important that the proposal be signed by an authorized representative of the insurer/ service provider in order to receive consideration. Additional information or proposals may be submitted in addition to the initial proposal. INSURANCE REQUIREMENT The successful proposer( s), throughout the term of the contract, shall purchase and maintain insurance as set forth in Attachment A. ADDITIONAL REQUIRED FORMS The following forms, included as Attachments B, C, D and E must be signed by an authorized representative and included with the proposals: 1. Public Entity Crime Form - Attachment B 2. Drug Free Workplace Form - Attachment C 3. Non-Collusion Affidavit - Attachment D 4. Ethics Clause - Attachment E 33 PROPOSAL FORMS Section 4 LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT COVERAGE; VOLUNTARY EMPLOYEE SUPPLEMENTAL LIFE; VOLUNTARY DEPENDENT LIFE Insurer/Provider Name Address, Telephone Number Current A.M. Best Rating Can this coverage be purchased independent of other coverages? Does Proposal match desired benefits? Please state any exceptions Outline reductions due to age Is a sample policy included? Waiyer of Premium included? Acceleration of Benefits included for terminal illness? Are conversion provisions included? What coverage is provided for retirees? Are rates guaranteed for twelve (12) months? Will at least 90 days notice be provided or any Renewal rate increase, or other modification Of the policy? 34 RA rES: Basic Life Basic AD&D Conversion Optional Life - Voluntary Supplemental Life For employees (attach schedule if necessary) Optional Dependent Life (voluntary) (attach schedule and details if necessary) Retiree Life (attach schedule if necessary) Is this an authorized offer? Has proposal been signed by an authorized person? Please state any exceptions to specifications. MONTHLY RATE/$1,OOO The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by The County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date Firm, Telephone 35 Authorized Representative Section 5 DISABILITY BENEFITS SHORT-TERM AND LONG-TERM The County does not currently offer income protection insurance to its employees. It wishes to make both short-term and long-term disability available on a voluntary basis through payroll deduction. DESIRED COVERAGE & LIMITS Short Term Disability Short Term Disability coverage providing income protection for sickness and accident. Limits may vary; please specify. Long Term Disability Long Term Disability extending the above. The County wishes to explore alternate plans at varying terms consistent with insurance industry products. Insurer alternatives will be considered. Please attach details of benefit amounts, terms and costs. Rates should be provided in increments of $50 per bi-weekly pay period subject to individual employee validation at time of application. USE OF PROPOSALS FORMS Proposers are required to submit their proposal on the forms included in this request. It is important that the proposal be signed by an authorized representative of the insurer/ service provider in order to receive consideration. Additional information or proposals may be submitted in addition to the initial proposal. INSURANCE REQUIREMENT The successful proposer(s), throughout the term of the contract, shall purchase and maintain insurance as set forth in Attachment A. ADDITIONAL REQUIRED FORMS The following forms, included as Attachments B, C, D and E, must be signed by an authorized representative and included with the proposals: 1. Public Entity Crime Form - Attachment B 2. Drug Free Workplace Form - Attachment C 3. Non-Collusion Affidavit - Attachment D 4. Ethics Clause - Attachment E 36 EFFECTIVE DATE OF CONTRACT The effective date of the contract will be sometime during the fiscal year of 10/1/2001 - 9/30/2002 and may be for less than 12 months initially. Subsequent contract terms will coincide with the County's fiscal year. PROPOSAL SUBMITTAL Questions relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 facsimile: 1-813-287-1041 All Questions seekinl! additional information must be received no later than 5:00pm twentv (20) days orecedinl! the bid openinl! date An addendum to the RFP will be issu~d shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. Sealed proposals includinl! two (2) oril!inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL DISABILITY BENEFITS SHORT-TERM AND LONG-TERM RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will serve its best Interests. 37 AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. QUALIFICATIONS OF PROPOSER Experience with Government Entities will be a major factor in the evaluation of the proposals. All proposers should furnish a summary of all such experience. References, including client name, contact person and telephone number, should also be included. PAYMENT TERMS The preferred method of payment is monthly. Proposers must fully explain all rates and fees. If other terms are proposed, please be specific regarding amounts and time schedules. SAMPLE CONTRACT OR AGREEMENT Each proposal must contain a sample contract or agreement that will be used between the successful proposer and Monroe County. TERMINATION/NON-RENEWAL NOTICE Ninety, (90), days written notice is requested by the service provider for termination or non-renewal of the contract or agre~ment. CLAIM REpORTING LOCATIONS All proposals should indicate the address, telephone number and names of individuals who will be contacts in reference to claims. 38 PROPOSAL FORMS Section 5 DISABILITY INCOME PROTECTION COVERAGE PROPOSAL FORM Insurer/Provider Name Address, Telephone Number Current A.M. Best Rating Can this coverage be purchased independent of other coverages? Are Short-term Disability benefits proposed? Are Long-term Disability benefits proposed? Please state details Is a sample policy attached? What is definition of disability? Is partial disabilities caused? What is definition of partial disability? Are rates guaranteed for twelve (12) months? How are benefits paid? RATES: MONTHLY RATE Short Term Disability (attach schedule) Long Term Disability (attach schedule) 39 Are rates guaranteed for twelve (12) months? State minimum and maximum benefit amount. Is this an authorized offer? Has proposal been signed by an authorized person? Please state any exceptions to specifications. The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by the County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date Firm, Telephone Authorized Representative 40 Section 6 MONROE COUNTY EMMPLOYEE ASSISTANCE PROGRAM (EAP) REQUEST FOR PROPOSAL INTRODUCTION Recognizing that employees may have personal problems, pressures, and stresses that can adversely affect their job performance, attendance, and health, the Monroe County Board of County Commissioners is requesting proposals for an Employee Assistance Program (EAP) to provide professional and confidential assistance to employees and their dependents. The Monroe County Board of County Commissioners desires to contract with a qualified vendor to operate the EAP for twelve (12) months or longer. The contract term may be renewed for two additional one year periods at the discretion of the County. PROGRAM OBJECTIVES The objectives of the Monroe County Board of County Commissioners EAP are to: Provide employees and dependents (Bids are requested for employees only and employees and dependents) with confidential, professional counseling on personal matters affecting their physical and emotional well-being. Improve work performance, reduce absenteeism and retain valuable employees and enhance the work-home environment. SCOPE OF BENEFITS SERVICES GENERAL PROVISIONS The "participants" of the group will include either a) all full-time, regular Monroe County employees, including Constitutional Officers' employees or b) all full-time regular Monroe County employees including Constitutional Officers employees and their dependents. Monroe County will look at cost of employees only and cost of employees and dependents to determine if the EAP will include dependents. Presently, there are approximately 1364 county employees including Constitutional Officers. This number may be reduced in the future due to the incorporations of certain areas of the Keys. County officers are located in Key West, Marathon, and Plantation Key 41 and other satellite offices in the Keys and Miami, Florida. Dependents under the EAP are those persons claimed as dependents for federal income tax purposes. Prospective vendors proposing to develop and operate the EAP must have demonstrated experience with similar programs. Vendor personnel must have education and other credentials relevant to programs offered through the EAP. GENERAL PROVISIONS The responsibility of the vendor under the agreement will be to operate an EAP to include the follO\.ving components: Training of supervisory personnel. At least four (4) training programs for supervisors per year should be included in the overall contract price. Orientation of Monroe County Personnel. Meetings must be scheduled in all areas to educate the employees and their dependents about the services available through the EAP. Employer Education. At least four (4) educational "group" programs for employees to learn about various topics such as: Alcoholism; Dealing With Troubled Children; Stress Management; Understanding Mental Illness; Anger Management; etc. A certain number of individual counseling sessions (at least 5) provided through the EAP per year, per employee. Counseling should be available after hours as well as during working hours. 1. The following individual or group counseling services: Mental Health Care Substance Abuse EvaluationlRehabilitation Retirement Counseling Parenting Classes Anger Management Stress Management Elder Care 2. Referrals. The vendor shall evaluate the employee to determine their ability to assist himfher or if they need to be referred out of the EAP. 3. Aftercare Service should be identified so that once the contract counseling sessions have been exhausted, the employee and/or their dependent (s) knows what their options are. A quarterly report of the usage of the EAP must be provided. This information must be provided in a confidential manner. This report should include the following information: 42 a. Number of employees and dependents utilizing the EAP. b. Number of voluntary referrals are distinguished from the number of management referrals. c. Number of males/females participating in the EAP. d. Number of problem diagnoses broken down by category. e. The results of treatment by category including numbers: 1. Currently in treatment 11. Cooperating with treatment 111. Completed treatment IV. Referred out of the EAP v. Receiving aftercare support Prospective vendors should describe how they will evaluate and report overall program success without disturbing the confidentiality of the individual employee/dependent. Vendors should attach format of their reports. SPECIAL CONSIDERATIONS Employee/dependents treatment should be confidential unless referred by management. However, if the vendor feels the employee or dependent's psychological condition indicates a clear imminent danger to himself/herself or others, the employer must be advised immediately. In addition, when the employer requires an employee to attend an EAP session a written evaluation must be submitted to the employer. Prospective vendors must have offices in the Lower, Middle, and Upper Keys located within acceptable, driving distances for our employees. Telephone consultations should be available to those employees who reside or work outside of Monroe County. SELECTION PROCESS Bidders will submit two originals and five copies of their proposals. All sealed proposals submitted will be reviewed by a committee consisting of the Human Resources Director, the County Administrator and the Personnel Coordinator. After evaluating the proposals, staff will make a recommendation to the Board of County Commissioners to select the proposal best suiting the needs of the County. A presentation before the Board of County Commissioners may be requested by the County. 43 CONTENT OF PROPOSAL The proposal shall be complete and concise in description, clearly organized and presented in written form. The content should reflect the vendor's understanding of the stated purpose of the EAP and include specific information covered in Section III, "Scope of Benefits Services" in addition to the items listed below: COST Indicate the fee that the vendor will charge for the services of the EAP per employee only and what fee would be charged for employee and dependents including the number of consultations included in the annual cost per employee, and the fee schedule charged for any continuation of consultation services by the vendor beyond the basic services provided through the EAP. Please indicate the cost for employees and the cost for employees and dependents. STAFF QUALIFICATION Describe the credentials, qualifications and pertinent experience of the staff members to be assigned to employees and their dependents. Attach resumes, give the name, title and telephone number of the person to be designated as the principal contact. SUBCONTRACTORS List any subcontractors or special consultants who might be utilized for this EAP and comments on their particular qualifications along with their resumes. SCHEDULE OF PROGRAMS Provide a tentative schedule for the orientation and training programs offered during the year. Provide hours of availability including after hours as well as working hours. LICENSES The vendor must show proof of proper licenses by the State of Florida and Monroe County. INDEMNIFICATION/HOLD HARMLESSIINSURANCE Insurance coverage must be maintained during the full period of this contract. proof of insurance coverages as indicated by the Attachment "A" must be provided in the form of certificates of insurance or certified copies of the insurance policies. REFERENCE Bidders will provide a list of other clients for when similar services have been provided. 44 PROPOSAL SUBMISSION REQUIREMENTS Sealed proposals for an EAP will be received, opened and publicly by the Purchasing Department at the time and place specified in the advertisement. Purchasing will then turn over all proposals to the requesting department for evaluation. Bidders must submit two (2) signed originals and five (5) complete copies of each bid in a sealed envelope marked on the outside, "SEALED BID FOR MONROE COUNTY EMPLOYEE ASSISTANCE PROGRAM (EAP)". All bids must remain valid for a period of ninety (90) days. The Board reserves the right to reject any and all bids, to waive informalities in any and all bids, and to re-advertise for bids. The Board also reserves the right to separately accept or reject and item or items of bid and to award and/or negotiate a contract in the best interest of the county. Notice of cancellation, intention not to renew or continue services on anniversary, or elimination or restriction of services , or any other material changes in the contract shall not be effective without sixty days prior notice in 'Writing, addressed to the Benefits and Insurance Administrator. Cancellation by either party shall be pro-rated. All rates and premiums must be firm. 45 Section 6 Proposal Sheet TO PROVIDE AN EMPLOYEE ASSISTANCE PROGRAM FOR COUNTY EMPLOYEES INCLUDING CONSTITUTIONAL OFFICERS' EMPLOYEES Amount per employee per month (Amount in writing) AND/OR Amount per employee and dependents per month (Amount in writing) Amount per employee and dependents per month (Amount in numbers) BIDDER INFORMATION: Name of Company Address: Telephone Number: By(name and title): Date The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by the County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date F 46 Section 7 Monroe County Board of County Commissioners Request for Proposals for Nationwide Provider Network GENERAL INFORMATION The Monroe County Board of County Commissioners desires to obtain proposals for a Nationwide Provider Network. CURRENT PROGRAM The county is using the Keys Physician Hospital Alliance for a network in Monroe County and the Dimension Network for South Florida. DESIRED PROGRAM The County wishes to eliminate their "out-of-network" exclusion for employees and/or dependants that reside outside our networks. We desire to obtain a national network and when it is not utilized, employees will be penalized by having less of their medical expenses paid. Current out of network penalty is 10% reduction of benefits. The attached census shows the states where our retirees reside. EFFECTIVE DATE OF CONTRACT The contract will be implemented sometime during the 10/1/2001-9/30/2002 Fiscal Year and may be initially for less than 12 months. Subsequent contract terms will coincide with the County's fiscal year. PROPOSAL SUBMITTAL Questions relating to the specifications of this Request For Proposals shall be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 11 II North Westshore Blvd., Suite 208 Tampa, Florida 33607-471 1 facsimile: 1-813-287-1041 All Questions seekinl! additional information must be received no later than 5:00pm hventv (20) days precedinl! the bid openinl! date An addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. 47 Sealed proposals includin1! two (2) oril!inaIs and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice.. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL NATIONWIDE PROVIDER NETIVORK RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will serve its best interests. AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. 48 Monroe County Board of County Commissioners Request for Proposals For Section 7 Nationwide Provider Network PROPOSAL FORM Please complete a separate proposal form for each option offered. Name of Network Address: Telephone: Does plan have restrictions to location? Please identify: Will proposal charge any initial or set -up fees? Charge for use of Network - Identify by unit of charge, Per Employee/Per Month or other basis Will minimum fee apply to contract? Is this an authorized offer? Has proposal been signed by an authorized person? How is the network access charged for What is access charge? How is it paid? Is sample network contract included? List name, address, telephone number, fax number, And e-mail address of contact person. 49 Life Insurance Loss Report EXHIBIT #7 YEAR PAID PREMIUM PAID CLAIMS 98/99 $171,588 $200,044 99/00 $144,881 $125,028 (7 Months) 00/01 $97,830 $25,000 Totals: $414,299 $350,072 Monroe County Board of County Commissioners Will you commit to continued access to all providers For remainder of contract form? If not, what is standard procedure for selecting new Providers for employees and dependents? Please state any exceptions to specifications. The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by the County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date Firm, Telephone Authorized Representative 50 Section 8 Monroe County Board of County Commissioners Request for Proposals for Flexible Spending Account Administration GENERAL INFORMATION The Monroe County Board of County Commissioners desires to obtain proposals for a Flexible Spending Account Administration. CURRENT PROGRAM The county is uses their Section 125 designation for the payment of dependant coverage only. Monroe County does not currently have a flexible spending account program in place and therefore seeks an administrator with experience in implementation as well as administration of these programs. DESIRED PROGRAM The County wishes to maintain a basic health insurance plan for the employees while providing options that will be either totally or partially employee funded for periphery benefits of dental, vision, enhanced pharmaceutical. EFFECTIVE DATE OF CONTRACT The contract will be implemented sometime during the 1O/I/2001-9/30/2002 Fiscal Year and may be initially for less than 12 months. Subsequent contract terms will coincide with the County's fiscal year. Questions relating to the specifications of this Request For Proposals shaH be submitted in writing directly to: Lawton Swan, III, CPCU, CLU, ARM Interisk Corporation 1111 North Westshore Blvd., Suite 208 Tampa, Florida 33607-4711 facsimile: 1-813-287-1041 All Questions seekinl! additional information must be received no later than 5:00pm twenty (20) days precedinl! the bid openinl! date An addendum to the RFP will be issued shortly thereafter and distributed to all interested Proposers, responding with the County's best ability to answer all questions. 51 Sealed proposals includinl! two (2) oril!inals and five (5) copies shall be directed to: Purchasing Department Monroe County 5100 College Road West Cross Wing, Room 002 Key West, Florida 33040 and must be received no later than 3:00 p.m. on the date specified in the legal notice.. All proposals will be officially opened at that time. Any proposal received after the specified date and time will be returned unopened to the proposer. All proposals must be clearly marked with the words: REQUEST FOR PROPOSAL FLEXIBLE SPENDING ACCOUNT ADMINISTRATION RIGHT TO REJECT PROPOSALS Monroe County reserves the right to reject or waive any proposal, including any portion of a proposal for any reason that it deems appropriate. Monroe County reserves the right to negotiate with whichever proposer(s) it deems appropriate. Monroe County reserves the right to select the proposal(s) that it believes will serve its best interests. AUTHORITY OF PROPOSERS Proposals must be signed by an authorized representative of the company that will provide the service. Proposals submitted without a proper signature will not be given the same consideration as authorized proposals. 52 Monroe County Board of County Commissioners Request for Proposals For Section 8 Flexible Spending Account Administration PROPOSAL FORM Please complete a separate proposal form for each option offered. Name of Administrator Address: Telephone: Funding for types of coverage Please identify: Will proposal charge any initial or set -up fees? Charge for Administration - Identify by unit of charge, Per Employee/Per Month or other basis Please submit plan for converting from self-funded plan to flexible spending account: Will minimum fee apply to contract? Is this an authorized offer? Has proposal been signed by an authorized person? 53 Please state any exceptions to specifications. The Representative stated below is the authorized agent of the Proposer and is authorized to bind the company upon acceptance by the County. Deviations from the requested program have been stated. Coverage(s) or services will be issued as proposed. Date Firm, Telephone Authorized Representative 54 Attachments Insurance Requirements Public Entity Crime Form Drug Free Workplace Form N on-collusion Affidavit Ethics Clause Attachment A (1-6) Attachment B Attachment C Attachment D Attachment E Exhibits Enrollment Census Monthly Lives Reports (98/99 & 99/00) Claims History Report (99/00) Loss History Reports (98/99, 99/00 & 10/01/00 to 05/31/01) Funding Levels Large Loss Report - Medical (99/00 and 10/01/00 to 04/30/01) Life Insurance Loss Report Plan Booklets with current changes 55 1996 Edition RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRA nON MANUAL General Insurance Requirements for Other Contractors and Subcontractors As a pre-requisite of the work governed, or the goods supplied under this contract (including the pre-staging of personnel and material), the Contractor shall obtain, at his/her own expense, insurance as specified in any attached schedules, which are made part of this contract. The Contractor will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the Contractor. As an alternative, the Contractor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Contractor will not be pennitted to commence work governed by this contract (including pre- staging of personnel and material) until satisfactory evidence of the required insurance has been furnished to the County as specified below. Delays in the commencement of work, resulting from the failure of the Contractor to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the Contractor's failure to provide satisfactory evidence. The Contractor shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced. Delays in the completion of work resulting from the failure of the Contractor to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the Contractor's failure to maintain the required insurance. The Contractor shall provide, to the County, as satisfactory evidence of the required insurance, either: · Certificate of Insurance or · A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. Administration Instruction #4709.3 14 ATI'ACHMENT A-I PAGE 1 OF 2 1996 Edition The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request for Waiver of Insurance Requirements" and approved by Monroe County Risk Management. Administration Instruction #4709.3 PAGE 2 OF 2 15 A'ITACHMENT A-I 199'; Edition INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: . · Premises Operations · Products and Completed Operations · Blanket Contractual Liability · Personal Injury Liability · Expanded Definition of Property Damage The minimum limits acceptable shall be: $500,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $250,000 per Person $500,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. GL2 Administration Instruction #4709.3 54 ATl'ACHMENT A-2 1996 Edition WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self- insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate ofInsurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. WC2 Administration Instruction #4709.3 88 ATI'ACHMENT A-3 1996 Edition PROFESSIONAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract involves the furnishing of advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits ofliability shall be: $500,000 per Occurrence/$l, 000, 000 Aggregate PR02 Administration Instruction #4709.3 77 ATTACHMENT A-4 1996 Edition VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: · Owned, Non-Owned, and Hired Vehicles The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. VL2 Administration Instruction #4709.3 81 ATI'ACHMENT A-S 1996 Editioo EMPLOYEE DISHONESTY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND The Contractor shall purchase and maintain, throughout the term of the contract, Employee Dishonesty Insurance which will pay for losses to County property or money caused by the fraudulent or dishonest acts of the Contractor's employees or its agents, whether acting alone or in collusion of others. The minimum limits shall be: $100,000 per Occurrence ED2 Administration Instruction #4709.3 45 ATI'ACHMENT A-6 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list follmving a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the dale of being placed on the convicted vendor list." ATTACHMENT B DRUG-FREE WORKPLACE FORM The undersigned vendor in accordancc with f10rida Statute 287.087 hereby certifies that: (Name of Busincss) I. Publish a statement noti(ving employees that the unlawlid manufacture. distribution. dispcnsing.. possession. or use of a controlh:d substance is prohibited in the workplace and specifying the actions th;u will bc takcn against employees for violati,?ns of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace. the business's policy of maintaining a drug-free workplace. any available drug counseling. rehabilitation, and employec assistance programs. and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (I). 4. In the statement specified in subsection (I), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Bidder's Signature Date ATTACHMENT C OMB - MCPlf5 NON-COLLUSION AFFIDAVIT I, of the city of according to law on my oath, and under penalty of perjury, depose and say that; 1) I am Proposal for the project described as follows: , the bidder making the 2) The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4) No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; 5) The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF (Signature of Bidder) COUNTY OF DATE PERSONAllY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this day of ,19 My commission expires: NOTARY PUBLIC OMS - MCP FORM #1 ATTACHMENT 0 SWORN STArU'v1ENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY. FLORIDA ETHICS CLAUSE warrants that he/it has not employed. retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance no. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance No. J 0-1 <)<)0. For brcach or violation of this provision the County may. in its discrction. terminate this ctlntract without liability and may also, in its discrction. deduct from the contract or purchase price. or othcrwisc recover. the full amount of any fee, commission, percentagc, gift. or consideration paid to the former County officer or employee. (signature) Date: STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed his/her signaturc (name of individual signing) in the space provided above on this day of ,19_ NOTARY PUBLIC My commission expircs: OMB - MCP FORM #4 ATTACHMENT E GROuf'l:@URANC~RA TES:--"fl'''-~TI\lE1()10172000- iNo Changr-==___-t===-----= DEPARTMENT CHAkGE ---PER EMPL~YEElPER MDNTH:~-iNOChangifrom 10/01/98) IL-$47O:Qo -. -.~ - --- ~- ~~. -r---- ~ -~-.-~.-r---~.-- --_n~. __.__ __ _ __ _____ __~___~_ ,- _____== ~---- ---~---------------. '--.----J______ , ~ D~f'"NDE.NTc::(),,~~GE:-("'" chang!, from 10/01/98L____ ----L-"~~A YDA Y ~!'E,~ ~ -.. - ~n - _l~ --.. - - -- - _lONE DEPE~D""'I = ___ ___ ___ L ___ $100.00 I $217.~ i 'TWo DR MORE DEPENDENTS= I $120.00 I $260.00 -- -..-~.-~-... '-~i -~'- ~'-~- -nut -----.---------------l------~" ! _ LEAVE WITHOUT PA Y:~-- ---- -.-.-,EMPlOyEE-ONl yon! ~_ ___I_~ .---~---_.n ~~--'_'__ '__~ ~n ~ ______________ __ ' i EMPLOYEE & ONE DEPENDENT: I i $687.00 '- ~. ~.. ~. -. - -. ~~--.-~_. '-"-'~ - ~----- ----.----~--~---~--~~--. --.._--~--- -----------.....--.+..-- .-------_!EM'=-~~YEE~O OR MORE DEPI~~NTS: i $730.~ i I I ==-==== .===T_======~j==_~_-:_====:= _-=_-_=- -=-:-~=---=----==-11'~R MONTH I I :: (ROUNDED) --.---- ~~ -'-- - -.~~, ~ ~- ~ -~'-~ -----'---':..-----~--~------ -r-------______ _, C~'!~:___n_j- - - ----- i;~~~~"v~~~"o~'i;EPENDENT:IL-- _ _ +_--{~:~:gg -~---- - - -, --, 1-- -~~ --~------TEMPLOYEE & TWO OR MORE DEPENDENTS: i $730.00 -- I T 1_ i 'COBRA rates are calculated as follows: Depl rate - Hie 'nsurance rate" ($9.00 for 00101) x 2% (servlcin9 fee -----=-:--- r- _ as allowed by law) + monlly dependent coverage premIum, when applicable. I "Life insurance rate for 00101: .39x 20 = $7.80 + .06 x 20 = 1.20 T olal = $9.00 I _ -------- I ~, I . -1-== I ~"-~-=-~- IWlTH 10 OR MORE YEARS SERVICE WITH THE COUNTY: -, I ~ FREE I (al thIs time) '- - - ----.J__ 1_. L__ I ~'- --.-------IVViTH lESS THAN 10 YEARS OF COVERAGE UNDER OUR PIAN. BUT WHo I ---.-----j HAVE ATlEASTJ.O.'f.EARS WITH THE FRS MUST PAY: 1 I T UNDER AGE 65: I I ==~=:==-L=:::::-_-____ lOVER AG."- 65: ----1'--=- i ~-'-----,-~~ ----1_ --~ L_ ---- _n___ '_~~___, ----.J__ ___ I _____ " i i -=-- .l.___ ; ______ REl'lR_EE DEP~DEI-IT ~\lERAGE: i -__._ 1_ i iSPOUSE UNDER 65 OR ONE DEPENDENT CHILD: I -'~~--'--_._-~-------=---,----- , ISPOUSE UNDER 65 AND ONE CHILD OR CHILDREN: i ----~--- -.JtJ9 SPOUSE. BUT TWOOR MORE CHILDREN: 1 i - ~ -, -- -, -. I SPOUSE OVER 65 (50% of under 65 or one dependent rate) I ----~ , I - - I , - --~ ----- ~~, -L ----~,~- ---,-~ o__~ ---- -'--- ~_ _~ _, ,l -- --- ----- n_ L. '~--~ -~- --nul, -,,-,- -_______~_ ~~'~____ --L_____,___..! !: I I - '-~---- -- ---','- -~--- - --, - -- ,- - - - ------------~~-, ~--~-- I ~ -- - - -, ~~, ~ - - ~_ n~_ '_~ _',_ _'_~__,~_,_~ _,_ __ ~ _ _~_ __,~ __, ~~ ~__ ____, __-_ _ __ _____ RA TES FOR FY 00/01 Group Insurance Rates Effective 10/01/2000 FUNDING LEVEL EXHIBIT #5 $470.00 $282.00 $217.00 $260.0<[; $260.00 $108.50 -- Rates.x/s ~ \ t . t ENROLLMENT CENSUS Exhibit 1 # Fund Cost Center Location # of Dependent: Type of CVf 0.0.8. Sex Date of Hire State Zip Code l. 001 00101 100 1 F 10/24/46 F 11/27/00 Florida 33040 2. 001 00101 300 1 F 12/17/47 F OS/28/95 Florida 33036 3. 001 00101 100 0 S 11/01/40 F 10/24/77 Florida 33040 4. 001 00101 100 0 S 07/28/44 F 10/08/98 Florida 33040 5. 001 00101 200 0 S 09/01/59 F 10/25/00 Florida 33050-1877 6. 001 00101 100 0 S 08/07/51 F 06/05/97 Florida 33042 7. 001 00101 100 0 S 01/16/28 /ol 11/21/00 Florida 33040 8. 001 00101 300 1 F 10/19/38 /ol 11/21/00 Florida 33037 9. 001 00101 100 1 F 05/16/~8 /ol 11/12/98 Florida 33050 10. 001 00101 100 0 S 07/29/41 F 11/21/00 Florida 33040 1l. 001 00101 200 0 S 01/26/60 F 11/12/98 Florida 33036 12. 001 04301 100 0 S 03/19/68 F 07/28/86 Florida 33040 13. 001 04301 100 1 F 04/26/50 /ol 04/20/98 Florida 33043 14. 001 04301 100 0 S 02/27/67 F 09/23/96 Florida 33044-0155 15. 001 04301 100 2 F 03/03/78 F 08/11/97 Florida 33040 16. 001 04301 100 1 F 01/04/47 F 08/24/92 Florida 33042 17. 001 04301 100 0 S 10/30/54 F 01/22/91 Florida 33040 18. 001 04301 100 0 S 11/10/66 F 06/21/94 Florida 33040 19. 001 04301 100 1 F 01/22/64 F 04/05/82 Florida 33042 20. 001 04301 100 0 S 06/05/75 F 09/11/00 Florida 33040 2l. 001 04301 100 0 S 04/12/4B /ol 07/27/92 Florida 33040 22. 001 04301 100 2 F 11/04/65 F 03/03/97 Florida 33041 23. 001 04301 100 1 F 03/11/42 F 11/01/79 Florida 33043 24. 001 04301 100 0 S 08/24/63 F 06/0B/92 Florida 33040 25. 001 04301 100 0 S 09/16/74 F 10/25/99 Florida 33040 26. 001 04301 100 6 F 07/0B/56 F 01/02/97 Florida 33050 27. 001 04301 100 0 S 06/12/57 F 09/27/99 Florida 33040 2B. 001 04301 100 0 S 12/15/73 F 04/17/01 Florida 33040 29. 001 04301 100 1 F 09/02/51 F 05/06/91 Florida 33040 30. 001 04301 100 1 F 11/27/50 F 05/17/99 Florida 33041 3l. 001 04301 100 0 S 11/19/69 F 07/10/00 Florida 33041 32. 001 04301 100 2 F 08/25/5B F 01/16/01 Florida 33040 33. 001 04301 100 0 S 01/16/63 /ol 07/19/99 Florida 33040 34. 001 04302 100 2 F 05/15/76 F 06/14/99 Florida 33040 35. 001 04302 300 0 s OS/24/53 F 06/26/00 Florida 33037 36. 001 04302 100 2 F 07/12/70 F 09/02/97 Florida 33040 37. 001 04302 300 0 S 09/24/54 F 05/03/93 Florida 33001 38. 001 04302 100 0 S 10/2B/6B F 05/03/93 Florida 33040 39. 001 04302 200 2 F OB/17/4B F 01/14/B6 Florida 33050 40. 001 04302 100 0 S OB/20/74 F OB/31/92 Florida 33040 4l. 001 04302 300 0 S 07/04/46 F 01/19/99 Florida 33070 42. 001 04302 100 0 S 07/24/7B F 08/02/99 Florida 33040 43. 001 04302 100 0 S 07/31/47 F 03/28/00 Florida 33040 44. 001 04302 100 0 S 01/05/50 F 01/24/00 Florida 33040 45. 001 04304 100 0 S 04/14/67 F 06/05/95 Florida 33040 46. 001 04304 100 0 S 11/29/B1 F 10/16/00 Florida 33040 47. 001 04304 200 0 S 03/19/54 F 12/04/89 Florida 33040 48. 001 04304 100 3 F 01/17/68 F 06/23/B6 Florida 33040 49. 001 04304 200 1 F OS/2B/64 F 07/21/97 Florida 33050 50. 001 04304 100 0 S 05/05/61 F 02/05/01 Florida 33040 5l. 001 04304 100 0 S 12/16/66 /ol 11/0B/B9 Florida 33042 52. 001 04304 300 0 S 03/02/69 F 10/27/97 Florida 33036 53. 001 04304 300 1 F 10/19/77 F 06/01/99 Florida 33037 54. 001 04304 200 0 S 02/11/4B F 10/11/BB Florida 33050 55. 001 04304 100 0 S 09/16/75 F 01/23/95 Florida 33040 56. 001 04304 100 3 F 10/15/70 F 09/26/94 Florida 33040 57. 001 04304 300 1 F 04/30/51 F 07/24/00 Florida 33070 58. 001 04304 200 0 S 02/08/57 F 04/16/01 Florida 33050-1767 59. 001 04304 300 2 F 09/30/51 F 05/06/99 Florida 33037 60. 001 04305 300 0 S 07/26/46 F 02/22/99 Florida 33070 6l. 001 04305 300 0 S 08/28/49 F 07/01/9B Florida 33036 62. 001 04305 300 3 F 12/05/59 F 02/12/01 Florida 33037 Monroe County Board of County Commissioners Page 1 June 2001 ENROLLMENT CENSUS ';l!> 63. 001 04305 100 3 F 01/12/67 F 09/01/99 Florida 33040 64. 001 04305 200 0 S 12/23/64 F 03/14 /00 Florida 33050 65. 001 04306 100 3 F 10/06/61 F 08/02/79 Florida 33040 66. 001 04307 100 0 S 01/17/49 F 10/02/76 Florida 33040 67. 001 04307 300 0 S 04/16/74 F 01/13/97 Florida 33037 68. 001 04308 100 0 07/14/50 F 12/15/00 Florida 33040 69. 001 04309 100 0 S 12/17/61 F 05/16/89 Florida 33040 70. 001 04309 100 3 F 07/12/67 F 07/01/86 Florida 33040 71. 001 04309 300 0 S 06/01/57 F 09/12/94 Florida 33037 72. 001 04309 100 0 S 11/08/61 F 06/27/79 Florida 33040 73. 001 04309 100 4 F 08/28/55 F 12/05/88 Florida 33040 74. 001 04309 100 0 S 01/06/64 F 04/18/01 Florida 33040 75. 001 04309 100 0 S 03/29/57 F 07/31/95 Florida 33040 76. 001 04309 300 0 S 05/13/44 F 11/24/97 Florida 33034 77. 001 04309 100 0 S 10/06/77 F 02/20/01 Florida 33042 78. 001 04309 100 0 S 04/04/74 F 03/14/94 Florida 33040 79. 001 04309 200 0 S 03/14/52 F 09/27/00 Florida 33050 80. 001 04309 100 0 S 08/10/74 F 11/14/00 Florida 33040 81. 001 04309 100 1 F 10/16/54 F 05/07/99 Florida 33040 82. 001 04309 100 2 F 09/12/49 F 01/02/91 Florida 33040 '- 83. 001 04311 100 1 F 12/28/44 F 09/23/96 Florida 33040 64. 001 04311 300 0 S 10/18/62 F 09/05/00 Florida 33070 85. 001 04311 100 0 S 01/24/53 F 08/03/77 Florida 33040 86. 001 04311 100 1 F 02/18/38 F 08/02/93 Florida 33040 87. 001 04311 100 0 S 02/06/72 F 01/27/99 Florida 33040 88. 001 04311 300 0 S 02/07/71 F 09/29/97 Florida 33037 89. 001 04311 100 0 S 03/18/37 F 08/03/77 Florida 33040 90. 001 04311 100 3 F 10/11/62 F 10/25/89 Florida 33040 91. 001 04311 100 0 S 07/05/40 F 08/23/99 Florida 33042 92. 001 04311 100 0 S 04/01/42 F 10/10/89 Florida 33040 93. 001 04311 100 0 S 12/15/28 F 04/27/99 Florida 33040 94. 001 04311 100 2 F 07/31/69 F 06/01/99 Florida 33040 95. 001 04311 100 0 S 04/08/68 M 08/10/92 Florida 33041 96. 001 04311 100 0 S 02/05/51 F 07/15/96 Florida 33040 97. 001 04312 100 3 F 12/12/55 F 10/03/74 Florida 33041 98. 001 04313 100 0 S 09/10/48 M 11/04/87 Florida 33041 99. 001 04313 100 0 S 07/01/39 H 01/02/85 Florida 33042 100. 001 04313 100 0 S 11/17 /60 F 08/28/78 Florida 33040 101. 001 on13 100 3 F 01/16/56 F 05/04/87 Florida 33042 102. 001 04314 200 1 F 06/01/51 F 03/01/7 6 Florida 33052 103. 001 04314 100 0 S 12/04/51 F 08/04/97 Florida 33042 104. 001 04314 100 1 F 10/07/44 M 02/04/74 Florida 33040 105. 001 04314 300 1 F 11/03/47 F 12/16/91 Florida 33051-0674 106. 001 04314 100 0 S 06/01/44 F 07/11/76 Florida 33040 107. 001 04315 100 0 S 05/18/60 F 01/24/00 Florida 33040 108. 001 04315 200 0 S 06/30/53 F 12/13/93 Florida 33043 109. 001 04315 100 0 S 09/08/41 F 02/15/73 Florida 33040 110. 001 04315 100 0 s 12/27/70 F 08/21/00 Florida 33043 111. 001 04315 300 1 F 07/02/50 F 03/18/96 Florida 33070 112. 001 04315 100 0 S 04/15/71 F 01/18/00 Florida 33040 113. 001 04315 100 0 S 10/27/74 F 01/26/98 Florida 33040 114. 001 04315 100 0 S 08/26/79 F 09/09/99 Florida 33040 115. 001 04318 100 1 F 10/14/77 F 08/01/96 Florida 33040 116. 001 04318 100 0 S 12/29/42 F 06/01/99 Florida 33041 117. 001 04318 100 2 F 12/02/54 F 04/16/84 Florida 33040 118. 001 04318 300 1 F 08/10/66 F 11/29/93 Florida 33037 119. 001 04318 100 0 S 08/14/61 F 04/02/00 Florida 33041 120. 001 04318 300 0 S 07/11/64 F 03/19/90 Florida 33070 121. 001 04318 100 3 F 08/29/63 F 02/12/96 Florida 33041 122. 001 04318 100 0 S 12/31/71 F 11/13/90 Florida 33041 123. 001 04318 100 1 F OS/29/50 H 01/03/89 Florida 33040 124. 001 04318 100 0 s OS/29/70 F 10/04/92 Florida 33051 125. 001 05000 100 3 F 11/05/74 F 04/18/94 Florida 33040 126. 001 05000 100 0 S 08/03/64 F 06/08/87 Florida 33040 Monroe County Board of County Commissioners Page 2 June 2001 ENROLL:MENT CENSUS 127. 001 05000 100 1 F 05/07/44 M 09/13/93 Florida 33040 128. 001 06001 100 2 F 04/19/46 F 05/15/95 Florida 33040 129. 001 06001 100 1 F 07/05/67 F 10/01/87 Florida 33040 130. 001 06001 100 1 F 11/07/72 F 11/15/93 Florida 33040 13I. 001 06001 100 0 S 05/03/43 F 04/10/95 Florida 33043-1637 132. 001 06001 100 0 S 10/08/56 M 04/13/93 Florida 33040 133. 001 05001 100 2 F 04/04/74 F 08/03/94 Florida 33040 134. 001 06001 100 1 F 10/30/47 M 11/19/96 Florida 33040 135. 001 06002 200 0 S 02/18/56 F 02/05/01 Florida 33050 136. 001 06002 100 0 S OS/23/54 N 10/10/00 Florida 33040 137. 001 06002 100 0 S 04/17/61 F 06/30/80 Florida 33045 138. 001 06002 100 1 F 02/10/61 F 09/16/81 Florida 33041 139. 001 06002 100 0 S 07/06/51 M OS/20/91 Florida 33040-4849 140. 001 06002 100 2 F 06/30/68 N 12/05/00 Florida 33040 HI. 001 06002 100 0 S 01/02/42 F 10/01/76 Florida 33040 142. 001 06002 200 0 S 05/13/53 N 09/18/00 Florida 33050 143. 001 06002 100 0 S 09/18/62 N 02/20/95 Florida 33043 144. 001 06002 100 0 S 02/14/47 N OS/23/90 Florida 33040 145. 001 06002 100 0 S 01/09/52 F 12/29/97 Florida 33045 146. 001 06500 100 2 F 08/04/68 F 08/11/86 Florida 33040 147. 001 06500 100 0 S 12/18/56 N 11/01/84 Florida 33040 148. 001 06500 100 0 S 08/02/71 F 04/30/90 Florida 33040 149. 001 06500 100 1 F 11/06/58 F 02/19/80 Florida 33040 150. 001 06500 100 3 F 10/16/57 F 10/03/94 Florida 33040 15I. 001 06500 100 1 F 01/20/70 F 05/04/95 Florida 33040 152. 001 10000 200 2 F 02/20/52 F 03/16/77 Florida 33050 153. 001 10000 200 4 F 09/19/50 M 01/03/77 Florida 33050-0211 154. 001 10501 200 0 S 11/24/49 M 03/25/90 Florida 33030-5441 155. 001 10501 200 3 F 11/04/45 N 06/17/93 Florida 33043 156. 001 10501 200 0 S 11/23/50 N 06/23/99 Florida 33050-1741 157. 001 10501 200 0 S 01/29/62 F 01/04/99 Florida 33043 158. 001 10501 200 0 S 01/05/48. M 07/07/88 Florida 33050 159. 001 13000 200 1 F 12/26/41 M 11/05/87 Florida 33050 160. 001 13000 200 0 S 12/12/50 F 12/27/00 Florida 33043 16I. 001 13500 200 0 S 07/25/49 F 04/01/98 Florida 33037 162. 001 13500 200 1 F 04/29/35 M 06/17/81 Florida 33050 163. 0(}1 13500 200 4 F 12/25/54 F 08/09/99 Florida 33037 164. 001 20000 100 2 F 06/24/63 F 06/01/83 Florida 33040 165. 001 20000 100 0 S 10/28/51 F 04/16/81 Florida 33040 166. 001 20000 100 3 F 11/26/52 N 10/04/82 Florida 33040 167. 001 20501 300 0 S 09/10/50 F 10/04/99 Florida 33037 168. 001 20501 200 0 S 02/10/65 F 11/29/99 Florida 33037 169. 001 20501 100 0 S 12/07/46 N 08/12/85 Florida 33041 170. 001 20501 100 3 F 12/17/51 N 11 /08 /93 Florida 33040 17I. 001 20501 100 0 S 07/23/46 M 11/08/87 Florida 33040 172. 001 20501 300 0 S 05/09/52 F 06/07/81 Florida 33037 173. 001 20501 100 0 S 06/22/71 H 08/09/00 Florida 33043 174. 001 20501 100 0 S 06/07/41 M 06/26/90 Florida 33040 175. 001 20501 100 2 F 12/17/54 N 09/15/97 Florida 33043 176. 001 20501 200 1 F 08/28/50 N 10/03/94 Florida 33050 177. 001 20501 200 1 F 07/15/51 M 01/27/93 Florida 33050 178. 001 20501 100 0 S 10/15/69 N 10/05/88 Florida 33042 179. 001 20501 100 2 F 07/16/38 M 06/03/96 Florida 33040 180. 001 20501 300 0 S 11/17/59 M 10/23/96 Florida 33036 18I. 001 20501 100 1 F 09/12/41 N 05/18/81 Florida 33040 182. 001 20501 100 0 S 10/06/44 F 01/31/00 Florida 33040 183. 001 20501 300 4 F 04/24/58 M 06/17 /97 Florida 33037 184. 001 20501 100 0 S 01/14/48 M 05/18/81 Florida 33040 185. 001 20501 100 0 S 10/10/49 M 01/17/95 Flcrida 33040 186. 001 20501 300 0 S 01/27/60 F 08/08/00 Florida 33037 187. 001 20501 100 1 F 07/26/38 M 03/24/94 Florida 33040 188. 001 20501 100 0 S 03/21/64 N 12/14/98 Florida 33040 189. 001 20501 100 0 S 06/14/60 M 05/14/98 Florida 33040 190. 001 20501 100 0 S 01/24/55 M 12/16/78 Florida 33045 Monroe County Board of County Commlssloner.s Page 3 June 2001 ENROLLMENT CENSUS 191. 001 20501 100 0 S 07/07/47 M 08/01/76 Florida 33045-2373 192. 001 20501 100 0 S 11/12/45 F 10/21/97 Florida 33040 193. 001 20501 200 0 S 06/20/40 F 08/14/86 Florida 33051 194. 001 20501 200 0 S 11/14/51 M 03/23/92 Florida 33042 195. 001 20501 100 1 F 02/19/54 M 05/18/92 Florida 33040 196. 001 20501 100 0 S 08/09/47 M 12/30/98 Florida 33045 197. 001 20501 100 0 S 02/04/42 M 02/21/99 Florida 33040 198. 001 20501 300 0 S 12/23/45 M 03/01/93 Florida 33036 199. 001 20501 100 1 F 06/10/36 M 02/10/91 Florida 33040 200. 001 20501 200 1 F 02/15/45 N 01/31/94 Florida 33050 201. 001 20501 100 0 S 10/18/64 ~ 12/05/98 Flo:=ida 33040 202. 001 20501 100 0 S OS/27/61 F 05/01/94 Florida 33042 203. 001 20501 100 0 S 06/08/49 M 07/29/86 Florida 33040-6105 204. 001 20501 100 0 S 11/08/40 H 07/16/90 Florida 33040 205. 001 20501 100 0 S 01/04/34 F 03/13/00 Florida 33040 206. 001 20501 100 :2 F 12/15/66 N 10/17/95 Florida 33040 207. 001 20501 100 0 S 01/30/64 M 10/02/00 Florida 33040 208. 001 20501 200 0 F 07/25/47 M 06/27/96 Florida 33043 209. 001 20501 200 0 S 09/11/41 M 04/17 /00 Florida 33051 210. 001 20501 100 0 S 03/11/56 M 01/24/00 Florida 33040 211. 001 20501 100 0 S 11/14/57 M 03/29/99 Florida 33040 212. 001 20501 100 1 F 05/05/30 M 02/04/86 Florida 33040 213. 001 20501 100 3 F 08/21/60 M 11/12/91 Florida 33040 214. 001 20501 100 0 S 12/19/57 M 02/28/94 Florida 33040 215. 001 20501 100 3 F 11/06/52 N 11/04/91 Florida 33040 216. 001 20501 200 0 S 09/29/49 M 08/07/94 Florida 33052 217. 001 20501 100 4 F 04/20/68 M 01/21/97 Florida 33040 218. 001 20501 100 1 F 02/28/50 M 03/02/92 Florida 33040 219. 001 20502 100 0 S 03/16/40 F 03/23/99 Florida 33040 220. 001 20517 200 1 F 10/12/48 M 04/25/01 Florida 33050 221. 001 40501 200 0 S 10/25/48 M 12/19/94 Florida 33050 222. 001 40501 100 0 S 04/21/48 M 10/01/79 Florida 33043 223. 001 60000 100 0 S 07/09/42 N 06/03/96 Florida 33040 224. 001 60000 100 0 S 07/07/57 F 01/28/82 Florida 33042 225. 001 61000 100 0 S 08/24/53 F 03/13/90 Florida 33040 226. 001 61000 100 0 S 12/23/64 M 08/07/95 Florida 33042 227. 001 61501 100 0 S 12/30/42 F 07/08/83 Florida 33040 228. 001 61501 100 0 S 04/21/37 M 06/24/96 Florida 33040 229. 001 61501 300 0 S 08/27/35 F 03/06/89 Florida 33070 230. 001 61501 200 1 F 05/05/52 F 01/14/00 Florida 33050 231. 001 61501 100 1 F 03/07/44 F 09/16/77 Florida 33040 232. 001 61501 100 0 S 08/05/45 M 02/27/95 Florida 33040 233. 001 61501 100 0 S 10/16/47 M 02/01/77 Florida 33040 234. 001 61501 100 0 S 12/31/46 F 11/17/98 Florida 33043 235. 001 61501 100 2 F 08/30/54 M OS/22/00 Florida 33051 236. 001 61501 100 0 S 06/01/65 F 11/06/00 Florida 33040 237. 001 61501 200 4 F 01/18/51 F 02/08/99 Florida 33037 238. 001 61504 200 1 F 10/22/56 F 01/16/96 Florida 33043 239. 001 61504 100 0 S 12/29/44 F 07/31/00 Florida 33040 240. 001 61504 100 0 S 06/09/48 F 04/28/98 Florida 33040 241. 001 61504 100 0 s 02/22/66 F 09/17/97 Florida 33040 242. 001 61504 100 0 S 07/03/50 F 05/16/93 Florida 33040 243. 001 61504 100 1 F 01/23/44 F 09/19/93 Florida 33040 244. 001 61504 100 0 S 11/05/63 F 09/27/99 Florida 33041 245. 001 61504 100 0 s 04/04/43 M OS/28/95 Florida 33041-0181 246. 001 62500 100 0 s 01/03/63 F OS/29/88 Florida 33040 247. 001 67001 300 0 S 01/10/41 M 12/07/98 Florida 33036 248. 001 67001 200 0 S 07/27/56 F 10/03/94 Florida 33050 249. 001 67001 100 0 S 06/24/47 M 01/13/92 Florida 33042 250. 001 67001 100 0 S 08/09/46 M 02/12/98 Florida 33040 251. 001 67001 300 0 S 11/19/43 F 10/01/87 Florida 33037 252. 001 67001 100 1 F 11/24/71 F 09/26/94 Florida 33040 253. 001 67001 100 0 S 09/06/46 M 02/24/91 Florida 33042 254. 001 67501 100 3 F 12/17/47 M 07/01/95 Florida 33040 Monroe County Board of County Commissioners Page 4 June 2001 ENROLLMENT CENSUS 255. 001 67501 100 1 F 01/10/39 F 05/13/85 Florida 33040 256. 001 67501 100 0 S 10/23/50 F 05/02/90 Florida 33043-4611 257. 001 67501 100 0 S 01/27/69 F 08/03/89 Florida 33040 258. 001 67501 200 0 S 03/17/41 F 01/19/96 Florida 33043 259. 001 67501 100 0 S 02/05/53 M OS/28/85 Florida 33040 260. 001 69000 300 0 S 07/29/30 M 02/19/90 Florida 33070 26l. 001 69000 100 3 F 02/09/65 F 01/24/00 Florida 33040 262. 001 69000 100 0 S 06/29/81 F 08/23/99 Florida 33040 263. 001 69000 100 0 S 07/21/48 F 03/31/92 Florida 33040 264. 001 69000 200 0 S 06/21/50 F 09/02/86 Florida 33050 265. 001 69000 100 0 S 11/13/17 M 09/16/74 Florida 33040 266. 001 69000 100 0 S 05/11/58 M 09/20/99 Florida 33040 267. 001 69000 100 0 S 07/26/43 F 10/01/80 Florida 33040 268. 001 69000 100 0 S OS/27/44 F 12/04/72 Florida 33040 269. 001 69000 300 1 F 05/10/45 F 03/08/93 Florida 33070 270. 001 69000 100 0 S 04/27/43 M 03/12/90 Florida 33040 271. 001 69000 300 0 S 07/27/68 F 08/07/00 Florida 33037 272. 001 69000 100 0 S 07/24/29 F 11/04/97 Florida 33040 273. 001 69000 300 0 S 06/19/64 F 12/04/00 Florida 33037 274. 001 69000 100 1 F 02/07/54 N 04/28/97 Florida 33040 275. 001 69000 100 0 S 12/16/68 F 10/18/93 Florida 33040 276. 001 69000 100 2 F 08/08/43 M 11/20/95 Florida 33040 277. 001 69000 100 0 F 03/15/71 F 06/11/90 Florida 33040 278. 001 69000 200 0 S 05/03/67 F 10/01/96 Florida 33050 279. 001 69000 100 3 F 03/14/64 F 02/11/91 Florida 33041 280. 001 69000 300 0 S 01/15/62 M 07/29/96 Florida 33070 28l. 001 69000 100 2 F 12/27/66 F 02/18/86 Florida 33040 282. 001 69000 100 1 F 08/04/43 F 02/17/70 Florida 33040 283. 001 69000 100 0 S 10/07/40 F 01/01/86 Florida 33040 284. 001 69000 200 0 S 09/04/71 F 03/01/99 Florida 33043 285. 001 69000 100 0 S 02/16/71 F 09/03/96 Florida 33040 286. 001 69000 100 0 S 07/21/65 F 08/28/00 Florida 33041 287. 001 69000 100 0 S 02/19/71 F 09/11/00 Florida 33040 288. 001 69000 300 4 F 02/06/65 F 01/27/86 Florida 33070 289. 001 69000 100 1 F 10/17/57 F 09/17/79 Florida 33040 290. 001 69000 300 1 F 01/26/51 F 10/25/99 Florida 33036 29l. 001 69000 100 3 F 10/25/64 F 01/01/84 Florida 33042 292. 001 69000 300 0 S 08/31/42 F 08/13/90 Florida 33037 293. 001 69000 100 0 S 04/28/53 F 10/02/78 Florida 33040-7339 294. 001 69000 200 0 S 07/04/45 F OS/28/96 Florida 33050 295. 001 69000 100 0 S OS/27/30 N 07/29/91 Florida 33040 296. 001 69000 100 0 S 06/28/31 F 05/08/91 Florida 33040 297. 001 69000 100 1 F 06/21/39 F 08/01/64 Florida 33040 298. 001 69000 200 0 S 08/11/41 F 06/16/98 Florida 33051-0706 299. 001 69000 200 0 S 09/28/72 F 08/21/00 Florida 33050 300. 001 69000 100 0 S 08/26/69 F 02/14/94 Florida 33045 30l. 001 69000 100 0 S 01/09/47 F 09/10/86 Florida 33040 302. 001 69000 100 0 S 11/08/51 F 02/14/00 Florida 33040 303. 001 69000 200 0 S 06/10/58 F OS/22/00 Florida 33050 304. 001 69000 300 0 S 06/15/54 F 10/25/93 Florida 33037 305. 001 69000 100 0 S 03/25/56 F 11/01/93 Florida 33040 306. 001 69000 100 4 F 12/07/62 F 05/01/00 Florida 33040 307. 001 69200 300 2 F 12/13/58 F 05/01/00 Florida 33036 308. 001 69200 300 1 F 11/01/34 M 07/25/94 Florida 33037 309. 001 69200 300 3 F 03/05/48 M 08/29/88 Florida 33037 310. 001 69200 100 0 S 10/30/40 F 06/22/98 Florida 33040 311. 001 69200 100 1 F 10/14/42 F 09/24/73 Florida 33040 312. 001 69200 100 0 s 09/28/59 F 06/01/77 Florida 33040 313. 001 69200 200 1 F 03/05/52 F 04/07/97 Florida 33050 314. 001 69200 200 1 F 11/22/43 M 02/10/97 Florida 33040 315. 001 69200 300 0 S 08/01/52 F 09/01/99 Florida 33070 316. 001 69200 100 4 F 08/27/59 F 01/23/84 Florida 33040 317. 001 69200 100 0 S 02/12/80 F 08/30/99 Florida 33040 318. 001 69200 100 1 F 01/15/47 M OS/29/90 Florida 33040 Monroe County Board of County Commissioners Page 5 June 2001 ENROLLMENT CENSUS 319. 001 69200 300 0 S 04/09/35 M 06/10/96 Florida 33037 320. 001 69200 100 0 S 08/11/58 M 01/03/95 Florida 33040 321. 001 69200 100 2 F 11/11/60 F 06/11/84 Florida 33040 322. 001 69200 100 3 F 10/23/51 F 12/15/69 Florida 33040 323. 001 69200 100 3 F 07/01/65 M 11/06/00 Florida 33050 324. 001 69200 300 1 F 06/30/40 F 08/12/91 Florida 33036 325. 001 69200 100 0 S 04/19/37 F 01/28/69 Florida 33040 326. 001 69200 100 1 F 04/30/36 M 12/13/65 Florida 33040 327. 001 69200 200 0 S 07/24/38 F 07/06/93 Florida 33050 328. 001 69200 lOG 0 S 02/07/51 4 04/08/98 Florida 33043 329. 001 69200 100 0 S 03/05/48 M 04/15/98 Florida 33043 330. 001 69200 300 0 S OS/28/51 F 04/14/99 Florida 33036 331. 001 69200 100 0 S 04/22/42 H 07/29/96 Florida 33040 332. 001 69200 100 0 S 07/28/37 M 08/01/90 Florida 33040 333. 001 69200 100 0 S 05/12/43 F 01/16/79 Florida 33040 334. 001 69200 100 0 S 06/17/47 M 07/06/98 Florida 33040 335. 001 69200 100 4 F OS/28/50 H 02/28/01 Florida 33040 336. 001 69200 100 0 S 08/23/56 H 11/23/98 Florida 33040 337. 001 69200 200 1 F 07/29/54 F 07/02/99 Florida 33043 338. 001 69200 100 0 S 12/20/59 F 07/01/79 Florida 33040 339. 001 69200 100 0 S 02/21/45 M 08/04/86 Florida 33040 340. 001 69200 100 0 S 11/28/53 F 10/24/83 Florida 33040 341. 001 69200 100 1 F 07/02/39 H 02/03/92 Florida 33040 342. 001 69200 200 0 S 04/26/63 M 10/06/97 Florida 33040 343. 001 69200 100 0 S 10/26/47 F 06/28/99 Florida 33045-5855 344- 001 69200 300 1 F 09/30/40 M 06/01/92 Florida 33037 345. 001 69200 200 0 S 03/02/45 H 02/18/97 Florida 33040 346. 001 69200 100 0 S 01/20/64 F 10/01/82 Florida 33040 347. 001 69200 200 0 S OS/22/61 F 11/09/98 Florida 33050 348. 001 80002 300 0 S OS/26/56 F 08/01/98 Florida 33037 349. 001 80002 100 3 F OS/29/69 F 02/11/91 Florida 33040 350. 001 80002 100 0 S 09/17/69 F 02/12/01 Florida 33040 351. 001 80005 100 0 S 09/30/69 F 04/10/00 Florida 33040 352. 001 80007 100 0 s 09/24/73 F 08/02/99 Florida 33040 353. 001 82001 100 0 S 08/27/67 F 04/19/99 Florida 33042 354. 001 82001 200 1 F 03/19/46 M 01/24/01 Florida 33050 355. 091 82001 l~J 1 F 01/30/57 F 12/03/90 Florida 33040 356. 001 82003 100 0 S 01/13/64 H 01/02/01 Florida 33041 357. 001 82003 300 1 F 11/25/48 F 01/02/98 Florida 33037 358. 001 82501 100 0 S 07/27/49 F 02/22/99 Florida 33040 359. 001 82501 300 0 S 12/09/53 1-1 01/18/00 Florida 33070 360. 001 82501 100 1 F 06/23/54 F 03/26/01 Florida 33042 361. 001 82501 100 3 F 10/30/60 F 02/19/96 Florida 33043 362. 001 83001 300 2 F 08/22/72 F 01/08/01 Florida 33070 363. 001 83001 100 0 S 10/30/48 F 10/13/97 Florida 33040 364. 001 83001 100 1 F 07/23/49 F 04/25/01 Florida 33042-1033 365. 001 83001 100 0 S 11/23/61 F 12/09/96 Florida 33040 366. 001 83500 100 1 F 12/24/46 M 03/15/00 Florida 33040 367. 001 83500 100 5 F 12/04/61 F 06/27/97 Florida 33042 368. 001 83500 100 0 S 08/26/58 M 03/02/98 Florida 33040 369. 001 83500 100 0 S 02/26/49 M 02/27/01 Florida 33040 370. 001 83500 300 4 F 07/18/52 M 07/17/00 Florida 33037 371. 001 83500 100 0 S 08/04/49 M 10/11/99 Florida 33042 372. 001 83500 100 1 F 03/01/57 F 06/26/89 Florida 33042 373. 001 83500 100 0 S 05/07/46 F 04/29/88 Florida 33040 374. 001 84500 100 0 S 02/21/57 F 07/12/99 Florida 33070 375. 002 62002 100 0 S 09/07/41 F 03/12/01 Florida 33040 376. 002 62002 100 0 S 03/01/19 F 02/01/74 Florida 33040 377. 002 62002 100 0 S 09/09/55 F 07/24/95 Flc'rida 33040 378. 002 62002 100 0 S 12/05/48 M 12/16/86 Florida 33040 379. 002 62002 300 1 F OS/29/40 F 05/16/84 Florida 33070 380. 002 62002 100 0 S 08/22/68 F OS/21/90 Florida 33040 381. 002 62004 100 0 S 02/13/64 F OS/29/98 Florida 33040 382. 002 62002 100 0 S 01/20/61 F 09/14/98 Florida 33040 Monroe County Board or County Com missioners Page 6 June 2001 ENROLLMENT CENSUS 383. 002 62004 100 1 F 03/18/43 F 04/25/94 Florida 33040 384. 002 62004 100 0 S 05/16/44 F 03/13/91 Florida 33040 385. 002 62004 100 0 S 02/23/38 M 12/03/85 Florida 33040 386. 002 62004 100 0 S 07/25/52 F 09/29/97 Florida 33041 387. 002 62004 100 0 S 07/27/68 F 09/26/88 Florida 33040 388. 002 62004 100 0 S 09/27/43 M 08/29/00 Florida 33040 389. 002 62004 100 0 S 04/25/59 F 01/19/00 Florida 33040 390. 002 62004 100 0 S 10/23/68 M 01/16/01 Florida 33040 39l. 002 62004 100 0 S 05/04/59 F 09/23/99 Florida 33040 392. 002 62004 100 0 S 08/06/48 F 01/25/88 Florida 33040 393. 002 62006 200 0 S 06/12/25 F 01/03/00 Florida 33052 394. 002 62006 200 0 S 04/30/30 F 03/01/84 Florida 33050 395. 002 62006 100 1 F 09/09/43 F 01/06/92 Florida 33043 396. 002 62008 300 0 S 09/30/36 F OS/22/89 Florida 33070 397. 002 62008 300 1 F 11/13/41 M 06/19/87 Florida 33036 398. 002 62008 300 0 S 09/04/54 F 01/06/97 Florida 33070 399. 002 62008 300 0 S 03/10/40 M 10/11/98 Florida 33036 400. 002 62008 300 0 S 02/16/44 M 02/28/00 Florida 33036 40l. 002 62010 300 0 S 04/01/55 F 11/14/94 Florida 33037 402. 002 62010 300 0 S 06/07/51 F 01/06/97 Florida 33037 403. 002 62010 200 0 S 09/05/62 F 08/14/00 Florida 33037 404. 002 62010 300 2 F 06/13/43 F OS/29/96 Florida 33037 405. 002 62010 200 1 F 07/04/50 F OS/23/00 Florida 33037 406. 002 62010 300 0 S 11/25/42 M 02/26/01 Florida 33037 407. 002 62012 100 0 S 02/22/49 F 05/13/97 Florida 33043 408. 002 62012 100 0 S 10/01/53 M 05/05/97 Florida 33040 409. 002 62012 200 0 S 11/09/43 F 07/07/96 Florida 33043 410. 101 04303 H 100 0 S 10/06/57 F 08/22/88 Florida 33043-0066 41l. 101 04303 H 300 2 F 12/04/49 M 07/17/95 Florida 33173 412. 101 04303 H 300 0 s 10/21/70 F 08/24/98 Florida 33186 413. 101 04303 H 300 3 F 09/02/63 F 12/01/97 Florida 33023 414. 101 04303 H 300 0 S 06/30/42 F 10/01/94 Florida 33015 415. 101 04303 H 100 1 F 01/08/34 M 06/02/97 Florida 33027-3574 416. 101 04303 H 300 0 S 07/08/45 F 06/26/00 Florida 33024 417. 101 04303 H 300 4 F 11/27/52 F 10/01/94 Florida 33326 418. 101 04303 H 300 3 F 12/07/47 M 03/17/97 Florida 33133 419. 101 on03 H 300 0 S 02/06/50 F 10/01/94 Florida 33143 420. 101 04303 H 300 0 S 10/23/38 F 06/15/97 Florida 33014 42l. 101 04303 H 300 0 S 10/22/73 F 01/15/01 Florida 33025 422. 101 04303 H 300 0 S 03/15/59 F 09/17/96 Florida 33024 423. 101 04303 H 300 1 F 11/21/50 M 10/26/98 Florida 33193 424. 101 04303 H 300 0 S 10/28/67 F 11/08/99 Florida 33155 425. 101 04303 H 300 0 S 10/15/66 F 04/03/00 Florida 33014 426. 101 04303 H 300 0 S 06/09/66 F 08/14/00 Florida 33186 427. 101 04303 H 300 0 S 05/14/31 M 10/31/94 Florida 33433 428. 101 04303 H 300 0 S 11/03/76 F 03/24/97 Florida 33040 429. 101 04303 H 300 0 S 12/28/48 F 10/01/94 Florida 33015 430. 101 04303 H 300 0 S 05/14/50 M OS/29/00 Florida 33133 43l. 101 04303 H 300 2 F 01/18/51 F 10/01/94 Florida 33026 432. 101 04303 H 300 3 F 08/02/55 M 10/01/94 Florida 33134 433. 101 04303 H 300 0 S OS/22/57 F 10/01/94 Florida 33158 434. 101 04303 H 300 0 S 03/22/51 M 08/08/00 Florida 33173 435. 101 04303 H 300 0 S 10/05/51 F 10/01/94 Florida 33004 436. 101 04303 H 300 2 F 10/29/65 F 10/01/94 Florida 33156 437. 101 04303 H 300 0 S 04/08/50 M 10/01/94 Florida 33326 438. 101 04303 H 300 0 S 12/14/45 F 10/01/94 Florida 33134 439. 101 04303 H 300 2 F 03/25/62 F 10/03/94 Florida 33351 440. 101 04303 H 300 0 S OS/25/64 M 06/30/97 Florida 33314 44l. 101 04303 H 300 2 F 09/12/64 F 10/01/94 Florida 33143 442. 101 04303 H 300 0 S 10/28/60 F 01/27/97 Florida 33166 443. 101 04303 H 300 0 S 10/11/43 F 05/16/95 Florida 33484 444. 101 04303 H 300 0 S 10/12/65 F 07/03/00 Florida 33196 445. 101 04303 H 300 0 S 09/15/58 M 10/01/94 Florida 33185 446. 101 04303 H 300 0 S 02/17/46 M 11/01/95 Florida 33029 Monroe County Board of County Commissioners Page 7 June 2001 ENROLLMENT CENSUS 447. 101 04303 H 300 2 F 01/26/60 F 10/01/94 Florida 3314 9 448. 101 04303 H 300 0 S 03/29/60 F 10/01/94 Florida 33016 449. 101 04303 H 300 0 S 09/30/68 F 02/14/00 Florida 33150 450. 101 04303 H 300 0 S 12/10/69 F 10/01/94 Florida 33193 45l. 101 04303 H 300 0 S 07/06/59 F 11/01/99 Florida 33180 452. 101 04303 H 300 0 S 12/24/50 F 01/24/97 Florida 33176 453. 101 04303 H 300 0 S 02/16/66 F 01/11/99 F1orid3 33172 454. 101 04303 H 300 0 S 10/27/43 H 04/12/99 Florida 33116-3655 455. 101 04303 H 300 0 S 10/20/58 F 10/01/94 Florida 33027 456. 101 04303 H 300 0 S 02/23/74 F 01/24/97 Florida 33175 457. 101 04303 H 200 0 s 09/05139 F 08/31/84 Florida 33050 458. 101 04303 H 300 0 S 11/19/59 F 09/05/00 Florida 33025 459. 101 04303 H 300 0 S 05/05/61 F OS/22/00 Florida 33155 460. 101 04303 H 300 2 F 08/31/46 l-! 03/17/97 Florida 33016 46l. 101 04303 H 300 0 S 05/08/67 M OS/25/98 Florida 33026 462. 101 04303 H 300 0 S 07/24/69 F 10/01/94 Florida 33024 <: 63. 101 (.13:13 E 300 C S 04/05/69 ,.. 10/01/94 Florid2 33175 464. 101 04303 H 300 0 S 12/02/46 F 08/14/00 Florida 33126 465. 101 04303 H 100 0 S 03/31/55 F 12/15/93 Florida 33040 466. 101 04303 H 300 0 S 07/10/56 F 11/24/97 Florida 33166 467. 101 04303 H 300 0 S 06/25/57 M 10/20/86 Florida 33037 468. 101 04303 H 300 0 S 04/05/47 M 09/28/95 Florida 33169 469. 101 04303 H 300 0 S 02/23/53 F 06/02/97 Florida 33009 470. 101 04303 100 0 S 07/15/58 M 04/30/01 Florida 33045 47l. 101 04303 100 0 S 07/28/48 N 03/01/91 Florida 33040 472. 101 04303 300 0 s 02/04/66 F 10/24/94 Florida 33070 473. 101 04303 100 0 S 04/24/71 M 10/02/00 Florida 33040 474. 101 04303 100 0 S 01/01/64 M 01/16/98 Florida 33045 475. 101 04303 100 3 F 05130/61 N 10/16/80 Florida 33040 476. 101 04303 100 3 F 08/12/72 F 07/25/94 Florida 33040 477. 101 04303 100 2 F 12/16/38 M 01/01/00 Florida 33041 478. 101 04303 100 0 S 11/03/39 M 10/13/97 Florida 33040 479. 101 04303 100 1 F 06/02/43 M 03/01/91 Florida 33040 480. 101 04303 100 1 F 04/15/64 F 02/11/98 Florida 33040 48l. 101 04303 100 0 S 04/15/69 N 01/04/01 Florida 33040 482. 101 04303 100 0 S 08/11/64 F 08/19/94 Florida 33040 483. 10.1 04303 100 2 F 11/27/52 N 07/01/86 Florida 33043-0066 484. 101 04303 100 0 S 03/09/61 F 06/15/80 Florida 33043 485. 101 04303 100 0 s 12/31/69 M 03/01/91 Florida 33040 486. 101 04303 100 0 S 09/26/62 H 03/01/91 Florida 33040 487. 101 04303 100 0 s 08/13/63 M 06/14/99 Florida 33040 488. 101 04303 100 1 F 09/28/68 M 04/30/01 Florida 33040 489. 101 04303 200 0 S 11/14/66 F 01/20/98 Florida 33043 490. 101 04303 100 3 F 12/13/70 F 09/06/96 Florida 33041-1942 49l. 101 04303 100 0 S 02/11/47 M 08/21/89 Florida 33040 492. 101 04303 100 0 S 09/27/42 F 08/27/84 Florida 33040 493. 101 04303 100 0 S 11/20/77 H 03/05/01 Florida 33040 494. 101 04303 100 2 F 09/13/57 F 06/06/88 Florida 33040 495. 101 04303 100 2 F 09/30/60 M 10/01/91 Florida 33041 496. 101 04303 100 0 S 01/01/51 N 03/22/99 Florida 33043 497. 101 04303 100 1 F 01/06/60 M 10/28/99 Florida 33037 498. 101 04303 200 4 F 12/10/65 M 11/26/96 Florida 33043 499. 101 04303 100 2 F 10/29/64 M 11/10/94 Florida 33043 500. 101 04303 100 0 S 05/18/75 F 07/08/96 Florida 33040 SOL 101 04303 300 0 S 08/02/56 H 01/09/91 Florida 33037 502. 101 04303 100 0 S 03/12/63 M 06/08/98 Florida 33040 503. 101 04303 100 0 S 09/20/71 F OS/22/00 Florida 33040 504. 101 04303 100 0 S 09/25/51 F 10/02/00 Florida 33040 505. 101 04303 100 1 F 12/17/67 F 12/16/97 Flor'ida 33040 506. 101 04303 100 0 S 11/28/32 M 07/31/95 Florida 33040 507. 101 04303 100 0 S 05/14/46 M 12/18/89 Florida 33043 508. 101 04303 100 3 F 02/09/65 M 08/28/89 Florida 33042 509. 101 04303 100 0 s 04/15/60 F 12/03/81 Florida 33070 510. 101 04303 100 0 S 02/20/67 M 10/29/99 Florida 33040 Monroe County Board of County Commlsslonel'$ Page 8 Jlme 2001 ENROLLMENT CENSUS 511. 101 04303 300 0 S 06/02/52 H 02/13/90 Florida 33037 512. 101 04303 100 0 S 07/15/68 N 07/24/95 Florida 33040 513. 101 04303 100 0 S 11/10/77 M 04/16/01 Florida 33040 514. 101 04303 100 0 S 08/26/54 F 03/12/01 Florida 33040 515. 101 04303 100 3 F 08/21/68 F 11/29/98 Florida 33040 516. 101 04303 100 2 F 10/04/39 M 02/03/95 Florida 33040 517. 101 04303 100 0 S 04/02/37 F 11/24/00 Florida 33043-5026 518. 101 04303 100 2 F 07/06/67 N 04/16/01 Florida 33040 519. 101 04303 100 3 F 12/28/58 M 08/29/88 Florida 33040 520. 101 04303 100 0 S 12/31/64 F 04/15/99 Florida 33043 521. 101 0430.3 100 0 S 02/21/41 N 10/16/89 Florida 33041 522. 101 04303 100 0 S 02/22/58 M 04/01/97 Florida 33045-2566 523. 101 04303 100 0 S 07/09/77 F 11/14/00 Florida 33042 524. 101 04303 100 1 F 03/09/47 1-1 08/14/00 Florida 33050 525. 101 04303 100 3 F 11/17/70 F 11/15/99 Florida 33040 526. 101 04303 200 0 S 12/13/64 M 01/02/89 Florida 33050 527. 101 04303 300 2 F 02/02/61 F 04/29/91 Florida 33070 528. 101 04303 100 0 S 09/21/52 F 05/11/95 Florida 3042 529. 101 04303 100 0 S 01/04/58 H 07/05/99 Florida 33040 530. 101 04303 300 0 s 12/20/66 F 04/29/91 Florida 33070 531. 101 04303 100 0 S 05/15/63 F 02/10/86 Florida 33040 532. 101 04303 100 0 S 03/25/73 N 01/12/95 Florida 33042 533. 101 04303 100 0 S 05/08/49 M 05/11/92 Florida 33043 534. 101 04303 300 1 F 10/16/62 M 12/08/86 Florida 33037 535. 101 04303 300 0 S 08/22/62 F 08/19/88 Florida 33037 536. 101 04303 100 1 F 11/21/49 F 05/11/95 Florida 33042 537. 101 04303 100 0 S OS/20/41 H 10/20/97 Florida 33044 538. 101 04303 100 0 S 01/01/47 N 03/08/93 Florida 33040 539. 101 04303 100 0 S 09/27/53 H 08/04/88 Florida 33040 540. 101 04303 100 0 S 01/13/68 F 01/31/94 Florida 33040 541. 101 04303 100 0 S 04/16/47 H 04/12/00 Florida 33036 542. 101 04303 100 0 S 06/01/48 F 12/13/93 Florida 33040 543. 101 04303 100 0 S 04/05/43 H 01/04/88 Florida 33040 544. 101 04303 200 0 S 03/06/54 F 03/01/91 Florida 33052 545. 101 04303 100 0 S 06/09/52 M 11/11/94 Florida 33042 546. 101 04303 100 4 F 01/27/77 M 08/14/00 Florida 33170 547. 101 04303 200 0 S 07/08/65 H 03/27/00 Florida 33050 548. 101 04303 300 1 F 07/13/71 N 10/04/91 Florida 33070 549. 101 04303 100 0 S 11/08/76 N 06/29/98 Florida 33040 550. 101 04303 100 2 F 09/16/74 N 06/09/00 Florida 33040 55l. 101 04303 100 1 F 01/27/70 F 01/25/93 Florida 33040 552. 101 04303 200 5 F 12/29/66 M 05/31/00 Florida 33070 553. 101 04303 100 0 S 09/06/59 F 05/18/94 Florida 33040 554. 101 04303 100 0 S 02/11/64 F 07/10/00 Florida 33040 555. 101 04303 300 0 S 10/13/42 F 03/08/99 Florida 33036 556. 101 04303 200 2 F 09/30/64 H 12/20/83 Florida 33043 557. 101 04303 100 0 S 07/12/37 H 06/10/91 Florida 33040 558. 101 04303 100 1 F OS/21/65 N 11/14/88 Florida 33040 559. 101 04303 100 0 S 07/16/53 F 04/02/9Q Florida 33040 560. 101 04303 100 2 F 09/12/57 N 08/22/88 Florida 33051 56l. 101 04303 100 1 F 09/21/34 F 08/26/91 Florida 33040 562. 101 04303 100 0 S 04/15/67 F 04/01/97 Florida 33044-0326 563. 101 04303 100 0 S 03/03/64 F 07/22/94 Florida 33037-4406 564. 101 04303 200 2 F 02/28/63 H 10/08/90 Florida 33042 565. 101 04303 100 0 S 03/16/45 H 08/30/93 Florida 33042 566. 101 04303 300 4 F 12114/59 H 01/08/80 Florida 33070 567. 101 04303 100 0 S 11/24/63 F 07/20/94 Florida 33043 568. 101 04303 100 0 S 06/14/49 H 02/02/97 Florida 33043 569. 101 04303 100 0 S 09/30/65 M 01/24/00 Florida 33040 570. 101 04303 300 0 S 07/02/65 M 11/01/95 Florida 33036 57l. 101 04303 100 0 S 06/29/65 F 10/18/99 Florida 33040 572. 101 04303 100 0 S 12/06/58 M 06/05/00 Florida 33040 573. 101 04303 300 2 F 05/05/75 M 07/13/98 Florida 33037 574. 101 04303 100 0 S 02/09/78 M 04/01/98 Florida 33040 Monroe County Board of County Com missioners Page 9 June 2001 ENROLLMENT CENSUS 575. 101 04303 100 3 F 01/06/71 N 03/12/01 Florida 33042 576. 101 04303 100 0 S 07/22/82 F 04/30/01 Florida 33045 577. 101 04303 100 1 F 10/11/55 M 03/14/01 Florida 33040 578. 101 04303 100 0 S 09/25/80 F 11/29/99 Florida 33040 579. 101 04303 100 0 S 02/21/67 M 08/08/88 Florida 33043 580. 101 04303 100 0 '" 10/10/65 F 04/29/91 Florida 33043 58l. 101 04303 100 0 S 04/26/36 N 03/01/91 Florida 33040 582. 101 04303 200 0 S 06/16/64 F 06/24/85 Florida 33043 583. 101 04303 300 0 S 09/06/61 M 08/08/95 Florida 33070 584. 101 04303 100 0 S 02/25/42 to! 04/19/93 Florida 33043 585. 101 04303 100 0 s 10/29/70 N 08/14/00 Florida 33040 586. 101 04303 100 1 F 10/24/68 to! 08/24/98 Florida 33040 587. 101 04303 300 0 S 02/08/51 F 01/22/90 Florida 33037 588. 101 04303 100 0 S 02/28/68 N 03/12/01 Florida 33040 589. 101 04303 100 0 S 09/03/71 M 08/14/00 Florida 33042 590. 101 04303 100 0 S 02/16/42 N 12/06/99 Florida 33040 59l. 101 04303 100 0 S 01/17/68 M 11/02/92 Florida 33043 592. 101 04303 100 1 F 11/21/40 F 12/06/93 Florida 33042 593. 101 04303 100 1 F 12/21/47 M 03/15/82 Florida 33042 594. 101 04303 100 1 F 04/08/66 N 11/23/98 Florida 33040 595. 101 04303 300 1 F 08/19/51 M 01/31/90 Florida 33037-7274 596. 101 04303 200 0 S 03/13/54 M 12/26/97 Florida 33043 597. 101 04303 100 5 F 07/18/56 M 04/04/01 Florida 33042 598. 101 04303 100 0 S 10/20/76 F 03/22/99 Florida 33040 599. 101 04303 200 2 F 03/12/48 M 01/15/01 Florida 33040 600. 101 04303 100 0 S 04/30/66 to! 12/31/85 Florida 33040 60l. 101 04303 100 2 F 06/10/76 M 04/16/01 Florida 33043 602. 101 04303 300 0 S 10/30/45 N 11/01/78 Florida 33037 603. 101 04303 100 6 F 08/16/59 M 04/30/90 Florida 33040 604. 101 04303 100 0 S 11/15/63 F 11/25/96 Florida 33040 605. 101 04303 100 0 S 06/09/75 M 07/06/99 Florida 33042-0436 606. 101 04303 100 0 S 07/11/55 M 09/26/00 Florida 33042 607. 101 04303 300 0 S 03/10/43 F 02/12/90 Florida 33070 608. 101 04303 200 0 S 04/11/43 N 03/01/91 Florida 33070 609. 101 04303 100 0 S 08/05/69 M 08/09/94 Florida 33040 610. 101 04303 100 0 S 07/30/71 F 12/02/96 Florida 33040 61l. 1Q1 04303 100 0 S 05/11/56 M 12/27/00 Florida 33030 612. 101 04303 100 0 S 06/25/68 F 08/14/00 Florida 33040 613. 101 04303 100 0 S 07/15/69 F 07/12/87 Florida 33040 614. 101 04303 100 0 S 03/10/51 F 05/14/90 Florida 33050 615. 101 04303 100 0 S 01/09/78 F 01/10/00 Florida 33040 616. 101 04303 100 0 S 07/06/81 F 09/13/99 Florida 33040 617. 101 04303 100 0 S 09/09/65 F 07/06/82 Florida 33040 618. 101 04303 100 0 S 06/30/54 F 04/02/01 Florida 33040 619. 101 04303 300 0 S 09/20/56 M 05/10/91 Florida 33070 620. 101 04303 100 0 S 01/05/53 N 08/14/00 Florida 33042 62l. 101 04303 100 0 S 10/09/52 M 06/01/92 Florida 33042 622. 101 04303 100 0 S 07/14/52 F 11/21/96 Florida 33032 623. 101 04303 200 3 F 10/11/60 F 12/01/97 Florida 33050 624. 101 04303 300 1 F 05/05/67 N 06/09/98 Florida 33070 625. 101 04303 100 0 S 09/14/54 M 10/30/00 Florida 33040 626. 101 04303 100 1 F OS/26/48 M 08/17/94 Florida 33043 627. 101 04303 100 0 S 01/02/59 M 11/21/97 Florida 33043 628. 101 04303 100 4 F 06/26/58 to! 01/25/93 Florida 33042 629. 101 04303 200 0 S 11/21/54 F 11/22/93 Florida 33050 630. 101 04303 100 0 S 11/02/47 M 05/12/93 Florida 33042 63l. 101 04303 100 0 S 11/23/41 M 10/11/99 Florida 33040 632. 101 04303 100 0 S 05/12/74 M 11/06/00 Florida 33026 633. 101 04303 100 0 S 04/29/40 M 12/21/98 Florida 33040 634. 101 04303 100 0 S 02/11/46 F 10/12/92 Florida 33043 635. 101 04303 100 4 F 08/17/62 M 11/04/91 Florida 33040 636. 101 04303 100 0 S 12/03/56 M 04/16/01 Florida 33050 637. 101 04303 100 3 F 08/08/58 F 08/24/98 Florida 33040 638. 101 04303 100 0 S 03/26/54 F 07/10/92 Florida 33050 Monroe County Board of County CommIssioners Page 10 June 2001 ENROLLMENT CENSUS 639. 101 04303 300 0 S 05/10/47 H 02/01/91 Florida 33070 640. 101 04303 100 0 S 05/02/52 M 10/02/00 Florida 33037 64l. 101 04303 100 3 F 08/26/65 M 03/05/01 Florida 33040 642. 101 04303 100 0 S 01/03/69 F 10/14/96 Florida 33040 643. 101 04303 300 0 S 02/04/65 M 12/10/91 Florida 33037 644. 101 04303 100 0 S OS/29/53 F 06/08/92 Florida 33040 645. 101 04303 200 0 S 10/24/42 M 07/22/91 Florida 33050 646. 101 04303 100 0 S 06/21/75 F 10/09/00 Florida 33040 647. 101 04303 100 3 F 04/06/67 F 05/01/88 Florida 33040 648. 101 04303 100 0 S OS/21/76 F 06/01/00 Florida 33040 649. 101 04303 100 0 S 11/28/62 F 04/01/88 Florida 33040 650. 101 04303 100 0 s 04/26/70 F 03/2 6/90 Florida 33040 65l. 101 04303 200 0 S OS/27/68 H 07/14/87 Florida 33040 652. liE 0.;303 10C 0 S 02/03/7::> F OU03/J0 Florida 33040 653. 101 04303 100 0 S 12/27/80 F 08/14/00 Florida 33040 654. 101 04303 200 2 F 05/16/61 F 01/12/98 Florida 33050 655. 101 04303 300 1 F 01/29/47 F 11/06/97 Florida 33070 656. 101 04303 100 0 S 04/16/81 F 10/23/00 Florida 33050 657. 101 04303 100 0 S 08/20/41 H 07107/86 Florida 33042 658. 101 04303 100 0 s 08/21/70 M 07/17/00 Florida 33040 659. 101 04303 100 0 S 06/26/52 F 01/02/01 Florida 33040 660. 101 04303 200 0 S 06/04/75 F 08/10/94 Florida 33050 66l. 101 04303 200 0 S 07/14/73 M 05/08/00 Florida 33050 662. 101 04303 100 0 S 11/05/53 M 01/19/87 Florida 33043 663. 101 04303 300 0 S 02/22/52 F 12/08/86 Florida 33037 664. 101 04303 100 0 S 01/02/69 F 09/18/91 Florida 33040 665. 101 04303 100 1 F 01/22/62 F OS/29/98 Florida 33040 666. 101 04303 100 1 F 03/09/75 F 07/04/00 Florida 33040 667. 101 04303 100 2 F 06/10/50 M 04/05/00 Florida 33050 668. 101 04303 100 3 F 08/24/62 F 03/31/91 Florida 33043 669. 101 04303 300 0 S 01/07/48 M 07/13/98 Florida 33045 670. 101 04303 100 0 S 09/15/65 F 11/18/91 Florida 33045 67l. 101 04303 100 0 S 03/19/77 M 10/02/00 Florida 33070 672. 101 04303 100 0 S 07/28/69 M 01/12/95 Florida 33040 673. 101 04303 100 0 S 02/18/40 F 11/26/91 Florida 33040 674. 101 04303 300 1 F 09/14/49 M 01/02/85 Florida 33037 675. 101 04303 100 0 s 01/16/70 F 08/16/86 Florida 33045-2848 676. 101 04303 100 0 S 04/01/55 M 02/06/95 Florida 33040 677. 101 04303 300 0 S 01/14/44 H 01/16/87 Florida 33037 678. 101 04303 300 3 F 09/16/50 M 12/07/87 Florida 33037 679. 101 04303 100 1 F 09/08/71 M 12/06/96 Florida 33042 680. 101 04303 100 2 F 03/11/69 M 05/17/93 Florida 33040 68l. 101 04303 100 0 s 02/19/70 F 04/21/91 Florida 33050 682. 101 04303 300 1 F 11/02/54 M 06/15/98 Florida 33070 683. 101 04303 200 1 F 07/10/37 M 07/29/91 Florida 33043 684. 101 04303 100 3 F 11/12/57 M 03/01/91 Florida 33045 685. 101 04303 100 0 S 03/19/51 F 04/12/99 Florida 33040 686. 101 04303 300 0 S OS/28/61 F 08/09/00 Florida 33189 687. 101 04303 100 2 F 02/21/67 M 12/15/97 Florida 33042 688. 101 04303 200 0 S 11/13/63 F 06/13/94 Florida 33050 689. 101 04303 100 0 S 07/23/68 H 08/14/00 Florida 33043 690. 101 04303 300 1 F 05/15/59 M 11/30/87 Florida 33070 69l. 101 04303 100 0 S OS/24/78 M 06/21/00 Florida 33040 692. 101 04303 100 1 F 11/16/51 F 01/03/91 Florida 33040 693. 101 04303 200 0 F OS/24/66 M 05/17/89 Florida 33042 694. 101 04303 100 0 s 10/27/70 M 04/19/99 Florida 33040 695. 101 04303 100 0 S 10/16/48 M OS/22/00 Florida 33040 696. 101 04303 100 0 S 06/15/68 M 08/14/00 Florida 33155 697. 101 04303 100 1 F OS/27/68 F 09/04/00 Florida 33042 698. 101 04303 100 0 S 06/27/29 M 11/01/83 Florida 33040 699. 101 04303 100 1 F 07/08/66 F 04/10/00 Florida 33037 700. 101 04303 100 4 F 10/16/59 M 06/23/97 Florida 33043 70l. 101 04303 100 1 F 01/04/54 F 01/13/95 Florida 33040 MonrO<! County Board of County Commissioners Page 11 June 2001 ENROLLMENT CENSUS 702. 101 04303 300 0 S 09/11/74 M 05/11/98 Florida 33050 703. 101 04303 200 0 S 12/02/40 N 09/26/83 Florida 33042 704. 101 04303 200 0 S 08/08/58 F 12/09/79 Florida 33043 705. 101 04303 100 0 S 04/02/63 M 04/03/01 Florida 33040 706. 101 04303 100 0 S 11 /08/71 N 04/20/92 Florida 33040-5424 707. 101 04303 200 0 S 10/24/78 F 03/08/01 Florida 33050 708. 101 04303 200 2 F 04/16/55 F 09/16/83 Florida 33050 709. 101 04303 100 0 S 10/05/69 N 01/15/01 Florida 33033 710. 101 0003 lca 0 S 11/06/72 H 09/08/97 Florida 33040 71l. 101 04303 100 4 F 12/29/58 N 03/01/91 Florida 33040 712. 101 04303 100 0 S 01/15/77 F 01/20/98 Florida 33040 713. 101 04303 100 1 F 12/03/50 M 07/24/00 Florida 33043 714. 101 04303 100 0 S 10/09/50 F 07/24/00 Florida 33043 715. 10~ 043C3 200 0 S 01/28/75 C' 03/06/95 Florida 33050 716. 101 04303 100 0 S 10/01/65 H OS/22/91 Florida 33043 717. 101 04303 200 0 S 09/18/72 N 01/01/99 Florida 33050 718. 101 04303 300 5 F 10/31/66 t.! 04/29/91 Florida 33070 719. 101 04303 100 0 S 08/02/73 N 12/15/97 Florida 33040 720. 101 04303 100 6 F 10/16/57 H OS/25/98 Florida 33040 72l. 101 04303 100 1 F 12/28/41 F 02/15/85 Florida 33042 722. 101 04303 100 3 F 10/09/56 M 03/01/91 Florida 33040 723. 101 04303 200 1 F 11/24/78 M 12/01/97 Florida 33040 724. 101 04303 100 0 S 03/03/47 F 10/28/96 Florida 33040 725. 101 04303 300 0 S 04/08/67 F 04/12/99 Florida 33070 726. 101 04303 100 0 S 12/29/56 F 08/20/82 Florida 33040 727. 101 04303 100 0 S 01/21/31 F 03/01/91 Florida 33040 728. 101 04303 200 3 F 02/13/65 N 12/02/85 Florida 33042 729. 101 04303 300 3 F 10/18/61 F 08/21/00 Florida 33034 730. 101 04303 100 0 S 06/13/50 F 03/19/01 Florida 33040 73l. 101 04303 100 2 F 08/18/67 F 04/16/01 Florida 33043 732. 101 04303 100 0 S 07/19/72 F 03/05/01 Florida 33040 733. 101 04303 100 0 S 09/12/49 F 11/14/94 Florida 33042 734. 101 04303 100 2 F 05/19/73 M 01/10/00 Florida 33040 735. 101 04303 100 0 S 02/02/44 F 10/17/94 Florida 33034 736. 101 04303 100 4 F 10/29/45 M 12/27/82 Florida 33050 737. 101 04303 100 0 S 11/06/78 N 09/04/00 Florida 33050 738. 101 04303 100 0 S 10/10/54 F 12/26/00 Florida 33043 739. 101 04303 100 1 F OS/26/60 M 03/29/93 Florida 33040 740. 101 04303 100 0 S 10/24/71 N 02/10/95 Florida 33043 74l. 101 04303 100 0 S 03/26/75 F 04/19/99 Florida 33040 742. 101 04303 100 0 S 02/06/69 F 05/11/95 Florida 33040 743. 101 04303 300 0 S 10/12/39 M 09/30/91 Florida 33037 744. 101 04303 100 1 F 10/02/71 F 06/02/97 Florida 33042 745. 101 04303 100 0 S OS/27/65 F 12/21/99 Florida 33043 746. 101 04303 100 0 S 02/20/76 N 03/05/01 Florida 33040 747. 101 04303 100 1 F 10/30/48 M 11/09/98 Florida 33040 748. 101 04303 100 0 S 01/08/62 F 05/05/92 Florida 33042 749. 101 04303 200 0 S 12/22/57 H 12/09/96 Florida 33042 750. 101 04303 100 0 S 01/01/40 F 08/29/94 Florida 33040 75l. 101 04303 100 0 S 10/10/77 F 09/04/00 Florida 33040 752. 101 04303 200 2 F 09/08/72 N 05/08/95 Florida 33050 753. 101 04303 100 0 S 09/09/50 F 01/26/77 Florida 33040 754. 101 04303 100 0 S 06/01/64 M 12/18/00 Florida 33040 755. 101 04303 100 0 S 07/15/59 F 12/03/90 Florida 33040 756. 101 04303 100 3 F 12/07/70 r1 05/11/95 Florida 33040 757. 101 04303 300 2 F 11/15/69 M 08/04/94 Florida 33037 758. 101 04303 100 1 F 02/03/47 M 04/23/84 Florida 33037 759. 101 04303 100 0 S 05/01/64 F 08/10/00 Florida 33045 760. 101 04303 200 0 S 10/21/53 F 10/06/88 F1o.:ida 33043 76l. 101 04303 100 0 S 07/28/47 F 07/01/66 Florida 33040 762. 101 04303 100 0 S 03/05/51 F 03/01/91 Florida 33041 763. 101 04303 300 0 S 10/11/35 F 05/07/84 Florida 33070 764. 101 04303 200 0 S 07/03/53 M 11/03/93 Florida 33043 765. 101 04303 300 0 S 06/23/73 M 02/21/94 Florida 33037 Monroe County Board of County Commissioners Page 12 June 2001 ENROLLMENT CENSUS 766. 101 04303 100 4 F 08/26/71 F 05/08/90 Florida 33040 767. 101 04303 100 3 F 04/02/62 F 11/05/85 Florida 33040 768. 101 04303 300 4 F 12127/62 M 07/27/87 Florida 33070 769. 101 04303 100 1 F 09/08/44 M 06/19/89 Florida 33040 770. 101 04303 100 0 S 01/01/80 F 11/06/00 Florida 33040 771. 101 04303 100 0 S 03/03/48 F 01/25/99 Florida 33040 772. 101 04303 200 2 F 05/30/58 M 02/03/87 Florida 33050 773. 101 04303 100 0 S 12/16/70 F 04/05/93 Florida 33050 774. 101 04303 100 0 s 03/12/53 M 03/18/91 Florida 33042 775. 101 04303 100 0 S 07/09/59 M 06/22/98 Florida 33043 776. 101 04303 100 3 F 06/01/73 M 01/12/96 Florida 33050 777. 101 04303 100 2 F 08/11/63 M 03/16/87 Florida 33042 778. 101 04303 100 0 S 07/02/54 M 06/28/99 Florida 33050 779. 101 04303 300 0 S 06/04/73 r-: 06/30/99 Florida 33050 780. 101 04303 100 0 S 08/10/54 F 02/17/94 Florida 33043 781. 101 04303 100 0 S 03/21/69 M 03/22/96 Florida 33040 782. 101 04303 100 3 F 10/01/55 M 06/21/00 Florida 33040 783. 101 04303 100 0 S 11/30/61 F 03/05/01 Florida 33040 784. 101 04303 100 3 F 05/14/57 F 08/08/79 Florida 33043 785. 101 04303 300 0 S 03/22/55 M 10/02/81 Florida 33043 786. 101 04303 100 0 S 03/16/59 M 08/12/87 Florida 33042-5648 787. 101 04303 100 1 F 04/27/37 M 08/01/80 Florida 33043 788. 101 04303 100 2 F 01/28/65 M 10/02/00 Florida 33042 789. 101 04303 100 0 S 11/04/76 M 02/22/99 Florida 33040 790. 101 04303 100 0 S 06/23/75 M 04/16/01 Florida 33050 791. 101 04303 100 1 F 04/05/47 F 07/07/98 Florida 33040 792. 101 04303 100 0 S 12/12/44 F 01/29/96 Florida 33040 793. 101 04303 100 0 S 09/19/54 F 10/30/00 Florida 33040 794. 101 04303 100 0 S 10/23/38 F 04/25/94 Florida 33040 795. 101 04303 100 0 F 07/21/66 F 04/15/96 Florida 33042 796. 101 04303 100 0 s 07/13/70 F 08/07/00 Florida 33040 797. 101 04303 100 0 S 06/12/49 F 12/29/97 Florida 33040 798. 101 04303 3')0 0 S 09/25/64 M 08/21/89 Florida 33173 799. 101 04303 200 0 S 11/16/65 M 11/09/87 Florida 33050 800. 101 04303 200 1 F 05/03/51 M 07/06/87 Florida 33052 801. 101 04303 100 0 S 12/27/48 M 03/13/00 Florida 33041 802. 10.1 04303 100 0 S 07/23/72 F 11/30/92 Florida 33040 803. 101 04303 100 0 S 10/29/77 H 08/30/99 Florida 33040 804. 101 04303 100 0 S 07/05/73 M 04/05/99 Florida 33040 805. 101 04303 100 2 S 12130/57 F 08/15/91 Florida 33040 806. 101 04303 200 0 s 05/31/66 F 04/21/86 Florida 33037 807. 101 04303 100 1 F 12/26/48 M 03/01/91 Florida 33042 808. 101 04303 100 0 S 08/10/49 M 08/25/94 Florida 33040 809. 101 04303 100 0 s 11/24/70 M 12/16/98 Florida 33040 810. 101 04303 100 0 S 01/10/63 M 04/16/01 Florida 33043 811. 101 04303 100 0 S 02115/55 F 06/01/98 Florida 33040 812. 101 04303 100 0 S 02/21/65 F 08/29/94 Florida 33040 813. 101 04303 100 0 S OS/21/73 M 06/09/99 Florida 33041 814. 101 04303 100 0 S 11 /09/72 F 06/06/94 Florida 33045 815. 101 04303 200 1 F 02/07/48 F 10/23/00 Florida 33036 816. 101 04303 100 0 S 11/13/63 M 12/05/94 Florida 33040 817. 101 04303 300 0 s 01/26/70 M 11/09/96 Florida 33070-1055 818. 101 04303 300 0 F 05/05/59 M 09/30/99 Florida 33050 819. 101 04303 100 1 F 05/12/41 F 10/05/92 Florida 3300 820. 101 04303 100 0 S 03/25/78 M 08/01/00 Florida 33147 821. 101 04303 100 0 S 05/16/51 M 07/11/96 Florida 33040 822. 101 04303 100 0 S 01/15/62 F 10/23/89 Florida 33040 823. 101 04303 300 0 S 03/09/66 M 02/11 /91 Florida 33070 824. 101 04303 200 0 S 11/19/38 M 06/01/70 Flor'ida 33050 825. 101 04303 100 1 F 03/12/66 M 11/12/91 Florida 33040 826. 101 04303 200 0 s 12/03/70 F 09/12/94 Florida 33050 827. 101 04303 100 1 F 08/31/64 F 10/02/00 Florida 33043 828. 101 04303 100 0 S 07/28/79 M 03/05/01 Florida 33040 829. 101 04303 100 1 F 09/19/60 M 06121/90 Florida 33070 Monroe County Board of County Com missioners Page 13 June 2001 ENROLLMENT CENSUS 830. 101 04303 100 2 F 10/04/40 M 12/12/00 Florida 33196 831. 101 04303 300 1 F 10/06/74 M 08/21/89 Florida 33036 832. 101 04303 300 1 F 06/03/45 F 10/04/99 Florida 33070 833. 101 04303 100 0 S 09/01/64 M 05/12/89 Florida 33040 834. 101 04303 100 0 S 12/07/28 F 03/01/91 Florida 33040 835. 101 04303 200 2 F 04/07/65 M 11/05/85 Florida 33050 836. 101 04303 100 0 F 07/24/46 M 01/22/96 Florida 33040 837. 101 04303 100 0 S 01/30/51 F 08/02/89 Florida 33042 838. 101 04303 100 0 S 08/26/45 M 06/26/89 Florida 33042 839. 101 04303 100 0 S 10/27/62 !-! 05/10/99 Florida 33040 840. 101 04303 300 0 S 12/12/51 l.! 10/20/94 Florida 33050 84l. 101 04303 200 3 F 02/01/70 M 07/11/96 Florida 33051 842. 101 04303 100 0 S 01/15/58 !-! 11/14/97 Florida 33040 843. 101 04303 300 0 S 11/28/61 F 03/15/80 Florida 33037 844. 101 04303 300 0 S 04/03/41 F 08/18/99 Florida 33037 845. 101 04303 300 0 S 10/08/61 M 09/09/91 Florida 33037 846. 101 04303 100 3 F 12/04/58 M 01/12/96 Florida 33040 847. 101 04303 100 0 S 09/12/74 M 04/16/01 Florida 33042 848. 101 04303 100 2 F 02/10/44 F 09/21/87 Florida 33045 849. 101 04303 100 0 S 08/03/67 M 05/11/95 Florida 33045 850. 101 04303 100 0 S OS/29/57 F 03/01/91 Florida 33040 851. 101 04303 200 0 S 05/14/53 F 07/22/86 Florida 33050 852. 101 04303 200 0 S 08/19/41 M 10/08/79 Florida 33050 853. 101 04303 100 1 F 08/13/64 M 10/05/98 Florida 33040 854. 101 04303 300 0 S 11/22/64 F 05/12/86 Florida 33037 855. 101 04303 100 0 S 04/21/47 F 12/15/86 Florida 33040 856. 101 04303 100 0 S 08/23/59 M 01/06/86 Florida 33043 857. 101 04303 100 2 F 09/07/64 F 06/03/85 Florida 33043 858. 101 04303 100 5 F 09/21/46 M 05/14/86 Florida 33040 859. 101 04303 300 5 F 10/06/48 !-l 07/31/00 Florida 33030 860. 101 04303 100 2 S 08/15/47 M 05/11/95 Florida 33040 86l. 101 04303 100 0 S 01/08/80 !-! 05/17/88 Florida 33042 862. 101 04303 100 0 S 11/01/78 F 03/29/00 Florida 33040 863. 101 04303 100 0 S 04/06/61 F 01/26/98 Florida 33040 864. 101 04303 100 0 F 01/01/76 M 07/03/9'1 Florida 33040 865. 101 04303 100 0 S 11/23/62 !-l 03/26/01 Florida 33040 866. 101 04303 100 0 S 08/23/52 F 12/06/96 Florida 33040 867. 101 04303 300 0 S 04/21/41 !-l OS/23/94 Florida 33036 868. 101 04303 100 0 S 03/13/54 !-! 08/29/89 Florida 33040 869. 101 04303 100 0 S 04/11/61 F 06/15/99 Florida 33975 870. 101 04303 100 0 S 03/08/61 M 01/15/98 Florida 33975 871. 101 04303 100 0 S 12/27/48 !-l 10/05/94 Florida 33040 872. 101 04303 100 0 S 08/26/65 M 03/05/01 Florida 33036 873. 101 04303 200 0 S 07/06/68 M 12/01/00 Florida 33036 874. 101 04303 100 2 F 05/30/56 F 01/11/00 Florida 33040 875. 101 04303 100 0 S 07/26/56 !-l 01/24/00 Florida 33041 876. 101 04303 100 0 S 03/18/57 F 01/08/01 Florida 33040 877. 101 04303 100 1 F 05/12/65 M 12/16/93 Florida 33050 878. 101 04303 100 3 F 12/26/66 M 11/01/93 Florida 33042 879. 101 04303 100 0 S 01/28/59 M 12/27/93 Florida 33040 880. 101 04303 100 2 F 10/06/78 F 11/02/98 Florida 33050 881. 101 04303 100 3 F 02/23/74 M 06/22/98 Florida 33040 882. 101 04303 100 0 S 10/11/44 !-l 05/11/95 Florida 33040 883. 101 04303 200 0 S 03/12/80 F 07/26/99 Florida 33043 884. 101 04303 200 0 S 04/01/71 F 10/23/00 Florida 33050 885. 101 04303 100 0 S 11/12/45 M 08/01/00 Florida 33040 885. 101 04303 100 0 S 07/25/57 F 03/08/94 Florida 33040 887. 101 04303 100 4 F 12/17/61 M 03/23/92 Florida 33040 888. 101 04303 100 3 F 03/14/61 F 07/20/87 Flo:=ida 33040 889. 101 04303 300 3 F OS/21/67 M 03/01/91 Florida 33043 890. 101 04303 200 0 S 03/19/65 M 11/11/91 Florida 33043 891. 101 04303 200 0 S 07/20/68 M 01/09/95 Florida 33043 892. 101 04303 100 0 S 05/19/68 M 04/10/95 Florida 33040 893. 101 04303 100 0 S 10/25/71 M 09/20/00 Florida 33040 Monroe County Board of County Commissioners Page 14 June 2001 ENROLLMENT CENSUS 894. 101 04303 100 0 S 04/02/32 M 08/03/00 Florida 33040 895. 101 04303 100 0 S 05/05/74 F 11/26/96 Florida 33040 896. 101 04303 200 0 s 03/31/75 F 09/24/99 Florida 33050 897. 101 04303 100 1 F 11/21/79 F 10/23/00 Florida 33040 898. 101 04303 100 0 S 07/09/75 M 11/24/97 Florida 33040 899. 101 04303' 100 0 S 11/15/40 M 02/10/92 Florida 33040 900. 101 04303 100 2 F 11/26/64 F 03/01/91 Florida 33040 90l. 101 04303 100 1 F 04/25/27 F OS/27/93 Florida 33042 902. 101 04303 100 0 S 01/31/47 r-; 07/03/97 Florida 33042-5521 903. 101 04303 300 2 F 11/18/61 N 06/24/85 Florida 33030 904. 101 04303 100 2 F 10/20/55 t.! 12/02/94 Florida 3340 905. 101 04303 100 3 F 12102/70 M 08/16/88 Florida 33040 906. 101 04303 300 1 F 03/18/38 M 09/22/86 Florida 33070 907. 101 04303 100 2 F 11/13/58 F 01/06/94 Florida 33050 908. 101 04303 300 0 S 08/02/48 F 04/01/85 Florida 33037 909. 101 04303 100 0 s 09/09/70 F 09/20/95 Florida 33040 910. 101 04303 100 0 S 12/18/48 F 02/02/82 Florida 33040 911. 101 04303 100 3 F 02124/57 M 04/02/90 Florida 33040 912. 101 04303 200 3 F 09/10/65 F 01/03/89 Florida 33070 913. 101 04303 100 0 S 09/20/68 F 11/25/91 Florida 33042 914. 101 04303 100 2 F 09/13/58 M 09/01/81 Florida 33042 915. 101 04303 100 0 S 06/27/41 F 03/04/97 Florida 33040 916. 101 04303 200 3 F 11/20/56 H 01/25/83 Florida 33042 917. 101 04303 100 0 S OS/21/54 F 05/30/89 Florida 33040 918. 101 04303 100 0 S 10/26/67 M 02/05/01 Florida 33167 919. 101 04303 300 2 F 01/24/68 M 11/258/89 Florida 33070 920. 101 04303 100 4 F 11/15/52 H 12/30/91 Florida 33040 92l. 101 20505 100 0 S 04/29/49 F 10/06/91 Florida 33040 922. 101 20505 100 0 S 08/30/44 M 04/25/94 Florida 33045 923. 101 20505 100 0 s 09/25/46 M 10/02/94 Florida 33040 924. 101 20505 100 0 S 09/25/42 M 01/03/94 Florida 33040 925. 101 20505 100 0 S 08/10/62 M 11/01/94 Florida 33040 926. 101 20505 200 0 S 01/22/51 M 01/31/94 Florida 33050 927. 101 20505 100 3 F 08/08/64 M 04/25/94 Florida 33040 928. 101 20505 100 0 S 11/07/49 M 11/23/88 Florida 33040 929. 101 20505 100 0 S 06/08/54 M 03/02/98 Florida 33050 930. 101 20505 300 0 S 12/15/50 M 06/25/90 Florida 33037 93l. 101 20505 100 0 S 05/18/45 M 11/25/91 Florida 33040 932. 101 20505 100 0 S 02/03/55 M 02/14/94 Florida 33042 933. 102 22002 200 0 S 02/18/64 M 06/02/99 Florida 33043 934. 102 22002 200 1 F 01/21/28 H 12/06/88 Florida 33050 935. 102 22002 100 0 S 07/31/61 F 04/11/94 Florida 33043 936. 102 22002 100 3 F 07/03/58 M 04/06/87 Florida 33043 937. 102 22002 100 0 S 09/07/50 F 04/15/85 Florida 33040 93B. 102 22002 200 1 F 08/22/28 M 04/12/99 Florida 33037 939. 102 22002 100 0 s 03/13/56 M 11/01/00 Florida 33040 940. 102 22002 100 2 F 01/22/47 F 09/28/92 Florida 33040 94l. 102 22002 200 1 F 07/01/44 M 01/13/98 Florida 33050 942. 102 22002 100 0 S 01/29/47 M 08/21/00 Florida 33041 943. 102 22002 200 3 F 01/08/60 H 12/15/97 Florida 33050 944. 102 22500 100 0 S OB/08/56 M 08/17/98 Florida 33040 945. 102 22500 300 4 S 06/10/64 M OB/11/99 Florida 33070 946. 102 22500 100 3 F 01/23/61 N 01/27/81 Florida 33040 947. 102 22500 200 0 S OS/21/53 M 06/26/00 Florida 33037 948. 102 22500 100 0 S 06/23/76 M 03/05/01 Florida 33040 949. 102 22500 100 0 S 08/15/45 M 04/22/91 Florida 33040 950. 102 22500 100 2 F 10/05/59 H 06/12/B1 Florida 33040 95l. 102 22500 200 0 S 09/12/47 H 12/15/B9 Florida 33050 952. 102 22500 200 4 F 05/08/59 M 08/21/00 Flol:ida 33050 953. 102 22500 200 0 S 01/17/56 N 09/27/99 Florida 33050 954. 102 22500 200 1 F 06/27/39 M 12/09/96 Florida 33050 955. 102 22500 100 4 F 12/16/60 M 05/05/86 Florida 33040 956. 102 22500 300 0 S 02/25/42 M 12/12/94 Florida 33036 957. 102 22500 300 1 F 09/17/56 M 11/04/81 Florida 33050 Monroe County Board of County Com missioners Page 15 June 2001 ENROLLMENT CENSUS 958. 102 22500 100 0 S 02/02/56 M 01/05/98 Florida 33040 959. 102 22500 200 0 s 08/08/46 M 05/07/87 Florida 33042 960. 102 22500 300 0 S 08/23/78 F 06/01/92 Florida 33070 96l. 102 22500 300 0 S 04/30/41 M 09/30/99 Florida 33037 962. 102 22500 100 0 S 08/11/48 H 09/09/96 Florida 33040 963. 102 22500 200 1 F 02/13/47 M 02/05/96 Florida 33043 964. 102 22500 200 1 F 02/24/49 F 02/22/94 Florida 33001 965. 102 22500 200 0 S 12/18/57 M 04/06/92 Florida 33050 966. 102 22500 100 2 F 02/05/76 M 08/14 /00 Florida 33040 967. 102 22500 100 0 S 08/09/41 M 08/07/00 Florida 33040 968. 102 22500 300 1 F 12/26/57 M 12/05/94 Florida 33070 969. 102 22500 200 0 S 10/01/60 M 01/08/01 Florida 33042 970. 102 22500 100 0 S 04/13/58 M 04/20/00 Florida 33040 97l. 102 22500 200 0 F 11/05/69 M 12/06/94 Florida 33037 972. 102 22500 100 0 S 02/16/52 M 12/03/73 Florida 33040 973. 102 22500 100 0 S OS/23/45 M 10/15/85 Florida 33040 974. 102 61505 100 0 S 11/11/63 F 01/04/00 Florida 33040 975. 102 61505 300 0 S 05/11/46 M 04/04/94 Florida 33070 976. 102 61505 200 1 F 05/07/34 M 06/26/94 Florida 33043 977. 102 61505 300 0 S 03/28/51 M 04/03/00 Florida 33037 978. 102 61505 100 0 S 10/07/55 M 05/18/98 Florida 33040 979. 102 61505 100 1 F OS/21/43 F 09/14/98 Florida 33045 980. 102 61505 100 1 F 01/27/46 M 11/23/92 Florida 33045 98l. 102 61505 200 1 F 07/01/40 M 03/15/93 Florida 33050 982. 102 61505 100 0 S 04/11/69 F 04/17 /00 Florida 33040 983. 102 61505 100 0 S 02/08/47 M 07/22/96 Florida 33040 984. 102 61505 200 1 F 09/20/54 F 09/05/95 Florida 33051-0458 985. 102 61505 300 1 F 09/21/55 M 01/08/90 Florida 33037 986. 102 61505 100 0 S 09/19/71 F 07/01/97 Florida 33040 987. 102 61505 100 0 S 04/05/72 F 08/30/99 Florida 33040 988. 102 67002 100 0 S 08/24/42 F 11/12/96 Florida 33036 989. 102 67002 100 0 S 04/02/56 M 03/15/01 Florida 33041 990. 102 67002 100 0 S OS/29/50 M 01/03/96 Florida 33040 99l. 103 85001 100 1 F 02/22/54 F 11/16/98 Florida 33043 992. 116 76007 100 1 F 02/19/66 F 06/01/98 Florida 33040 993. 117 77040 100 0 S 09/18/54 M 04/11/01 Florida 33040 994. 117 77040 100 0 S 11/04/55 M 04/24/00 Florida 33040 995. 118 78040 200 1 S 05/09/32 M 01/21/92 Florida 33042 996. 125 13502 200 3 F 10/07/46 M 10/17/94 Florida 33050 997. 125 13502 200 0 S 03/07/68 M 05/03/00 Florida 33036 998. 125 13505 200 0 S 07/02/48 M 10/06/97 Florida 33060 999. 125 50506 200 0 S 07/11/60 F 10/27/00 Florida 33042 1000. 125 61506 100 3 F 12/14/69 F 12/07/92 Florida 33040 1001. 125 61530 100 0 S 10/16/46 M 12/07/98 Florida 33040 1002. 125 61530 300 0 S 09/27/53 F 08/30/99 Florida 33070 1003. 125 61530 100 0 S 11 /28/38 F 05/02/99 Florida 33040 1004. 125 61531 100 0 S 10/09/49 F 07/19/93 Florida 33040 1005. 125 61531 200 0 S 04/14/33 F 12/22/97 Florida 33050 1006. 125 61531 100 0 S 12/22/36 F 01/03/77 Florida 33040 1007. 125 61531 300 1 S 08/20/28 F 01/23/95 Florida 33070 1008. 125 61531 100 0 S 12/30/25 F OS/20/96 Florida 33043 1009. 125 61532 100 0 s 05/05/48 F 08/28/00 Florida 33040 1010. 125 61533 100 0 S 10/08/74 F 07/10/95 Florida 33040 lOll. 125 61536 100 0 s 11/25/47 F 01/01/94 Florida 33042 1012. 125 61537 100 0 S 09/26/43 F 02/27/97 Florida 33040 1013. 125 61538 300 4 F 03/08/53 F 04/03/95 Florida 33037 1014. 125 61538 200 0 s 12/20/49 F 07/21/97 Florida 33050 1015. 125 61538 100 0 S 03/11/41 M 02/22/00 Florida 33040 1016. 125 61538 300 0 S 09/25/52 F 03/14/94 Florida 33070 1017. 125 61538 100 0 S 10/22/48 F 12/15/00 Florida 33040 1018. 125 61538 200 0 S 10/08/57 F 11/25/91 Florida 33043 1019. 125 61538 100 0 S 07/09/68 M 10/22/99 Florida 33040 1020. 125 61538 200 0 S 01/19/52 F 06/19/00 Florida 33042 102l. 125 61538 100 3 F 12/14/47 F 12/24/97 Florida 33040 Monroe County Board or County Commissioners Page 16 June 2001 ENROLLMENT CENSUS 1022. 125 61538 100 0 S 12/24/41 F 09/26/87 Florida 33040 1023. 125 61538 100 0 S 02/29/56 M 12/06/99 Florida 33040 1024. 125 61538 300 0 S 05/16/60 F 04/03/89 Florida 33070 1025. 125 61538 100 0 S 07/03/38 F 01/25/84 Florida 33043-3209 1026. 125 61538 100 0 S 03/23/51 F 05/18/82 Florida 33040 1027. 125 61538 300 0 S 01/09/54 M 04/03/95 Florida 33070 1028. 125 61538 200 0 S 01/09/29 F 03/30/98 Florida 33050 1029. 125 61538 200 0 S 10/27/55 F 07/31/00 Florida 33052 1030. 125 61538 300 0 S 01/08/53 M 05/05/97 Florida 33070 1031. 125 61538 100 0 S 06/25/58 F 12/16/92 Florida 33045 1032. 125 61538 200 0 S 09/12/45 M 06/01/82 Florida 33050 1033. 125 61538 100 1 F 07/25/48 F 10/07/96 Florida 33040 1034. 125 61538 100 0 S 06/29/43 H 09/04/85 Florida 33040 1035. 125 83007 100 4 F 07/21/58 F 09/23/91 Florida 33040 1036. 141 11500 200 0 S OS/24/55 M 09/02/99 Florida 33037 1037. 141 11500 200 0 S 10/16/78 M 03/05/01 Florida 33041-1942 1038. HI 11500 200 0 S 05/13/61 N 10/13/98 Florida 33040 1039. 141 11500 200 0 S 05/08/74 M 03/12/01 Florida 33070 1040. 141 11500 200 5 F 11/05/65 M 12/15/99 Florida 33037 1041. 141 11500 200 0 S 04/29/60 M 12/01/98 Florida 33040 1042. 141 11500 200 0 S 01/18/36 M 08/18/98 Florida 33043 1043. 141 11500 200 0 S 10/04/78 F 12/19/99 Florida 33050 1044- 141 11500 200 0 S 04/26/67 F 09/21/98 Florida 33042 1045. 141 11500 200 2 F 08/11/50 M 06/22/98 Florida 33043 1046. 141 13001 200 1 F 05/04/45 N 06/24/96 Florida 33037 1047. 141 13001 200 3 F 09/16/70 M 10/24/00 Florida 33042 1048. 141 13001 200 0 S 01/20/76 M 02/17/98 Florida 33042 1049. 141 13001 200 0 S 06/13/49 F 04/16/97 Florida 33040 1050. 141 13001 300 0 S 03/10/58 M 10/09/92 Florida 33070 1051. 141 13001 200 2 F 07/13/59 N 07/23/96 Florida 33037 1052. 141 13001 200 0 S 03/22/79 M 12/16/99 Florida 33169 1053. 141 13001 200 0 S 04/11/61 M 05/30/95 Florida 33157 1054. 141 13001 200 2 F 08/21/64 N 12/12/89 Florida 33196 1055. 141 13001 300 2 F 06/30/7 6 M 02/20/01 Florida 33037 1056. 141 13001 100 0 S 05/10/45 M 12/23/87 Florida 33193 1057. 141 13001 200 0 S 06/10/56 F 12/12/89 Florida 33037 1058. 141 13001 200 0 S OS/26/60 F 03/25/90 Florida 33001 1059. 141 13001 200 0 S 06/03/73 M 03/22/99 Florida 33040 1060. 141 13001 200 2 F 09/26/57 N 12/09/96 Florida 33050 1061. 141 13001 200 2 F 06/11/58 N 11/03/87 Florida 33043 1062. 141 13001 200 0 S 01/28/71 N 12/14/99 Florida 33070 1063. 141 13001 200 0 S 09/14/71 M 11/06/00 Florida 33045 1064. 141 13001 200 1 F 02/13/52 N 11/03/87 Florida 33043 1065. 141 13001 200 0 s 11/16/70 M 09/24/99 Florida 33043 1066. 141 13001 200 0 S 12/03/59 M 08/18/98 Florida 33043 1067. 141 13001 200 0 S 08/01/51 M 07/01/70 Florida 33037 1068. 141 13001 200 0 S 03/30/62 M 07/09/89 Florida 33187 1069. 141 13001 200 3 F 11/12/53 M 02/06/90 Florida 33037 1070. 141 13001 200 0 S 12/06/50 F 01/08/96 Florida 33037 1071. 141 13001 200 0 S 06/27/69 M 02/13/01 Florida 33050 1072 . 141 13001 200 0 S 10/20/61 M 11/03/87 Florida 33050 1073. 141 13001 300 0 S 12/09/61 N 09/20/92 Florida 33001 1074. 141 13001 300 1 F 07/13/64 N 05/01/95 Florida 33070 1075. 141 13001 200 0 S 07/11/75 M 01/22/96 Florida 33037 1076. 141 13001 100 0 S 02/06/56 M 10/22/87 Florida 33045-2563 1077. 141 13001 200 0 S 08/09/64 M 08/20/90 Florida 33040 1078. 141 13001 300 0 S 11/15/69 F 05/15/95 Florida 33037 1079. 141 13001 300 0 S 09/11/55 to! 10/22/87 Florida 33050 1080. 141 13001 200 0 S 10/05/57 M' 04/25/94 Florida 33076 1081. 141 13001 200 0 S 03/29/65 M OS/24/99 Florida 33036 1082. 144 68501 300 0 S 08/20/50 F 10/07/91 Florida 33037 1083. 144 68501 300 0 S 02/19/64 F 06/30/99 Florida 33037 1084. 146 13002 300 0 S 12/23/43 F 02/03/92 Florida 33070 1085. 147 20503 300 2 F 09/02/52 M 12/15/91 Florida 33037 Monroe County Board of County Commissioners Page 17 June 2001 ENROLLMENT CENSUS 1086. 147 20503 200 0 S 11/06/49 M 09/22/99 Florida 33070 1087. 147 20503 300 0 S 07/10/47 M 04/20/98 Florida 33037 1088. 147 20503 200 0 S 02/03/49 F 02/11/00 Florida 33070 1089. 147 205C3 100 3 F 10/12/64 F 09/30/99 Florida 33040 1090. 147 20503 200 0 S 07/13/69 M 05/01/00 Florida 33037 109l. 147 20503 200 0 S 06/26/58 M 09/07/99 Florida 33037 1092. 147 20503 200 0 S 02/04/56 M 07/02/90 Florida 33031 1093. 147 20503 100 0 S 05/31/49 M 10/30/95 Florida 33040 1094. 147 20503 200 1 F 01/06/43 M 07/26/99 Florida 33050 1095. 147 20503 200 0 S 10/06/51 M 02/08/00 Florida 33037 1096. 148 12000 200 2 F 11/16/58 M 06/21/99 Florida 33037 1097. 148 12000 200 0 S 01/19/63 F 02/02/98 Florida 33042 1098. 148 14000 200 0 S 09/28/34 t-I 05/01/85 Florida 33070 1099. 1'0 HOOO 200 0 S 03/30/54 N 09/05/,0 Florida 33050 ~" 1100. 148 14000 200 0 s 08/06/55 M 06/24/96 Florida 33043 1101. 148 50001 200 1 F 09/07/66 F 01/25/99 Florida 33043 1102. 148 50001 100 3 F 10/19/46 F 11/30/92 Florida 33042 1103. 148 50001 200 1 F 09/12/46 t-I 03/18/96 Florida 33052-2499 1104. 148 50001 200 2 F 06/19/51 F 11/14/94 Florida 33050 1105. 148 50500 200 1 F 04/15/37 F 12/02/96 Florida 33050 1106. 148 50500 200 1 F 01/30/43 F 09/27/99 Florida 33050 1107. 148 50500 200 0 S 11/20/34 H 11/06/00 Florida 33042 1108. 148 50500 200 3 F 08/23/56 t-I 10/17/00 Florida 33051-0585 1109. 148 50500 200 0 F 04/13/65 M 05/19/97 Florida 33070 1110. 148 50500 200 0 S 03/17/38 M 06/11/97 Florida 33070 111l. 148 50500 200 0 S 01/08/73 F 05/01/00 Florida 33051-0345 1112. 148 50500 200 0 s 01/20/66 F 06/09/98 Florida 33070 1113. 148 50500 200 0 S 07/29/70 N 03/15/01 Florida 33070 1114. 148 50500 200 0 S 08/12/56 F 04/16/91 Florida 33050 1115. 148 50500 200 0 S 02/21/58 F 03/01/99 Florida 33050 1116. 148 50500 200 0 S 02/07/51 F 03/05/01 Florida 33050 1117. 148 52000 200 1 F 10/19/50 M 11/04/96 Florida 33042 1118. 148 52000 200 1 F OS/25/63 F 01/02/96 Florida 33050-5732 1119. 148 52000 100 0 S 10/19/48 F 04/18/88 Florida 33037 1120. 148 52000 100 0 S 09/08/50 F 02/27/89 Florida 33043 1121. 148 52500 300 1 F 02/08/43 M 10/30/94 Florida 33036 1122. 148 52500 200 0 S 12/25/47 F 04/27/98 Florida 33051-0265 1123. 148 52500 200 0 S 05/16/44 F 05/10/85 Florida 33043-6018 1124. 148 52500 300 0 S 09/14/34 M 04/01/80 Florida 33037 1125. 148 52500 300 0 S OS/20/45 F 03/13/89 Florida 33070 1126. 148 52500 200 0 S 06/10/52 F 05/01/01 Florida 33050-2611 1127. 148 52500 300 1 F 08/24/43 t-I 03/26/01 Florida 33036 1128. 148 52500 200 0 F 02/06/53 F 03/28/94 Florida 33040 1129. 148 52500 200 1 F 04/06/43 F 09/14/98 Florida 33042 1130. 148 52500 200 0 S 06/12/41 M 10/09/88 Florida 33050 113l. 148 52500 300 0 S 09/18/43 F 01/08/01 Florida 33070 1132. 148 52500 200 0 S 02/20/43 F 12/21/98 Florida 33036-0937 1133. 148 52500 300 0 S 09/13/49 F 08/22/94 Florida 33070 1134. 148 52500 200 0 S 12/26/59 F 02/01/00 Florida 33070 1135. 148 52500 100 0 S 06/07/48 M 09/25/87 Florida 33050 1136. 148 52500 300 1 F 09/03/56 F 05/02/87 Florida 33070 1137. 148 52500 300 1 F 09/27/55 F 06/26/00 Florida 33036 1138. 148 52500 200 0 S 08/17/51 M 03/22/00 Florida 33042 1139. 148 52500 300 1 F 10/20/38 M 09/19/00 Florida 33001 1140. 148 52500 200 1 F 01/03/48 F 09/28/90 Florida 33042 114l. 148 52500 200 2 F 02/12/52 M 01/12/00 Florida 33036 1142. 148 52500 100 2 F 12/19/60 F 10/31/94 Florida 33040 1143. 148 52500 200 3 F 05/06/63 F 03/08/95 Florida 33043 1144. 148 52500 200 0 S 04/05/54 M 03/14/01 Florida 33040 1145. 148 53000 100 1 F 02/11/55 M 10/09/85 Florida 33051 1146. 148 53000 200 0 S 10/15/57 M 11/05/97 Florida 33050 1147. 148 53000 200 0 S 01/11/68 F 06/19/00 Florida 33050 1148. 148 60500 200 0 S 01/07/56 F 08/31/98 Florida 33050 Monroe County Board of County Commissioners Page 18 June 2001 ENROLLMENT CENSUS 1149. 148 60500 200 0 S 09/10/65 F 09/14/98 Florida 33050 1150. 148 60500 100 0 S 09/22/50 M 04/23/90 Florida 33040 115l. 148 60500 100 0 S 04/12/59 F 05/15/00 Florida 33040 1152. 148 60500 100 C S 07/08/53 M C~/13/00 Florida 33042 1153. 148 60500 300 0 S 01/23/42 F 07/24/00 Florida 33036 1154. 148 60500 300 0 S 06/03/47 F 08/24/98 Florida 33036 1155. 148 60500 100 3 F 11/06/59 F 02/03/97 Florida 33040 1156. 148 60500 300 0 S 08/11/56 F OS/23/83 Florida 33036 1157. 148 60500 100 0 S 02/24/67 F 12/04/95 Florida 33043 1158. 148 60500 200 0 S 10/14/59 F 04/02/90 Florida 33043 1159. 148 60500 300 0 S 03/07/33 M 09/05/89 Florida 33037 1160. 148 60500 300 0 S 08/15/48 M 03/20/00 Florida 33037 116l. 148 67502 100 3 F 05/16/65 M 12/18/00 Florida 33040 1162. 149 04319 100 0 S 01/12/77 N 01/10/00 Florida 33037 1163. 149 04319 200 0 S 08/27/70 F 07/15/91 Florida 33043 1164. 149 04319 300 1 F 08/04/50 N 09/30/91 Florida 33037 1165. 149 04319 300 0 S 03/10/52 M 01/10/00 Florida 33036 1166. 149 04319 300 0 S 01/25/62 M 04/22/86 Florida 33070 1167. 149 04319 100 0 S 12/25/52 N 03/10/86 Florida 33040 1168. 149 04319 300 0 S 08/27/70 H 05/15/00 Florida 33070 1169. 149 04319 300 0 s 09/16/70 M 04/16/99 Florida 33070 1170. 149 04319 300 0 S 10/05/72 F 06/26/00 Florida 33035 117l. 149 04319 100 0 S 12/08/73 M 10/29/98 Florida 33040 1172. 149 04319 300 0 S 03/18/67 M 04/06/92 Florida 33037 1173. 149 04319 100 0 S 01/17/46 M OS/20/81 Florida 33040 1174. 149 04319 300 3 F 06/29/51 M 08/16/00 Florida 33030 1175. 149 04319 100 3 F 07/01/53 F 10/01/78 Florida 33042 1176. 149 04319 100 0 S 04/20/64 F 11/12/97 Florida 33040 1177. 149 04319 300 2 F 01/26/64 M 03/19/99 Florida 33040 1178. 149 04319 100 2 F 10/03/66 M 01/04/99 Florida 33043 1179. 149 04319 100 3 F 06/18/62 M 06/25/80 Florida 33043 1180. 149 04319 100 0 S 08/08/69 N 09/16/96 Florida 33040 1181. 149 04319 300 1 F 02/10/60 M 08/25/86 Florida 33070 1182. 149 04319 300 3 F 06/25/63 M 09/06/88 Florida 33037 1183. 149 04319 200 0 S 11/27/75 N 09/05/00 Florida 32277 1184. 149 04319 100 0 S 05/13/52 F 12/06/98 Florida 33041 1185. 14~ 04319 200 1 F 07/27/44 M 03/01/82 Florida 33043 1186. 149 04319 100 0 S 12/25/72 H 03/09/98 Florida 33043 1187. 149 04319 300 0 S 10/26/71 M 06/19/00 Florida 33070 1188. 149 04319 100 0 S 08/16/60 N 02/22/81 Florida 33040 1189. 149 04319 300 4 F 08/08/68 M 07/15/95 Florida 33033 1190. 149 04320 200 4 F 05/09/62 M 05/02/83 Florida 33070 1191. 149 04)20 300 0 S 10/16/59 N 09/14/81 Florida 33070 1192. 149 04320 100 3 F 07/02/67 M 10/15/99 Florida 33030 1193. 149 04320 300 0 S 09/10/66 M 01/10/94 Florida 33037 1194. 149 04320 300 0 S 04/03/69 M 01/12/96 Florida 33050 1195. 149 04320 300 0 S 12/06/47 M 05/17/80 Florida 33070 1196. 149 04320 300 0 S 04/21/63 M 04/28/97 Florida 33037 1197. 149 04320 100 0 S 09/28/75 M 05/11/95 Florida 33070 1198. 149 04320 100 0 S 05/09/63 F 02/19/98 Florida 33030 1199. 149 04320 300 0 S 03/12/59 F 01/19/99 Florida 33037 1200. 149 04320 300 0 S 04/08/54 M 07/15/91 Florida 33037 120l. 149 04320 100 2 F 10/16/73 M 01/12/96 Florida 33037 1202. 149 04321 100 0 S 12/22/71 M 05/01/98 Florida 33043-6132 1203. 149 04321 200 2 F 05/30/64 M 11 /09/99 Florida 33043 1204. 149 04321 100 0 S 06/03/65 N 03/28/89 Florida 33050 1205. 149 04321 300 1 F 08/09/59 M 09/23/98 Florida 33050 1206. 149 04321 200 0 S 09/22/66 M 04/24/01 Florida 33036 1207. 149 04321 100 1 F 09/09/59 F 11/14/94 Florida 33051 1208. 149 04321 200 1 F 08/09/41 M 07/13/92 Florida 33043 1209. 149 04321 200 0 S 06/10/71 M 12/03/90 Florida 33050 1210. 149 04321 100 3 S 09/01/74 M 01/10/00 Florida 33045 121l. 149 04321 200 0 S 04/05/74 M 03/19/99 Florida 33050 Monroe County Board of County Com missioners Page 19 June 2001 ENROLLMENT CENSUS 1212. 149 04321 100 0 S 08/31/49 M 12/08/86 Florida 33043 1213. 149 04321 100 0 S 08/17/61 M 07/26/94 Florida 33043-4743 1214. 304 22004 100 0 S 02/14/59 F 08/23/00 Florida 33042 1215. 304 22004 1CO 0 S 06/10/52 F 08/31/00 Florida 33042 1216. 304 22004 200 0 S 03/05/44 N 08/06/93 Florida 33052-3142 1217. 304 22004 100 0 S 11/25/60 F 06/06/94 Florida 33042-4242 1218. 304 22004 100 2 F 04/10/56 N 01/10/96 Florida 33042-4708 1219. 401 22502 300 6 F 03/29/53 M 12/26/89 Florida 33090 1220. 401 22502 300 0 S 12/12/46 M 11/03/91 Florida 33033 1221. 401 22502 300 0 S 07/19/39 N 02/21/93 Florida 33037 1222. 401 22502 300 0 S 07/10/40 N 07/28/91 Florida 33030 1223. 401 22502 300 0 S 01/25/57 M 04/07/91 Florida 33037 1224. 401 22502 300 0 S 08/15/54 N 03/27/88 Florida 33037 1225. 401 22502 300 2 F 09/28/57 N 02/03/92 Florida 33037 1226. 401 22502 200 0 S 12/01/57 N 06/29/00 Florida 33037 1227. 401 22502 300 0 S 04/27/63 N 06/04/90 Florida 33037 1228. 403 63501 200 0 S 03/27/60 F 04/19/99 Florida 33043 1229. 403 63501 200 0 S 10/25/47 M 02/20/96 Florida 33043 1230. 403 63501 200 0 S 03/13/38 F 02/03/97 Florida 33052 1231. 404 63001 100 1 F 08/19/53 N 03/15/98 Florida 33040 1232. 404 63001 100 0 S OS/21/39 M 08/12/91 Florida 33040 1233. 404 63001 100 0 S 05/31/73 N 11/15/99 Florida 33040 1234. 404 63001 100 0 S 03/12/57 F 03/01/91 Florida 33040 1235. 404 63001 100 0 S 01/02/79 N 03/01/00 Florida 33040 1236. 404 63001 100 0 S OS/23/57 N 02/10/81 Florida 33040 1237. 404 63001 100 3 F 03/11/62 M 11/29/99 Florida 33040 1238. 404 63001 100 0 S 05/30/36 M 03/11/96 Florida 33040 1239. 404 63001 100 0 S 07/28/51 M 01/11/99 Florida 33040 1240. 404 63001 100 0 S 10/28/47 N 06/24/99 Florida 33040 1241. 404 63001 100 0 S 11/17/57 M 10/20/97 Florida 33050 1242. 404 63001 100 0 S 10/13/42 F 12/11/84 Florida 33040 1243. 404 63001 100 3 F 09/19/70 M 12/02/98 Florida 33040 1244. 404 63001 100 0 S 02/02/44 N 10/04/99 Florida 33040 1245. 404 63001 100 0 S 10/21/37 M OS/26/86 Florida 33040 1246. 404 63001 100 0 S 09/16/48 N 10/24/75 Florida 33040 1247. 404 63001 100 1 F 01/01/47 M OS/21/97 Florida 33042 1248. 404 63001 100 0 S 06/06/56 N OS/23/94 Florida 33040 1249. 404 63001 100 0 S 01/30/52 F 02/16/88 Florida 33042 1250. 414 40000 100 0 S 01/02/45 F 04/24/89 Florida 33042 1251. 414 40000 100 0 S 11/04/54 F 01/16/01 Florida 33040 1252. 414 40000 100 0 S 09/07/58 F 01/01/84 Florida 33040 1253. 414 42002 300 0 S 11/30/60 M 11/17/87 Florida 33050 1254. 414 42002 300 1 F 09/29/53 M 01/17/95 Florida 33050 1255. 414 42003 300 0 S OS/23/41 N 09/19/95 Florida 33037 1256. 414 43003 300 0 S 09/21/54 N 08/16/99 Florida 33037 1257. 414 43500 300 0 S 11/01/57 M 10/16/77 Florida 33001 1258. 414 43500 300 1 F 01/18/49 F 10/21/86 Florida 33050 1259. 414 43500 300 0 S 02/02/50 N 01/03/95 Florida 33050 1260. 414 43500 300 1 F 09/23/39 M 08/21/75 Florida 33050 1261. 414 43500 200 1 F 05/07/55 M 12/15/97 Florida 33001 1262. 414 43500 300 0 S 03/18/48 M 03/12/89 Florida 33040 1263. 501 05101 100 0 S 01/03/50 F 03/30/88 Florida 33070 1264. 501 07501 100 0 S 01/15/49 F 02/04/85 Florida 33040 1265. 501 07501 100 0 S 02/21/71 F 07/03/95 Florida 33040 1266. 502 08001 100 3 F 10/02/55 F 04/20/92 Florida 33040 1267. 502 08001 100 0 S 01/13/65 M 02/28/00 Florida 33045 1268. 502 08001 100 0 S 10/18/76 F 04/19/99 Florida 33045 1269. 503 08501 100 1 F 08/22/57 F 10/28/91 Florida 33040 1270. 503 08501 100 0 S 09/16/49 M 06/28/99 Florida 33040 1271. 504 23501 100 2 F 06/23/67 M 04/11/96 Florida 33040 1272. 504 23501 100 0 S 06/09/61 F 09/14/81 Florida 33040 1273. 504 23501 100 0 S 11/01/62 M 11/18/96 Florida 33040 1274. 504 23501 100 0 S 07/13/72 M 04/19/99 Florida 33040 1275. 504 23501 200 1 F 06/29/48 M 09/28/98 Florida 33050 Monroe County Board or County Commissioners Page 20 June 2001 ENROLLMENT CENSUS 1276. 504 23501 200 0 S 02/27/64 M 06/13/00 Florida 33050 1277 . 504 23501 100 0 S 11/11/77 M 03/06/00 Florida 33040 1278. 504 23501 100 0 S 04/06/65 M 02/18/92 FloridC'. 33040 1279. 504 23501 100 1 F 03/04/45 M 12/11/91 Florida 33040 1280. 504 23501 300 0 S 03/03/54 M 08/23/00 Florida 33070 128l. 504 23501 100 0 S 03/11/59 M 04/01/98 Florida 33041 1282. 504 23501 300 0 S 04/12/57 M 03/23/92 Florida 33070 1283. 504 23501 300 0 S 02/15/45 M 11/24/81 Florida 33037 1284. 504 23501 100 3 F 02/08/59 M 06/16/86 Florida 33040 1285. 504 23501 100 0 S 08/30/65 M 10/02/95 Florida 33042 1286. 504 23501 200 0 S 08/07/60 M 07/26/99 Florida 33050 1287. 610 00001 100 0 S 08/23/58 F 05/01/98 Florida 33043 1288. 610 00001 100 2 F 02/24/61 M 08/02/88 Florida 33040 1289. IMPACT I/oIPACT 100 1 F 07/16/67 H 06/30/93 Florida 33238-1806 1290. IMPACT IMPACT 200 0 S 01/22/71 H 06/16/97 Florida 33037 129l. IMPACT IMPACT 300 0 S 11/08/70 H OS/27/94 Florida 33037 1292. IMPACT IMPACT 100 2 F 06/05/39 N 12/01/80 Florida 33040 1293. IMPACT IMPACT 200 0 5 08/28/65 N 01/21/85 Florida 33050 1294. IMPACT IMPACT 100 2 F 09/03/63 F 01/23/93 Florida 33070 1295. IMPACT IMPACT 300 0 S 08/06/65 M 08/18/86 Florida 33031 1296. IMPACT IMPACT 300 0 S 06/16/47 M 08/31/98 Florida 33028 1297. IMPACT IMPACT 200 2 F 11/24/39 M 10/04/82 Florida 33040 1298. IMPACT IMPACT 300 4 F 09/04/62 M 08/22/94 Florida 33070 1299. IMPACT IMPACT 100 2 F 06/05/59 N 12/01/80 Florida 33070 1300. IMPACT IMPACT 300 3 F 01/18/49 N 06/06/88 Florida 33036 1301. IMPACT SUPPORT 300 0 S 10/12/72 F 09/17/96 Florida 33196 1302. HJPACT SUPPORT 300 0 S 01/11/70 F 10/11/99 Florida 33155-2153 1303. IMPACT SUPPORT 300 0 S 09/19/78 F 02/14/00 Florida 33143 1304. IMPACT SUPPORT 300 0 S 12/14/30 F 09/17/96 Florida 33161 1305. IMPACT SUPPORT 300 0 S 01/31/7 3 F OS/22/00 Florida 33175 1306. JUVENILE PROGRAM 100 0 S 04/04/58 F 02/05/01 Florida 33042 1307. JUVENILE PROGRAM 100 1 F 06/24/48 F 01/01/01 Florida 33040 1308. JUVENILE PROGRAM 100 1 F 10/06/44 M 01/01/01 Florida 33040 1309. JUVENILE PROGRAM 200 1 F 11/05/60 F 02/05/01 Florida 33050 1310. VOCA VOCA 100 0 S 08/17/54 F 12/01/00 Florida 33037 1311. 611 000002 200 0 S 07/16/41 M 08/17/87 Florida 33051-0265 1312. 611 000002 200 1 F 05/04/45 M 05/15/00 Florida 33050 1313. 611 000002 100 0 S 11/11/29 F 12/17/84 Florida 33040 1314 . 611 000002 200 3 F 10/19/61 H 06/08/87 Florida 3051 1315. 611 000002 200 0 S 11/16/52 M 01/29/90 Florida 33043 1316. 611 000002 100 0 S OS/21/70 M 03/24/94 Florida 33040 1317. 611 000002 100 2 F 12/05/50 M 03/29/93 Florida 33040 1318. 611 000002 100 0 S 09/15/70 F 01/29/01 Florida 33040 1319. 611 000002 100 0 S 07/08/33 M 10/01/97 Florida 33040 1320. 611 000002 100 3 F 07/31/57 M 12/20/93 Florida 33040 1321. 611 000002 100 0 S 09/08/72 M 01/02/01 Florida 33041-4736 1322. 611 000002 200 0 S 02/28/54 M 04/06/87 Florida 33050 1323. 611 000002 100 0 S 11/07/60 M 06/24/91 Florida 33040 1324. 611 000002 100 0 S 02/27/41 M 07/26/88 Florida 33040 1325. 611 000002 100 1 F 10/01/48 M 05/06/88 Florida 33050 1326. 611 000002 200 2 F 11/22/60 M 05/06/98 Florida 33052 1327. 611 000002 300 0 S 09/21/73 F 01/21/01 Tennesse 38002 1328. 611 000002 100 0 S 02/17/59 M 07130/87 Florida 33040 1329. 611 000002 100 0 S 11/29/74 M 12/05/00 Florida 33040 1330. 611 000002 300 0 S 10/15/44 M 01/05/99 Florida 33037 1331. 611 000002 300 0 S 08/26/50 M 03/29/82 Florida 33014 1332. 611 000002 200 2 F 09/24/43 M 05/13/91 Florida 33050 1333. 611 000002 100 0 S 07/05/73 M OS/26/98 Florida 33040 1334. 611 000002 100 0 S 02/07/58 M 04/27/92 Florida 33040 1335. 611 000002 100 0 S 09/20/31 F 01/05/93 Florida 33040 1336. 611 000002 300 0 S 05/09/36 M 07/09/92 Florida 33037 1337. 611 000002 100 0 S 10131/60 M 06/03/81 Florida 33040 1338. 611 000002 300 2 F 04/18/45 F 12/27/90 Florida 33037 Monroe County Board of County Commissioners Page 21 June 2001 ENROI,L~'.!ENT CENSUS 1339. 611 000002 200 0 S 06/17/49 M 09/26/94 Florida 33050 1340. 611 000002 100 3 F 08/19/42 M 12/26/89 Florida 33042 1341. 611 000002 300 2 F 11/18/42 M 10/08/92 Florida 33157 1342. 611 000002 300 0 S 09/29/52 N 01/16/90 Florida 33037 1343. 611 000002 200 0 S 03/26/68 M 11/17/97 Florida 33040 1344. 611 000002 100 0 S OS/29/49 M 05/30/91 Florida 33042 1345. 611 000002 100 0 S 09/29174 F 11/01/00 Florida 33043 1346. 611 000002 200 0 S 07/19/38 M 01/05/99 Florida 33050 1347. 611 000002 300 4 F 12/13/45 N 11/25/91 Florida 33189 1348. 611 000002 100 0 S 04/30/53 F 01/05/98 Florida 33043 1349. 611 000002 200 0 S 10/15/51 N 09/22/80 Florida 33050 1350. 611 000002 100 1 F 02/01/45 M 08/03/98 Florida 33042 1351. 611 000002 200 1 F 04/07/37 M 03/04/80 Florida 33052 1352. 611 000002 200 0 S 11/03/45 M 01/07/97 Florida 33050 1353. 611 000002 100 0 S 04/27/75 F 10/18/99 Florida 33040 1354. 611 000002 100 0 S 11/05/50 M 01/07/97 Florida 33041 1355. 611 000002 100 1 F 09/19/56 N 12/25/88 Florida 33040 1356. 611 000002 100 3 F 08/08/59 N 06/13/90 Florida 33040 1357. 611 000002 300 0 S 04/12/62 F 02/09/98 Florida 33037 1358. 611 000002 100 2 F 03/28/59 N 10/12/99 Florida 33040 1359. 611 000002 200 0 S 03/25/63 N 08/08/99 Florida 33001-0838 1360. 611 000002 300 0 S 09/18174 N 01/03/00 Florida 33037 1361. 611 000002 100 0 S 03/25/57 F 11/12/90 Florida 33040 1362. 611 000002 100 0 S 05/10175 M 08/24/99 Florida 33040 1363. 611 000002 100 0 S 12/23/42 N 02/01/88 Florida 33040 1364. 611 000002 200 2 F 10/26/64 N 07/11/88 Florida 33050 # of participants in Lower Keys 815 # of participants in Middle Keys 269 # of participants in Upper Keys & other 280 total # of active participants 1364 Monroe County Board of County Commissioners Page 22 June 2001 ENP.O:.,!__:HY.NT CENSUS Retired Participants Retirement # of Type of # Status Date Location dependents Coverage DOB Sex Hire Date State Zip Code l. Retired 01/31/93 100 0 S 11/09/31 F 05/12/80 Florida 33040 2. Retired 01/31/89 200 1 F 05/01/27 M 04/01/66 Florida 33050-3170 3. Retired 05/31/91 300 1 F 05/04/21 M 04/06/74 Florida 32763 4. Retired 07/31/91 300 0 S OS/24/30 F 11/12/62 Florida 33037 5. Retired 06/11/99 300 0 S 05/08/28 N 08/24/93 Florida 33070 6. Retired 09/20/99 100 0 S 08/23/44 F 09/06/78 Florida 33040 7. Retired 07/24/98 300 1 F 09/07/24 N 07/19/88 Florida 33177 8. Retired 04/01/94 300 0 S 04/03/46 N 03/01/95 Florida 33037 9. Retired 05/08/98 300 0 S 01/21/35 M 11/27/89 Florida 34606 10. Retired 03/12/99 300 1 f 12/19/44 F 12/16/80 <:T.!:Ene.sJ>e- 38371 1l. Retired 09/08/98 200 0 S 03/07/37 M 09/01/83 Florida 33050 12. Retired 07/31/96 300 0 S 06/02/43 M 07/20/66~~~ 38488 13. Retired 03/31/00 100 0 S 09/03/37 F 11/09/81 Florida 33040 14. Retired OS/28/99 300 1 f 03/07/50 F 06/04/90 Florida 33070 15. Retired 10/01/91 200 0 S 10/19/23 F 12/20/79 Florida 33050-9801 16. Retired 12/31/95 300 1 f 11/19/41 N 12/30/85 ~ 24090 17. Retired OS/22/98 100 1 F 10/30/23 M 05/04/88 Florida 33040 18. Retired OS/29/98 100 0 S 11/26/35 F 05/16/83 Florida 33040 19. Retired 06/26/99 200 1 f 06/26/34 N 04/04/94 Florida 33043 20. Retired 09/30/99 300 0 S 08/30/44 F 06/27/88 Florida 32935 2l. Retired 02/23/01 300 0 S 12/11/33 F 06/12/90 ~-S;~ChusseG)39648 22. Retired 07/22/97 100 0 S 02/11/39 N 01/11/99 Flortcra----- 33040 23. Retired 06/01/96 100 0 S 04/14/44 N 03/01/91 Florida 33040 24. Retired 11/01/99 100 0 S 09/14/48 F 08/01/77 Florida 33040 25. Retired 08/01/89 300 0 S 04/29/25 F 06/10/81 Florida 33825-9037 26. Retired OS/25/96 100 0 S 06/18/34 M 05/06/86 Florida 33040 27. Retired 07/01/97 300 0 S 02/23/37 M 11/06/86 Florida 33556-4724 28. Retired 04/21/01 100 1 f 06/06/39 M 04/21/91 Florida 33040 29. Retired 03/30/89 300 0 S 07/23/20 F 11/28/88 _~~lvani~ 15126 30. Retired . 11/30/94 100 1 F 04/27/27 M 06/04/81 Florida 33040 3l. Retired 11/30/90 300 0 S 10/15/28 M 05/16/69 Florida 33016 32. Retired 01/18/91 300 1 F OS/22/32 F 01/04/77\~. caro~ 28751 33. Retired 07/06/92 300 1 F 01/04/30 M 06/02/80 Florida 32308 34. Retired 06/28/96 300 0 S 01/27/41 F 06/18/81 Florida 34983 35. Retired 08/31/89 100 0 S 09/06/27 M 10/08/75 Florida 33040 36. Retired 11/01/96 100 1 F 01/20/31 M 10/28/86 Florida 33040 37. Retired 07/28/89 100 2 f OS/27/45 F 08/28/74 Florida 33040 38. Retired 08/29/99 100 0 S 09/30/34 M 06/09/89 Florida 33041 39. Retired 06/30/97 100 0 S 05/03/30 M 07/01/85 Florida 33040 40. Retired 07/23/99 300 0 S 10/01/48 M 10/11/84 ,~ 22963 4l. Retired 08/27/90 100 1 F 03/15/26 M 12/16/77 Florida 33040 42. Retired OS/27/95 100 1 F 09/17/29 M 01/04/88 Florida 33040 43. Retired OS/21/99 100 0 S 12/22/38 F 09/25/89 Florida 33040 44. Retired 12/31/89 300 0 S 09/25/24 F 08/16/66 Florida 33036 45. Retired 09/30/90 200 0 S 08/14/34 M 10/01/58 Florida 33042 46. Retired 06/02/89 300 0 S 05/16/31 M 02/19/80 \!enness~) 37716 47. Retired 06/30/89 300 0 S 11/25/23 M 06/11/79 FloiIdaj 33176 48. Retired 03/17/95 100 0 S 01/20/29 M 07/02/84 Florida 33040 49. Retired 08/11/98 100 0 S 06/09/55 F 10/06/86 Florida 33040 50. Retired 01/15/93 300 0 S 01/19/34 M 01/15/82 Flor.ida 32935 5l. Retired 08/21/98 100 0 S 07/17/51 F 04/06/87 Florida 33041 52. Retired 02/28/97 300 0 S 10/24/48 M 02/27/87 Florida 33326 53. Retired 09/11/00 300 0 f 04/28/56 F 06/19/88 Florida 33037 54. Retired 11/03/91 300 0 S 06/29/27 M 06/09/87 Florida 33070 55. Retired 03/31/95 300 0 S 04/07/30 F 07/09/84 Florida 33070 Monroe County Board of County Com missioners Page 23 June 2001 L~E).O::"U:Sl:rT CENSUS 56. Retired OS/24/96 300 0 S 11/03/30 F 02/03/86 Florida 33415 57. Retired 06/30/94 300 0 S 07/19/32 M 02/19/82 Florida 32958 58. Retired 01/07/91 300 0 S 08/30/24 F 05/06/76 Florida 33037 59. Retired 06/26/98 300 1 f 07/19/46 F 05/14/84 Florida 33827 60. Retired 09/30/99 200 1 f 01/02/57 F 04/11/88 Florida 33043 6I. Retired 08/31/92 100 0 S 05/05/16 F 04/01/78 Florida 33040 62. Retired 01/14/00 100 0 S 11/14/37 M 06/01/87 Florida 33040 63. Retired 03/31/98 300 0 S 02/25/48 F 07/01/80 Florida 34433 64. Retired 07/31/97 200 1 F 01/10/40 F 10/02/95 Florida 33042 65. Retired 09/29/99 300 0 S 10/20/56 M 11/03/87 Arizona 85299 66. Retired 08/27/99 100 1 f 02/10/37 F 01/19/76 Florida 33040 67. Retired 02/25/94 300 0 S 07/25/28 F 02/05/82 Florida 33704 68. Retired 11/20/00 100 0 S 02/16/35 F 11/17/92 Florida 33040 69. Retired 04/25/97 300 0 S 07/09/34 M 07/25/83 Florida 34286 70. Retired 03/26/99 100 0 S 05/18/43 F 01/12/87 Florida 33040 7I. Retired 08/31/89 200 0 S 04/27/27 /ol 08/01/74 Florida 33042 72. Retired 10/18/94 300 0 S 12/02/32 /ol 06/29/82 rt~ 09593-0143 73. Retired 07/28/00 300 1 F 07/30/35 M 11/09/86 Florida 33036 74. Retired 06/30/95 100 0 S 04/30/35 M 01/30/90 Florida 33040 75. Retired 00/00/00 300 0 S 11/04/29 M 09/17/83 Florida 33070 76. Retired 01/04/99 300 0 S 10/22/35 F 11/20/87 \-New-MeXIco'" 87108 L _ 77. Retired 09/10/99 100 1 f 01/31/44 F OS/23/89 FloThta-- -.--/ 33040 78. Retired 12/29/89 100 1 F 04/29/19 /ol 10/08/75 Florida 33040 79. Retired 01/24/90 300 0 S 12/04/28 M 10/21/82 Florida 32911-0445 80. Retired 08/31/95 300 0 S 06/29/50 F 07/25/84 .~~svl~& 17522 8I. Retired 06/11/99 300 0 S 01/01/47 F 09/24/90 Florida 34711 82. Retired 06/10/94 100 0 S 12/07/25 F 03/25/80 Florida 33040 83. Retired 06/30/97 100 0 S 07/03/26 S 07/28/69 Florida 33040-4013 84. Retired 09/30/99 300 1 f 01/31/38 /ol 03/29/82 Florida 33037 85. Retired 04/30/00 300 1 f 11/26/35 M 01/01/79 Florida 321 76 86. Retired 11/20/00 100 0 S 02/07/12 F 11/22/88 Florida 33040 87. Retired 04/28/89 300 0 S 07/24/32 F 04/16/79Cc:~~~ 92557 88. Retired 05/31/99 100 0 S 02/05/37 F 11/01/55 Florida 33040 89. Retired 01/04/99 300 0 S 01/15/51 F 11/23/83 Florida 32308 90. Retired 01/10/99 300 0 S 08/16/47 M 12/10/85 Florida 32308 9I. Retired . 10/01/92 100 0 S 01/30/35 M 01/04/93 Florida 33040 92. Retired 11/22/88 100 0 S 01/02/33 M 11/18/86 Florida 33040 93. Retired 06/16/00 100 0 S 06/06/38 F 10/01/96 Florida 33040 94. Retired 10/20/89 100 0 S OS/24/27 F 04/01/65 Florida 33040 95. Retired 06/30/01 100 0 S 12/18/38 M 06/04/79 Florida 33040 96. Retired 03/21/94 300 0 S 09/25/27 M 01/16/79 Florida 33972-3442 97. Retired 09/01/99 200 0 S 12/15/44 F 06/01/76 Florida 33050 98. Retired 01/03/92 300 0 S 10/18/29 M 12/31/73 Florida 34974 99. Retired 05/31/97 300 0 S 05/09/35 M 11/26/90 Florida 32837 100. Retired 04/22/97 300 0 S 02/26/35 F 04/20/87 Florida 32211 10I. Retired 05/31/00 300 0 S 12/11/35 N 06/27/84 Florida 32808 102. Retired OS/29/98 300 0 S 03/26/35 F 09/01/83 Florida 32808-5445 103. Retired 08/01/89 100 0 S OS/28/39 M 06/01/70 Florida 33040 104. Retired 05/31/99 100 0 S ~2/06/3~ M 04/19/93 Florida 33040 105. Retired 06/30/99 300 0 S 11/22/29 F 07/06/87 Florida 33037 106. Retired 09/30/95 20b 0 s 09/05/34 F 08/27/85 Florida 33044 107. Retired 04/30/93 300 0 S 09/27/33 F 01/01/78 Florida 34748 108. Retired 07/31/92 300 1 f 02/22/33 M 02/03/86 Florida 33030 109. Retired 08/27/99 300 0 S 08/06/50 M 10/21/87 Florida 33037 110. Retired 04/30/92 300 0 s 04/28/30 /ol 07/17/81 Florida 34748 11I. Retired 11/30/99 300 1 f 07/29/38 M 03/24/88 Florida 34464 112. Retired 10/19/94 300 0 S 06/19/22 M 10/05/81 Florida 33070 113. Retired 09/30/00 100 1 f 07/09/44 M 09/05/89 Florida 33040 114. Retired 07/30/99 200 0 S 09/11/35 M 06/28/83 Florida 33050 115. Retired 11/17/00 100 0 S 10/23/38 F 11/30/87 Florida 33040 116. Retired 05/31/88 100 0 S 08/12/35 M 06/01/70 Florida 33040 Monroe County Board of County Commissioners Page 24 June 2001 ENROLLMENT CENSUS 117 . Retired 09/30/91 100 0 S 03/24/41 F 02/01/72 Florida 33040 118. Retired 08/31/94 200 0 S 02/02/28 F 08/28/84 Florida 33050 119. Retired 12/31/94 300 0 S 10/13/29 F 12/15/82 Florida 33036 120. Retired 01/02/01 100 0 S 10/03/22 M 01/08/69 Florida 33041-4102 121. Retired 12/29/90 100 0 S 03/27/27 F 10/06/75 Florida 33041 122. Retired 07/30/99 100 1 f 11/17/45 M 07/03/72 Florida 33040 123. Retired 06/30/98 100 0 S 08/26/39 M 10/26/87 Florida 33040 124. Retired 02/28/97 100 0 S 07/15/46 F 02/02/70 Florida 33040 125. Retired 07/14/94 300 0 S 07/12/46 F 06/01/77 (V~ 22842 Retired --_._,~-------- 126. 04/15/00 300 3 f 04/24/63 M 03/08/93 Florida 33037 127. Retired 10/31/94 300 0 S 11/08/42 F 04/03/89 Florida 33975 128. Retired 12/31/88 100 0 S 04/28/29 F 09/13/80 Florida 33040 129. Retired 07/31/98 100 0 S 07/18/36 F OS/28/75 Florid:t 33040 130. Retired 09/30/99 100 0 S 04/19/52 F 03/10/86 Florida 33040 131. Retired 06/03/00 300 0 S 01/01/39 M 07/18/94 Florid:t 33950 132. Retired 01/30/93 300 0 S 06/08/34 F OS/20/82 Florida 33870-5380 133. Retired 07/02/01 300 0 S 06/30/39 F 10/14/75 Florida 33036 134. Retired 11/12/98 100 1 f 09/14/37 M 11/20/90 F1orid:t 33040 135. Retired 08/31/95 100 1 F 06/26/15 M 02/03/69 Florida 33040 136. Retired 12/29/00 300 1 f 09/30/33 M 09/17/90 Florida 32159 137. Retired 04/30/91 200 0 S 02/24/28 M 09/19/77 Florida 33042-3208 138. Retired 06/30/95 300 1 f OS/27/30 M 10/01/87 Florida 33852 139. Retired 10/10/97 300 1 F 02/14 /32 M 10/27/87 Florida 33613 140. Retired 04/12/01 300 0 S 04/02/37 F 10/23/90 Florida 33870 141. Retired 10/11/88 300 0 S 03/27/29 F 07/16/73 Florida 33037 142. Retired 06/30/99 200 0 S 09/30/50 F 04/11/89 Florida 33043 143. Retired 12/31/88 100 0 S 12/09/21 F 08/23/62 Florida 33040 144. Retired 08/05/94 300 0 S 08/22/32 M 07/05/84 Florida 34117 145. Retired 11/02/00 300 0 S 11/04/43 F 11/04/86 Florida 33778 146. Retired 06/26/92 200 0 S 11/28/17 M 02/18/76 Florida 33050 147. Retired 04/01/94 300 0 S 02/26/33 M 09/12/83 Florida 33070 148. Retired 03/31/92 100 0 S 12/11/22 F 10/10/73 ~ 33040 149. Retired 09/01/95 300 0 S 11/19/43 M 09/15/74 -1'~~nese 37687 150. Retired 07/28/00 200 1 f 08/06/44 F 08/11/97 Florida 33050 151. Retired 04/30/99 300 0 F 10/27/28 H 05/01/89 Florida 33090 152. Retired 09/29/95 100 0 S 05/31/23 F 04/25/83 Florida 33040 153. Retired 12/31/93 100 0 S 12/18/24 M 10/09/89 Florida 33040 154. Retired 12/06/96 100 1 F 10/01/13 M 03/19/90 Florida 33040 155. Retired 07/07/95 300 0 S 09/04/12 F 05/15/80 Florida 33037 156. Retired 03/30/90 300 0 S 03/22/22 F 04/01/80 Florida 33434 157. Retired 11/30/96 300 0 S 11/27/35 F 10/20/87 Florida 33070 158. Retired 12/29/89 300 0 S 12/24/37 F 06/01/79 Florida 33872 159. Retired 12/12/89 300 0 S 11/07/26 N 04/01/79 Florida 33872 160. Retired 11/30/98 300 0 S 10/17/18 N 11/23/88 Florida 33196 161. Retired 04/29/95 300 0 S 04/12/33 F 11/22/83 Florida 33884 162. Retired 09/18/92 100 0 S 08/01/24 F 09/01/77 Florida 33040 163. Retired 03/03/91 300 0 S 01/01/33 F 06/08/81COhio --, 45238 164. Retired 07/01/98 300 0 S 12/11/45 F 06/24/85~~,~~~s~ 38114-1727 165. Retired 12/31/95 300 0 S 02/27/29 F 05/07/84 Flo'!:'ida 33936-5922 166. Retired 10/18/96 100 0 S 10/14/34 F 07/18179 Florida 33040 167. Retired 12/01/89 200 0 S 12/02/42 F 12/18/80 Florida 33043-6080 168. Retired 04/28/00 100 0 S 06/23/35 F 05/16/77 Florida 33040 169. Retired 07/09/99 300 0 S 08/17/49 F 06/03/81 ~e-~ee) 38501 170. Retired 07/31/96 100 1 F 04/13/30 N 04/24/91 F orida 33040 171. Retired 12/31/92 200 0 S 12/16/33 N 11 /05 /82 Florida 33042 172. Retired 07/31/99 300 2 f 01/05/44 M 07/07/82 -!'hi:::Ipines ) 5800 173. Retired 01/03/95 300 1 F 03/09/30 M 09/06/77 FlorIda 33036 174. Retired 05/01/94 300 1 f 10/27/41 M 03/15/82 Florida 32168 175. Retired 06/28/91 100 0 S OS/25/29 M 07/06/78 Florida 33040 176. Retired 06/30/99 100 0 S 08/19/41 F 09/01/70 Florida 33040 17 7. Retired 04/14/90 100 0 S 01/12/38 M 06/01/70 Florida 33040 Monroe County Board of County Commissioners Page 25 June 2001 ENROLLMENT CENSUS 178. Retired 04/15/89 300 1 f 08/06/27 M 04/15/79 Florida 34474 179. Retired OS/25/97 200 0 S 12/23/47 F 06/01/70 Florida 33042 180. Retired 01/30/98 200 1 F 01/06/29 M 01/25/88 Florida. 33050 181. Retired 06/30/97 200 0 S 08/31/35 F 01/01/90 Florida 33052 182. Retired 11/20/00 200 0 S 01/30/33 F 11/17/92 Florida 33050 183. Retired 09/10/99 200 0 S OS/28/49 F 08/15/94 Florida 33050 184. Retired 11/30/95 100 1 F 11/28/30 M 06/10/85 Florida 33040 185. Retired 08/15/90 100 0 S 08/14/33 F 01/31/83 Florida 33040 186. Retired 01/30/98 300 1 F 08/20/33 F 01/05/83 Florida 33036 187. Retired 12/31/97 100 0 S 12/19/35 F 10/15/85 Florida 33040 188. Retired 09/27/96 300 0 S 09/02/40 F 10/01/76 Florida 34613 189. Retired 11/27/89 200 1 F 11/14/24 M 02/07/85 Florida 33050-2442 190. Retired 11/19/92 300 0 S 12/19/50 M 08/10/72 Florida 33513 191. Retired 10/01/99 300 0 S 03/13/48 H 03/30/67 Florida 33037 192. Retired 09/30/89 100 0 S 09/20/27 F 07/01/62 Florida 33040 193. Retired 02/28/94 100 0 S 02/10/23 F 10/01/53 Florida 33040 194. Retired 11/05/98 200 0 S 02/07/34 F 11/09/88 Florida 33070 195. Retired 06/01/99 300 0 S 08/26/25 M 11/01/84 Florida 34479 196. Retired 06/01/99 300 0 S 05/01/52 F OS/25/88 Tennesee 37205-3730 197. Retired 04/01/94 300 0 S 04/04/27 M 09/19/83 Florida 34434 198. Retired OS/21/99 300 0 S 07/12/30 M 05/16/89 Florida 33037 199. Retired 04/30/99 300 1 f 10/13/55 N 10/11/88 Alabama 36301 200. Retired 01/23/93 300 0 S 12/16/32 F 08/20/79 Florida 33032 201. Retired 05/31/91 300 1 f OS/23/27 M 05/14/80 Ohio 44041 202. Retired 01/02/89 100 0 S 12/24/14 M 04/17/78 Florida 33040 203. Retired 12/31/98 200 0 S 06/22/34 M 09/22/80 Florida 33042-3641 204. Retired 05/01/92 200 0 S 05/05/30 M 12/11/77 Florida 33042 205. Retired 09/13/96 300 0 S 09/24/38 M 09/01/71 Florida 33426 206. Retired 09/30/88 300 0 S 05/11/18 F 01/22/73 Florida 33426 207. Retired 09/30/99 300 0 S 02/01/40 M 09/17/81 Florida 33070 208. Retired 05/31/96 300 0 S 03/21/39 F 01/13/92 Tennesee 37709-9735 209. Retired 06/30/97 300 0 S 07/22/34 M 10/11/83 Florida 33619 210. Retired 06/01/90 300 0 S 02/02/32 F 03/05/90 Florida 34788 211. Retired 08/31/90 300 0 S 09/01/27 F 04/03/78 Texas 76543 212. Retired 06/30/93 100 0 S 08/02/28 F 01/01/82 Florida 33040 213. Retired . 08/14/98 200 1 f 10/28/60 M 01/27/83 Florida 33052 214. Retired 04/01/93 300 1 f 02/22/38 M 11/20/84 Florida 33070 215. Retired 12/29/94 300 0 S 12/06/44 F 01/07/84 Michigan 48183-5805 216. Retired 12/27/94 300 0 S 07/03/45 M 06/24/82 Michigan 48183 217. Retired 12/15/00 100 1 F 03/01/17 M 10/01/84 Florida 33040 218. Retired 05/31/89 300 0 S 05/13/27 M 05/05/65 Florida 34420 219. Retired 07/14/00 300 0 S 12/15/39 M 06/29/87 Florida 34476-8916 220. Retired 05/31/00 300 0 S 09/08/39 F 09/19/87 Florida 34476-8916 221. Retired 09/21/99 300 0 S 01/29/44 F 10/31/88 Florida 32514 222. Retired 02/25/94 100 0 S 06/05/26 M 01/20/84 Florida 33040 223. Retired 12/20/96 200 1 f 04/12/38 M 10/01/77 Florida 33042-0817 224. Retired 12/25/99 300 1 f ~2/01/3~ M 12/18/89 Tennesee 37843 225. Retired 03/12/99 300 1 F 03/27/24 M 03/24/91 Florida 33024 226. Retired 03/23/01 100 0 S 12/24/32 M 03/01/91 Florida 33040 227. Retired 06/01/99 300 0 S 03/13/51 F 08/16/78 Florida 32757 228. Retired 11/07/98 300 0 S 07121/41 F 02/02/87 Ireland 229. Retired 08/05/97 300 1 f 07/20/37 M 07/23/74 Florida 33811 230. Retired 10/31/96 300 0 S 01/12/33 M 06/13/83 Florida 33051 231. Retired 03/27/99 100 0 S 06/16/28 M 06/05/88 Florida 33040 232. Retired 06/29/99 300 0 S 04/04/43 M 04/15/91 Florida 33070 233. Retired 08/31/96 300 0 S ~2/17/26 M 06/01/92 Flori.da 32431 234. Retired 04/04/96 300 0 S 03/11/47 M 09/28/82 Florida 32136 235. Retired 03/28/97 100 0 S 10/16/30 M 01/01/87 Florida 33040 236. Retired 03/10/00 100 0 S 09/19/37 M 02/15/90 Florida 33040 237. Retired 01/29/99 300 1 f ~2/20/36 M 03/21/88 Florida 32958 238. Retired 02/24/94 300 0 S 01/01/28 F 11/24/84 Florida 23724 Monroe County Board of County Commissioners Page 26 June 2001 ENROLLMENT CENSUS 239. Retired 07/01/97 300 0 S 10/24/47 M 07/16/77 Nevada 89147 240. Retired < 87 00/00/00 100 0 S 05/10/14 H 00/00/48 Florida 33040 24l. Retired < 87 11/25/85 100 0 S 09/10/37 M 09/15/74 Florida 33040 242. Retired < 87 12/31/85 100 0 S 08/25/23 M 07/01/63 Florida 33040 243. Retired < 87 02/15/84 100 0 S 03/30/18 F 10/01/62 Florida 33040 244. Retired < 87 02/08/86 100 1 F 02/25/24 M 11/01/73 Florida 33040 245. Retired < 87 12/31/86 100 0 S OS/27/21 M 09/01/74 Florida 33040 246. Retired < 87 09/30/86 100 1 F 09/22/24 M 00/00/00 Florida 33040 247. Retired < 87 08/01/79 300 0 s 12/10/30 M 08/01/79 N. Carolina 28741 248. Retired < 87 01/31/87 300 0 S 04/26/24 F 01/31/87 Florida 33511 249. Retired < 87 04/17/87 100 1 F 03/17/36 M 04/17/87 Florida 33040 250. Retired < 87 01/13/86 100 0 S 11/08/26 M 01/13/86 Florida 33040 25l. Retired < 87 10/31/85 300 0 S 06/18/24 F 10/31/85 Virginia 22508 Total Retired Partcipants: 251 Monroe County. Board or County Commissioners Page 27 June 2001 E.li.F:OLI1-:2:'rT C:::;:LSUS Surviving Spouses (No Life Insurance) # Status Locatior # of Dependent! Type of Cvr O.O.B. Sex Date of Hire State 1. Ret/Dependenl 300 0 N/A 06/08/50 F N/A Florida 2. Ret/Dependen1 300 0 N/A 03/02/36 F N/A Illinois 3. Ret/Dependen1 300 0 N/A 02/07/46 F N/A Florida 4. Ret/Dependen1 300 0 N/A 07/11/28 H N/A Florida 5. Ret/Dependen1 300 0 N/A 05/05/31 F N/A Florida 6. Ret/Dependent 100 0 N/A 11/07/19 F N/A Florida 7. Eet/Dependent 100 0 N/A 11/17/27 F N/A Florida 8. Ret/Dependen1 100 0 N/A 05/30/17 F N/A Florida 9. Ret/Dependent 100 0 N/A 08/29/36 F N/A Florida 10. Ret /Dependen1 200 0 N/A 11/11/22 F N/A Florida Total Surviving Spouses: 10 COBRA Enrollees: (No Life Insurance) # Status Status Locatior # of Dependent: Type of Cvr D.O.B. Sex Date of Hire State 1. COBRA COBRA 300 0 S 03/21/40 F N/A Florida 2. COBRA COBRA 300 0 S 12111/59 F N/A Florida 3. COBRA COBRA 100 0 S 07/28/58 F N/A Florida 4. COBRA COBRA 300 0 S 06/23/37 M N/A Florida 5. COBRA COBRA 100 1 F1 06/06/41 F 12/16/99 Florida 6. COBRA COBRA 300 1 F1 12/13/51 M 09/27/94 Florida 7. COBRA COBRA 200 3 F2 06/22/62 F 01/06/97 Florida Total COBRA participants: 7 'Wa"rver of Premium" (For Life Insurance) # Status Date of Event Locatior # of Dependent: Type of Cvr D.O.B. Sex Date of Hire State 1. Terminated 12/26/92 300 0 S 09/11/36 F 219322460 N. Carolina 2. Retired 08/11/98 100 0 S 06/09/55 F 263291646 Florida 3. Retired 08/14/98 200 1 F 10/28/60 M 267671757 Florida Total 'Waiver of Premium" : 3 Monroe County Board of County Commissioners Page 1 June 2001 ENROLLMENT CENSUS Active Participants: Retired Participants Subtotal: 1364 251 1615 Surviving Spouses: COBRA Enrollees: "Waiver of Premium": Subtotal: 10 7 3 20 GRAND TOTAL: I 1635 Reductions in workforce possible if incorporations occur in the Florida Keys. Monroe County Board of County Commissioners Page 37 June 2001 as: o g 3 ..., 3 g (ji. a !!.!. 0 o c: :J :J co - ...,'< (II OJ o OJ ..., a. o -+, "TI"TI -<-< co co co co -- -- o co o co , . ~m' , ~ e...lC:Z:o ':t>' m mo' "'Orce... e... , > 3: OJ :t> 0<10 -1,(;') c,c ::::. -c :t> ;0 Z m'm -I ~:c:riz :t>,~ ;0 c ~'3:'3:,g OJ ~ -<;ml.~lriQ :t>';o OJ OJ'm m-l " I ;o~mm;o; ;0, i 1 i -< :;0;;0, I I 'I I 'I! , I ~I~ ~ ~I~ ~ ~I~ ~I~I~I~ ~~ a> '-w'-w -w'-w -w -w -wl-w'-Wl-w:-wl-w ~ 5' ->. 'W ~ ~ CJ1'CJ1 ~1CJ1 W ~'CJ1iW N Q.. N 'CJ1I->. 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I " '" , I' I I I i I <IJ t:lll l'U Q" I ItIl ,0 ~ '~ icn , I I I , ! ~ I:>: /8 !fig , I~ JJf< /'" H '" o :>: ~ o ll: r>. ..! ~' ~: 0: 1>0' [:ll i CI1! ~ H ji u' ~; ~: ~L , I Health Care Employers Will Keep Depleting Retirees' Benefits, Report Says Employers likely will continue to scale back retiree health benefits, spurred by changes in federal ac- counting rules, age-discrimination rulings by federal courts, medical in- flation, and potential federal legisla- tion, according to an Aug. 15 report by the Employee Benefit Research In- stitute. EBRI said the current trend to- ward cutbacks in retiree health ben- efit programs began more than 10 years ago when the Financial Ac- counting Standards Board put in Paul N. Wojcik, Publisher Gregory C. McCaffery, Editor-in-Chief Emily M. Chabel, Executive Editor Jeff Day, Managing Editor Bob Combs, Copy Editor Brian Carr, Bronwyn Davis, Linda Mlcco, PHR, Angela Swinson, Staff Reporters Todd Bunce, Editorial Assistant place tougher standards for how companies must account for their re- tiree health benefits. Financial Ac- counting Statement 106 required companies to record unfunded retiree health benefit liabilities on their fi- nancial statements in accordance with generally accepted accounting principles. New Incentives for Review The EBRI report said federal age discrimination laws and regulations, particularly as interpreted in a recent federal appeals court ruling in "may create new incentives for employers to review their retiree health ben- efits." In Erie County Retirees Assoc. v. Erie County (24 EBC 2390, 2000), the U.S. Court of Appeals for the Third Circuit allowed claims of viola- tions of federal age discrimination law when employers make distinc- tions in health benefits they offer re- tirees on the basis of Medicare eligi- bility. The ruling has raised a number of questions, including "its implications for retiree health benefit programs," the report said. It added that because the Erie County decision increases employers' uncertainty about their future liability, some employers may decide to review some features of their retiree health plans. In addition, bills pending in Con- gress that would place a number of requirements on employer sponsors of retiree health coverage are a source of additional pressure on com- panies, the report said. Rep. John F. Tierney (D-Mass.) is the leading sponsor of a bill (H.R. 1322) that would amend the Employee Retire- ment Income Security Act to prohibit group health plans from making post- retirement reductions in retiree health benefits. - BULLETIN TO MANAGEMENT Conversely, legislation introduced July 18 by Rep. Thomas Petri (R- Wis.) proposes that early retirement incentive plans would not violate the Age Discrimination in Employment Act by altering, reducing, or eliminat- ing medical benefits for a retiree par- ticipant when the participant be- cornes eligible for Medicare. Some industry groups, however, favor a regulatory rather than legisla- tive fix. "I think at the moment we feel that a regulatory solution is pref- erable since it tends to be a more sur- gical approach to what is a fairly nar- row issue," ERISA Industry Council President Mark Ugoretz told BNA. A Continuing Trend In May, the General Accounting Office issued a report saying the de- cline in employer-provided retiree health benefits has not reversed since 1997, and several indicators suggest there might be further erosion. The GAD pointed to some of the same fac- tors as contributors to the decline, in- cluding a resumption of health insur- ance premium increases at a rate faster than general inflation and the t. Erie County ruling. Most employers that are continu- ing to offer retiree health benefits are modifying the benefits packages, ac- cording to the report. A common change is in the area of cost-sharing, where employers are asking retirees to pick up more of the tab. Another increasingly common change is to tighten the age and service require- ments for eligibility, the report said. - The report, Retiree Health Benefits: ..Trends and Outlook, is available for $25 by calling (202) 775-9132. Request EBR! Issue Brief No. 236. Bulletin to Management (ISSN 0525-2156) is published weekly, except one issue in either last week of December or first week of January. by The Bureau of National Affairs, Inc., 1231 25th Street N.W., Washing- ton, D.C. 20037. Tel. (202) 452-4200. Subscription rate $393 a year. Multiple copy rates available. Periodical postage rates paid at Washington, D.C. POSTMASTER: Send address changes to Bulletin to Management. The Bureau of National Affairs. Inc., P.O. Box 40949. Washington. D.C. 20016-0949. Printed in U.S.A. Human Resources Library on CD Including Bulletin to Management and Fair Employment Practices newsletter&-$1,653 a year. BNA Polley And Practice Series Including Bulletin to Management, Labor Relations, Wages and Hours, Personnel Manegement, Compensation, and Fair Employment Practlce_$1,965 a year, $1,898 for renewal. HR Practitioners Guide on CD, Including Bulletin to Management-$879 a year. Employment Guide, Including Bulletin to Management-$590 a year, $530 for renewal. Employment Guide on CD-$474 a year. Additional editors of BNA's HR Ubrary and Policy & Practice Series publications. Maureen Doallas. Assis- tant Managing Editor; Richard Blngler. Tom Buschman. AnnTherese Carlozzo. Eric Lekus, Uza Lundell. Mich- elle Peters, Paul Stelter, Chrissie Vidas, Staff Editors. BNA Surveys: Mike Reidy, Manager; Wendy Desma- rais. Nikki Allen. Mark Naydan. Graphics: Cordelia Gaffney, Manager; Kyttie Ayiku. LaDora Redman. Mike Foley. Comments about editorial content should be directed to the managinp editor. (202) 452-4474. Copyright Polley: Authorization to photocopy selected pages for intema or personal use is granted pro- vided that appropriate fees are paid to Copyright Clearance Center \978) 750-8400, http:// www.copyright.com. Or send written requests to BNA Permissions Manager: 202) 452-4084 (fax) or permissions@bna.com (e-mail). For more information, see http://www.bna.comlcorp/copyright or call (202) 452-4471. For Customer Service, call 800-372-1033. fax 800-253-0332. or e-mail customercare@bna.com. (-.- [I) 8-23-01 COPYRIGHT .~ 2001 BY THE BUREAU OF NATIONAL AFFAIRS. INC., WASHINGTON. D.C. BTM ISSN 0525-2156 rJ.J ~ 12 t..-.i ~ o ~ == o rJ.J ~ rJ.J o U rJ.J rJ.J C\j ~ o ~ .~ ~ . ..-.4 . I rJ.J 8 . ..-.4 ~ ElIllI.....:'>.Q) I Q)Q,IIlQ) "'!:l1ll0 "" U '0 ...:> ~ U ~ ""..c U 0'.-1 ... o O'E "".... III O!:l Q) OJ .::: ,I;l "" ... ...!:l ill >..... ........ III .... i III !:l ""..c:l El ~.- 0 0 ~ Q) ~ III t ~ ~8~... ~1Il~-ElQ,~~~~~~ ::;I "" Ellll 1Il~.c 001llQ)0_ III ""..... ~ ..c:l . "".::l III Q) El ~ ... "" 0 Q, ~~~o "'~IIl'fl~~ ~u.cEl ~ S ... u ~ III 0 ~ 'il '.j;l :::l] ira'S t- Q) . 1Il........oQ)CJ Q)O..c:l.cQ) Ill.... II 0~00..c:l:>",,'il..c!:l~""~ ~Q)~1Il ... c Q) III I 0..... "" . III 0 0 1Il..c:l "" 0 ~illEl~~a~~~clll~",Q)ElQ)""~U Q)1Il00N OJQ)lIlill""lIlll >.0 Q) ~ t 1Il't III I ] =: gj ~~ ~>. ~ ~ M .!!l S 'fl .clQ,alll III Q) "".coo' U Q)Q)~!:l o III Ill... 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"" C ~ U ... .!3 4:: 0 1IJ N C 1IJ'fl:t:l0 ~~"O>.u"''-:;Q,eIl:a~CUIIl~'''''''' -B-5'il"'~ -1IJ~~1Il511J1IJ1IJ "'~~... 13~ -5 ~ ~ 1IJ ~ ~ ~.S Q, :> -a U :; ~:g :i ~ '3 .;: J -b >. ~~s..c:lggo~-d';~ll1J~]u~lIJo~...::::~lIJg 1IJ ~ 0 ~.... ~ 1:: coo ~ 1IJ 1IJ .::: -5 C >.] o.....u 1IJ ~ C! p;: a- N 'cu ~ ... ~ -< ~ 'il ~ ~ < III 'il .g M 1IJ U ~:.g ~ c.9 ~ cu.S El 'fl B 1IJ la la ~'fl :t ~ ~ 8 ~ :t~] S ~ ~ ~ ~ .~ a: LIJ ..... C E Z 8 <-0 6"E LIJ '" ......c L1J~ ::c '" 2'8 :i: lij >13 !Xl E ~ u.f cc C3 :2: ~ L:i5 :2: t:tl cr.> L.U cr.> ~ 0... - ~ ~ JUL-18-01 13,35 FROM,MONROE COUNTY ATTY OFFICE IO,3052823516 PAGE 1/1 REOUEST FOR PROPOSA~ NOTICE IS HEREBY GIVEN TO WHOM IT MAY CONCERN that on September 13, 2001, at 3:00 PM, at the Purchasing Office, a committee consisting of the Director of OMB, the County Administrator, the County Attorney and the requesting Division Director or their designees, will open sealed proposals for the following: Health Benefits Plan Claims Administration &. Utilization Review Services Excess/Stop-Loss Insurance for Group Self-Insured Medical Benefits Prescription Benefits Plan Group Ufe Insurance and Accidental Death & Dismemberment Group Employee Voluntary Supplemental Ufe Insurance Group Voluntary Dependent Life Insurance Group Voluntary Short Term &. Long Term Disability Employee Assistance Plan Nationwide Provider Network Flexible Sending Account Program All proposals must be received by the Purchasing Office, 5100 College Road, Public Service Building~ Cross Wing Room #002, Stock Island, Key West, FL 33040 on or before 3:00 PM on September 13, 2001. Any proposals received after this date and time will be automatically rejected. Two (2) signed originals and five (S) copies of each proposal shalt be submitted in a sealed envelope clearly marked "Sealed Proposal for Health Benefits Plan Oaims Administration.. All proposals must remain valid for a period of ninety (90) days. The Board will automatically reject the bid of any person or affiliate who appears on the convicted vendor list prepared by thF Department of General Services, State of Florida, under s~c. 287.133(3)(d), Fla. Stat. <j997). All proposals, including the recommendation of the County Administrator and the requesting Department Head, will be presented to the Board of County Commissioners of Monroe County, for final awarding or otherwise. The Board reserves the right to reject any and all proposals, to waive informalities in any or all proposals, and to readvertise for proposals. The Board also reserves the right to separately accept or reject any item or items of bid and to award and/or negotiate a contract in the best interest of the County. Specifications may be obtained by contacting the Purchasing Department, 305/292- 4464;for additional information contact Lawton Swan, III, CPCU, CLU, ARM; Interisk Corp,1111 N. Westshore Blvd. #208, Tampa, FL 33607-4711; fax 813/287-1041. DATED at Key West, Florida, this 19th day of July, 2001 Publication dates Reporter Key West Citizen Keynoter Miami Herald Monroe County Purchasing Department 7/26 - 8/2/01 7/27 - 8/3/01 7/28 - 8/4/01 7/29 - 8/5/01 t) 9/5/01 To the Board of County Commissioners: I attended the discussion in March of this year about raising the cost of insurance to the County Employees. A compromise was met that was at least reasonable. Because I have a spouse and two children covered under my insurance, the increase of premium deducted from my paycheck is going from $120 to $130 every two weeks. I had to take 5 hours of vacation time to attend that meeting but apparently that was for naught. Now the same discussion is happening again. I can't afford to take more vacation time to drive to Key West to protest what I have already protested. Now the proposal is to raise the contribution for family insurance to $160. That is option II, whereas option I is even more expensive, although it is not broken down in the proposal. I understand the cost of insurance has gone up and accept the increase in copay at $11,000 and the additional $10 per paycheck as inflation. This was already discussed, and agreed to. Raising the copay limit immediately to $20,000 and increasing the premium to $160 a pay period will negate any raise we may get in October. This will hurt the employees that can least afford it. I feel I am being punished for having two children. Also, one of the reasons I stay with the County and put up with derision and abuse from the public is for the benefits. Please stay with what you voted on in March. Sincerely, . ~ Mary Wingate Growth Management f,; ,,;"!~i':'~("';,"~,""'" ".,~,,_'...' .,.':...:~:"'r'J"':. ,.'-'-'~"'. ,".."".."",.,,-,~;...;':;;,",~~, ",<~, ,.. ,,-'~'.. ",,' .' ","" ""'1""'- , "," "',"'!""""".'1'''''''''''~''T'''f'r~'''''~~'''''H!'."l". ",\1',','~ "'f'~'r: '''''~'''''1'J. ork..Jl..".".,., .,~ .",,- - -,.,. , : ~':'. ::'.1 .," :':'L.~:~',.~:-"'" ','c'::: "'......::j..':.......:.., .":.t;;,;~:,,.... ..... (f j I i r1 .... "" ,.... ~,~, ":" I , '" Group Health Insurance Plan Booklet and Benefit Document Dear State Employees' PPO Plan Participant: The State Employees' PPO Plan Group Health Insurance Plan Booklet and Benefits Document has received a face-lift and we are interested in hearing your comments. The Division of State Group Insurance revised this document with the objective of providing accurate and detailed information in an easy-to-read and user friendly format. Although, we are proud of this booklet, we know there is always room for improvements-that's why your comments are of interest to us. Please take a few minutes to answer the following questions and provide any additional comments in the space provided. When you have finished, simply tear this page out of your booklet, fold where marked, tape and return to our office. The postage is on us! Thank you for your participation. .................................................................... 1. The information is easier to locate than in the previous booklet. (1) (2) (3) (4) (5) D D D D D Strongly Agree Agree Neutral Disagree Strongly Disagree 2. The information is easier to read and understand than the previous booklet. (1) (2) (3) (4) (5) D D D D D Strongly Agree Agree Neutral Disagree Strongly Disagree 3. What do you like most about the revised booklet? 4. What do you like least about the revised booklet? Comments or Suggestions: (SJSH PIO,:j) NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO 711 TALLAHASSEE FL POSTAGE WILL BE PAID BY ADDRESSEE DIVISION OF STATE GROUP INSURANCE BUREAU OF POLICY ANALYSIS & PROGRAM DEV PO BOX 5450 TALLAHASSEE FL 32314-9889 1..11...1.1..11....11.1..11.1.11..1.1..1.1.111.111.1 (Fold Here) state Of Florida Employees' PPO Plan Who To Call for Information If You Need Information ~bout . . . Contad . . . Benefits or claims (other than prescription drug claims) under the PPOplan,or finding a network provider within the State. of Florida PPO Plan Pre-Admission Certification Finding a PPO network provider outside. the State of Florida - BlueCardilfl PPO Program Healthy Additionilfl Pre-Natal Program Personal Health Advisorilfl Prescription drug program information Finding a participating pharmacy Enrollment, eligibility, or changing coverage Medicare eligibility and enrollment Blue Cross P.O. Box 2896 Jacksonville, FL 32232-0079 1-800-825-2583 1-800-955-5692 1-800-810-2583 1-800-825-2583 1-800-667-2546 Eckerd Health Services (EHS) P.O. Box 9062 Clearwater, FL 34618 1-888-782-8335 MedImpact, Inc. 1-800-761-1081 Division of State Group Insurance P.O. Box 5450 Tallahassee, FL 32314-5450 1-800-226-3734 or wwvv.dsgi.s .fl.us 1-850-921-4600 SunCom 291 The Social Security Administration your area This benefit document replaces any other brochure or booklet printed prior tOJanuary 1,2000, relative to the Plan and shall remain in effect until further notice. The State Employees' PPO Plan is further subject to federal and State of Florida laws and rules promulgated pursuant to law including, but not limited to, Title 60 of the Florida Administrative Code. This health insurance plan contains a deductible provision. Details on deductible dollar amounts can be found on pages 4 and 5. The Summary of Plan Benefits starting on page 11 shows when deductibles may be applied. " Important Information About lhe Plan Plan Administrator Division of State Group Insurance Post Office Box 5450 Tallahassee, FL 32314-5450 1-850-921-4600; 1-800-226-3734 SunCom 291-4600 The Division of State Group Insurance (DSGI), within the Department of Management Services, has been designated by the Florida Legislature as the entity responsible for administering state employee benefits, including this health insurance plan. DSGI is authorized to provide health insurance coverage through fully insured or self-insured plans. This PPO plan is a self-insured plan. This means that claims are paid from a fund established by the State of Florida. Because this plan is self- insured, the plan does not have to pay typical insurance company fees, such as retention, reinsurance, premium taxes and other insurance-related charges. DSGI has full and final decision-making authority concerning eligibility, coverage, benefits, claims, and interpretation of this plan's benefit document. Final decisions concerning the existence of coverage or benefits under this Plan shall not be delegated or deemed to have been delegated by DSGI. However, the Medical and Prescription Drug Program Third Party Administrators hired by DSGI are responsible for processing claims in accordance with the benefits in this health plan. Medical Claim Administrator Blue Cross and Blue Shield of Florida, Inc. P.O. Box 2896 Jacksonville, FL 32232-0079 1-800-825-2583 Blue Cross and Blue Shield of Florida (BCBSF) provides claim payment services, customer service, provider network access, and utilization and benefit management services. Benefits are offered through a preferred provider organization (PPO), which is a network of providers managed by BCBSF. Prescription Drug Program Claim Administrator Eckerd Health Services (EHS) P.O. Box 9062 Clearwater, FL 34618 1-888-782-8335 MedImpact, Inc. 10680 Treena Street San Diego, CA 92131 1-800-788-2949 Eckerd Health Services (EHS) provides prescription drug utilization and benefit management services. MedImpact provides prescription drug claims payment services and pharmacy network access. Plan Documents and Contracts Rights to Employment Right to Amend or Terminate The Plan Continuity of Care The descriptions contained in this document are intended to provide a summary explanation of your benefits. Easy-to-read language has been used as much as possible to help you understand the plan provisions. Your insurance coverage is limited to the express written terms of this benefit document. Your coverage cannot be changed based upon statements or representations made to you by anyone, including employees of DSGI, BCBSF, EHS, MedImpact or your employer. The existence of this health insurance plan does not affect the employment rights of any employee or the rights of the State to discharge an employee. The State of Florida has arranged to sponsor this health insurance plan indefinitely, but reserves the right to amend, suspend, or terminate this health insurance plan for any reason. PPO plan fee schedules, allowed amounts, physician network participation status, medical policy guidelines and premium rates are subject to change at any time without the consent of plan participants. You will be given notice of any changes that affect your benefit levels as soon as administratively possible. In order to provide continuity of care, DSGI and BCBSF have developed a "transition of care" policy for certain situations when your provider terminates his or her network participation during a course of treatment. When it would not be consistent with quality medical care to require that you transfer your care to another in-network provider, this plan may continue to provide in-network benefits, from your current provider, during the course of treatment or for a set period of time. Examples of conditions and services, which may qualify for the transition of care policy, include: - when in the 2nd trimester as of the date the participation status changed. roved and scheduled n status change and the change in the provider's roved within 30 tion status. Outpatien of the provider's approved through participation status changed. Chemotherapy/radiation therapy when approved through the conclusi f oncurrent treatment plan in process, through 90 as of the date the provider's participation status cha 11/ Table of Contents Page Introduction.................................................................................................................. 1 An Overview....................................................................................................................... 2 Payment For Covered Services - Your Share And The Plan's Share ............................3 How The Plan Pays Benefits.............................................................................................. 3 For Office Visits............................................................................................................ 3 For Emergency Room Visits.......................................................................................... 3 Deductible For Most Other Covered Care................................................................... 4 Deductible For Hospital Stays.................................................................................... 5 Health Insurance Plan Pays a Major Share of Covered Expenses......................................................................... 5 Calendar Year Limit On Your Share of Covered Expenses......................................... 6 Maximum Plan Benefits..................................................................................................... 7 About the Preferred Patient Care,m Network..................................................................... 7 How To Use the PPC,m Network ....................................................................................... 8 An Important Note About Using Non-Network Providers.......................................... 8 Pre-Admission Certification For Hospital Stays .......................................................... 9 Precertifying Your Non-Network Hospital Admission ......................... ....... ........ ............. 9 If You Have An Emergency Admission To A Non-Network Hospital.................................................................................................... 9 If You Do Not Precertify Your Stay................................................................................. 10 Summary Of Plan Benefits .......................................................................................... 11 Covered Services ............................................................................................................. 11 Other Special Limits On Benefits For Covered Services............................................... 21 Doctor's Care ............................................................................................................. 21 Surgical Procedures................................................................................................... 21 Surgery for Breast Reduction.................................................................................... 22 About The Health Screening Benefit - Coverage For Active Employees and COBRA Participants .......................................................... 22 About Maternity Care - Coverage For Mothers And Newborns ................................... 23 Limitations And Exclusions ........................................................................................ 24 Pre-Existing Conditions and Creditable Coverage........................................................ 24 Pre-Existing Conditions............................................................................................. 24 Credit for Previous Coverage.................................................................................... 24 Waiving Some or All of the Pre-Existing Conditio,n Limitations............................................................................................ 25 Proving Creditable Coverage.................................................................................... 25 Requesting a Pre-Existing Condition Waiver........................................................... 26 Services Not Covered By The Plan................................................................................. 27 Prescription Drug Program........................................................................................ 32 How the Program Works .................................................................................................. 32 Purchasing Prescriptions At Retail Pharmacies.............................................................. 32 Using a Participating Pharmacy.............................................................................. 33 Using a Non-Participating Pharmacy....................................................................... 33 Using the Mail Order Program........................................................................................ 34 Drugs That Are Covered By the Prescription Drug Program .......................................35 Drugs That Are Not Covered By The Prescription Drug Program ...............................36 Special Plan Features ......... ......... ........ ............... .................. ....................................... 37 Healthy Addition@ Pre-Natal Education Program .......................................................... 37 Personal Health Advisor@ Program.... .... ...... ....... ..... ...... ...... ...... ...... .... ........ ...... ...... ....... 37 Medical Case Management Program............................................................................... 37 Patient-Auditor Program............... .... .................. ...... ...... ...... ........ .... ...... ........ ..... ..... ...... 38 Worldwide Coverage....................................................................................................... 38 BlueCard@ PPO Program.................... ...... ..... ....... ...... .............. ...... .... ........ ..... ...... ...... .... 39 Coordination Of Benefits With Other Coverage ........................................................ 40 Coordination With Other Group Insurance Plans ........................................................ 40 How Coordination Works ..... ............ .... ...... ...... ...... ...... ...... ...... ............ ...... ...... ...... ........ 41 For All Covered Individuals........................................................................ ...... ........ 41 For Eligible Dependent Children............................................................................... 41 Coordination With Medicare .......................................................................................... 42 Active Employees....................................................................................................... 42 Retired Employees..................................................................................................... 42 Plan's Right To Recover And Sue For Losses .............................................................. 45 How To File A Claim .................................................................................................... 46 Medical Claims ................................................................................................................. 46 When You Use Network Providers.................................................... ......................... 46 When You Use Non-Network Providers......................................... ............................ 46 Prescription Drug Claims ................................................................................................ 47 When You Use A Participating Pharmacy................................................................. 47 When You Use A Non-Participating Pharmacy......................................................... 47 Appealing a Denied Claim ........................................................................................... 48 Appealing to the Third Party Administrator - A Level I Appeal ................................... 48 Appealing to DSG I - A Level II Appeal........................................................................... 48 Requesting an Administrative Hearing........................................................................... 48 Definitions Of Selected Terms Used By The Plan ...................................................... 49 Introduction This booklet describes the benefits available to employees, retirees, COBRA participants, the surviving spouses of active State employees or retirees, and covered dependents through the State Employees' PPO Plan. The PPO plan is also called "this health insurance plan" or "the plan" in this booklet. If you have questions about your coverage after reading this booklet, you may call any of the telephone numbers listed on page i and talk with a member service representative. The PPO plan is designed to cover most major medical expenses for a covered illness or injury, including hospital and physician services. However, you will be responsible for: ... deductibles ... copayments ... admission fees ... non-covered services ... amounts above the plan's allowed amount for non-network services ... amounts above plan limitations ... penalties for not certifying hospital admissions or stays, and ... coinsurance (a percentage of the cost of the service provided). This booklet describes covered services, what the plan pays, amounts that are your responsibility and services that are not covered in greater detail. This health insurance plan contains a deductible provision. Details on deductible dollar amounts can be found on pages 4 and 5. The Summary of Plan Benefits starting on page 11 shows when deductibles may be applied. Other important information about your medical coverage through the State of Florida can be found in a separate booklet including information on: ... who is eligible to participate in this plan ... how to enroll for coverage ... when coverage begins and ends ... when coverage may be continued - including COBRA continuation coverage. This separate eligibility and enrollment booklet is available through your agency personnel office or from the Division of State Group Insurance (DSGI). You should refer to the separate booklet if you have any questions about eligibility, enrollment or taking part in the PPO plan. 2 An Overview Here is a brief overview of how this health insurance plan pays benefits. More detail is provided later in this booklet. Calendar year deductible Emergency room copayment Hospital stay deductible Prescription drug copayments Calendar year out-of-pocket limit" Lifetime maximum Network Non-Network $150/person $300/family $300/person $600/family 80010 or 90%, depending on type of se.rvice or type of provider 70%, 80% or 90%, depending on type of service or type of provider $20 $25, waived if admitted* no copayment applies* $150 $300 At network pharmacies n. $7 generic, $20 brand name ... up to 30-day supply retail pharmacy .... up to 90-day supply mail order $2,500/person; $5,OOO/family network and non-network care combined $1,000,000 network and non-network care combined * Emergency room services are subject to the calendar year deductible and coinsurance. ** Deductibles, copayments, charges for non-covered services, and amounts above the non-network allowance do not count toward the calendar year out-of-pocket limit. Payment for Covered Services - Your Share And The Plan' s Share How The Plan Pays Benefits For Office Visits For covered services in a physician's office, you pay a copayment each time you receive care: ... $10 per visit for network physicians ... $20 per visit for non-network physicians. After your copayment, this health insurance plan pays 90% of the network allowed amount for network physicians, or 70% of the non-network allowance for non-network physicians, for covered office visits and services you receive during the visit. You pay coinsurance of 10% of the network allowed amount for visits to network physicians or 30% of the non-network allowance for non-network physicians. In addition, if you use non-network physicians, you will pay any amount above the non-network allowance. See page 5 for more information about the network allowed amount and the non-network allowance. Copayments for office visits do not count toward meeting the plan's calendar year deductible or the calendar year out-of-pocket limit. Also, charges for services received as part of an office visit do not count toward meeting the calendar year deductible if those services are provided on the same day as the office visit and by the same health care provider. For Emergency Room Visits For emergency room (ER) visits, the amount you pay depends on whether you use a network or non-network facility. At A Network Facility You pay a set copayment of $25 per visit. This copayment is waived if you are admitted to the hospital directly from the emergency room. For any other covered facility services you receive in the network ER, the plan pays 90% of the network allowed amount after you meet the calendar year deductible. You pay the remaining 10%. The plan also pays 90% of the network allowed amount, after you meet the calendar year deductible1 for physician services provided in the network ER if the physician is a network provider. If the ER physician is not a network provider, benefits for physician services will be paid at the non-network level - 70% of the non-network allowance - after you meet the calendar year deductible. You are responsible for 30% coinsurance and any amount above the non- network allowance. It is not uncommon to receive non-network ER physician services within a network facility. The $25 per visit ER copayment does not count toward meeting the plan's calendar year deductible or the calendar year out-of-pocket limit. 3 4 At A Non-Network Facility This health insurance plan pays 70% of the non-network allowance for covered facility services and physician services, after you meet the calendar year deductible. You pay the remaining 30% and any amounts above the non-network allowance. Deductible For Most Other Covered Care Before this health insurance plan pays benefits for covered expenses - except for services requiring copayments, such as health screening exams, well child care, hospice, pre- approved home health care or inpatient hospital services - you must meet a calendar year deductible. The calendar year deductible applies each January 1 to December 31. Once the calendar year deductible is met, this health insurance plan pays a percentage of the network allowed amount for network providers and a percentage of the non-network allowance for non-network providers - you pay the rest. See page 7 for more information about the network. The amount of the calendar year deductible depends on whether you use network or non- network providers. Amounts you pay for network covered services will count toward satisfying the non-network deductible, and vice versa. Individual Family If you have individual coverage, this health insurance plan begins paying a percentage of your eligible expenses after you meet your individual deductible. How The Deductible Works If you have family coverage, you can meet the family deductible in one of two ways: Assume Joe and his family had the following covered medica three months in expenses a and are not ... two family members can each meet the individual calendar year deductible, or ... all family members can combine their covered expenses to meet the family deductible. Joe Wife Daughter Son Total Once your family satisfies the family deductible, this health insurance plan begins paying a percentage of covered expenses for you and all your covered dependents for the rest of the calendar year. If one person in your family meets the individual deductible, the plan begins paying a percentage of covered expenses for that person for the rest of the calendar year. Deductible For Hospital Stays The calendar year deductible does not apply to covered facility services for inpatient hospital stays, but there is a separate hospital stay deductible that applies to each hospital stay. This means that you must meet the hospital stay deductible each time you are admitted as an inpatient before the plan pays benefits for covered facility services. The calendar year deductible does apply to physician or other professional services provided during your inpatient hospital stay. Health Insurance Plan Pays a Major Share of Covered Expenses Benefits are paid at two different levels. The level you receive depends on whether your care is provided by network providers or non-network providers. After you meet the deductible ... ... network providers - the plan pays 90%, or in some cases, 80% of the network allowed amount can avoid unexpected cha the amount the plan will pay for covered services. ... Use the network... when you go to PPO providers, you will not be billed for charges above the network allowed a t. Network providers are some called Preferred Patient Caresm (PPCsm) Providers. ... non-network providers - the plan pays 70%, or in some cases, 80% of the non-network allowance. This health insurance plan pays benefits for covered services based on the network allowed amount for network care and the non-network .... allowance for non-network care. The network allowed amounts are preferred rates BCBSF has negotiated with network providers - and network providers are not allowed to charge you for any amounts above the network allowed amounts. When you use network providers, you take advantage of the preferred rates of the network allowed amounts and the plan pays the highest level of benefits - keeping your cost down. Go to a BCBSF participating provider ... BCBSF has agreements with providers throughout the state - including doctors, hospitals, and other healthcare specialists - who are not in the PPO network but have agreed to charge within a negotiated limit that is not higher than the non-network allowance. These providers are sometimes called Payment for Professional Services (PPS) or Payment for Hospital Services (PHS) providers. These providers can be identified by asking the provider or by calling BCBSF customer service. When you go to a participating (PPS or PHS) provider who is not in the network, this health insurance plan pays at the lower non-network level of benefit, but you are protected from being balance-billed for charges above the non-network allowance. When you go to non-network providers, this health insurance plan pays benefits based on the non-network allowance. If your provider charges more than the non-network allowance, you are responsible for any amounts above the non- network allowance. In addition, because the plan pays a lower benefit level for non-network care, you pay more out-of-pocket for non-network care. In selecting BCBSF as the third party administrator for the State Employees' PPO Plan, DSGI agreed to accept the non-network allowance schedule used by BCBSF to make payment for specific healthcare services submitted by non-network providers. 5 6 Keep in mind that you will receive benefits at the non-network level whenever you use non- network providers, even if a network provider is unavailable. See page 7 for more information about the PPOm network. Calendar Year Limit On Your Share of Covered Expenses There is a limit on the amount of coinsurance you payout of your pocket toward covered expenses in anyone calendar year - for network and non-network care combined. Once your share of out-of-pocket coinsurance expenses reaches the annual limit, this health insurance plan begins paying 100% of the network allowed amount for care from network providers and 100% of the non-network allowance for care from non-network providers - after any required copayments or deductibles - for the rest of the calendar year. You meet the family out-of-pocket coinsurance limit when the coinsurance expenses of at least two of your covered family members add up to the family maximum. $2,500 $5,000 Both your network and non-network covered expenses count toward the out-of-pocket limit. The following expenses, however, do not count toward the out-of-pocket limit: ... calendar year and inpatient hospital deductibles ... copayments for office visits and network emergency room visits ... hospice care expenses ... charges for services and supplies that are not covered by this health insurance plan ... health screening benefit services ... charges greater than the non-network allowance for non-network providers .... charges greater than plan limits on dollar amounts, number of treatments, or number of days of treatment ... pre-admission certification or other penalties. 20 i For surgical sterilization: 1.1 Does not include reversal of sterilization . . ___________--.-.---.--1-----------'--------..-----..--..----..- I I 70% Skilled Nursing Facility Care ... Room, board and general nursing care ... Charges for services and supplies for necessary treatment Surgical Sterilization Weight Loss Services 80% 80% For skilled nursing facility care: .I Up to 60 days/person a calendar year .I Convalescent facility care must come after hospital stay of at least 3 days, and I patient must be transferred from the I hospital to the facility 1.1 Patient must require skilled care for a condition that was treated in the hospital, as certified by a doctor 1.1 Room and board benefit payment is I based on $95/day allowance I .I Inpatient hospital deductible does not apply to skilled nursing facility admission I ; ... 90% 70% 90% For weight loss: .I Must be required by a covered person's surgeon before performing a medically necessary covered surgical procedure .I Limited to $150 per person in any 12-month period ---t--..------------ i For wigs: .I Hair loss must be caused by chemotherapy, radiation therapy or cranial surgery .I Limited to $40 for one wig and fitting in the 12 months following treatment or surgery Wigs 80% r- 80% 'Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. % Payable % Payable Types of Care Network * Non-Network' Special Limits/Circumstances Outpatient Care 90% 70% ... Treatment as an outpatient in a hospital, an ambulatory surgical center or an outpatient health care facility ... Clinical laboratory i I services I ! ... Services for I outpatient surgery I For outpatient surgery and treatment: and outpatient I .,t' Includes supplies provided or used by treatment of an injury the facility during the surgery or treatment Oxygen 80% 80% .... Oxygen and rental of equipment for its administration Physical Therapy and 90% 70% ./ Combined limitation for physical and Massage Therapy massage therapy limited to 4 modalitiesl treatment day, with no more than 21 treatment days during any six-month period ./ Physical therapy may be provided by a physician, chiropractor, or a licensed physical therapist ./ Massage therapy must be prescribed by your doctor as medically necessary for a specific number of treatments, not to exceed the 4/modalities/day 21 days/6 month limitation, and may be provided by a physician, a chiropractor, a licensed physical t~rapist or a licensed massage therapist Prostheses 80% 80% For artificial limbs or eyes: ... Artificial limbs or ./ Replacement covered if medically eyes, except necessary based on medical review by replacement of such BCBSF prostheses Reduction Mammoplasty 90% 70% For reduction mammoplasty, see page 22 for special limits. Rental of Trusses, 80% 80% For rental of trusses, braces or crutches: Braces or Crutches ./ No shoe build-up, orthotic, shoe brace or shoe support will be covered unless the shoe is attached to a brace 19 *Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. % Payable % Payable Types of Care Network* Non-Network* Special Limits/Circumstances Mental Health and For any inpatient care: Substance Abuse Care ,/ Up to 31-day inpatient stay maximum/ .... Hospital for acute year for mental health and substance care abuse care combined ... outpatient 90% 70% For hospital inpatient care: ... inpatient 90% 80% ,/ Room and board benefits for non- ... Specialty facility network or non-participating hospitals ... outpatient 90% 70% for based on $190/day allowance for semi- substance private room, unless private room is abuse care only medically necessary ,/ Detoxification limited to 6 days/year, .... inpatient 90% 80% for which counts toward 31-day maximum substance for inpatient stays abuse care only For specialty facilities: ,/ Non-network care covered for substance abuse treatment only - with inpatient care limited to active employees only, when requested by employing agency and approved by DSGI ,/ Room and board benefits for non- network or non-participating facilities based on $190/day allowance for semi- private room, unless private room is medically necessary ,/ Detoxification limited to 6 days/year, which counts toward 31-day maximum for inpatient stays Nursing Services 80% For nursing care: ... Nursing care by a ,/ Includes inpatient private duty nursing registered nurse (RN) only when determined medically or licensed practical necessary nurse (LPN) Organ Transplants 90% 70% for For organ transplants: .... heart physician ,/ Prior approval from BCBSF required for ... heart/lung services; 80% all organ transplants other than kidney or .... lung for facility cornea .... liver charges For bone marrow transplants: .... kidney ,/ Donor costs are covered in the same .... kidney/pancreas way, including limitations and non- .... bone marrow covered services, as costs for the .... cornea covered person. Donor search costs are limited to immediate family and the National Bone Marrow Donor Program. 'Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. % Payable % Payable Types of Care Network* Non-Network' Special Limits/Circumstances Mastectomy and 90% 70% Reconstructive Surgery ... Removal of all or part of the breast for medically necessary reasons ... Reconstruction of the breast on which mastectomy was performed ... Surgery and reconstruction of the other breast for a symmetrical appearance ... Treatment of physical complications of all stages of mastectomy, including Iymphedemas ... Prostheses and 80% 80% mastectomy bras Maternity Care 90% 70% for For maternity care: ... Pre-natal care and physician and .I Covered for female employees, retirees monitoring other or COBRA participants and spouses of ... Delivery in a hospital professional male employees, retirees or COBRA or birth center services; 80% participants; maternity care not covered ... Postpartum care for facility for dependent children who become ... Newborn care and charges and pregnant, except for certain pregnancy one assessment, midwife complications and care of the newborn including initial exam services (see page 49-50 for a definition of from pediatrician "complications of pregnancy") ... Medically necessary .I Covered hospital stays for the mother and clinical tests and newborn child will be no less than immunizations ... 48 hours for a normal delivery ... Routine nursery ... 96 hours for a Cesarean-section charges delivery ... Midwife services unless agreed to by the provider and ... Birthing centers 80% 80% patient. See page 23 for more information on coverage for mothers and newborns. 'Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. 17 % Payable % Payable Types of Care Network* Non-Network* Special Limits/Circumstances ... transfusion supplies and services including blood, blood plasma and serum albumin, if not replaced ... laboratory services ... electrocardio- grams .... basal metabolism examinations ... x-ray, including therapy .... electroen- cephalograms .... diathermy and physical therapy Mammograms .... breast cancer screening .... diagnosis Manipulative Services 'Calendar year deductibles allowances for non-network care. 90% 70% For mammograms: ./ These services are considered eligible expenses: ... one baseline mammogram - age 35 through 39 ... one mammogram every two years - age 40 through 49 ... one mammogram every year - age 50 and over ... mammogram at any age if medically necessary ./ Covered when referred by doctor or received at a health testing facility using equipment registered with the Department of Health 90% 70% For manipulative services: ./ Limited to 26 treatments/year or a maximum of $500/year, whichever occurs first noted. Percentages indicate percentage of network allowed amount for network care or non-network % Payable % Payable Types of Care Network* Non-Network* Special Limits/Circumst:;nces Hospice Care (continued) ... Hospice outpatient care ... Physician services .... Laboratory, x-ray and diagnostic testing .... Ambulance service, up to $100 per use ... Same covered services as in- home hospice care Inpatient Hospital Care ... Hospital room, board and general nursing care up to the charge for a semi-private room per day, unless a private room is medically necessary .... Room, board and treatment in an intensive or progressive care unit .... Other necessary services and supplies, for example... .... use of operating room, labor room, delivery room and recovery room .... all drugs and medicines if listed in "New and Non- Official Remedies" or the United States Pharmacopoeia Drug Information ... solutions, including glucose .... dressings ... anesthesia and related supplies ... oxygen therapy 90% with no deductible 90% 90% with no deductible 80%; reduced if not precertified (see page 10) See special limits/circumstances on page 14. For care at non-network or non-participating hospitals: .I Room and board benefits based on $190/day allowance for semi-private room, unless private room is medically necessary .I Room and board benefits based on $380/day allowance for intensive care unit, $285/day allowance for progressive care unit 'Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. lS 14 Hospice Care .... In-home care .... Physician services .... Physical, respiratory and occupational therapy .... Drugs, medicines and medical supplies ... Private duty nursing services in a series of shifts (e.g., three eight- hour shifts) .... Home health aide services ... Rental of durable medical equipment .... Oxygen ... Hospice inpatient care .... Room and board and general nursing charges, including the cost of overnight visitations by covered family members .... Inpatient care services same as inpatient hospital care .... Same covered services as in- home and outpatient hospice care 90% with no deductible 80% with no deductible 90% with no deductible 80% with no deductible For hospice care: ./ Treatment for and counseling of terminally ill patients whose doctor has certified that they have less than six months to live ./ Prospective reimbursement for hospice treatment can be requested. To do this, the hospice program submits a 90-day treatment plan for hospice care. If approved by BCBSF, payments are made every 30 days as treatment is completed. A second 90-day treatment plan may be submitted if the patient continues in hospice care. One additional treatment plan for 30 days may be submitted after two 90-day plans are completed. No further benefits are payable after 210 days. ./ While in the hospice program, regular plan benefits are not payable for expenses related to the terminal illness ./ Hospice care limited to 210 days per person per lifetime ./ The calendar year out-of-pocket limit for coinsurance expenses does not apply to hospice expenses. These services are not covered as hospice care: ./ Any volunteer services or services which would normally be provided free of charge ./ Purchase of durable medical equipment unless purchase is less costly than rental ./ Services of a person who ordinarily resides in the home of the terminally ill patient or member of the patient's family or spouse's family unless prior approval has been received from BCBSF ./ Any services not provided through the approved hospice program ./ Continuous bedside nursing services provided by one nurse to one patient either in a hospital or patient's home will not be covered. 'Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. % Payable % Payable Types of Care Network' Non-Network' Special Limits/Circumstances Fertility Testing and Treatment Services Hearing Tests Home Health Care ... Services by a home healthcare agency for treatment, therapy, equipment, medication and supplies if you are confined and convalescing at home 90% 70% For fertility testing and treatment services: ./ Some fertility tests and/or treatments are considered investigational or experimental and are not covered ./ Artificial insemination, gamete intrafallopian transfer, ovum or embryo placement or transfer, in-vitro fertilization, cryogenic and/or other preservation techniques used in such and/or similar procedures are not covered 90% ,~___"~___,_,~,,~_,~,,_____,__~_"~H_____~___' 90% with no deductible if pre-approved; 80% after calendar year deductible if not pre-approved but determined medically necessary 70% 90% with no deductible if pre-approved; 80% after calendar year deductible if not pre-approved but determined medically necessary For hearing tests: ./ Covered after a related covered ear surgery or when medically necessary for diagnosis of a covered condition other than hearing loss; no other hearing tests are covered even for supplying or fitting a hearing aid For pre-approved home healthcare: ./ Your doctor must provide a detailed and priced home healthcare plan to BCBSF for prior approval of home health care ./ To be approved and paid at the highest benefit level, home healthcare must be less costly than inpatient hospital or skilled nursing facility care ./ Charges to the home healthcare plan must be approved in advance ./ Home healthcare agency must provide weekly reports to the attending physician and an itemized bill to BCBSF ./ Home healthcare agency employees must be fully licensed .Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. 13 % Payable % Payable Types of Care Network* Non-Network* Special Limits/Circumstances Doctor's Care 90% after you 70% after you See page 21 for special limits applying to ... Office visits pay $1 0 pay $20 doctor visits and doctor fees for surgery. (including covered copayment with copayment with services received at no deductible no deductible ,/ For well-child health supervision the same time and by services: The number of well-child visits the same provider as considered as eligible expenses varies - the office visit) ... Up to 6 visits from birth to 12 months .... Up to 2 visits from 1 year to 2 years ... Medical treatment in 90% 70% ... 1 visit each year from 2 years hospital or outpatient through 8 years facility or surgery .... 1 visit from 9 years through 10 years (other than office visit) ... 1 visit from 11 years through 12 years ... Well-child health 90% with no 70% with no ... 1 visitfrom 13 years through 14 supervision deductible or deductible or years services copayment copayment ... 1 visit from 15 years through 16 years See page 22 regarding health screening benefit. Visits and age intervals shall be consistent with prevailing medical practice as established by the American Academy of Pediactrics and in accordance with s.627.6579, Florida Statutes. Durable Medical 80% 80% For rental or purchase of durable medical Equipment equipment: .... Rental or purchase of ,/ Coverage for standard models of durable wheel chair, hospital medical equipment only unless type bed and other upgraded model determined to be durable medical medically necessary equipment ,/ Purchase of equipment covered only if purchase price is less than rental cost ,/ If equipment is rented first and later purchased, the amount the plan would pay toward purchase will be reduced by the amount already paid toward rental Emergency Room Care .... facility charges 90% - you pay 70% See page 3 for special limits applying to $25 copaymenU emergency room care. visit; copayment waived if admitted directly from ER .... physician services 90% 70% Eye Glasses or Contacts 80% 80% For eye glasses or contacts: ,/ Limited to the first pair following an 12 accident to the eye or cataract surgery. .Calendar year deductibles apply unless noted. Percentages indicate percentage of network allowed amount for network care or non-network allowances for non-network care. ----- Summary Of Plan Benefits Covered Services This chart provides an overview of services and supplies covered by this health insurance plan. It shows how much the plan pays for these services and supplies after you meet any copayments or deductibles that apply. This health insurance plan pays a percentage of the cost of covered care and medical supplies as long as the care or supplies are ordered by a covered provider and are considered medically necessary for your treatment as a result of a covered accident, illness, condition or mental or nervous disorder. % Payable % Payable Types of Care Network * Non-Network* Special Limits/Circumstances Acupuncture 90% 70% For acupuncture: .I May be provided by a medical doctor, a doctor of osteopathy, a chiropractor certified in acupuncture, or a certified acupuncturist Ambulance ... Ambulance service to the nearest hospital 80% with no deductible 80% with no deductible For ambulance service: .I Allowance is limited to $125 for each use; limited to $1,000 for each use for a newborn baby under 31 days of age if the doctor certifies that the ambulance is necessary to protect the health and safety of the newborn child Cleft Lip and Cleft Palate Treatment and Services ... for children under 18 years, including medical, dental, speech therapy, audiology and nutrition services 90% 70% Dental Services .... Dental work, treatment or examinations needed because of accidental injury to teeth ... Non-physician services provided by a hospital, ambulatory surgical center, outpatient health care facility or skilled nursing facility related to dental work or exams *Calendar year deductibles apply unless noted. Percentages indicate percent81'1e of network allowed amount for network care or non-network allowances for non-network care. 90% 70% for outpatient care; 80% for inpatient care For dental services: .I Accident must occur while the person is covered by this health insurance plan .I Must be performed within 120 days of accident unless extension is requested within 120 days of accident and approved by BCBSF .I In no instance will any services be covered unless provided within 120 days of the termination of the person's coverage 11 10 If You Do Not Precertify Your stay .... If you are admitted to a participating BCBSF hospital (PHS) that is not part of the PPOm network and you have not submitted a Request For Admission Certification or your request is denied, benefits for covered services will be reduced by 25% of the covered charges - not to exceed a maximum benefit reduction of $500. .... If your hospital admission is denied, but you are admitted to a non-network hospital anyway, the plan will not pay room and board benefits for your first two days of hospitalization. ... If you are admitted to a non-network hospital without submitting a Request for Admission Certification or having your doctor call first, the plan will not pay room and board benefits for your hospital stay. ... If your hospital admission is certified but your stay is longer than the number of days for which the admission was certified, the plan will not pay room and board benefits for days that were not certified. Pre-Admission Certification for Hospital stays All non-emergency admissions to a non-network hospital must be precertified. This means that BCBSF must certify the hospital admission and approve the number of days for which certification is given. Precertification of non-network hospital stays is your responsibility, even if the doctor admitting you to the hospital is a network provider. You are not required to obtain precertification for admission to a network hospital. The network hospital handles precertification for you. Because precertification is the hospital's responsibility when you use network hospitals, you will not be penalized if the network hospital fails to precertify your admission. BCBSF will review requests for hospital admission and for extended hospital days in accordance with national hospital admission standards. Only a medical doctor can deny a hospital admission or request for additional hospital days. See page 10 for information on penalties if you do not precertify your stay. Precertifying Your Non-Network Hospital Admission To pre certify your stay in a non-network hospital, ask your doctor to complete a Request for Admission Certification form and send it to BCBSF within seven days before your scheduled date of admission. Or, instead of submitting the Request for Admission Certification form, your doctor can call BCBSF at 1-800-955-5692 before your hospital admission and provide the reason for hospitalization, the proposed treatment or surgery, testing, and the number of hospital days anticipated. BCBSF will review your doctor's Request for Admission Certification form or telephone information and immediately notify you, your doctor and the hospital if your admission has been certified and the number of days for which certification has been given. If the admission is not certified, your doctor may submit additional information for a second review. If your hospital stay is certified and you need to stay longer than the number of days for which certification was given, your doctor must call BCBSF to request certification for the additional days. Your doctor should make this call as soon as possible. If You Have An Emergency Admission To A Non-Network Hospital If you are admitted to a non-network hospital in a medical emergency - including maternity admissions - you must notify BCBSF within one working day of your admission, or as soon as reasonably possible. You are responsible for this notification. BCBSF will review the admission information and certify the hospital stay as appropriate. 9 8 How To Use the pp(sm Network Once you are enrolled in the plan, use the PPOm network by contacting a provider listed in the PPOm Provider Directory. You can obtain a directory from: ... agency personnel office ... DSGI Client Services ... DSGI Website, www.dsgLstate.fl.us ... BCBSF Customer Service ... BCBSF Website, www.bcbsfl.com Because the network is extensive, you may find that the health care professionals you already use are part of the network. However, before you use a provider under this plan, be sure the provider is a member of the network by calling the provider's office and BCBSF customer service, to confirm that the provider is still in the network. When you go for treatment, take your health insurance plan identification card with you. Your card will help the provider confirm your eligibility and coverage, and will also ensure that your claims paperwork is handled properly. An Important Note About Using Non-Network Providers To make sure you receive the highest level of benefits from the plan, it's important to understand when non-network benefits are paid. When you use non-network providers, you receive non-network benefits. Here are some examples. ... In some situations, your network provider may use, or recommend, a non-network provider. For example, your network family doctor says you need to see another doctor and recommends a non-network doctor. It is your choice - you decide whether to go to the recommended non-network doctor or to ask your doctor for another recommendation to a network doctor. In this example, even though your family doctor is a network doctor, you will receive non-network benefits if you go to the recommended non-network doctor. ... Sometimes the healthcare professional you need to see is not in the network. You receive non-network benefits when you use non-network providers - even if no network provider is available. ... Not all healthcare professionals offering services at a network facility are network providers. For instance, an anesthesiologist or emergency room doctor working at a network hospital might be a non-network provider. In that case, the non-network provider's services will be paid at the non-network benefit level. You may request that network providers be used whenever possible. However, in some situations you will have no choice but to use non-network providers. In those cases the non. network provider's services will be paid at the non-network benefit level. Maximum Plan Benefits The total lifetime maximum amount this health insurance plan will pay is $1,000,000 toward the covered expenses each enrolled person has for all years that the person is covered by this health insurance plan. Keep in mind, some services and treatments have specific limits as well. Any expenses paid toward these special limits count toward the overall lifetime maximum. This chart shows the plan maximums for network and non-network care combined. About the Preferred Patient (areSm Network The Blue Cross and Blue Shield of Florida Preferred Patient Care'm (PPC,m) network is this health insurance plan's preferred provider organization (PPO) network. The PPOm network is a large group of independent doctors, hospitals and other healthcare specialists and facilities who have agreements with BCBSF to provide health care services to plan participants. Network providers offer a broad range of services - such as, family practice, internal medicine, OB-GYN and pediatrics. BCBSF, as the PPOm network manager, evaluates the credentials of providers for membership in the PPOm network. The responsibility of selecting the providers and facilities that make up the network and for addressing network-provider related issues and concerns rests with BCBSF as the PPOm network manager. In an effort to contain health care costs and keep premiums down, BCBSF has negotiated with PPOm network healthcare providers to provide services to health plan participants at reduced amounts. PPOm network providers have agreed to accept as payment a set amount for covered services. You are responsible for any applicable copayment and a percentage of the network allowed amount as your coinsurance. The network provider cannot balance-bill you for the difference between the provider's charges and the network allowed amount for the service. Non-network providers will bill you their regular charges. You will be responsible for a larger coinsurance and/or copayment, and you will be responsible for paying the difference between the provider's charges and the amount established as the non-network allowance for the service. The non-network allowance may be considerably less than the amount the non-network provider charges. 7 32 Prescription Drug Program How the Program Works You automatically participate in the prescription drug program if you are enrolled in the State Employees' PPO Plan. The prescription drug program features a network of participating retail pharmacies and a mail order program. Here is an overview, suggesting when to use each. medications or that yoU. need like antibiotics for a up to a 30-day supply at one time tenance or long-term tionsyou take regularly, like blood pressure medication up to a 9o-day supply at one time, as long as the prescription is written to allow dispensing of a 90-day supply Purchasing Prescriptions At Retail Pharmacies When your doctor prescribes a medication, you may have your prescription filled at any pharmacy - although there are advantages to using pharmacies that participate in the pharmacy network such as: ... you pay a set copayment for prescriptions ... you do not have to file a claim form - your pharmacist handles the paperwork. Participating pharmacies include most major drug chains - with over 45,000 pharmacies nationwide. To find out if your pharmacy participates, check the pharmacy network directory or call 1-800-761-1081. You should receive a pharmacy network directory when you enroll in this plan. If you have not received yours, you may request one by calling the toll-free number. You can also use this toll-free number to locate a participating pharmacy if you are traveling anywhere in the United States. 47. Services and procedures considered by BCBSF to be experimental or investigational, or services and procedures not in accordance with generally accepted professional medical standards, including complications resulting from these non-covered services. 48. Services and supplies provided by an institution that is used mainly as a nursing home or rest facility for the care and treatment of the aged. 49. Services and supplies provided by a skilled nursing facility for: .... custodial care, including but not limited to assistance with the activities of daily living ... alcoholism, drug addiction or mental and nervous disorders .... the convenience of the covered person or covered person's family. 50. Inpatient services provided by a hospital, specialty institution, residential facility or any other facility while a participant is confined for treatment of a mental or nervous disorder and/or alcoholism or drug addiction above the 31-day per calendar year limit. 51. The following services when they are provided for the treatment of alcoholism or drug addiction: ambulance; nursing care by an RN or LPN; artificial limbs or eyes; rental of trusses, braces or crutches; rental of wheel chair or hospital bed; oxygen; and durable medical equipment. 52. Expenses that are the result of mental or physical disability of children who are over the age 25 when you enroll. 53. Complications resulting from non-covered services, except complications of pregnancy defined on pages 49-50. 54. Expenses for wigs unless hair loss is caused by chemotherapy, radiation therapy or cranial surgery. Coverage for wigs in those cases is limited to $40 for one wig and fitting in the 12 months following treatment or surgery. 31 27. Occupational, recreational, educational, vocal, sleep therapy. 28. Speech therapy, except for the treatment of cleft lip or cleft palate for children under 18 years old. 29. Marriage or family counseling. 30. Orthoptics. 31. Biofeedback. 32. Contraceptives, except for the treatment of a covered condition. 33. Telephone consultations. 34. Exercise programs, including cardiac rehabilitation exercise programs, or visits for the purpose of exercise by bicycle ergometer or treadmill. These programs or visits are excluded even if the purpose is to determine the feasibility of an exercise program. 35. Autopsy or post mortem. 36. In-vitro fertilization, artificial insemination, ovum or embryo placement or transfer, gamete intrafallopian transfer, cryogenic and/or other preservation techniques used in such and/or similar procedures. 37. Genetic tests to determine the father of or the sex of a child. 38. Education or training, except for diabetes outpatient self-management training and educational services pursuant to s.627.6408, Florida Statutes. 39. Electrolysis. 40. Food, food substitutes or vitamins, except certain internal formula food products pursuant to s.627.42395, Florida Statutes. 41. Mind expansion or elective psychotherapy such as, but not limited to, Gestalt Therapy, Transactional Analysis, Transcendental Meditation, Z-therapy and Erhard Seminar Training (EST). 42. Services related to the treatment of mental retardation. 43. Air conditioners, humidifiers, dehumidifiers, air purifiers or filters, whirlpools and blood pressure kits. 44. Modifications to motor vehicles and/or homes such as wheelchair lifts or ramps. 45. Water therapy devices such as Jacuzzis. 46. Services for which a claim has been submitted for payment to BCBSF more than 16 months after the date services or supplies were received. 16. Any services provided for custodial care - including but not limited to assistance with the activities of daily living. See page 50 for a definition of custodial care. 17. Immunizations - except those immunizations provided as part of the well-child health supervision services or when necessary as a result of an accident. 18. Any services provided for preventive care - except those services provided as part of the well-child health supervision services or those services obtained through the $100 Health Screening benefit (see page 22). 19. All services, supplies, and prescription drugs related to obesity or weight reduction except: .... medically necessary intestinal or stomach by-pass surgery, or ... medically related services, excluding prescription drugs, provided as part of a weight loss program when weight loss is required by the covered person's surgeon before performing a medically necessary covered surgical procedure. Coverage for these services is limited to $150 in any 12-month period. 20. Any service or supply to eliminate or reduce a dependency on or addiction to tobacco, including but not limited to nicotine withdrawal programs, Nicorette gum or nicotine patch. 21. Any service or supply to correct baldness. 22. Services or supplies necessary to provide a testicular prosthesis. 23. Surgery to reverse surgical sterilization procedures. 24. Services or supplies necessary to treat sexual deviations and disorders or psychosexual dysfunction. 25. Services or supplies provided in connection with intersex surgery. 26. Insertion of penile prosthesis except when necessary in the treatment of organic impotence resulting from: ... diabetes mellitus .... peripheral neuropathy ... medical endocrine causes of impotence ... arteriosclerosis/postoperative bilateral sympathectomy ... spinal cord injury ... pelvic-perineal injury .... postprostatectomy ... postpriapism ~ epispadias and exstrophy. 29 28 9. Services and supplies for dental work, dental treatment, or dental examinations unless ... necessary as a result of an accident while covered by this health plan (see page 11) .... it is medically necessary to be provided by a hospital, ambulatory surgical center, outpatient healthcare facility or skilled nursing facility. Only facility charges are covered in this circumstance; physician services (including general and specialty dentists and oral surgeons) are not covered. Services must be provided within 120 days of the accident unless a written explanation from the dentist or physician stating any extenuating circumstances requiring treatment over a longer period of time is received and approved by BCBSF as medically necessary within 120 days. In no instance will any services be covered unless provided within 120 days of the termination of the person's coverage. In no case is orthodontia covered. 10. Services, supplies, care or treatment provided by: ... a person who usually lives in the covered person's home ... a person or facility that is not included as covered in this booklet. 11. Services and supplies for treating or diagnosing refractive disorders (vision errors which can be corrected with glasses) including eye glasses, contact lenses, or the examination for the prescribing or fitting of eye glasses or contact lenses, unless required because of an accident or cataract surgery that occurred while covered by this health insurance plan. This health insurance plan will cover the first pair of eye glasses or contact lenses following an accident to the eye or cataract surgery. 12. Hearing aids or the examination, including hearing tests, for the prescription or fitting of hearing aids. Hearing tests associated with a covered ear surgery or for the diagnosis of a covered condition are covered. 13. Services and supplies provided by a specialty facility or residential facility except as described on page 18. 14. Elective abortions, performed at any time during a pregnancy. 15. Services related to the pregnancy of eligible dependent children, except medically necessary services for these complications of pregnancy: ... conditions not related to pregnancy but adversely affected by pregnancy ... conditions that are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity ... a non-elective Cesarean section ... an ectopic pregnancy which is terminated ... a spontaneous termination of pregnancy that occurs before the twenty-second week. Complications of pregnancy do not include false labor, occasional spotting, physician- prescribed rest during the pregnancy, morning sickness, hyperemesis gravidarum, pre- eclampsia and similar conditions associated with the management of a difficult pregnancy that do not constitute a nosologically distinct complication of pregnancy. Services Not Covered By The Plan The following services and supplies are excluded from coverage under this health insurance plan unless a specific exception is noted. Exceptions may be subject to certain coverage limitations. 1. Cosmetic surgery or treatment, unless it is: .... a result of a covered accident if the accident happens and the surgery or treatment is performed while the person is covered by this health insurance plan ... for correction of a congenital anomaly for an eligible dependent born while the employee has family coverage and performed while the dependent is covered by this health insurance plan ... a medically necessary procedure to correct an abnormal bodily function ... for reconstruction to an area of the body that has been altered by the treatment of a disease, provided the alteration occurred while the person was covered by this health insurance plan ... for breast reconstructive surgery and the prosthetic devices related to a mastectomy. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons as determined by a licensed physician, and "breast reconstructive surgery" means surgery to reestablish symmetry between the two breasts. 2. Services and supplies received as a result of war or act of war while in any active military, naval or air service. 3. Services, supplies or treatment provided without charge. 4. Any services or supplies which are not medically necessary; as determined by BCBSF clinical staff and DSGL 5. Services or supplies received as a result of injury or disease caused by the covered person's participation in a crime punishable as a felony or illegal occupation. 6. Services or supplies received as a result of an intentional self-inflicted injury whether the covered person was sane or insane. An injury is considered to be intentional if the covered person intended to perform the act that caused the injury, regardless of whether the covered person intended to cause the injury. 7. Services for any occupational condition, ailment or injury arising out of or in the course of employment by any employer. The covered person will not be eligible for benefits from this health insurance plan, even if the covered person waives rights to the benefits or services mentioned above. 8. Services provided to a covered person under the laws of the United States or any state or political subdivision. The covered person will not be eligible for benefits from this health insurance plan, even if the covered person waives rights to the benefits or services mentioned above. 27 26 If you do not receive a certificate of coverage from your previous plan, you can show creditable coverage by providing: .... a schedule of benefits or summary of benefits for the previous health insurance coverage and ... a dated letter from your previous employer, insurance company or plan administrator showing a list of the persons covered by the insurance and a beginning and ending date of coverage for each person. If the coverage is still in effect, the letter must state that the coverage has not ended. Requesting a Pre-Existing Condition Waiver You or your agency personnel office(er) can submit your request for a pre-existing condition waiver to DSGI. Waiver requests should be mailed to the attention of the "Pre-Existing Waivers Coordinator." To request a pre-existing condition waiver, you must include: ... the employee's Social Security number .... the name of each person for whom the waiver is requested, and ~ the Certificate of Health Insurance Coverage (or Portability) - or the schedule of benefits or summary of benefits and a letter from the previous employer, insurance company or plan administrator as described above. Once DSGI has determined your creditable coverage and how it affects the pre-existing condition limitation, DSGI will notify you by letter and modify your enrollment records to reflect a full or partial waiver. The medical claims administrator, BCBSF, will review your claims history and reprocess any claims related to a pre-existing condition if necessary. If you know you have a pre-existing condition, submit your request for a waiver as soon as you enroll in this health insurance plan so claims can be paid correctly. Waiving Some or All of the Pre-Existing Condition I.imitations If you enroll as a new hire, this plan does not cover pre-existing conditions until you have been employed for 12 months - or 365 days. When you add coverage during the annual open enrollment period or because of a change in status (qualifying event) or special enrollment period event, this plan does not cover pre-existing conditions for 12 months from the effective date of coverage. Creditable coverage from a previous health insurance plan, however, can reduce or eliminate this 12-month pre-existing condition limitation. An Example: This example shows how creditable coverage under a previous plan can reduce the pre-existing condition limitation under this health insurance plan. For this example, assume this employee: .... is hired as an eligible employee 1/1/1999 ... enrolls for coverage under the health insurance plan, effective 3/1/1999 .... was treated for a knee injury several times during the six months before date of hire ... has four months of creditable coverage without a break in coverage under a previous health plan Because this employee has four months of creditable coverage, the limitation on coverage for the pre-existing condition - the knee injury - is reduced to eight months. This means this health insurance plan will cover the knee injury starting 9/1/1999 - eight months from this employee's date of hire. Proving Creditable Coverage Generally; when your coverage under a previous health care plan ends, you will receive a Certificate of Health Insurance Coverage (or Portability). This certificate should include the name of each person covered by the policy; the beginning and ending dates of coverage, and whether the coverage is still in effect. If you do not receive a certificate of coverage from your previous plan within a reasonable length of time after coverage ends, contact your previous plan administrator. Some health plan providers - including Medicaid, the Indian Health Service and CHAMPUS - do not automatically provide a certificate when your coverage ends. In this case, you should contact the plan administrator and request a certificate of coverage. 25 24 limitcJtions And fxclusions Pre-fxisting Conditions and Creditable Coverage Pre-Existing Conditions A pre-existing condition under this health insurance plan is any condition for which you or your eligible dependents received medical advice or treatment within six months of: ... your date of hire if you enroll as a new hire ... January 1 if you are adding coverage during the annual open enrollment period, or ... the date your coverage becomes effective if you are adding coverage because of a qualified status change event or special enrollment period event. Pre-existing conditions do not include covered services related to domestic violence, pregnancy or medical treatment of a newborn or newly adopted child of a covered employee or dependent, as long as the child is enrolled in this health insurance plan within 31 days of its birth, adoption or placement for adoption. This plan does not pay benefits for pre-existing conditions that would otherwise be considered a covered service until: ... you have been employed for 12 months - or 365 days - if you enroll as a new hire, or ... your coverage has been effective for 12 months - or 365 days - if you add coverage during the annual open enrollment period or because of a change in status qualifying event or special enrollment period event. Credit for Previous Coverage The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that group health plans give credit for prior coverage when applying pre-existing condition limitations. You will receive credit for previous healthcare coverage, as long as you do not have a break in coverage of 63 or more days. This is called "creditable coverage." Your creditable coverage equals the number of days you were covered by your previous plan. COBRA coverage also counts as creditable coverage, as long as you do not have a break in coverage of 63 or more days between the time COBRA coverage ends and the time you become covered by this health insurance plan. If you use a non-network provider, the Health Screening benefit will pay the non-network provider's charge up to the non-network allowance for the service up to the $100 annual maximum for Health Screening benefit. If the payment for any health screening procedure is less than $100, any remaining balance can be used toward additional routine procedures for the remainder of the year. Services that are submitted for payment after you have exhausted your $100 Health Screening benefit will be denied as non-covered services. You will be responsible for 100% of the provider's charges regardless of the provider's network status. About Maternity Care - Coverage for Mothers And Newborns Under federal law, group health plans offering group health insurance generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by Cesarean section. However, the plan may pay for a shorter stay if the attending provider - for example, the physician, nurse midwife or physician assistant _ after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour or 96-hour stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan may not, under federal law, require that a physician or other healthcare provider obtain authorization for prescribing a length of stay up to 48 hours - or 96 hours. However, to use certain providers or facilities, or to reduce your out-of-pocket costs, you may be required to obtain precertification. See page 9 or contact BCBSF for information about precertification. Coverage for care for a mother and her newborn infant includes coverage for a post partum and newborn assessment. In order for such services to be covered under the Plan, the care must be provided at a hospital, an attending physician's office, an outpatient maternity center, or in the home by a qualified licensed health care professional trained in care for a newborn and mother. Coverage for these services includes coverage for a physical assessment of the' newborn and mother, and the performance of any medically necessary clinical tests and immunizations in accordance with prevailing medical standards. 23 22 Surgery for Breast Reduction ... Payment for a reduction mammoplasty - which is surgery to reduce the size of the breast and the skin envelope - is not covered unless the patient is experiencing all of the following physical problems: ... back or neck pain requiring repeated treatment, .... deep grooves in the shoulder from bra straps, and ... dermatitis requiring long-term treatment with prescription medications and ... the amount of tissue to be removed from each breast, according to the pathology report, is at least ... 400 grams for patients 5'2" tall and 110 pounds or less, or .... 500 grams for patients over 5'2" tall and 111 pounds or more. ... If fewer grams of tissue are to be removed from each breast, benefits may still be paid if: ... your doctor sends a written request for approval to BCBSF before the surgery documenting the physical problems and estimating that the amount of tissue to be removed would be equal to or greater than the above numbers .... BCBSF recommends approval of the request and DSGI approves the request ... your doctor documents the medical reason why the actual amount of tissue was less than the guidelines, BCBSF recommends approval and DSGI approves the lesser amount. About The Health Screening Benefit- Coverage for Active fmployees and COBRA Participants Each year, active employees covered under this Plan and former active employees with COBRA coverage are eligible for a $100 Health Screening benefit. The benefit covers up to $100 toward the cost of: ... physical exams ... gynecological exams .... routine eye tests ... routine hearing tests ... tests associated with routine exams (lab work, EKGs) .... prostate specific antigen (PSA) tests (males age 50 years and above). These tests must be for routine care only, not for a medical diagnosis. Immunizations are not covered. If you use a network provider, the Health Screening benefit will pay the provider's charges up to the network allowed amount for the service up to the $100 annual maximum. If payment for any health screening procedure is less than $100, any remaining balance can be used toward additional routine procedures for the remainder of the year. Services that are submitted for payment after you have exhausted your $100 Health Screening benefit will be denied as non-covered services. You will be responsible for 100% of the provider's charges regardless of the provider's network status. other SpecialUmits On Benefits for Covered Services Doctor's Care There are some special limits on how doctor visits will be covered by this health insurance plan. .... Whenever you are receiving medical care related to surgery, additional inpatient visits from your doctor are covered only if: ... you need medical care that is not related to your surgery and is not part of your pre- operative or post-operative care .... you are hospitalized for medical care and the need for surgery develops after you are first admitted to the hospital. In this case, payment for doctor visits for other medical care will generally end on the date of surgery. ... Non-surgical inpatient doctor visits are limited to one visit by one doctor each day. Visits from other doctors may be covered, however, if needed because of the severity or complexity of your condition. ... Inpatient or outpatient visits to one doctor for a non-surgical condition - or related conditions - are limited to one visit a day. ... Outpatient doctor visits on the same day you have inpatient surgery will not be covered unless the outpatient visit is unrelated to your surgery or is with a doctor who is not performing your surgery. ... Outpatient office visits on the same day you have outpatient surgery will not be covered if the charge for the office visit is determined by BCBSF to be included in the surgery charge. An office visit to a doctor who is not performing your surgery will be covered. Surgical Procedures If more than one surgical procedure is performed at the same time, the primary procedure will be covered at the usual benefit level for the type of provider - meaning the percentage payable for network or non-network providers. For the secondary procedure, however, this health insurance plan will pay the lesser of: ... 50% of the network allowed amount for network care or 50% of the non-network allowance for non-network care, or ... 100% of the doctor's fee. This health insurance plan will not pay any benefits for an incidental procedure performed through the same incision as the primary surgical procedure. 21 34 An Example - Using A Non-Participating Pharmacy: Suppose you fill a prescription for a brand name drug with an AWP of $50 and a retail price of $85. You will pay $85 for the prescription and submit a claim for reimbursement. You will be reimbursed: 82% of $50 (AWP) plus the fill fee minus your copayment $41.00 + $ 4.28 - $20.00 total reimbursement $25.28 In this example, the cost to you for using a non- participating pharmacy is $59.72 ($85.00 retail price minus reimbursement of $25.28). If you had filled this prescription at a participating pharmacy and your physician requested the brand name drug, you would have paid only the $20 copayment. Using the Mail Order Program If you are taking a maintenance drug - blood pressure medication, for example - you may want to use the prescription drug mail order program to order up to a 90-day supply. To use mail order, you: ... complete a mail order form available from your agency personnel office (er) .... enclose your prescription written for a 90-day supply, and the appropriate copayment. Using a Participating Pharmacy When you take your prescription to a participating pharmacy, simply present your prescription drug program card to the pharmacist. You will pay a copayment for up to a 30-day supply of each covered prescription: $7 for a generic drug $20 for a brand name drug when no generic is available or if your doctor writes on the prescription "dispense as written" or "brand name medically necessary" $20 plus the difference in the plan's cost between the brand name and the generic if a generic is available and you - rather than your doctor - request the brand name drug. What If You Request A Brand Name At A Participating Pharmacy? If your prescription is filled with a generic, you pay only the $7 copayment. If a generic isn't available _ or if your doctor writes on the prescription "dispense as written" or "brand name medically necessary" _ you pay a $20 copayment forthe brand name. But if you request a brand name instead of an available generic, you will pay: The brand name copayment - $20 plus The difference between the plan's cost for the brand. name drug and the plan's cost for the .genericdrug. Take a look at an example showing how this works. In this example, you are using a network pharmacy. At network pharmacies, the plan's.cost for a. drug is less than the full retail price. Assume you request a brand name drug that costs the plan ..$50 instead of the available generic substitute that costs the. plan $25 - in this case, you would pay: Brand name + copayment Plan's cost difference between brand name and generic = Your cost $20 + brand $50 = $45 generic - $25 $25 There is no paperwork when you use your prescription drug program card at a participating pharmacy. The pharmacist files claims for you. Using a Non-Participating Pharmacy To receive prescription drug benefits when you use a non-participating pharmacy, . you must pay the full retail price for your prescription and file a claim for reimbursement. You will not be reimbursed in full for prescriptions filled at a non-participating pharmacy. If you fill your prescriptions at a non- participating pharmacy you will be reimbursed at 82% of the average wholesale price (AWP) for brand name drugs or 75% of the maximum allowable cost for generic drugs, plus a $4.28 fill fee, minus your copayment amount. You pay any amount above the AWP. A fill fee is a fee that every pharmacist is paid for filling a prescription under the plan in addition to the cost of the drug. See the example on the next page for more on how reimbursement works when you use a non-participating pharmacy. 33 Drugs That Are Not Covered By The Prescription Drug Program The prescription drug program does not cover: ... Oral contraceptives when used solely for birth control ... Retin-A for cosmetic purposes .... Anti-obesity drugs and amphetamines and/or anorexiants for weight loss .... Devices or appliances .... Non-federal legend - or over-the-counter - drugs .... Drugs labeled "Caution - Limited by Federal Law to Investigational Use," or experimental drugs, even though a charge is made .01lIl Nicorette and similar drugs to deter smoking .... Immunization agents .01lIl Medication that is covered by Workers' Compensation or Occupational Disease Laws or by any state or governmental agency .... Medication furnished by any drug or medical service for which no charge is made .... Viagra, for psychosexual disorders, females, and males under the age of 18. The plan's general limitations and exclusions may also apply to the prescription drug program. See pages 27 to 31 for a complete listing of plan limitations and exclusions. The copayments for the mail order program are the same as the copayments when you use a participating retail pharmacy, but you receive up to a 90-day supply for a single copayment - as long as the prescription is written to allow a 90-day supply to be dispensed. The copayments are: ... $7 for a generic drug ... $20 for a brand name drug when no generic is available or if your doctor writes on the prescription "dispense as written" or "brand name medically necessary" ... $20 plus the difference in the plan's cost between the brand name and the generic if a generic is available and you - rather than your doctor - request the brand name drug. Your medication will be mailed to your home within one to two weeks after your order is received. Drugs That Are Covered By the Prescription Drug Program Covered drugs include: ... Federal legend drugs ... State restricted drugs ... Compounded medications ... Insulin and other covered injectable medications ... Needles and syringes for insulin and other covered injectables ... FDA-approved glucose strips, tablets and lancets. Some medications require pre-approval before your prescription can be filled. Your pharmacist will let you know if your prescription requires pre-approval. If it does, you will need to provide a letter from your doctor stating that the medication is medically necessary. You can send this letter to: Eckerd Health Services P.O. Box 9062 Clearwater, Florida 34618 or Fax it to (727) 395-7892. Your pharmacist can tell you whether your prescription has been approved, 24 hours after your doctor's letter has been received by Eckerd Health Services. 3S If the patient's alternative treatment plan is approved by BCBSF, recommended services will be paid at 100% of the charge negotiated by BCBSF. The case management alternative treatment plan will end if: ~ the patient's condition changes and the level of care provided under case management is no longer necessary ~ the patient has reached the plan's $1,000,000 maximum lifetime benefit ~ the case management approach costs more than traditional benefits ~ the patient is no longer eligible to take part in this health insurance plan. Patient-Auditor Program Sometimes providers make a mistake and overcharge a patient. This may result in an overpayment of the claim by this health insurance plan. If you discover an overpayment from: .... a charge for a covered service or supply that the covered person did not receive .... a charge higher than the amount previously agreed to in writing by the provider in a pre- treatment estimate, other than charges for complications or procedures that were not anticipated .... a charge that is part of an arithmetic billing error you may receive 50% of any amount the health insurance plan recovers - up to a maximum of $1,000 per inpatient stay or outpatient claim. Report any suspected overcharges to DSGI. Worldwide Coverage This health insurance plan will pay benefits for covered services anywhere in the world you receive them. When you receive medical care while traveling in another country, you must submit a claim to receive benefits and the claim form must include a description of services in English and charges in US dollars. See pages 46 and 47 for information on filing claims - including time limits. Special Plan features Healthy Addition@ Pre-Natal Education Program Healthy Addition@ is BCBSF's prenatal education and early intervention program. It is designed to educate pregnant employees or eligible spouses about appropriate prenatal education and care - including monitoring of high-risk pregnancies. Under this voluntary program, trained nurses will screen pregnant employees or eligible spouses for potential risk factors and assist in the development of a personalized educational and monitoring program. To participate in the Healthy Addition@ program, call BCBSF at 1-800-825-2583. A member of the prenatal nursing team will Contact you or your spOuse to begin helping you with your new family addition. Personal Health Advisor@ Program The Personal Health Advisor@ Program, a product of Access Health, Inc., is a healthcare information service offered through BCBSF. The program is designed to help you make more informed and appropriate healthcare decisions. The Personal Health Advisor@ Program includes: .... an extensive audio health library available in English and Spanish, plus follow-up literature .... access to registered nurses available to discuss health issues and provide personalized health information research, preventive education, chronic disease and treatment/ procedure education, and general information about immediate health problems .... information on network hospitals, physicians or other healthcare resources. To use the Personal Health Advisor@ Program, call 1-800-667-2546. This confidential service is available 24 hours a day, 7 days a week. Medical (ase Management Program Through this program, BCBSF helps coordinate alternative treatments when a covered person is faced with a serious or complicated medical condition. These alternative treatments may include services that are not usually covered by this health insurance plan. The medical case management program is voluntary. Healthcare professionals will review the case with the patient, the patient's family and doctor and, if appropriate, suggest an alternative treatment plan. The patient and the patient's doctor must agree to the suggested treatment plan. 37 Coordination Of Benefits With Other Coverage Coordination With Other Group Insurance Plans If you, your spouse or your dependents are covered by this health insurance plan and any other group medical insurance plan, no-fault automobile insurance, health maintenance organization or Medicare, benefits from this health insurance plan will coordinate with any other benefits you receive. When benefits are coordinated, the total benefits payable from both plans will not be more than 100% of the total reasonable expenses. The term "group medical insurance plan" means a plan provided under a master policy issued to: an employer the trustees of a fund established by an employer or by several employers employers for one or more unions according to a collective bargaining agreement a union group, or any other group to which a group master policy may be legally issued in the State of Florida or any other jurisdiction for the purpose of insuring a group of individuals. In accordance with s.627.4235(5), Florida Statutes, this plan will not coordinate benefits with an indemnity-type policy, an excess insurance policy as defined by Florida law, insurance that covers only specific illnesses or accidents, or a Medicare supplement policy. In order to ensure claims processing accuracy and appropriate coordination of benefits, DSGI requires that BCBSF verify if you, your spouse, or your other dependents have other insurance coverage or other carrier liability (OCL). Each year, approximately 365 days from the previous verification, you will be notified by BCBSF, on an explanation of benefits statement, that you should contact its office, by mail or telephone (800-477-3736), to verify OCL information. BCBSF will automatically process or reprocess any claims, which may have been denied or suspended, once you have provided the requested OCL information. BlueCard@ PPO Program The BlueCard@ Program is a national Blue Cross and Blue Shield Association program available to you through BCBSF. Subject to the program's rules, you and your covered family members can take advantage of the provider discounts of other Blue Cross and/or Blue Shield PPO Plans across the country. The BlueCard@ PPO Program is not available for anyone who has Medicare as their primary coverage. When you are outside of BCBSF's service area and need health care, call 1-800-81O-BLUE (2583) for the name of a participating Blue Cross and/or Blue Shield Plan PPO provider in the area. When you present your ID card, the provider will verify your coverage and handle any claims-related paperwork. When you use a local Blue Cross and/or Blue Shield Plan's PPO provider through the BlueCard@ PPO Program, this health insurance plan pays network level benefits for covered services. You are responsible for any applicable deductibles, copayments, coinsurance, and charges for non-covered services. Providers who participate in the BlueCard@ PPO Program have agreed to accept negotiated amounts for covered services, so you will not receive an unexpected bill for amounts above those negotiated amounts. Also, please note that this health plan's calculation of your coinsurance and other out-of-pocket expenses for covered services will be at the lower of the allowed amount or the PPO network provider's billed charges. Here is an overview of how claims and benefits work, depending on the provider you use. ... If you receive care from a BlueCard@ participating provider because a BlueCard@ PPO provider is not available to you, the provider files your claims for you and you receive network benefits. You are not responsible for charges above the network allowed amount. ... If you receive care from a BlueCard@ participating provider when a BlueCard@ PPO provider is available, the provider still files claims for you, but you receive non- network benefits. You are not responsible for charges above the non-network allowance. ... If you receive care from a non-network provider not associated with the BlueCard@ program, your claims are processed as non-network and you must file your own claims. This plan will pay non-network benefits. You are responsible for charges above the non-network allowance. In some areas, state law may affect how this health insurance plan pays benefits for services provided through the BlueCard@ PPO Program. And, in a limited number of areas, the local Blue Cross and/or Blue Shield Plan may not have a PPO network available. So please call 1-800-81O-BLUE (2583) to verify availability before receiving services. 39 Coordination With Medicare It is important for you or your dependents to enroll for Medicare coverage when you first become eligible. Active Employees If you are an active employee enrolled in Medicare Part A or Part B, this health insurance plan will pay benefits for you and your dependent spouse first. Medicare will pay second. However, if this health insurance plan's payment is above what Medicare would normally allow for the service if Medicare were paying first, Medicare will not pay benefits. If you are an active employee or the spouse of an active employee and became eligible for Medicare because of age or disability, you may choose to defer Medicare Part B benefits until you or your spouse retires. For active employees with a dependent who is disabled for reasons other than end-stage renal disease, this health insurance plan will pay benefits first for the disabled dependent until he or she reaches age 65. At age 65, Medicare becomes the primary plan and will pay benefits first for any disabled dependent other than the spouse. If the disabled dependent is your spouse, your spouse's coverage under this health insurance plan will continue to be primary, paying benefits first, as long as you are an active employee. If you or your covered dependent requires treatment for end-stage renal disease, this health insurance plan will pay benefits first for the first 30 months of treatment and Medicare will pay second. After that, Medicare will pay benefits first and this health insurance plan will pay benefits second. If you become eligible for Medicare because of age or disability, before becoming eligible due to end-stage renal disease, however, Medicare would continue to pay first as your primary carrier and this health insurance plan would pay second. Retired Employees If you are a retiree, the spouse of a retiree, or the surviving spouse of a retiree enrolled in Medicare, Medicare will pay benefits for you first. This health insurance plan will pay benefits second. If you are eligible for Medicare but you have not enrolled, benefits from this health insurance plan will still be paid as if Medicare had paid first as the primary plan. Benefits from this plan and from Medicare will never be more than 100% of total reasonable expenses. Also, when this health insurance plan is secondary, it will not pay benefits above what it normally would pay if it was the primary plan. If you are covered under this health insurance plan through COBRA and become eligible for Medicare, coverage under this plan will end. Your dependents may generally continue their COBRA coverage. When Medicare is primary, this health insurance plan will pay benefits up to: ... the covered expenses Medicare does not pay, up to the Medicare allowance ... the amount this health insurance plan would have paid if you had no other coverage ... whichever is less. 42 Here are two examples showing how coordination of benefits with Medicare works. In both examples, assume that the provider accepts Medicare assignment - meaning the provider agrees to accept the Medicare allowance as full payment and will not bill the patient for any amount above the Medicare allowance. How Coordination Works The plan that considers expenses first is the primary plan. The plan that considers expenses after the primary plan pays benefits is the secondary plan. ~ If this health insurance plan is primary, it will pay benefits first. Benefits will be paid as they normally would under this plan, regardless of your other insurance coverage. ~ If this health insurance plan is secondary, it will pay benefits second. In this case, benefits from this health insurance plan and from the primary plan will not be more than 100% of total reasonable expenses. Also, when this health insurance plan is secondary, it will not pay benefits above what it would pay if it was the primary plan. Here are some guidelines for determining which plan pays first _ or is the primary plan _ and which plan is the secondary plan. For All Covered Individuals ~ The plan covering a person as an employee or member, rather than as a dependent, pays first. .... The plan covering a person as an active employee, or that employee's dependent, pays before the plan that covers a person as a laid-off or retired employee, or that employee's dependent. In a case where the other policy or plan does not have this rule and the plans do not agree on the order of benefits, this rule will not apply. For Eligible Dependent Children ~ The plan of the parent whose birthday comes first in the calendar year pays first for covered dependent children, unless the parents are divorced or separated. If both parents have the same birthday, the plan that has covered the parent for the longest time pays first. ~ In the case of divorce or separation, the plan of the parent with custody pays first, except where a court decrees otherwise. ~ If the parent with legal custody has remarried: .... the plan of the parent with legal custody pays first ~ the plan of the spouse of the parent with custody pays second .... the plan of the parent without custody pays last .. . unless a court decrees otherwise. . If this plan coordinates benefits with an out-of-state plan that says the plan covering the male parent pays first - and the two plans do not agree on the order of benefits _ the rules of the other plan will determine the order of benefits for eligible dependent children. If none of the rules listed in this section apply, the plan that has covered a person for the longest time pays first. 41 44 Next, Medicare benefits are calculated. Medicare Allowance Minor Surgery $150 Lab Work $ 10 Lab Work $ 10 Medicare deductible -$75 -$ 0 -$ 0 Medicare payment (80%) $60.00 $10.00 $10.00 $80.00 =$75 =$10 =$10 What Medicare doesn't pay $90 $ 0 !....Q $90 In this example, $125 would be applied to this health insurance plan's non-network deductible, so this plan would not pay anything even if you had no other coverage. You owe the amount that Medicare does not pay - $90. An Important Note For Retirees If you are not yet eligible for Medicare but your spouse is, the provider will file claims for your spouse directly to Medicare. Once your spouse receives the Explanation of Medicare Benefits statement showing that the claim has been processed by Medicare, your spouse then must file a separate claim with BCBSF until you, the retiree and former employee of the State of Florida, become eligible for Medicare. Once you become eligible for Medicare, any claims filed with Medicare for you or your spouse will automatically be filed with BCBSF after Medicare pays what is covered. No separate filing to BCBSF will be required. Example 1# Network Office Visit Assume you go to the doctor for an office visit that includes an x-ray. The doctor's normal charge for these services would be: Jype of Service Office Visit: Radiology: Charge $60 $30 First, this health insurance plan benefits are calculated as if you have no other coverage. Network Allowance Office Visit: $50 Radiology: $25 minus per visit network copayment -$10 -$ 0 Next, Medicare benefits are calculated. Medicare Allowance Office Visit: $40 Radiology: $20 Medicare deductible -$0 -$0 =$40 =$25 =$40 =$20 Total this plan would pay (90%) $36.00 $22.50 $58.50 Medicare payment (80%) $32.00 $16.00 $48.00 What Medicare doesn't pay $ 8 $ 4 $12 In this example, the amount Medicare does not pay - $12.00 - is less than the amount this health insurance plan would pay if you had no other coverage - $58.50. This health insurance plan will pay $12.00 to the provider. You will not pay anything for these services because this health insurance plan payment and Medicare payment together equal the Medicare allowance. Example 2 - Non-network Office Visit For this example, assume the person goes to the doctor for minor surgery and lab work. The doctor's normal charge for these services would be: Jype of Service Minor Surgery Lab work Lab work Charge $200 $ 15 $10 First, this health insurance plan benefits are calculated as if you have no other coverage. Non-network Allowance Minor Surgery Lab work Lab work $100 $ 15 $ 10 Expenses applied to non-network deductible $100 $ 15 1-l..Q $125 What this plan would pay $0 $0 $0 $0 43 46 How To file A Claim Medical Claims When You Use Network Providers When you go to a network provider, you do not need to file a claim.1 This includes providers in the PPOm Network, the BlueCard@ Program, and other participating (PPS or PHS) BCBSF I providers. The provider will file the claim for you and you will be re$ponsible for paying any coinsurance, deductibles, copayments and non-covered services. The third party administrator, BCBSF, will process the claim in accordance with plan benefits, usually within 30 days of receipt. BCBSF will send you an "Explanation of Benefits," also called an EOB form, that will give you important information about your claim. When You Use Non- Network Providers If you go to a non-network provider, you will be responsible for filing your own claim. You must file the claim within 16 months of the day you received services or supplies. Benefits will be paid directly to you. You can get medical claim forms from BCBSF, DSGI or your agency personnel office. To submit the claim: ... Complete all information on the claim form, as indicated. .... Attach original bills to the claim form - make sure the bills include the patient's name, date, place and nature of treatment, procedure and diagnosis codes, and the physician's name and federal tax ID number. Statement if you want If you have filed a duplicate claim with another health insurance plan or with Medicare, include a copy of the other plan's Explanation of Benefits (EOB) statement with your claim form. PionS Right To Recover And Sue for losses This health insurance plan reserves the right to be reimbursed for benefits paid under this plan if the covered person has a right to recover those benefits from a third party. This provision helps the State continue providing cost-effective healthcare benefits. You will not be asked to reimburse this plan for an amount higher than the actual payments it made on your behalf. If you or your dependents receive plan benefits for a claim that is in connection with a condition caused, directly or indirectly, by an intentional act or from the negligence or fault of any third person or entity; this health insurance plan will be subrogated to the right of recovery you or your dependent has against the other person or entity. This health insurance plan's subrogation rights apply to any settlement of a claim, regardiess of whether there is a lawsuit, and will not be off-set by any premiums you have paid. This right to subrogation will be for the amount of benefits paid by this plan for healthcare services. You, your dependent or your legal representative, will be required to: ... provide this plan with information pertaining to your settlement, settlement negotiations or litigation ... provide the assistance necessary to enforce this right to subrogation ... notify BCBSF of any settlement negotiations before entering into any settlement agreement ... notify BCBSF of any amount recovered from the person or entity that may be liable ... obtain the prior written consent of BCBSF or DSGI before entering into any settlement agreement. No waiver, release of liability or other documents you execute without notice to BCBSF shall be binding upon this health insurance plan. 45 48 Appealing a Denied Claim If your benefit claim is totally or partially denied, BCBSF or Eckerd Health Services will send you a written notice on an Explanation of Benefits (EOB) statement stating the specific reason(s) for the denial within 30 days of receiving your claim. The notice will include a list of any additional information needed to appeal the denial to BCBSF or Eckerd Health Services. Appealing to the Third Party Administrator - A level I Appeal You or your authorized representative can appeal a claim that is denied within 90 days of receiving the EOB denial notice. Your written appeal should include any information, questions or comments you think are appropriate. Mail your written appeal to the third party administrator - BCBSF for medical claims or Eckerd Health Services for prescription drug claims - at the address shown on the inside cover of this booklet. The third party administrator will review your claim and provide you with a written notice of the review decision. On this notice, you will also receive information about appealing the decision to DSGI. Appealing to DSGI- A level I! Appeal If you are not satisfied with the first appeal decision given by the third party administrator, you may make a second appeal through DSGI. After you have asked the third party administrator to review your claim and you have received their written notification, you may submit a second appeal to DSGI. Your written appeal to DSGI should include: ... a copy of the EOB ... a copy of your letter requesting the third party administrator to review the claim ... a copy of the third party administrator's written notice of their review decision ... a letter to DSGI appealing the decision, and ... any other information or documentation you think is appropriate. Mail your written appeal to DSGI at the address shown on page i. Send your appeal to the attention of the '~ppeals Coordinator." Requesting an Administrative Hearing If you want to contest the second appeal decision, you must submit a petition for an administrative proceeding that complies with section 28-106.201 or 28-106.301, Florida Administrative Code. DSGI must receive your petition within 21 days after you received the written decision on your second appeal. Keep in mind that when you use non-network providers, you are responsible for any charges above the non-network allowance as well as any coinsurance, deductibles, copayments and non-covered services. There may be times when BCBSF will request additional information from you to process your claim. You are responsible for providing the additional information within 30 days of receiving the request. Prescription Drug Claims When You Use A Participating Pharmacy When you use a participating pharmacy, you do not need to file a claim. The provider will file the claim for you and you will be responsible for your copayment. When You Use A Non-Participating Pharmacy If you use a non-participating pharmacy, you will be responsible for filing your own claim. You must file the claim within 16 months of the day you fill your prescription. Benefits will be paid directly to you. You can get prescription claim forms from your agency personnel office(er) or DSGI. To submit the claim: ... Complete all information on the claim form, as indicated. ... Attach original bills to the claim form - make sure the bills include the patient's name, date, pharmacy name, prescription name, quantity dispensed, dosage dispensed, and billed price of medication. ... Send the claim to MedImpact, Inc. the company that provides prescription claims payment services, at the address on the prescription claim form. 47 50 ... ectopic pregnancy which is terminated ... spontaneous termination of pregnancy that occurs before the twenty-second week. Complications of pregnancy do not include false labor, occasional spotting, physician- prescribed rest during pregnancy, morning sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions associated with a difficult pregnancy that do not constitute a nosologically distinct complication of pregnancy. Condition. . . any disease, illness, injury, accident, bodily dysfunction, pregnancy, drug addiction, alcoholism or mental or nervous disorder. Covered provider . . . a person, institution or facility defined in this booklet who furnishes a covered service or supply. When this health insurance plan requires licensing or certification by the State of Florida, the license of the state in which the service or supply is provided may substitute for the Florida license or certificate. Covered services and supplies . . . healthcare services and supplies, including pharmaceuticals and chemical compounds, for which reimbursement is covered under this health insurance plan. The Division of State Group Insurance has final authority to determine if a service or supply is covered, limited or excluded by the plan. Custodial care or services . . . care or services that are maintenance in nature that serve to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered or administered by a trained home care giver. Custodial care essentially is care that does not require the continuing attention of trained medical or paramedical personnel and that can be provided by or taught to home care givers. In determining whether a person is receiving custodial care, consideration is given to the level of care and medical supervision required and furnished. A determination that care received is custodial is not based on the patient's diagnosis, type of condition, degree of functional limitation or rehabilitation potentiaL Care or services that meet this definition are not covered by the health plan. See exclusion 16 on page 29. Diabetes educator . . . a person who is legally certified under state law to supervise diabetes outpatient self-management training and educational services. These services are designed to teach diabetics self-management skills and lifestyle changes to effectively manage diabetes and to avoid or delay complications from diabetes. Dialysis center . . . an outpatient facility certified by the US Health Care Financing Administration and the Florida Agency for Health Care Administration to provide hemodialysis and peritoneal dialysis services and support. Dietician . . . a person who is licensed under Florida law to provide nutritional counseling for diabetes out-patient self-management services. Durable Medical Equipment (DME) provider . . . a person or entity licensed under state law to provide home medical equipment, oxygen therapy services or dialysis supplies in the patient's home under a physician's prescription. , Definitions Of Seleded Terms Used By The Plan Here are definitions of selected terms used by this health insurance plan. Accident . . . an accidental bodily injury that is not related to any illness. Acupuncture . . . a technique for treating certain conditions by passing long, thin needles through the skin to specific points. Acupuncturist . . . a person who is legally qualified and licensed to perform acupuncture. Ambulance . . . any licensed land, air or water vehicle designed, constructed, or equipped for and used for transporting persons in need of medical or surgical attention. Ambulatory surgical center . . . a facility: ... licensed by the appropriate state agency to provide elective surgical care ... to which the patient is admitted and discharged within the same working day, and ... that is not part of a hospital. A facility existing mainly for performing abortions, an office maintained by a doctor for the practice of medicine or an office maintained for the practice of dentistry is not an ambulatory surgical center. Birth center. . . any facility, institution or place where births are planned to occur following a normal, uncomplicated, low risk pregnancy. The facility must be licensed under state law: A facility is not considered a birth center if it is an ambulatory surgical center, a hospital or part of a hospital. Child Health Supervision Services . . . doctor-delivered or doctor-supervised services that include a history, a developmental assessment and anticipatory guidance, and appropriate immunizations and laboratory tests based on prevailing medical standards under the Recommendations for Preventive Pediatric Health Care of the American Academy of Pediatrics. Coinsurance . . . A percentage share of the costs for covered services that you pay after you meet your deductible. Complications of pregnancy. . . complications of pregnancy include: ... conditions not related to pregnancy but adversely affected by pregnancy .... conditions caused by pregnancy, like acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity ... non-elective Cesarean section 49 52 Hospice . . . an autonomous, centrally administered, nurse-coordinated program providing home, outpatient and inpatient care for a covered person who is terminally ill and members of that person's family. At a hospice, a team of healthcare providers assist in providing palliative and supportive care to meet the special needs arising during the final stages of illness _ and during dying and bereavement. This team of providers includes a doctor and nurse and may also include a social worker, a clergy member or counselor and volunteers. Hospital . . . a licensed institution providing medical care and treatment to a patient as a result of illness, accident or mental or nervous disorders on an inpatient/outpatient basis and that meets all the following: ... It is accredited by the Joint Commission on the Accreditation of Hospitals, the American Osteopathic Association or the Commission on the Accreditation of Rehabilitative Facilities. Licensed institutions in rural, sparsely-populated geographic regions, however, may not be required to be accredited. ... It maintains diagnostic and therapeutic facilities for surgical and medical diagnosis and treatment of patients under the supervision of a staff of fully licensed doctors. A facility may be considered a hospital if it does not have major surgical facilities but provides primarily rehabilitative services for treatment of physical disability. ... It continuously provides 24-hour-a-day nursing service by or under the supervision of registered nurses. The term "hospital" does not include a specialty institution or residential facility, or a US Government hospital or any other hospital operated by a governmental unit, unless a charge is made by the hospital that the patient is legally required to pay without regard to insurance coverage. Illness . . . physical sickness or disease, pregnancy, bodily injury or congenital anomaly. For this plan, illness includes any medically necessary services related to non-emergency surgical procedures performed by a doctor for sterilization. Independent clinical laboratory . . . a facility properly licensed under state law where human materials or specimens are examined for the purpose of diagnosis, prevention or treatment of a condition. Intensive care unit . . . a specialized area in a hospital where an acutely ill patient receives intensive care or treatment. Included in the hospital's charge for an intensive care unit are the services of specially trained professional staff and nurses, supplies, the use of any and all equipment and the patient's board. A coronary care unit is also considered an intensive care unit. Manipulative services . . . physical medicine involving the skillful and trained use of the hands to treat diseases or symptoms resulting from misalignment of the spine. Massage therapist . . . a person licensed under Florida law to practice massage therapy. DoctorlPhysician . . . a doctor of medicine (M.D.), doctor of osteopathy (D.O.), doctor of surgical chiropody (D.S.C.) or doctor of podiatric medicine (D.P.M.), who is legally qualified and licensed to practice medicine and perform surgery at the time and place the service is rendered. Doctor also means: ... a licensed dentist who performs surgical or non-dental procedures covered by this plan, or provides treatment of injuries resulting from accidents .... a licensed optometrist who performs procedures covered by this plan .... a licensed psychologist or licensed mental health professional, as defined by state law, who provides covered services ... a licensed chiropractor who performs procedures covered by this plan. To be considered a doctor/physician by this health insurance plan, any healthcare professional must be providing covered services that are within the scope of his or her professional license. Experimental or investigational services . . . any evaluation, treatment, therapy or device that: ... cannot be lawfully marketed without approval of the US Food and Drug Administration or the Florida Department of Health if approval for marketing has not been given at the time the service is provided to the covered person ... is the subject of ongoing Phase I or II clinical investigation, or the experimental or research arm of a Phase III clinical investigation - or is under study to determine the maximum dosage, toxicity, safety or efficacy, or to determine the efficacy compared to standard treatment for the condition .... is generally regarded by experts as requiring more study to determine maximum dosage, toxicity, safety or efficacy, or to determine the efficacy compared to standard treatment for the condition ... has not been proven safe and effective for treatment of the condition based on the most recently published medical literature of the US, Canada or Great Britain using generally accepted scientific, medical or public health methodologies or statistical practices .... is not accepted in consensus by practicing doctors as safe and effective for the condition ... is not regularly used by practicing doctors to treat patients with the same or a similar condition. BCBSF and DSGI determine whether a service or supply is experimental or investigational. Home health aide . . . a person legally certified under state law as having completed an approved course of study and employed by a state-licensed institution or agency. Home heaIthcare agency. . . an agency or institution licensed by the appropriate state agency to provide an approved plan of service for people who are confined and convalescing at home instead of in the hospital. A home healthcare agency may operate independently or as part of a hospital. Organizations or other persons providing home hemodialysis services are not home healthcare agencies. 51 54 Non-network provider. . . covered providers who are not members of BCBSF's PPOm Network or another Blue Cross and/or Blue Shield Plan under the BlueCard@ Program. Nurse anesthetist . . . a registered nurse who administers anesthesia to patients in the operating and delivery room. Anesthesia causes partial or complete loss of sensation and is usually administered by injection or inhalation. Outpatient healthcare facility. . . a licensed facility other than a doctor's, physical therapist's or midwife's office that provides outpatient services for treatment of an illness or accident - other than mental or nervous disorders, drug addiction or alcoholism. Payment for Professional Services (PPS) . . . providers not in the Preferred Patient Care 'm Network but who have an agreement with BCBSF to provide services at a negotiated fee. These providers are also called participating BCBSF providers. Palliative Care . . . reduction or abatement of pain and other troubling symptoms through services provided by members of the hospice team of healthcare providers. Physical therapist . . . a person licensed under Florida law to engage in the practice of physical therapy. Physician assistant . . . a specially trained individual licensed under state law to perform tasks ordinarily done by a physician. Physician assistants work under the supervision of a physician. Preferred Patient Care.m Network (PPOm) . . . a registered trademark name for BCBSF's preferred provider organization network. Prosthetist/Orthotist . . . a person or entity licensed under state law to provide services for the design and construction of medical devices such as braces, splints and artificial limbs under a physician's prescription. Purchasing of Hospital Services (PHS) . . . hospitals not in the Preferred Patient Care.m Network but who have an agreement with BCBSF to provide services at a negotiated fee. Registered dietician . . . a person who is legally certified to provide nutrition counseling for diabetes outpatient self-management services. Registered nurse or licensed practical nurse . . . a person licensed under state law to practice nursing. Registered nurse first assistant . . . a registered nurse who works with a surgeon and has specific knowledge and training in surgical practices. Skilled Nursing Care . . . care furnished by, or under the direct supervision of, licensed registered nurses (under the general direction of the physician) - to achieve the medically desired result and to ensure the covered person's safety. Skilled nursing care may include providing direct care when the ability to provide the service requires specialized and/or professional training, observation and assessment of the participant's medical needs, or supervision of a medical treatment plan involving multiple services where specialized health care knowledge must be applied in order to attain the desired medical results. Medically necessary . . . services required to identify or treat the illness, injury, condition, or mental and nervous disorder a doctor has diagnosed or reasonably suspects. The service must be: ... consistent with the symptom, diagnosis and treatment of the patient's condition ... in accordance with standards of good medical practice ... required for reasons other than convenience of the patient or the doctor ... approved by the appropriate medical body or board for the illness or injury in question, and ... at the most appropriate level of medical supply, service, or care that can be safely provided. The fact that a service is prescribed by a doctor does not necessarily mean that the service is medically necessary. BCBSF and DSGI determine whether a service or supply is medically necessary. Medical supplies or equipment . . . supplies or equipment that are: ... ordered by a physician ... of no further use when medical need ends ... usable only by the particular patient ... not primarily for the patient's comfort or hygiene ... not for environmental control ... not for exercise, and ... specifically manufactured for medical use. Mental or nervous disorder . . . any and all disorders listed in the diagnostic categories of the most recently published edition of the American psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, regardless of the underlying cause, or effect, of the disorder. Midwife . . . a person licensed under state law to assist in childbirth. A nurse midwife has received special training in obstetrics and is qualified to deliver infants. Network allowed amount . . . the maximum amount this health insurance plan will approve for covered services and supplies received from a covered provider who is a member of the preferred provider organization network. Network provider. . . covered providers who are members of BCBSF's ppc>m Network or another Blue Cross and/or Blue Shield Plan under the BlueCard@ Program. Non-Network allowance. . . the maximum amount this health insurance plan will approve for covered services and supplies received from a covered provider who is not a member of the preferred provider organization network. 53 Skilled nursing facility . . . a licensed institution, or a distinct part of a hospital, primarily engaged in providing to inpatients: .... skilled nursing care by, or under the supervision of, licensed registered nurses ... rehabilitation services by, or under the supervision of, licensed physical therapists, and ... other medically necessary related health services. Specialty facility or residential facility . . . a licensed facility providing an inpatient rehabilitation program for the treatment of alcohol or drug abuse or mental or nervous conditions. The program must be accredited by the Joint Commission of the Accreditation of Hospitals aCAH) and licensed by the Department of Children and Family Services. Specialty and residential facilities may also provide outpatient rehabilitation services. Terminally ill . . . means a person has a life expectancy of six months or less because of a chronic, progressive illness that is incurable according to the person's doctor. 55