Item K1M
C ounty of f Monroe
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BOARD OF COUNTY COMMISSIONERS
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Mayor George Neugent, District 2
The Florida. Ke Se
y
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Mayor Pro Tern David Rice, District 4
Danny L. Kolhage, District 1
Heather Carruthers, District 3
Sylvia J. Murphy, District 5
County Commission Meeting
July 19, 2017
Agenda Item Number: K.1
Agenda Item Summary #3162
BULK ITEM: No DEPARTMENT: BOCC District 4
TIME APPROXIMATE: STAFF CONTACT: Tamara Lamarche (305) 289 -6000
9:OOAM
AGENDA ITEM WORDING: Consideration of a motion to reconsider the vote taken on June 20,
2017 at the Special BOCC Meeting on the health insurance plan regarding option #7 of the
proposals, which would phase out the County subsidy for "rule of 70" retires over 5 years (20% per
year) and direction to staff to develop alternate options for Rule of 70 retirees including
reconsideration of Option 7A or other options for July 25 Budget meeting.
ITEM BACKGROUND: Amended Option 7 would phase out the County subsidy provided
towards the monthly premium to Rule of 70 retirees over a five -year period at a reduction of 20% a
year to zero. At the end of the five years, those retirees would pay the full department rate for their
monthly premium going forward. They rely on their County health insurance as their primary
coverage, and will not be eligible for Medicare coverage until age 65.
PREVIOUS RELEVANT BOCC ACTION: At the Spec BOCC meeting of June 20, 2017 to
discuss various changes to the health insurance program for employees, the Board approved Option
7, amended to discontinue the County subsidy for the monthly insurance premium cost to Rule of 70
retirees with a gradual five -year reduction at 20% a year.
CONTRACT /AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION:
DOCUMENTATION:
Spec BOCC June 20 2017
FINANCIAL IMPACT:
Effective Date: January 1, 2018
To Be Determined
07/19/17 502 -08002 - GROUP INS OPERATIONS
To Be Determined
$0.00
REVIEWED BY:
Christine Hurley
David Rice
Bob Shillinger
Kathy Peters
Board of County Commissioners
Skipped
06/29/2017 2:26 PM
Skipped
06/29/2017 12:54 PM
Completed
06/30/2017 4:32 PM
Completed
07/03/2017 1:35 PM
Pending
07/19/2017 9:00 AM
MINUTES
OF THE MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
Special Meeting
Board of County Commissioners
Tuesday, June 20, 2017
Marathon, Florida
A special meeting of the Monroe County Board of County Commissioners convened at
1:30 P.M., at the Marathon Government Center. Present and answering to roll call were
Commissioner Heather Carruthers, Commissioner Danny Kolhage, Commissioner Sylvia
Murphy, Commissioner David Rice and Mayor George Neugent. Also present at the meeting
were Roman Gastesi, County Administrator; Cynthia Hall, Assistant County Attorney; Bob
Shillinger, County Attorney; Kevin Madok, Clerk; Pamela Hancock, Deputy Clerk; county staff,
members of the press and radio; and the general public.
ADDITIONS, CORRECTIONS, DELETIONS
A There were no Additions, Corrections or Deletions to the agenda
EMPLOYEE SERVICES
B1 Christine Hurley, Assistant County Administrator, addressed the Board concerning
direction on recommended changes, from the May 10, 2017 meeting, to the County's Group
Health & Prescription Plan for 2018. The following individual addressed the Board: Lora
Albritton. Glenn Volk, representing Gallagher Bassett, made a Power Point Presentation on the
Fiscal Year 2018 Health Plan Options (HPO). Roman Gastesi, County Administrator; Cynthia
Hall, Assistant County Administrator; Christine Hurley, Assistant County Administrator; and,
Maria Fernandez - Gonzalez, Sr. Benefits Administrator, addressed the Board during the
discussion of the HPO.
The Board voted on the following Benefit and Contribution Changes Recommended for
Fiscal Year 2018:
#13 Dual Option HSA with low option (employees and retirees paying $0); (dependents pay
less) high option (employees and retirees pay more monthly to stay on rich plan). Motion was
made by Commissioner Carruthers and seconded by Commissioner Murphy to approve the item
Roll call vote was taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
06/20/2017 Page 1
#29 Change Primary Care Physician, Behavioral Health and Pre/Post Natal Care from $25.00
to $30.00. Motion was made by Commissioner Murphy and seconded by Commissioner Rice to
approve the item. Roll call vote was taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#2A Increase Urgent Care copay from $25.00 to $50.00. Motion was made by Commissioner
Murphy and seconded by Commissioner Carruthers to approve the item. Roll call vote was
taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#30 Add $10.00 copay for Independent Clinical Lab (Quest). Motion was made by
Commissioner Murphy and seconded by Commissioner Rice to approve the item. Roll call vote
was taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#3A Add $100.00 pharmacy deductible limited to $200.00 per family. Motion was made by
Commissioner Carruthers and seconded by Commissioner Murphy to approve the item. Roll call
vote was taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
06/20/2017 Page 2
Motion carried.
#31 Increase generic drug copay to $15.00. Motion was made by Commissioner Murphy and
seconded by Commissioner Carruthers to approve the item. Roll call vote was taken with the
following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#28 Add $150.00 per month smoker surcharge. After discussion, motion was made by
Commissioner Murphy and seconded by Commissioner Carruthers to add $75.00 per month
smoker surcharge. Roll vote carried unanimously.
#22 Increase brand drug copays from $50.00/$90.00 to $60.00/$100.00 (30 day) and
$150.00/$250.00 (90 day). Motion was made by Commissioner Murphy and seconded by
Commissioner Rice to approve the item. Roll call vote was taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#6 No subsidy for dependents of any retirees. The following individual addressed the
Board: Louis LaTorre. After discussion, motion was made by Commissioner Carruthers and
seconded by Commissioner Murphy to reduce the subsidy by 35% next year (1s year); reduce it
by 70% the following year (2" d year); and eliminate it the following year (3r year). After further
discussion, the motion was withdrawn by the maker. This item was reconsidered later in the
meeting.
#18A All spouses of employees or retirees who have access to coverage through his /her own
employer are ineligible for county insurance. Motion was made by Commissioner Murphy and
seconded by Commissioner Carruthers to approve the item. Roll vote carried unanimously.
06/20/2017 Page 3
Commissioner Carruthers '>
Yes >'
Commissioner Kolhage
No
Commissioner Murphy,'
Yes>
Commissioner Rice
Yes>
Mayor Neugent
Yes>
Motion carried.'
#4A Provide a flat $250.00 subsidy to Medicare eligible retirees ($697.00 - $250.00 =
$447.00). The following individual addressed the Board: Louis LaTorre. Motion was made by
Commissioner Murphy and seconded by Commissioner Rice to approve the item. Roll call vote
carried unanimously.
#19 Conduct dependent eligibility audit (estimated 4% dependent claims). Motion was made
by Commissioner Carruthers and seconded by Commissioner Rice to approve the item. Roll call
vote carried unanimously.
#34 Adopt Envision Select Formulary. Motion was made by Commissioner Murphy and
seconded by Commissioner Carruthers to approve the item. Roll call vote was taken with the
following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#36 Exclude drugs available over the counter (OTC). Motion was made by Commissioner
Murphy and seconded by Commissioner Carruthers to approve the item. Roll call vote carried
unanimously.
#39 Request Clerk audit claims processing. Motion was made by Commissioner Rice and
seconded by Commissioner Murphy to approve the item. Roll call vote carried unanimously.
#40 Exclude CVS from network for all prescriptions. Motion was made by Commissioner
Murphy and seconded by Commissioner Carruthers to approve the item. Roll call vote was
taken with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
06/20/2017 Page 4
Motion carried.
#6 No subsidy for dependents of any retirees. Motion was made by Commissioner
Carruthers and seconded by Commissioner Murphy to phase out the subsidy over a three (3) year
period at 35% the 1s year; 70% the 2nd year; and, 100% the 3r year. Roll call vote was taken
with the following results:
Commissioner Carruthers
Yes
Commissioner Kolhage
No
Commissioner Murphy
Yes
Commissioner Rice
Yes
Mayor Neugent
Yes
Motion carried.
#15 Change Medicare retiree drug coverage from RDS to EGWP. Motion was made by
Commissioner Murphy and seconded by Commissioner Carruthers to consider the item. Roll
call vote carried unanimously.
There being no further business, the meeting of the Board of County Commissioners was
adj ourned.
Kevin Madok, CPA, Clerk
and ex- officio Clerk to the
Board of County Commissioners
Monroe County, Florida
e& � 4, D. C.
06/20/2017 Page 5
TO: County Attorney Robert Shillinger
From; Louis Latorre; County Retiree
Subject: Monroe County Health Insurance of Active employees, Dependent coverage,
and Retirees.
Please be advised of the following facts on Monroe County Health .Insurance
program for the active employees, Dependent Coverage, and Retiree.
In 1980's the Monroe County Commissioners at a board meeting, approved a
motion to allow all county employees who remain with the county for ten (10) years,
that when they retire they will be given "free" Health Insurance. This was a contract
between the employer (Monroe County BOCC) and all it's employees. This is the
reason for this decision by the Monroe County Commissioners.
(1) Since 1973, Monroe County, has been the highest cost of living county in
Florida (#1), to the present.
(2) The county salaries of the employees was deplorable.
(3) The county was experiencing a huge turnover of good employees„ in both
administrative positions, workforce, leaving the county.
(4) The facilities & equipment etc., was in questionable condition etc.
In mid -1990, the county administrator Jim Roberts, question the Health Insurance cost &
liabilities to the County Commissioners which involved the active employees, dependent
coverage, and the retiree. He created a Health Insurance Committee, composed of County staff,
employees from all the various Departments, and the retirees and constitutional employees.
This committee met many times during the years, and made various
recommendations to the County Administrator on how to improve the Health Insurance
program, and various recommendations on reducing cost. Many of the committee
recommendations were approved by the county administrator and commission, and
many were rejected. During Mr. Jim Roberts tenure, this committee met many times
during the years as needed on this subject matter on it's cost and liabilities. The
committee recommended to the county administrator (Jim Roberts), that the county
KI
should stop providing "free" Health Insurance to it's new employees, if it was legal this
idea was rejected by the county administrator and staff. So several years later, the same
county administrator, took a proposal to the to the county commissioners board meeting,
to stop providing free Health Insurance to new hired employees, effective October 1,
2001 when they retired, which was approved by the BOCC.
This action, by the county administrator and the county commission confirms the
fact that the prior contract approved by the BOCC in 1980, to provide "free insurance"
to retiree's when they retire (after 10 years of employment) was still in effect thru the
present, plus this decision by the county commission had no effect to the employee hired
prior to this October 1, 2001they were still eligible to receive "free Health Insurance
when they retired, that was the contract.
Mr. Robert Shillinger be advised that this decision by the county administrator, and
the county commission, to deny Health Insurance to those "New hire employees"
mention as of 10/1/2001 when they retire, may be a violation of Florida Statutes
112.0801.
Mr. Shillinger, I would like you to be aware of the following Health cost and
liabilities to the county.
(A) Active employees is the hi hest Health Cost and Liabilities to the county per
year over 14 million dollars in cost, plus liabilities and these employee are not charge for
any premium Health Insurance Cost (totally "free ").
(B) Active employee dependent coverage for children and spouses. Second highest
Health Cost and Liabilities to the county.
The premium Health Insurance rate is low and affordable, compared to what it
cost the county per month to provide this services.
(C) Retiree (Dependent coverage) are not provide the same premium insurance
cost as the cost provided for dependent coverage for active employees. (It's illegal)as it's
required by Florida Statute 112.0801.
W
(D) Retirees coverage for 64 years old and younger, and 65 years and older,
It's lowest cost and liabilities to County, Why.
Most of these retirees have other insurance coverage such as:
(A) Veteran benefits (Health) 100% coverage
(B) AARP
(C) Private insurance company coverage
(D) Federal (spouses coverage insurance)
(E) State (spouses coverage insurance)
(F) *Medicare part A,B,C,D,
(G) Medicaid
* This applies to retiree 65 years and older. 80% of the cost for
insurance Health Care is paid for by Medicare 20% of the cost is paid
by the above mentioned Health insurance plus the county insurance
coverage.
So these county retiree health cost and liabilities to the county is the lowest,
for those retiree on Medicare 65 years and older. Be advised that any retiree age
64 years and younger that is disable is also covered under Medicare And possible
Medicaid.
Any retiree with both Medicare and Medicaid insurance is covered fully, at no cost to
the county
Mr. Shillinger, This can not be legal to charge for health insurance (for the same
service) to retiree, based on years of services a higher rate, and less years of service a
lower rate and the fact that the county agreed to provide these retiree free health
insurance when they retired it's a violation of Florida Statutes, C roup insurance and
equal protection under State and Federal Laws, etc., and breach of contract and
discrimination of gender, race, and age.
K
Based on what I have mentioned (above), it's important for your office to get the
following data from the county: For year 2012 -2013. or prior years.
* (1) Total # of active employees
* (2) Total # of active employees /dependent coverage (child/spouses)
* (3) Total # of retiree dependent coverage.
* (4) Total # of retiree (all ages)
Total of 64 years and younger
Total of 65 years and older.
*Note A breakdown of health cost and liabilities (on the above) to the County, for year
2012 -2013. In each of the above.
The County has never informed the retiree 65 years and older, or disabled that the
Florida Retirement System provide a Medicare Supplement Insured Coverap-e Act to all
the retirees on Medicare. Who is the health provider of this services and the premium
cost for this services per month. This information needs or be provided to the retiree
(ASAP)
See: Florida Statutes 110.1234, 112.0804 (medicare supplement reform act) § 627 -671 —
627 -675
The State of Florida Retirement System provides " Retiree Health Insurance Subsidy
Florida Statutes 112.363, 110.1232
This subsidy is for health insurance such as (Medicare A,B,C,D) Premium cost and co-
pay and deductible or any other health insurance coverages as mentioned, also dental
and vision insurance cost. The State of Florida Retirement System provides this benefit
to it's retiree for years of services it's for the retiree it is not the County's su_ bsidy
Mr. Shillinger, it's my understanding that this new Health Insurance proposal of
premium cost to the retiree and benefit summary, was never submitted to the standing
health committee that was created in prior years. So, who ever made these decisions on
these changes to the county commissioners, has provided poor advice and unfair rates,
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and illegal recommendations, that is in violation of Florida Statutes, (breach of contract)
(unfair rates), ender, race and age discrimination to the retiree, violation equal
protection of law and discrimination 1983 U.S. Civil Right Act and violation of the
U.S. Constitution laws and the Florida Constitution law
Please be advised of the following violations of Florida Statute. See attached.
Florida Statute 112.0801 Group Ins.
Florida Statute
110.123
Florida Statute
112.363
Florida Statute
110.1232
Florida Statute
110.1234
Florida Statute
112.0804
Florida Statute
112
Florida Statute
112.044
Florida Statute
112.043
§ 627 -671 — 627 -675
Please be advised that I just received in late December, 2013 my package from
mail service, on the Monroe county health proposal as of 1-
1-14.
I'm requesting that this entire new proposal Monroe County Group Health Plan be
put on hold until the county attorney is able to review the various violations of laws,
Mr. Shillinger, I hope that you can resolve this issue satisfactorily in behalf of the retiree
and there dependent's coverage as it's required by Florida Statute 112.0801, plus all the
other possible violations (mentioned above).
I hope that we don't have to take this to court, in behalf of the current retiree and
future retiree.
The law is clear, Florida Statute 112.0801.
(1) Retirees and there eligible dependents shall be offered the same health and
5
hospitalization insurance coverage as is offered to active employees at a premium cost of
no more than the premium cost applicable to active employees. The County is in
violation of this statute.
The active employee pay "no" premium cost It's free Health Insurance.
(2) The
rate proposed as of January
1, 2014 to the
retiree premium
increase is
totally illegal
based on Florida Statute
112.0801, and
equal protection
laws, and
discrimination etc.
Plus it's not legal to charge a premium to the retiree for the same Health Care Plan
a cost of $50.00 per month and a cost of $150.00 per month (based on services years), a
violation of breach of contract, (Free insurance coverage for retiree) plus violation of
equal protection laws, (age, gender, and race, discrimination) 1983 U.S. Civil Rights
laws, United States Constitution laws and Florida Constitution laws, etc.
(3) The retiree dependent coverage must be the same premium cost as it is for the
active employee dependent coverage. These cost for retiree dependent coverage is a
violation of Florida Statute 112.0801, plus other violations of law.
In closing the county must do the following, due to the violations of Florida
Statute 112.0801 not to mention other violations of law, such as equal protection laws,
gender, race, and age discrimination, 1983 U.S. Civil Rights Act, violation of United
States Constitution laws, and Florida Constitution laws, and breach of contract.
(1) The new change in premium open enrollment for retiree
health insurance of $50.00 to $150.00 per month is:
illegal violation of the above laws, especially Florida
Statute 112.0801, breach of contract, etc., this premium
cost must be canceled, stopped and terminated.
(2) The current rate concerning the $50.00 per month for
0
retirees premium for health insurance is illegal based on
the Florida Statute 112.0801 plus all the other violations
of laws mentioned above — the monthly cost must be
stopped and canceled and terminated, and the retirees
must be refunded for being charged $50.00 per month, for
health insurance cost, in violation of Florida Statute
112.0801 and breach of contracts plus other violation of
laws mentioned above, since the county started to collect
these premiums from the retirees " illegal ." Is the
insurance coverage benefits the same for both of the
active employee and retirees, if not it's also illegal,
(3) Is the eligibility requirement the same for the active
employees and the retirees, if not its illegal.
(4) The retirees Dependent insurance is also a violation of
law Florida Statute 112.0801 due to the fact that the
premium cost, Insurance Coverage Benefits eligibility
requirement is not the same as the active employee
dependent coverage and premium cost. active employee
Dependent premium is at lower rate per month, and the
retirees Dependent rate is a higher rate per month, this is
illegal. The retiree dependent insurance new rate effective
on 1/01/14. must be the same as the active employees
Dependent rate.
Also, the current rate (prior to 1/01/14 for retiree
dependent insurance is a violation of Florida Statute
112.0801, plus the other law violations. These
7
overcharge, to the retiree dependent insurance rates needs
to be the same as the active employee dependent
insurance rates, for the prior years that the plan was in
effect. The retirees need to be refunded for being over
charge rates, not being the same rate for insurance as the
active employee dependent insurance rates per month.
(5) What is the status on rates to the dental and vision
insurance plan, are the active employee, the retiree, and
the dependent being all charges the same rates for their
insurance coverage. If not, it's illegal.
Is the eligibility requirement for dependent's the same for
both the active employee Dependent and the retiree
Dependent, if not it's illegal.
(6) Are the Health Insurance Benefits the same for the active
employee and retirees, if not it's illegal
(7) Are the Health Insurance Benefits the same for the
dependents coverage for both the active employee and retiree.
Mr. Shillinger, be advised that the great majority of the retirees, County pension is
below the starting salaries of the current active employees annual income. The current
retirees are the victims for having this financial burden and hardship, for being promised
of getting "free" Health Insurance as agreed to by the County Commission, when they
retire. I apologize for the length of this letter, but someone in the county has provided
poor information and advice to the County Commissioners,on this subject matter.
Sincerely
Louis Latorre, Retiree (Monroe County)
i.,i -a3 -i3
N .
July 18, 2017
Dear Monroe County Commissioners:
In the interest of time, I will cut to the chase:
• The Health Plan Advisory Committee (HPAC) voted on Proposed 2018 Benefit and
Contribution Changes on April 28, 2017,
• The highest number of "yes" votes that any of the proposed changes received was 13
votes; only two of the proposed changes received that,
• The Committee voted to recommend that the BOCC fund $958,558 from County
Increase to Department Rate (from $12,420 /per employee per year to $13,228/per
employee per year)
• At some point between the April HPAC Meeting vote and the May 10, 2017 Board of
County Commissioners (BOCC) Meeting on May 10, 2017, Staff made additional
recommendations for presentation to the BOCC,
• The majority of these additional Staff recommendations had received less than 31%
"yes" votes from the HPAC; nowhere near a majority,
• At some point between the BOCC Meeting on May 10, 2017 and the Special BOCC
Meeting on June 20, 2017, things changed again and the BOCC voted in favor of
some proposed changes that the HPAC previously had given less than 23% "yes"
votes, and the BOCC opposed some other proposed changes that the HPAC had
almost unanimously supported,
• I understand that the HPAC is only advisory and the BOCC has the final say,
however the composition of the HPAC did represent a good cross section of the
County's active and retired employees, taxpayers and voters.
As most of you are aware, I chose to be a public service employee as a career and worked
for Monroe County for over 35 years, I retired at the age of 62, I met the Rule of 70, and
my primary insurance is currently Medicare. The actions of the BOCC at its June
meeting, if implemented, will cost me an additional $3,564 next year, out of pocket, if I
choose to remain in the County's Health Insurance Plan. It does appear that you are
discriminating by penalizing your longer -term employees who now are retired and are of
a certain age.
I recommend that you reconsider your previous actions taken at the June meeting and
instead, adopt the original recommendations from the HPAC, as they were fairer to all
involved, as cost increases were shared by all. Furthermore, I recommend that you
consider either directing the County Administrator to find the shortfall of $900,000+/ -
from elsewhere in the proposed budget; its in there and/or consider taxpayer funding as a
last resort; considering the tax base of the County, it's pennies on the dollar.
Yours truly,
Reggie Paros
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