Exhibit 08a - Cal Yr 2025 City of Miami CIGNA Medicare EGWP Prescription Drug Plan.pdf

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FOURTH AMENDMENT TO AND ASSIGNMENT OF

EMPLOYER/UNION GROUP PDP AGREEMENT

This is an Amendment to the Employer/Union Group Prescription Drug Plan (“PDP”) Agreement (hereinafter "Agreement") between Cigna Health and Life Insurance Company (“CHLIC”) and City of Miami (“Group”).

This amendment is effective from January 1, 2025 through December 31, 2025.

NOW THEREFORE, the parties hereby agree as follows:

1. Medco Containment Life Insurance Company (“Medco”) is hereby identified as a CHLIC affiliate which has contracted with the Centers for Medicare and Medicaid Services (“CMS”) to operate a Medicare Part D Prescription Drug Plan (“PDP”) and offer employer/union only group PDP plans.

2. Group hereby consents to the assignment of the Agreement from CHLIC to Medco.

3. All references to “Cigna Health and Life Insurance Company” are hereby removed and replaced by “Medco Containment Life Insurance Company.”

4. All references to “Cigna,” “Cigna Healthcare,” or “CHLIC” are hereby removed and replaced by “Medco.”

5. Pursuant to Section 1, “Term,” Medco and Group mutually agree to renew this Agreement. The Agreement is effective as of January 1, 2025 and shall continue in effect through December 31, 2025, unless sooner terminated in accordance with Section 2, Termination.

6. Other Prescription Drug Coverage/Other Health Insurance, Client acknowledges and agrees that to the extent that Client elects a plan benefit design that includes or incorporates other prescription drug coverage benefits, as that term is defined at 42 C.F.R. 423.464(f), such other prescription drug coverage benefits may be provided in certain states by an affiliated or unaffiliated insurer or health maintenance organization in conjunction with the Medicare Part D benefits that are offered by Medco in such states.

7. Exhibit A, 2024 Medicare Part D Prescription Drug Plan coverage description is hereby deleted in its entirety and replaced with the 2025 Exhibit A, attached hereto.

8. Exhibit B, Group Administrative Guidelines is hereby deleted in its entirety and replaced with the Exhibit B, attached hereto.

Except as modified by this Amendment, all other terms and provisions of the Agreement shall continue in full force and effect. Please indicate your agreement to the amendment by signing below and returning the executed document to Medco. Alternatively, this amendment shall become effective on the effective date indicated unless Group notifies Medco either electronically or in writing within sixty (60) days of the date of receipt of this amendment that it does not accept all terms as herein modified, in which case Medco shall cooperate to negotiate mutually agreeable terms with Group. Once agreement with respect to the terms of this amendment is reached the amendment terms will apply retroactively to the effective date.

The parties hereto have caused this Amendment to be executed in duplicate and signed by their respective officers duly authorized to do so.

EXHIBIT 08a

City of Miami

By: ___________________________________

Printed Name: __________________________

Medco Containment Life Insurance Company

By: _________________________________

Printed Name: Ryan Kocher

Its: Medicare, Chief Growth Officer

Date:

Its: ___________________________________

Date: __________________________________

Exhibit A Medicare Part D Prescription Drug Plan Coverage Description

1 11/4/2024

City of Miami- Cigna Healthcare Prescription Drug Plan

SUMMARY OF BENEFITS

Plan Type Cigna Healthcare Prescription Drug Plan Effective Dates January 1, 2025 - December 31, 2025 Pharmacy Premium Rate $262.42 Number of Medicare Beneficiaries 191 Funding Type Fully Insured Situs State FL Benefit Option Code RXPDP Rx Formulary Enhanced Pharmacy Network Medicare Broad Network Pharmacy Accumulation Period Calendar Year Benefit Description What the Customer pays Deductible Phase

Individual Deductible $0 Individual Deductible Applies to Not Applicable

Plan Out-of-Pocket Maximum Plan Out-of-Pocket Maximum $1,000

Initial Coverage Level Standard Retail Pharmacy (1-30 Day Supply) Tier 1 $15.00

Tier 2 $40.00 Tier 3 $60.00 Tier 4 $60.00

Standard Retail Pharmacy (31-60 Day Supply) Tier 1 $30.00 Tier 2 $80.00 Tier 3 $120.00 Tier 4 Not Available - Specialty drugs only available up to 30-day

Standard Retail Pharmacy (61-90 Day Supply) Tier 1 $0.00 Tier 2 $80.00 Tier 3 $120.00 Tier 4 Not Available - Specialty drugs only available up to 30-day

Long-Term Care (1-31 Day Supply) Tier 1 $15.00 Tier 2 $40.00 Tier 3 $60.00 Tier 4 $60.00

Standard Mail-Order Pharmacy (1-30 Day Supply) Tier 1 $15.00 Tier 2 $40.00 Tier 3 $60.00 Tier 4 $60.00

Standard Mail-Order Pharmacy (31-60 Day Supply) Tier 1 $30.00 Tier 2 $80.00 Tier 3 $120.00 Tier 4 Not Available - Specialty drugs only available up to 30-day

Standard Mail-Order Pharmacy (61-90 Day Supply) Tier 1 $0.00 Tier 2 $80.00 Tier 3 $120.00 Tier 4 Not Available - Specialty drugs only available up to 30-day

Out-of-Network Coverage (1-30 Day Supply) Cost-sharing is the same as In-Network Standard Retail Pharmacy, and benefit is limited to a 30 Day Supply

Catastrophic Coverage (Standard Part D Out-of-Pocket Maximum) $2,000 Generic Drugs $0

Brand Drugs $0 Clinical Management

Step Therapy Included Prior Authorizations Included

Quantity Limits Included Specialty Drugs

Generic and Brand High Cost Specialty Drugs Limited to one month supply Opioids

Opioids (all tiers) Limited to one month supply Non-Part D Supplemental Coverage

Fertility Drugs No Prescription Vitamins Yes Cold & Cough Preps Yes

Cold & Cough Preps including OTC Allergy Medicine No Weight Loss/Weight Gain No

Erectile Dysfunction Yes Courtesy & DESI Drugs Yes

Non-Sedating Antihistamines No Cosmetic Drugs including Drugs for Hair Loss No

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Preventive Drugs at $0 Copay Adherence Package (Preventive Preferred Brand and

Generic Drugs and Diabetic Drugs and Supplies) Yes

Preventive Generic Drugs No Preventive Diabetic Drugs and Supplies No

PPACA Preventive Aspirin No PPACA Preventive Breast Cancer Drugs No

PPACA Preventive Fluoride No PPACA Preventive Folic Acid No

PPACA Preventive HIV Drugs No PPACA Preventive Statins No

PPACA Smoking Cessation/Deterrent Medications No Contraceptive Drugs and Supplies No

State Mandated Benefits State Mandated Benefits Mail order equalization applies.

Non-Standard Benefits Non-Standard Benefits None

City of Miami - Cigna Healthcare Prescription Drug Plan CAVEATS, EXCLUSIONS and DEFINITIONS

The Employer Part D program does not integrate with medical plan deductibles, out-of-pocket maximums, or annual maximums.

Only retirees and their dependents who are entitled to Medicare Part A and/or enrolled in Part B are included in this quote. If a retiree or dependent is not entitled to Medicare Part A and/or not enrolled in Part B, then they are not eligible to join this plan.

Billing for this product is on a per member per month basis. Each enrollee will be set up on their own eligibility record and the employer group will be charged a single per Medicare member per month premium rate.

Cigna Healthcare reserves the right to adjust the benefits and/or premiums in this proposal if such adjustments are necessary to comply with current Centers for Medicare & Medicaid Services (CMS) rules and regulations, and applicable pharmacy state mandates.

Drug Exclusions:

A Medicare Prescription Drug Plan can’t cover a drug that would be covered under Medicare Part A or Part B. Also, while a Medicare Prescription Drug Plan can cover off-label uses (meaning for uses other than those indicated on a drug’s label as approved by the Food and Drug Administration) of a prescription drug, we cover the off-label use only in cases where the use is supported by certain reference book citations.

Congress specifically listed the reference books that list whether the off-label use would be permitted (these reference books are:

(1) American Hospital Formulary Service Drug Information, (2) the DRUGDEX Information System).

By law, certain types of drugs, or categories of drugs, are not covered by Medicare Prescription Drug Plans. These drugs are not considered Part D drugs and may be referred to as “exclusions” or “non-Part D drugs.” These drugs include:

• Non-prescription drugs (or over-the-counter drugs).

• Drugs used for anorexia, weight loss, or weight gain.

• Drugs when used to promote fertility.

• Drugs when used for cosmetic purposes or hair growth.

• Drugs when used for the symptomatic relief of cough and colds.

• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.

• Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale.

• Drugs, such as Viagra, Cialis, Levitra, and Caverject, when used for the treatment of sexual or erectile dysfunction.

In addition, the following exclusions apply to any service that is a covered expense under this plan, but is not covered by Medicare:

• Expenses for supplies, care, treatment, or surgery that are not medically necessary.

• To the extent that payment is unlawful where the person resides when the expenses are incurred.

• Charges which a customer is not obligated to pay or for which they are not billed or for which would not have been billed except that they were covered under this plan.

3 11/4/2024

Definitions

Cigna Healthcare:

For purposes of this agreement means Medco Containment Life Insurance Company.

Day Supply Proration:

Usually, the amount for a covered prescription drug is a one month supply. However, if the amount is less than a one month supply, then the amount paid is prorated based on the actual amount received. Proration may not apply in certain circumstances as outlined in CMS guidance. Typically proration applies to oral solid prescriptions.

Retail example: Plan has a $10 copay for a 30 day supply. Actual day supply filled is 10 day supply. Copay is prorated as follows:

$10 divided by 30 or $.3333 per day, rounded to $.33, times the day supply of 10, equals $3.30 copay owed by customer.

Long-Term Care example: Plan has a $10 copay for a 31 day supply. Actual day supply filled is 10 day supply. Copay is prorated as follows:

$10 divided by 31 or $.3226 per day, rounded to $.32, times the day supply of 10, equals $3.20 copay owed by customer.

Employer Group Waiver Plans (EGWPs):

EGWPs are a type of Medicare plan offered by employers to former employees and members of some companies, unions or government agencies.

EGWPs are offered by insurers who contract with CMS to provide coverage for medical and/or prescription drug benefits. CMS grants certain program waivers and/or modifications for EGWP plans that do not apply to individual plans. Waivers enable EGWPs to provide customized benefits, tailored beneficiary educational materials, and more flexible enrollment procedures.

Insulin Drug Products:

Customers won’t pay more than $35 for a one month supply of each insulin product covered by our plan no matter what cost-sharing tier it’s on, even if they haven’t paid the deductible. If the insulin is on a tier where cost-sharing is lower than $35, they will pay the lower cost.

Non-Part D Drugs:

The following drug categories are excluded from CMS coverage. If a plan deductible applies, any non-Part D coverage added to the plan is not subject to the plan deductible. The cost share for these drugs is the same as the cost-shares in the initial coverage phase based on drug classification.

• Cosmetic Drugs including Drugs for Hair Loss: drugs when used for cosmetic purposes or hair growth.

• Courtesy Drugs: refers to drugs normally covered under commercial pharmacy plans but are excluded by CMS.

• DESI (Drug Efficacy Study Implementation) Drugs: refers to drugs that were introduced between 1938-1962 and approved for safety but not effectiveness. DESI drugs are not “grandfathered” or generally recognized as safe and effective (GRAS/E).

• Fertility Drugs - drugs used to promote fertility.

• Prescription Vitamins - drugs used for prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations.

• Cold & Cough Preps - drugs used for symptomatic relief of cough and colds.

• Cold & Cough Preps including OTC Allergy Medicine - drugs used for symptomatic relief of cough and colds including OTC allergy medicine.

• Non-Sedating Antihistamines - Antihistamine tablets designed to not make people drowsy.

• Weight Loss/Weight Gain - drugs used for anorexia, weight loss, weight gain.

• Erectile Dysfunction - drugs used for erectile dysfunction and female sexual dysfunction.

Opioid Drugs:

Customers who have received a recent fill of an opioid pain medication (not opioid naïve) are limited to up to a month’s supply of that medication at one time.

Out-of-Network Coverage:

Generally, we cover drugs filled at an out-of-network pharmacy only when the plan participant is not able to use a network pharmacy. Customers will most likely be required to pay the difference between what they pay for the drug at the out-of-network pharmacy and the cost that we would cover at an in-network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

• Customer travels outside the plan’s service area and runs out of or loses covered Part D drugs, or becomes ill and needs a covered Part D drug and cannot access a network pharmacy.

• Customers are unable to obtain a covered Part D drug in a timely manner within the service area because, for example, there is no network pharmacy within a reasonable driving distance that provides 24/7 service.

• Customers are filling a prescription for a covered Part D drug and that particular drug is not regularly stocked at an accessible network

Retail or Mail-Order pharmacy.

• The Part D drugs are dispensed by an out-of-network institution-based pharmacy while in an emergency facility, provider-based clinic, outpatient surgery, or other outpatient setting.

Part D Vaccines:

Our plan covers most Part D vaccines at no cost, even when the deductible is not met.

Preferred Preventive Drugs at $0 Copay:

Certain Generic and/or Brand Preventive Medications identified by Cigna Healthcare that are dispensed by a Retail or Mail-Order pharmacy are not subject to the deductible (if applicable), copay or coinsurance.

Tier Labeling:

Tier 1: Generic Drugs Tier 2: Preferred Brand Drugs Tier 3: Non-Preferred Drugs Tier 4: Specialty Drugs

All Medco products and services are provided exclusively by or through operating subsidiaries or affiliates of Medco, including Medco Containment Life Insurance Company and Medco Containment Insurance Company of New York. The Medco name, logos, and marks are owned by Medco, or an affiliate of Medco. Medco contracts with Medicare to offer Part D Prescription Drug Plans (PDP) in select states.

Enrollment in a Medco product depends on contract renewal.

© 2024 Cigna Healthcare

4 11/4/2024

City of Miami - Cigna Healthcare Prescription Drug Plan Terms and Conditions

A. General Terms of this Proposal Cigna Healthcare is pleased to present this Proposal for a Fully Insured group Cigna Rx Medicare (PDP) benefit plan.

This proposal is valid for 90 days from its original date of release of 07/19/2024.

Any revisions or updates made to this proposal will not renew this valid timeframe unless expressly communicated by Cigna Healthcare.

The information contained in this Proposal by Cigna Healthcare is proprietary and highly confidential. It is being provided with the understanding that it will not be used by the employer, its representatives or consultants for any purpose other than the evaluation of the Proposal.

Under no circumstances is any of information contained herein (including excerpts, summaries, extracts, and evaluations thereof) to be used, disseminated, disclosed or otherwise the communicated to any person or entity other than the employer, its representatives and consultants, and their respective employees who are directly involved in the evaluation process.

Proposal Caveats Cigna Healthcare may revise or withdraw this Proposal if:

there is a change to the effective date of the quote.

the policy period length is different than the quote.

the Plan benefits are different than shown in the RFP or benefit modifications are requested.

the policy will not be sitused in FL.

there is a change in law, regulation, tax rates, or the application of any of these that affects Cigna Healthcare’s costs.

there are less than 50 retirees or less than 70% of total eligible individuals enroll in the Plan.

enrollment in the Plan at any time varies by 10% or more from the enrollment assumed by Cigna Healthcare in establishing the rates and/or fees set forth herein.

the employer changes its level of contribution toward the cost of the coverage.

the employer contributes toward the cost of purchasing individual coverage for an eligible individual.

Cigna Healthcare is not the exclusive provider of PDP benefits and the employer does not contribute the same percentage to the cost of each employer-sponsored plan unless expressly communicated by Cigna Healthcare.

the census data or experience data provided is deemed inaccurate.

there is a request to modify Commissions and/or benefit advisor fees.

Cigna Healthcare is requested to interface with a third party vendor.

Cigna Healthcare is requested to provide optional services.

administration of the Plan will require more than the following:

o Billing lines: 300 o Billing and Claim Branch Benefit Options: 60

5 11/4/2024

B. Scope and Application of this Proposal Unless otherwise indicated, the coverage reflected in this proposal supersedes and renders null and void any prior Cigna Healthcare offer or proposal with respect to the Plan.

Although this proposal may include multiple plans/options for the employer sponsored plan, Cigna Healthcare reserves the right to limit the number of plans/options based on the offering environment and the total number of Medicare eligible individuals. Final plan selection requires approval by underwriting prior to implementation.

The information and materials provided for evaluation of this quote were assumed to be correct.

If material errors or omissions are found after the quote is issued, Cigna Healthcare reserves the right to revise or rescind the quote.

Performance guarantees do not apply to this Medicare proposal.

This quote is on an incurred basis. Cigna Healthcare will be responsible for all eligible claims incurred on or after the effective date through the end of the contract period.

Group agrees to restrict enrollment in the Plan to those individuals eligible for Group’s employment-based retiree group coverage who are eligible for Medicare.

This proposal assumes all eligible individuals are enrolled in Medicare Part A and/or Part B and the group provides the beneficiary Medicare plan number to complete enrollment.

Information provided here is pending CMS approval unless otherwise noted.

Cigna Rx Medicare (PDP) The rates are contingent upon the eligible individual residing in the service area of the quoted Medicare Part D plan. The enrollment will be based on the eligible individual's primary residence as defined by CMS.

The benefits presented in the Proposal are a high-level summary. Please consult the summary of benefits for a more detailed list of benefits proposed in this Cigna Healthcare plan. Due to annual changes in CMS mandated benefits, benefits may differ for certain service categories.

Due to regulatory requirements for the Medicare Part D product, services and timing may differ.

Some areas of difference include, but are not limited to: reporting, web services, disease and wellness management, quality incentives, provider directories and networks, eligibility timing, communication pieces for pre-enrollment and members, billing, pharmacy and medical data integration, customer service, claims and appeals.

Cigna Healthcare requires a minimum of 20 enrolled members per standard product offering to renew an Employer Sponsored plan.

All Medco products and services are provided exclusively by or through operating subsidiaries or affiliates of Medco, including Medco Containment Life Insurance Company and Medco Containment Insurance Company of New York. The Medco name, logos, and marks are owned by Medco, or an affiliate of Medco. Medco contracts with Medicare to offer Part D Prescription Drug Plans (PDP) in select states. Enrollment in a Medco product depends on contract renewal.

© Cigna Healthcare 2024

Exhibit B Group Administrative Guidelines