Exhibit 59 - City of Miami CIGNA Medical - Professional Services Agreement AMENDMENT NO 1 May 6 2021 ASO Agreement with Fees.pdf

This document is an Administrative Services Only Amendment to a Professional Services Agreement between the City of Miami and Cigna Health and Life Insurance Company, dated May 26, 2021. The amendment modifies the original January 1, 2014 agreement to include the administration of an on-site virtual health clinic and updates various terms related to pharmacy benefit management services. The agreement establishes a virtual health center located at 444 SW 2nd Avenue, Miami, FL, which will operate Monday through Friday from 7:30 a.m. to 4:30 p.m., providing health and wellness services, immunizations, laboratory testing, and health coaching for eligible city employees and their dependents.

The financial terms include a Health Improvement Fund of $200,000 to be used for clinical/wellness/behavioral programs from January 1, 2021 to December 31, 2021, with Cigna managing pharmacy benefit services and providing various administrative support. The schedule of financial charges outlines medical and vision administration charges, including Network POSOA at $16.73 per employee/month, comprehensive medical plans at $17.06 per employee/month, and vision plans at $0.35 per employee/month. Additional services include pharmacy benefit management, specialty drug processing, member communications, and a call center with 24/7 customer service. The initial term is 36 months, with options to renew for additional 12-month periods, and can be terminated with 90 days' written notice.