PUR 7776 Single Source with SMIC.pdf

PUR 7776 (Revised 07/2022) Page 1 of 5 Incorporated by Reference: Rule 60A-1.045, F.A.C.

DESCRIPTION OF INTENDED

SINGLE SOURCE PURCHASE

(PUR 7776)

AGENCY: Department of Environmental Protection

TITLE: Single Source with Special Markets Insurance Consultants, Inc. (SMIC) Short description of the commodity or service desired: To provide healthcare to The Corps Network (TCN) AmeriCorps members as required by the Florida Conservation Corps and AmeriCorps Program through The Corps Network. Special Markets Insurance Consultants, Inc.

(SMIC) is the only company TCN authorizes to provide the health insurance coverage that meets the requirements of the AmeriCorps Provisions and contracted to provide this service.

AmeriCorps members are not employees of the state per the National and Community Service Act of 1990, as amended, through 1999, 42 USC Section 101.12511. The Corps Network Health Plan is an Affordable Care Act and Minimum Essential Coverage compliant health insurance plan for AmeriCorps members that serve under TCN member organizations. The plan was created out of a request from member Corps for a healthcare plan that met their bottom-line, the needs of their Corps members, and the rules and regulations of AmeriCorps. TCN’s Health Plan provides Corp members both comprehensive, and affordable medical, dental and vision insurance. (https://corpsnetwork.org/health-insurance/)

CONTACT

Name: Belinda Croft Address: 3800 Commonwealth Blvd., MS93, Tallahassee, Florida 32399 Telephone: 850.245.2467 Email: Belinda.Croft@FloridaDEP.gov

Internal tracking number, if any: 2023SS014

Date posted: May 12, 2023 Last day for receipt of information: June 5, 2023

This description of commodities or contractual services intended for purchase from a single source is posted in accordance with Sections 120.57(3) and 287.057(3), Florida Statutes (F.S.), and will remain posted for a period of at least 15 business days.

Commodity or Contractual Service Required (commodity or United National Standard Products and Services Code (UNSPSC), manufacturer, model, and description, as appropriate):

64122102 Group Health Insurance Policy

Quantity or Term (as appropriate):

12 months

Requestor (division, bureau, office, individual, as appropriate):

Division of Recreation and Parks (Florida Park Service), Natural and Cultural Resources, Florida Conservation Corps (FLCC) (AmeriCorps)

PUR 7776 (Revised 07/2022) Page 2 of 5 Incorporated by Reference: Rule 60A-1.045, F.A.C.

Performance and/or Design Requirements (e.g. intended use, function or application, compatibility, requirements; reference to policy, rule, statute or other act of the Legislature, etc., as appropriate):

The Corps Network Health Plan is an Affordable Care Act and Minimum Essential Coverage compliant health insurance plan for AmeriCorps members that serve under TCN member organizations.* The plan was created out of a request from member Corps for a healthcare plan that met their bottom-line, the needs of their Corps members, and the rules and regulations of AmeriCorps. Over the past 25 years, TCN’s Health Plan has annually provided thousands of Corps members with health care that is both comprehensive, and affordable for their host organization.

Plan options include medical, dental and vision insurance.

AmeriCorps members are not employees of the state per the National and Community Service Act of 1990, as amended, through 1999, 42 USC Section 101.12511.

Special Markets Insurance Consultants (SMIC) is the authorized Contractor to provide the eligibility, billing, and premium collection services. SMIC provides the enrollment portal for ongoing additions and terminations as well.

Anticipated Cost for FY 2023-2024: $183,000.00 Monthly Rate: $416.65*

Pursuant to the federal grant, the FDEP must make available health care coverage for the 65 AmeriCorps members serving a 1,700-hour full-term, who are not otherwise covered by a health care policy. Coverage provided must be provided for a period of no more than 364 days and cannot be renewed or extended beyond that point. Coverage must include the following minimum benefits.

Single Source approval is for the period of July 1, 2023 through June 30, 2023, subject to the continuation of the FLCC AmeriCorps program.

The Corps Network (TCN) Corpsmember Health Plan — Medical, Prescription & AD&D Medical by Cigna, AD&D by Gerber | Medical Group Number: 3338030

Benefit / Provision – Cigna Provider / Out of Network Deductible Per Plan Year - $175.00 / $350.00 (Applies to all services except in-network Preventive and Office Visits) Out-of-Pocket Maximum (Includes Deductible) - $2,750.00 / $5,500.00 Lifetime Maximum - Unlimited Preventive (Routine) Care (100% no deductible / 50%) Prescription Drugs (Express Scripts Value List)* (80% / 50%) Telehealth (MDLive; includes Behavioral Health) (No deductible $5.00 copay) Office Visits - Primary Care ($10.00 copay / 50%) Tier 1 Specialist ($10.00 copay / 50%) Non- Tier 1 Specialist ($20.00 copay / 50%) Professional Services (Surgery, Lab & X-Ray) (80% / 50%) Urgent Care ($20.00 co-pay, then covered at 80%)

PUR 7776 (Revised 07/2022) Page 3 of 5 Incorporated by Reference: Rule 60A-1.045, F.A.C.

Ambulance (80%) Emergency Room ($100.00 co-pay, then covered at 80%) Hospital (Inpatient pre-authorization required)* (80% / 50%) Mental Health - Inpatient (80% / 50%) Office Visit ($10.00 copay / 50%) Chemical Dependency (Inpatient and Outpatient) (80% / 50%) Outpatient Rehabilitation - 20 visits per Plan Year (Physical, Speech, Occupational, Cardiac therapies and Chiropractic) (80% / 50%) Employee Assistance Program (EAP) - 24/7 telephonic support, 3 free face-to-face visits for life events (Call 877-231-1492)

AD&D – ($10,000.00)

Monthly Rate (Paid by sponsoring program) ($416.65*) *Cigna requires pre-authorization for all inpatient hospital, some outpatient procedures and certain drugs.

Intended Single Source:

Special Markets Insurance Consultants, Inc. (SMIC)

Estimated Dollar Amount:

$183,000.00

Justification for single source acquisition (what is necessary and unique about the product, service or source; steps taken to confirm unavailability of competition, as appropriate):

The Florida Department of Environmental Protection (FDEP) is a recipient of federal grant funds from AmeriCorps formally known and the Corporation for National and Community Service (CNCS) that is awarded through Volunteer Florida, the Governor's Commission on Volunteerism and Community Service. These federal grant funds support the Florida Conservation Corps (FLCC) AmeriCorps program. The AmeriCorps federal program's Catalog of Federal Domestic Assistance is 94.006 and is entitled "AmeriCorps State." The FLCC AmeriCorps grant award is directed toward providing service in areas of habitat restoration, trail accessibility improvements, environmental education, and volunteer recruitment. Additionally, FLCC AmeriCorps members provide disaster relief assistance across Florida when called. The FDEP has utilized federal grant funds from AmeriCorps to support this AmeriCorps program for 25 years. The program is made up of 65 members serving 1,700-hour full-time terms of service. AmeriCorps members are not employees, and do not function in an employer-employee relationship within FDEP.

FLCC AmeriCorps members meeting certain participation requirements receive a modest living allowance, as well as health benefits, training and student loan deferment. Some members are eligible for child care benefits. Upon completion of service, members may receive an education award to help pay for continued education, or to pay back qualified student loans.

Pursuant to the federal grant, the FDEP must make available health care coverage for the 65 AmeriCorps members serving a 1,700-hour full-term, who are not otherwise covered by a health care policy. Coverage provided must be provided for a period of no more than 364 days and cannot be renewed or extended beyond that point.

Coverage must include the following minimum benefits:

a) Physician services for illness or injury

PUR 7776 (Revised 07/2022) Page 4 of 5 Incorporated by Reference: Rule 60A-1.045, F.A.C.

b) Hospital room and board

c) Emergency room

d) X-ray and laboratory

e) Prescription drugs

f) Limited mental/nervous disorders

g) Limited substance abuse coverage

h) An annual deductible of no more than $175.00 per member

i) No more than $2,750.00 total annual out-of-pocket per member

j) A 20% co-pay or comparable fixed fee except for a 50% co-pay for mental and substance abuse care

k) A maximum benefit of at least $50,000.00 per occurrence or cause

As an affiliate member of The Corps Network, Volunteer Florida and its AmeriCorps programs (of which FDEP is a recognized participant) are eligible to utilize the low-cost member health insurance that meets requirements for AmeriCorps. Although the AmeriCorps allows grantees to obtain healthcare from any provider, the FDEP must ensure that the coverage meets the above minimum benefits. It is critical for the FDEP to meet the minimum benefits established under the federal grant to maintain compliance with the federal grant terms and conditions. The extraordinary benefits and associated insurance coverage limits available only through Special Markets Insurance Consultants (SMIC) make them the only source available to provide comprehensive health insurance for such a varied group of individuals within AmeriCorps programs that meets or exceeds all AmeriCorps minimum benefit requirements Based on this need and Volunteer Florida’s acceptance of this insurance program, the FDEP is requesting single-source approval to utilize the health insurance program made available through The Corps Network. The Vendor providing access to this coverage is Special Markets Insurance Consultants (SMIC) which is underwritten by Cigna. The Department cannot purchase this insurance directly from the insurance company.

The Department of Management Services (DMS) attempted to procure this insurance coverage several years ago, but did not receive any bids, in part due to the limited number of participants for the insurance program. In 2021, it was confirmed by The Corps Network, the agency responsible for AmeriCorps grants, confirmed that SMIC is the only company providing health insurance coverage that meets the requirements of the AmeriCorps Provisions. AmeriCorps members cannot participate in the insurance coverage provided by DMS, as members are not employees of the state per the National and Community Service Act of 1990, as amended, through 1999, 42 USC Section 101.12511

Willis Towers Watson, The Corps Network’s AmeriCorps Member Health Plan is underwritten by Cigna. Gerber underwrites the AD&D portion of the plan.

The Corps Network Health Plan - Health Insurance for AmeriCorps Members

Willis Towers Watson Willis Towers Watson, as the broker for The Corps Network, created the Health Plan in February of 1992. They provide ongoing management of the insurance program. Willis Towers Watson is also available for general questions and concerns from program administrators.

PUR 7776 (Revised 07/2022) Page 5 of 5 Incorporated by Reference: Rule 60A-1.045, F.A.C.

Special Markets Insurance Consultants (SMIC) Eligibility, billing, and premium collection are handled by SMIC. SMIC provides the enrollment portal for ongoing additions and terminations as well.

The Corps Network The Corps Network is a national membership organization that provides various services to its member corps, including sponsorship of The Corps Network Health Plan. The Corps Network Health Plan complies with all AmeriCorps/CNCS requirements. Service organizations must be members in good standing with The Corps Network to be eligible for the program.

CIGNA – Group Number 3338030 Cigna administers the medical/prescription drug coverage. That includes claims processing and customer service, as well as virtual ID cards.

CIGNA Provider Network The OAP network allows you to receive a higher benefit from the plan and reduce your out-of-pocket expenses for both medical and prescription drugs. Members can access high quality providers by looking for those with a “Tier 1” designation (when available).

CIGNA – Dental and Vision Coverage (optional) CIGNA is the insurance company contracted to handle the dental/vision benefits available under The Corps Network Health Plan. They process the claims and provide customer service.

Approved By (names & titles, as appropriate, e.g., requestor, requestor management, information systems, budget, purchasing):

Adriana Betancourt, FLCC Program Coordinator Wes Howell, Bureau Chief Parks Small, Assistant Director Belinda Croft, Purchasing Specialist Supervisor

Prospective vendors are requested to provide information regarding their ability to supply the commodities or contractual services described. If it is determined in writing by the agency, after reviewing any information received from prospective vendors, that the commodities or contractual services are available only from a single source, the agency shall provide notice of its intended decision to enter a single-source purchase contract in the manner specified in Rule 60A-1.045, Florida Administrative Code, and section 120.57(3), F.S.