Placement: Consent Agenda
Action Requested: Motion / Vote
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Approve Stop Loss Insurance Policy with Cigna Health and Life Insurance Company (Cigna) for Fiscal Year 2026/2027
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Submitted By: Kimberly Sala, Assistant Director, Human Resources
Strategic Plan Link: The City’s Mission to utilize fiscal responsibility.
Summary Brief (Agreements/Contracts only)
1. Prepared by: City of Port St. Lucie and Cigna Health and Life Insurance Company (Cigna).
2. Parties: City of Port St. Lucie and Cigna Health and Life Insurance Company (Cigna).
3. Purpose: To provide Stop Loss Insurance for medical claims.
4. New/Renewal/Modified: New
5. Duration: 1 year
6. Benefits to Port St. Lucie: To provide protection to the City for medical claims that exceed the threshold of $500,000.00 per claimant.
7. Cost to Port St. Lucie (Annual and Potential): The estimated expenditure for FY 26/27 is $1,259,826.00 (a 20.3% reduction from the FY 25/26 cost).
Presentation Information: Staff is available to answer any questions the Council might have.
Staff Recommendation: Move that the Council approve the Stop Loss Insurance Policy with Cigna.
Alternate Recommendations:
1. Move that the Council amend the recommendation and approve the Stop Loss Insurance Policy with Cigna.
2. Move that the Council not approve the Stop Loss Insurance Policy with Cigna and provide staff direction.
Background: Stop Loss Insurance is a component of the City’s self-funded health insurance program and it provides protection to the City from the financial risk of unpredictable high costs and/or high-volume claims filed under the plan. Stop Loss coverage protects against claims that could compromise the City’s financial health. On July 17, 2026, the City’s third-party administrator, the Gehring Group, released an RFP to the market and solicited responses for Stop Loss Insurance proposals. A total of eight (8) proposals were received and all proposals were vetted by the Gehring Group and the City. Cigna had the best coverage for the most cost-effective amount. Additionally, as the City transitions to Cigna as the medical provider, there will be instant integration whereby Cigna has the ability to process claims, identify whether the Stop Loss threshold has been reached, and thus provide reimbursement to the City in a timelier and more efficient manner. Based on these factors, we are recommending selection of Cigna to provide Stop Loss coverage for the 2026/27 fiscal year.
Issues/Analysis: The option before Council for consideration proposes retaining the Individual Specific Limit (ISL) at $500,000.00 per claimant. Additionally, there is an unlimited maximum annual reimbursement, which includes medical and prescription claims. The policy also takes into consideration when the claims were incurred, with claims incurred twenty-four (24) months prior to the effective date of the policy, but billed after October 1, 2026, being covered (a 24/12 look back period). Further, no higher deductible is applied to certain high claimants, nor are any claimants excluded from coverage.
Financial Information: Funding has been appropriated in the Medical Trust Fund / General Government / Stop Loss account (605-1900-549353-00000).
Special Consideration: Additional cost savings will be realized as Cigna does not include any lasers. Under a stop loss policy, a laser refers to a specific high-cost claimant who is subject to special coverage terms because of the anticipated level of claims associated with that individual. In prior years, the City’s stop loss policies have included lasers for certain high-cost claimants. The proposed policy with Cigna does not include any lasers. In other words, the City is obtaining stop loss coverage without the additional risk restrictions that were included in prior years’ policies, while reducing the overall cost of the coverage.
Cigna will issue the City’s Policy after Council approval, therefore, the exact Policy documents are not available. However, to ensure Council is informed of what will be included in the Policy, a Sample Policy is attached here as Attachment 2. As part of this agenda item, staff is asking that Council approve Stop Loss Insurance with Cigna, with a Policy substantially the same as what is attached in Attachment 2.
Location of Project: N/A
Attachments:
1. Stop Loss Plan Evaluation (comparison of current plan offering versus proposed plan offering); and
2. Proposed Cigna Stop Loss Policy for FY 26/27 in substantially the same form as attached.
NOTE: All of the listed items in the “Attachment” section above are in the custody of the City Clerk. Any item(s) not provided in City Council packets are available upon request from the City Clerk.
Internal Reference Number: 26251-02
Legal Sufficiency Review:
Reviewed by Alyssa Lunin, Senior Deputy City Attorney. Approved as to Legal form and sufficiency by Richard Berrios, City Attorney.