R-98-11-24-14F1 - 11/24/1998WHEREAS, the City of Round Rock desires to retain
professional services to provide independent third -party
administration of the City's self- funded health plan, and
WHEREAS,HealthCare Benefits, Inc. will submit an agreement
to provide said services, and
WHEREAS, the City Council desires to enter into said
agreement with HealthCare Benefits, Inc., Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS,
That the Mayor is hereby authorized and directed to execute on
behalf of the City an agreement with HealthCare Benefits, Inc. to
provide independent third -party administration of the City's self -
funded health plan, subject to the City Manager's and City
Attorney's approval of the final language and terms.
The City Council hereby finds and declares that written notice
of the date, hour, place and subject of the meeting at which this
Resolution was adopted was posted and that such meeting was open to
the public as required by law at all times during which this
Resolution and the subject matter hereof were discussed, considered
and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended, and the Act.
RESOLVED this 24th day of Novemb
CHARLES CULPEP , Mayor
ST: City of Round Rock, Texas
NE LAND, City Secretary
,..: \WPDOCS \RESOLUTI \R81124,t WpD /a cg
RESOLUTION NO. R -98- 1124 -14F1
HBI-ASA/1 1-93
DRAFT
ADMINISTRATIVE SERVICES AGREEMENT
DRAFT
ADMINISTRATIVE SERVICES AGREEMENT
THIS AGREEMENT is made and entered into by and between HealthCare Benefits, Inc., a cprporation
organized, existing and doing business under and by virtue of the laws of the State of Texas {hereinafter
referred to as "Contractor") and CITY OF ROUND ROCK (hereinafter referred to as "Purchaser ").
WITNESSETH:
WHEREAS, Contractor is in the business of providing independent third -party administration of employee
welfare benefit programs; and
WHEREAS, Purchaser desires to engage the service of a third -party administrator for a welfare benefit
program (hereinafter referred to as "Benefit Program ") to be provided to Purchaser's employees and their
eligible dependents (hereinafter collectively referred to as "Participants "); and
WHEREAS, Contractor is willing to provide such services to Purchaser and other parties on an independent
contract basis.
NOW, THEREFORE, for and in consideration of the mutual promises, covenants and Agreements hereinafter
set forth, the parties hereto agree as follows:
SECTION ONE
OBLIGATION OF PURCHASER
1.01 Purchaser shall furnish Contractor with a detailed description of the Benefit Program to be
administered.
1.02 Purchaser, in consultation with Contractor, shall determine the administrative practices and
procedures to be followed in the processing and payment of claims.
1.03 Purchaser shall provide to Contractor a complete and current listing of all Participants
eligible to receive benefits prior to their date of eligibility— making timely changes to the
listing on a periodic basis.
1.04 Purchaser shall obtain the consent of Participants for the release of confidential medical
information required for administration and to process claims for the payment of fees for
medical services rendered to patients, including any fees for mental or emotional health
services performed by professionals, as may be required by state or federal law.
1.05 Purchaser shall establish and maintain a suitable banking arrangement to effectuate the
provisions of Section Six herein.
1.06 At Contractor's request, or at Purchaser's option, Purchaser shall make the final
determination of eligibility of Participants to receive benefits and any special issues arising
in the course of administration.
1
1.07 Purchaser shall designate in writing a contact person who will be empowered to act on
behalf of Purchaser with regard to the terms of the Agreement and with whom Contractor
can coordinate and resolve all questions arising in the course of administration.
SECTION TWO
OBLIGATION OF CONTRACTOR
2.01 Contractor shall administer Purchaser's Benefit Program in accordance with the benefit plan
description provided and the administrative practices and procedures established.
2.02 Contractor shall provide or arrange for suitable facilities, equipment and personnel
necessary for proper administration of the Benefit Program.
2.03 Contractor shall, upon request, assist Purchaser is establishing appropriate banking
arrangements for program administration.
2.04 Contractor shall provide standard administrative materials, including enrollment forms,
participant and provider claim forms and two identification cards for each participant in the
Benefit Program on the Effective Date of the Plan.
2.05 Contractor shall, upon request, assist Purchaser in incorporating the Benefit Program
description and design into a plan document and booklet for Participants. The Contractor
will provide one benefit booklet per participant enrolled in the Benefit Program on the
Effective Date of the Plan. The cost of reprinting additional benefit booklets shall be the
obligation of the Purchaser.
2.06 Contractor shall provide claims processing services to include:
a. Review and validation of all claims submitted for payment;
b. Determination of benefits in accordance with the specification of the Benefit
Program;
c. Coordination of benefits with other plans, where appropriate;
d. Preparation and mailing of explanation of benefit forms; and
e. Preparation and mailing of claim drafts drawn on Purchaser's bank account as
provided in Section Six herein.
2.07 Contractor shall establish liaison with Purchaser's designee, providers and Participants, as
required, to obtain and follow -up on additional service information, to verify eligibility of
Participants and to assist in resolving claims problems.
2
2.08 " Contractor shall provide periodic written reports to include:
a. Monthly check reconciliation report;
b. Monthly benefit experience reports; and
c. Those reports specified in Item Four of the current Exhibit to this Agreement, if
any.
d. Utilization reports, to include, claims incurred, claims paid and discounted services.
e. Estimates of incurred but unpaid claim liabilities.
f. Assistance with preparation of the Summary Plan Description, Summary Annual
Report, and other matters that are required for reporting and disclosure under Title
I, Part I of the Employees Retirement Income Security Act of 1974.
2.09 Contractor will provide Purchaser copies of specific claim payment drafts upon request.
2.10 Contractor shall evaluate late applicants for evidence of good health on behalf of Purchaser.
2.11 Contractor shall maintain current individual benefit records on all Participants and shall
maintain the confidentiality of any medical information contained in such records.
2.12 Contractor shall prepare IRS form 1099 reports on medical provider fees.
2.13 Contractor shall keep Purchaser informed with respect to non - routine "shock" claims and
matters of general interest, including recurring administration problems, local situations
meriting review and possible misuses of benefits.
2.14 Contractor shall refer to Purchaser any claim or class of claims Purchaser may specify for
consideration and final decision, to include:
a. Claims for services which do not appear to qualify for payment under the Benefit
Program;
b. Claims in which there is a question on the amount of payment due;
c. Claims involving any matter in controversy; and
d. Those claims or classes of claims specified in Item Three of the current Exhibit to
this Agreement, if any.
2.15 Contractor shall assist Purchaser in the analysis and resolution of disputed claims, provided,
however, that such assistance shall in no way include or be considered to include or
constitute legal advice or opinions.
2.16 Underwriting services will not be provided unless specifically identified in Item Two of the
Exhibit to this Agreement, if any. Any such services provided will include required
certifications by a qualified actuary.
2.17 Contractor shall also provide those services specified in Item Two of the current Exhibit to
this Agreement, if any.
3
2.18 Assist in complying with any and all State and Federal statues, rules or regulations,
including ERISA.
2.19 All files, records and reports prepared and maintained by the Contractor pursuant to this
agreement shall be the property of the Purchaser, but the right of possession .efsnch files,
and reports shall be and remain with the Contractor during the term of this agreement. All
files, records, and reports shall be made available for review and inspection during normal
business hours. Within fifteen (15) working days of completion of duties under this agree-
ment, all such files, and reports shall be transferred to the Purchaser on request and in
exchange for its receipt.
SECTION THREE
RELATIONSHIP OF PARTIES
3.01 Contractor shall not be construed, represented or held out to be a partner, associate, joint
venturer or employee of Purchaser nor shall the Contractor be construed, represented or held
out to be an agent of the Purchaser or agent of any insurance company. Contractor shall at
all times have the status of an independent contractor.
3.02 Contractor shall, upon request, assist purchaser in obtaining Stop Loss Reinsurance. If Stop
Loss reinsurance is purchased, Contractor shall not be responsible for claims not timely filed
and not included within the Stop Loss coverage. Contractor shall attempt to assist Purchaser
in encouraging providers to file claims timely but Contractor assumes no responsibility for
the timely filing of such claims, and Purchaser commits not to sue contractor regarding any
claims arising out of Stop Loss reinsurance coverage so purchased.
3.03 Contractor is not a statutory fiduciary of Purchaser's Benefit Program nor is Contractor a
plan administrator within the meaning of the Employee Retirement Income Security Act of
1974, Public Law 93 -406.
3.04 This Agreement is not a contract of insurance, and Contractor is not an insurer or
underwriter of Purchaser's liability under the Benefit Program. Purchaser has and retains
the ultimate responsibility for payment of claims and other expenses under the Benefit
Program.
4
SECTION FOUR
TERM AND TERMINATION
4.01 The term of this Agreement shall be for the period of one (1) year commencing on the
Effective Date specified herein and shall continue in full force and effect from year to year
thereafter unless terminated as provided herein.
4.02 This Agreement may be terminated as follows:
a. By either party on any anniversary of the Effective Date of this Agreement
following thirty (30) days' prior written notice to the other;
b. By Contractor upon Purchaser's failure to fund the bank account as provided for in
Paragraph 6.02 of Section Six below;
c. By Purchaser, upon thirty (30) day's prior written notice.
d. By both parties on a mutually agreeable date.
e. By Purchaser, upon Contractor's breach of any provision of this Agreement, after
upon (30) thirty days written notice and failure to cure such breach.
4.03 If this Agreement is terminated by Purchaser, except as provided in Paragraph 4.02, (a), (b)
or (d), above,,Purchaser agrees to pay to Contractor a termination fee in an amount equal
to twice the average of the monthly administration fee due for all months immediately
preceding termination. Such termination fee is due and payable within thirty (30) days after
notice of termination, or immediately upon termination if no notice is given, and is in
addition to any monthly administration fee, or portion thereof, or any other monies due and
payable to Contractor under this Agreement.
4.04 If this Agreement is terminated for cause by Purchaser under Paragraph 4.02 (a), (b), (d) and
(e), above, the Purchaser shall not be liable for any termination fees or changes. Moreover,
Purchaser may withhold from the current administration fee due Contractor, the costs
incurred by Purchaser in attempting to gain Contractor's performance of the Agreement
4.05 If this agreement is terminated, the Contractor shall complete the processing of all requests
for benefits payments under the plan that were received by Contractor on or before the date
of termination and which are due and payable prior to termination, but shall not include:
A. The processing of any requests if the Purchaser has not provided funds for
the benefits payment.
B. Process request for benefit payments presented to the Contractor after the
date of termination.
C. Issue benefit check after termination date.
SECTION FIVE
5
ADMINISTRATION FEES AND REIMBURSEMENT
5.01 Purchaser agrees to pay Contractor a monthly administration fee which shall be due and
payable in full on or before the first (1st) day of each month at its home office in
Richardson, Texas, during the term of this Agreement.
a. In the event payment of the monthly administration fee is not paid by the twentieth
(20th) day of the month, Contractor may suspend its performance under this
Agreement upon ten (10) days notice to the Purchaser until such fees and late
charges are paid.
b. After the twentieth (20th) day of the month, a late charge may be assessed each day
for late payment of all monies owed to Contractor by Purchaser under this
Agreement. The late charge shall be charged as interest and equal to ten percent
(1 0 %) of the past -due amount owed, or the maximum amount permitted by state
law, whichever is less.
c. After the thirty-first (31st) day the Contractor may terminate this Agreement for
non - payment of fees.
5.02 The amount of the administration fee shall be determined in accordance with the
specifications contained in Item One of the current Exhibit to this Agreement, if any.
5.03 The administration fee shall be subject to change by Contractor upon (90) ninety days prior
written notice to purchaser, as follows:
a. On each anniversary of the Effective date of this Agreement
b. On the implementation date of any changes in the Benefit Program which would
increase Contractor's cost of administration;
c. On any date that increased expenses are incurred by Contractor because of changes
imposed by governmental entities — limited to increases sufficient to recover the
additional expenses; or
d. On any date that Benefit Program enrollment changes by an amount equal to ten
percent (10%) or more of total enrollment.
5.04 Purchaser shall reimburse Contractor for the direct cost of any special supplies or forms
provided by Contractor for Purchaser —such reimbursement to be in addition to the monthly
administration fee.
5.05 Purchaser will reimburse Contractor for any taxes imposed or adjudged due by any lawful
authority with respect to the Benefit Program or its administration. In the case of imposition
of such tax liability, Purchaser may elect to terminate this Agreement upon thirty (30) days'
prior written notice without incurring liability for termination fees or charges.
SECTION SIX
6
•
CLAIMS PAYMENT AND BANKING ARRANGEMENT
6.01 Purchaser shall establish a bank account on which Contractor shall write drafts for the
payment of Benefit Program claims and expenses. Purchaser agrees and is obligated to
arrange for sufficient funds to be available in such account to cover all drafts validly issued
against the account. Contractor shall notify Purchaser, simultaneous with the release of
checks, the amount that is required to be deposited by Purchaser to cover the checks issued.
6.02 Contractor shall have the right to terminate this Agreement upon notice to Purchaser in the
event that Purchaser fails to fund such account within three (3) banking days after notice is
given by Contractor and received by Purchaser, that such funds are required to be deposited.
6.03 Notice by Contractor, as contemplated in paragraph 6.02, above, shall be sufficient if given
by telephone, fax or by United States mail, delivery services or personal delivery to
Purchasers designee or the signatory to this Agreement at the telephone number or address
specified in Item Five of the current Exhibit to this Agreement, if any. Any telephonic
notice given will be confirmed in writing within twenty-four (24) hours.
SECTION SEVEN
NOTICES
7.01 All notices given under in this Agreement, unless otherwise provided for herein, must be in
writing and shall be deemed to have been given for all purposes when personally delivered
and received or when deposited in the United States mail, first -class postage prepaid,
certified or registered, return receipt requested and addressed to the parties as set forth in
Item Five of the current Exhibit to this Agreement, if any.
7
SECTION EIGHTS
GENERAL PROVISIONS
8.01 ASSIGNMENT. No part of this Agreement, or any rights, duties or obligations described
herein, shall be assigned or delegated without the prior express written consent of both
parties, except for the use of a third party for printing and mailing services. Contractor's
acquisition and use of facilities, services, supplies, equipment and the use of temporary
personnel on site shall not constitute an assignment under this Agreement; provided,
however, that the supervision of all services provided under this Agreement will be
performed by Contractor's regular employees.
8.02 GOVERNING LAW. This contract shall be governed by and shall be construed in
accordance with the laws of the State of Texas, and venue for any cause related to this
Agreement shall be in Williamson County, Texas.
8.03 Jv1ODIFICATION. This Agreement shall not be amended or modified in any manner except
by an instrument in writing executed by the parties.
8.04 CAPTIONS. Captions appearing in this Agreement and its Exhibits, if any, are provided for
convenience only and in no way define, limit, construe or describe the scope of sections or
paragraphs to which they are inserted.
8.05 GENDER AND MODE. The use herein ofa personal pronoun in the masculine or feminine
gender or in the singular or plural mode, shall be deemed to include the opposite gender or
mode unless the context clearly indicates the contrary.
8.06 EXHIBIT. "Exhibit" means the attached document(s) setting out certain particulars of this
Agreement, or any replacement document(s) mutually agreed to by the parties.
8.07 LEGAL CONSTRUCTION. Should any provision(s) contained in this Agreement be held
to be invalid, illegal or otherwise unenforceable, the remaining provisions of the Agreement
shall be construed in their entirety as if separate and apart from the invalid, illegal or
unenforceable provision(s), subject to renegotiation by the parties if a material change in the
terms of the Agreement were to result.
8.08 ENFORCEMENT. Any delay or inconsistency in the enforcement of any part of this
Agreement shall not constitute a waiver of any rights with respect to the enforcement of this
Agreement at any future date, nor shall it limit any remedies which may be sought in any
action to enforce any provision of this Agreement.
8.09 FORCE MAJEURE. Neither party shall be liable for any failure to perform its obligations
under this Agreement if prevented from doing so by a cause or causes beyond its
commercially reasonable control, including, but not limited to, acts of God or nature, fires,
floods, storms, earthquakes, riots, strikes and wars or restraints of government.
8
8.10 EMBEDC. This Agreement and any Exhibits or amendments and advertisement for bids
shall constitute the entire Agreement between the parties and shall supersede any and all
prior Agreements or understandings, either oral or in writing, between the parties respecting
the subject matter herein.
8.11 DISCLOSURE. STATEMENT. Purchaser acknowledges that a disclosure of all payments
to be made to Contractor has been made to Purchaser and such disclosure statement is
incorporated herein by reference.
IN WITNESS HEREOF, the parties hereto have executed this Agreement for an Effective Date of Decemb.
1,1998.
FOR CITY OF ROUND ROCK, PURCHASER:
Title:
HealthCare Benefits, Inc.
9
(Date)
FOR HEA BE F)T,S, INC., CONTRACTOR:
(Date)
Between
HEALTHCARE BENEFITS, INC. (CONTRACTOR)
and
CITY OF ROUND ROCK (PURCHASER)
These specifications are to apply beginning with the Effective Date of the Agreement between the parties
to which this Exhibit is attached and shall continue in force and effect until the Agreement is terminated or
this Exhibit is superseded in whole or in part by a later executed exhibit.
As provided in Paragraph 5.02 of Section Five of the Agreement, for the first (1st) year this Agreement is
in effect, the monthly administration fee shall be an amount equal to twelve and 50 /100 dollars ($12.50)
multiplied by the number of Employees enrolled in the Benefit Program on the first (1st) day of each month.
This fee includes repricing and administration of St. David's PPO as well as Vision administration. The
monthly Hospital Pre - Certification fee shall be an additional amount equal to one and 80/100 dollars ($1.80)
multiplied by the number of Employees enrolled in the Benefit Program on the first (1st) day of each month.
The monthly Dental Administration fee shall be an additional amount equal to two and 25/100 dollars ($2.25)
multiplied by the number of Employees enrolled in the Benefit Program on the first (1st) day of each month.
C. Dental Administration.
EXHIBIT NUMBER ONE
Specifications For
ADMINISTRATIVE SERVICES AGREEMENT
ITEM ONE
ADMINISTRATION FEE
ITEM TWO
OTHER SERVICES
As provided in Paragraph 2.17 of Section Two of the Agreement, the following additional services shall be
furnished:
A. Inpatient Certification Program will be administered by Blue Cross Blue Shield of Texas, Inc. acting
as agent of Contractor.
B. Prescription Drug Program by arrangement with Blue Cross Blue Shield of Texas, Inc. acting as
agent of Contractor to provide benefits substantially the same as its insured Prescription Drug
Program. Your billing will include applicable dispensing fees, discounted pricing and one and
70/100 dollars ($1.70) per prescription filled payable to the drug card company.
1
ITEM THREE
SPECIAL CLAIMS PROCESSING
As provided in Paragraph 2.14d of Section Two of the Agreement, the following special claims handling
procedures shall be followed: Nona.
ITEM FOUR
OTHER REPORTS
As provided in Paragraph 2.08c of Section Two of the Agreement, the following additional reports shall be
furnished: None.
ITEM FIVE
NOTICE ADDRESS
As provided in Paragraph 7.01 of Section Seven of the Agreement, notice to Contractor shall be delivered
or mail to:
HealthCare Benefits, Inc.
1001 E. Campbell
Richardson, TX 75081
HealthCare Benefits, Inc.
P. O. Box 833889
Richardson, TX 75083 -3889
Written notice to Purchaser shall be delivered or mailed to:
CITY OF ROUND ROCK
221 East Main Street
Round Rock, TX 78664
Fax notice to Purchaser shall be made to the following number:
(512) 255 -6676
FOR CITY OF ROUND ROCK, PURCHASER:
Title: (Date)
FOR HEALTHCARE BENEFITS, INC., CONTRACTOR:
2
(Date)
Purchaser shall designate in writing a contact person who will be empowered to act on behalf of
Purchaser with regard to the terms of the Agreement and with whom Contractor can coordinate and
resolve all questions arising in the course of administration.
FOR CITY OF ROUND ROCK, PURCHASER:
Title: (Date)
Title: (Date)
CONTACT PERSON
DESIGNATED PERSON EMPOWERED TO ACT ON BEHALF OF PURCHASER:
Product: Stop Loss
EMPLOYEE BENEFIT PLAN
DISCLOSURE FORM
For
CITY OF ROUND ROCK
The agent and/or Health Care Benefits, Inc. will contract with or represent the insurance carrier in
conjunction with the sale of certain group insurance polices. This disclosure does not limit the agent's
ability to recommend the products of other insurance companies or other funding organizations, but is
intended to disclose the financial interest of the parties as to the Employee Benefit Plan. HealthCare
Benefits, Inc. is a wholly -owned subsidiary of Blue Cross Blue Shield of Texas, Inc. As requested by the
Purchaser, HealthCare Benefits, Inc. has solicited bids from Stop Loss Carriers, Life Carriers, etc., and
the Purchaser, after reviewing the proposals, has selected certain coverage. The relationship and dealings
of those companies are on file with the State Board of Insurance. If insurance is purchased through an
insurance company, HealthCare Benefits, Inc. may contract to facilitate the payment of insurance
premiums, claims and eligibility and may receive compensation for its services, but HealthCare Benefits,
Inc. is not an agent of the insurance company and does not receive commissions.
The following persons or companies are entitled to commissions as agents on the insurance contract
issued to you:
Product: Administration
Name of Broker: Keith Carmichael Commission: n/a
Name of Broker: Keith Carmichael Commission: j.
HealthCare Benefits, Inc., in addition to its administrative charge as indicated in the Administrative
Services Agreement, is entitled to the following payments and marketing allowances for its services:
Product: Stop Loss Administrative Charge: nLa
FOR CITY OF ROUND ROCK, PURCHASER:
Title: (Date)
2
FOR CITY OF ROUND ROCK, PURCHASER:
HealthCare Benefits, Inc.
3
The undersigned acknowledges receipt of the information contained herein prior to any purchase and
approves the proposed transaction on behalf of the plan without receiving, either directly or indirectly,
any personal compensation in connection with the purchase of policies under this Plan.
Title: (Date)
FOR HEALTHCARE BENEFITS, INC., CONTRACTOR:
(Date)
Employee Only
$25.71
324.43
518.54
- - -- _.. -- - •••.•.......,,.... .-,,. ua IMICINS ry. Gomn1 n
Specific
Paid
15/12
15/12
15/12
24/12
15/12
15112
15112
15112
gregate
Paid
15/12
15/12
15/12
24/12
15/12
Pald
15/12
15/12
op Loss
330,000
$30,000
330,000
530,000
330,000
330,000
530,000
530,000
530,000
Employee Only
$25.71
324.43
518.54
518.24
522.80
530.09
521.70
$21.30
517.01
Employee Family
369.43
565.97
545.85
345.03
552.30
369.14
553.92
354.51
544.70
Aggregate Corridor
120%
125%
125%
125%
125%
125%
125%
125%
125%
Aggregate Premium
53.05
52.54
54.27
$6.07
33.15
$3.32
$3.59
33.41
33.62
Expected Claims
Factor (ee)
S210.07
3200.14
$189.53
3190.62
$192.04
319926
3239.98
5191.63
5114.14
Expected Claims
Factor (el)
$210.07
5200.14
5189.53
$190.62
5192.04
3199.26
3239.98
5191.63
3285.31
Attachment Point
Factor (ee)
5252.06
5250.18
$236.91
S236.28
$240.05
5249.08
3299.95
5239.54
$142.68
Attachment Point
Factor (eQ
5252.08
3250.18
3236.91
5238.28
5240.05
5249.08
3299.95
3239.54
3358.64
TPA HBI
Reinsurance Carrier BCBSTX
A g
St
HBI
BCBSTX
3
HBI
Souttand
Medical Admin
Precertification
Dental/Vision Admin
PPO Fee
Prescription
Total Fixed Cost
Expected Claims
Annual Attachment
Point
Total Estimated Plan
Cost
Total Maximum
Plan Cost
312.50
51.80
52.25
30.00
included
5291,128.40
$1,033,544.40
31,240,233,60
51,324,672.80
51,531,362.00
512.50
51.80
52.25
50.00
included
3278,920.80
5984,688.80
51,230,885.60
31,263,609.60
31,509,806.40
512.50
51.80
S2.25
50.00
included
$236,254.60
3932,487.60
51,165,597.20
51 ,16 8,74 2.40
51,401,852.00
$12.50
51.80
5225
50.00
included
3242,823.60
5937,850.40
51,172,337.60
51,180,674.00
51,415,181.20
512.50
51.80
32.25
50.00
included
3255,120.00
$944,836.80
51,181,046.00
$1,199,956.80
31,436,166.00
312.50
51.80
32.25
30.00
included
3306,721.20
5980,35920
51,225,473.60
51,287,080.40
51,532,194.80
512.50
31.80
32.25
30.00
included
3256,116.00
51,180,60320
31,475,754.00
51.436,71920
$1,711,1170.00
38.45
52.00
5120
52.50
Included
1242,968.50
5942,819.60
31,178,630.60
31,185,815.40
$1,421,535.61
111,90
$1.65
52.10
53.90
31.10
3246,204.00
3828,594.00
11,038,763.20
$1,074,886.00
31,282,057.20
City of Round Rock
invitation for Bid Results
HBI
Jo hn AI
Run In Limit
none
none
none
P M.
• Lei { ,.rr. l, , 1 .
IYI/SaNi 47 --, CoS--sS
5175,491.00 not knovm 5153,429.00 not known Nan known 1 5207,151001
Qu .
- /1 a 0.5,ev... - . 1
/ t1AML
HBI
HBI
HBI
6 61
1
DATE: November 19, 1998
SUBJECT: City Council Meeting, November 24, 1998
ITEM: 14. F. 1. Consider a resolution authorizing the Mayor to execute an
agreement with HealthCare Benefits, Inc. for third party
administration of the City's self - funded health plan.
This agreement with HealthCare Benefits, Inc. (HBI) provides for
third -party administration and claims payments for the City's self - funded
health plan which includes medical, dental and vision care. The term of
this agreement is for the period of one year (renewable) and commences
on December 1, 1998. HBI has been the third -party administrator for the
past four years. Staff Resource Person: David Kautz, Finance Director.
PLAN' DOCUMENT NO.: 1189
PLAN SPONSOR: City of Round Rock
PLAN SPONSOR'S PRINCIPAL LOCATION: Round Rock, Texas
PLAN EFFECTIVE DATE: December 1, 1998
PLAN ANNIVERSARIES: December 1, 1999 and each year thereafter
STOP LOSS CARRIER: Southland Life Insurance Company
The Plan Sponsor has established a self- funded Employee Welfare Benefit Plan and the Plan
Sponsor has adopted this "PLAN DOCUMENT" (hereinafter "PLAN ") providing for certain
medical benefits as herein described for certain Employees and certain Dependents of such
Employees of the Plan Sponsor and other Participant Employers as herein listed.
The Plan Sponsor AGREES to pay, subject to all the provisions of this Plan, including any
amendments to this Plan, the benefits hereinafter described to the person or persons entitled
to such payments while covered hereunder.
The provisions of the following pages are a part of this Plan. Such provisions alone constitute
the agreement under which payments will be made and are a part of this "Plan" as fully as if
recited over the signatures hereto affixed.
IN WITNESS HEREOF, City of Round Rock has caused this Plan to be executed this 1st day
of December, 1998.
BY: WITNFSSED BY:
7)1A V■07
Title
Date
2
CT I ,.
4
Title f`
Date
•
•
PPO
RESTATED
EMPLOYEE BENEFIT PLAN
(herein referred to as the "Plan ")
MASTER BENEFIT PLAN DOCUMENT
describing the
COMPREHENSIVE MEDICAL, VISION AND DENTAL PLAN
for the Employees of
CITY OF ROUND ROCK
This Restated Plan's
Effective Date is
December 1, 1998
Plan Document No. 1169
•
LIST OF AFFILIATES OR SUBSIDIARIES
The Employees of a subsidiary or affiliated Company of the Plan Sponsor Covered under this
Plan are subject to the following conditions:
(1) Participation is not contrary to any applicable law; (2) the Plan Sponsor owns at least a
majority of the voting shares of stock and has legally enforceable control over the Corporate
entity of such Company, or the Plan Sponsor has controlling financial interest in the
non- corporate entity of such Company; (3) the Company is not a fraternal group, club or
organization of similar composition; (4) the Plan Sponsor agrees to include the Company in this
Plan; (5) the Plan Sponsor agrees that when eliminated from this list as a Participant, any
obligations under this Plan during which the Plan Sponsor was a Participant will not be
relieved; (6) the liability for payments made under this Plan on behalf of the Participant shall
be mutually agreed upon between the Claims Administrator and the Plan Sponsor; (7) the Plan
Sponsor acts for or on behalf of all Participants under the Plan; and (8) all such acts by the
Plan Sponsor shall be binding on the Participants.
Names of Subsidiaries
or Affiliates
Employer Principal Location
City of Round Rock Round Rock, Texas
3
Effective Date
of .Inclusion
December 1, 1998