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CM-04-12-092iLi @(I!, Request for City Council/City Manager Action Please submit this form when placing items on the council agenda or when submitting an item to the City Manager for approval. Department: Contact Person: Project Name: ContractorNendor Name: Human Resources Teresa Bledsoe COBRA Contract Great -West Insurance Amount: None Is Funding Required? Council Agenda Item Submission to City Manager - Project Manager/Resource: Linda Gunther Council Meeting Date: City Manager Approval Funding Source: N/A Assigned Attorney: J. Kay Gayle (contract, agreement,amendment,change order, purchase order,etc.) l(� ' ( tl(trki; ' 1,..) l'((( �t Yes X Non r Yes X No n Yes n No n f.tlrlSi C- (see required signatures below before submission to the City Manager) Agenda Wording: Initial Construction Contract Construction Contract Amendment Change Order 1Change in Quantity EJUnforeseen Circumstances 0 Initial Professional Services Agreement Supplemental Professional Svcs. Agr. # Purchasing/Service Agreement Purchase Order Item(s) to be purchased: Amount Other (Please clearly identify action on lines below) Contract with Great West Life & Annuity Insurance Company for the administration of COBRA for the continuation of the health plan coverage for eligible beneficiaries as defined by the City. For Submission to City Manager Only Project Mgr. Signature: Date: Dept. Director Signature: Date: City A}torney Signature: * Date: ty Manager Signature: :. Date: )r%..- /z3 -CA al Approval is required for all items requesting City Manager's approval. Finance Approval Finance -Date and Signature: Purchasing -Date and Signature Budget -Date and Signature: z g/administratonkmgr-council actionzls 11-1-04 DATE: SUBJECT: ITEM: City Manager Approval Contract with Great West Life & Annuity Insurance Company for the administration of COBRA for the continuation of the health plan coverage for eligible beneficiaries as defined by the City. Department: Human Resource Staff Person: Teresa S. Bledsoe Justification: This agreement with Great -West provides for independent third -party administration of the City's self-funded health plan, which includes the payment of medical, dental, and vision claims, monthly and quarterly reports and the coordination of benefits within the plan document to continue coverage for eligible beneficiaries as defined by the City. Funding: N/A Cost: N/A Source of funds: N/A Outside Resources: N/A Background Information: Great -West provides for independent third -party administration of the City's self- funded health plan which includes the payment of medical, dental, and vision claims, administration of the Flexible Spending Accounts for medical and dependent care reimbursement, monthly and quarterly reports and the coordination of benefits within the plan document. Public Comment: N/A 07202 Cobra (10) 2004 CONTINUATION OF COVERAGE (COBRA) PREMIUM COLLECTION SERVICE AGREEMENT by and between CITY OF ROUND ROCK, TEXAS (Herein called the Client) and GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY (Herein called the Service Contractor) The Client has established a written plan of health benefits (hereinafter called "the Plan") for its employees, and desires that the Service Contractor perform certain administrative services in connection with continued coverage for eligible Plan beneficiaries as identified by the Client (hereinafter called "Plan beneficiaries"). In consideration of the payment to the Service Contractor of the fees stated in the Payment Schedule, and subject to the terms and conditions of this Agreement, the Client and the Service Contractor agree as follows: Section 1. Services The Client and Service Contractor shall have the following responsibilities in connection with the administration of continued coverage for Plan beneficiaries according to the terms of the Plan: A. In the case of each Plan beneficiary who has chosen to continue coverage under the Plan, the Client shall provide the following information to the Service Contractor as soon as reasonably possible: The name and billing address of the Plan beneficiary. An original election form signed by the Plan beneficiary specifying the coverage(s) the beneficiary has chosen to continue, the date such continued coverage is to begin, the number of months the beneficiary may continue coverage, and the amount to be billed each month for such coverage(s). B. Upon receipt of the information described in paragraph I, the Service Contractor shall bill the beneficiary each month for the amount the Client has specified. Such bill shall indicate the coverage period being billed for, the payment due date, the amount due for the coverage period, any amount due for prior coverage periods, and the address to which payment should be sent. Within six months of the date the beneficiary's right to continue coverage will end, the Service Contractor will mail to the beneficiary a statement informing the beneficiary of his or her right to obtain individual conversion coverage, and whom to contact for information about the details of such coverage and how to apply. C. If the Service Contractor does not receive a beneficiary's payment within 31 days of the payment due date, coverage for that beneficiary and any persons covered through him or her will end as of such 31st day. If this happens, the Service Contractor will send written notice of termination to the beneficiary, and a copy of such notice to the Client. GA -COBRA -ADMIN -(4-00) 1 (Rev. 09-02) 07202 Cobra (10) 2004 Section 1. Services The Client and Service Contractor shall have the following responsibilities in connection with the administration of continued coverage for Plan beneficiaries according to the terms of the Plan: A. In the case of each Plan beneficiary who has been terminated under the Plan, the Client shall provide to the Service Contractor, eligibility data transmitted electronically on a weekly basis to include the name, date of termination, type(s) of health coverage being terminated, and reason for termination of Plan beneficiary. It is the Client's duty to notify the Service Contractor promptly should the Client determine that any such terminated Plan beneficiary does not qualify to receive COBRA continuation right notice letter as described in Section 1.B. below. B. Based upon the information described in Section 1. A. above and upon receipt of such information, the Service Contractor shall: 1. Within 14 days, mail to Plan beneficiaries (except for those Plan beneficiaries determined as to not qualify by the Client) a letter outlining their right to continue coverage under COBRA and an election form. 2. Upon receipt of the timely submitted signed election form indicating an election for coverage, bill the Plan beneficiary for the amount of the initial COBRA premium due as shown on the election form. For each month thereafter, bill the Plan beneficiary for a monthly COBRA premium due. Such bill shall indicate the coverage period being billed for, the payment due date, the amount due for the coverage period, any amount due for prior coverage periods, and the address to which payment should be sent. An election to continue COBRA is considered to be timely submitted only if it is mailed, delivered, or clearly communicated to the Service Contractor within 60 days after a) the date on which a letter of COBRA right notice stated in Section 1.B.1. above was mailed to the Plan beneficiary or b) the date on which the Plan beneficiary's coverage under the Plan would have been terminated, whichever date is later. C. If the Service Contractor does not receive full payment: 1. For the initial COBRA premium within 45 days after the COBRA election date, the Plan beneficiary will be considered to have forfeited his or her right to continue COBRA coverage. This forfeiture of COBRA rights will also affect other family member whose election for COBRA coverage was made through or jointly with the Plan beneficiary's COBRA election, or 2. For each subsequent monthly COBRA premium within 31 days of the payment due date, coverage for that Plan beneficiary and any persons covered through him or her will end as of the end of the period for which the last required COBRA premium was paid. For purposes of this section, a monthly premium is due in advance on the first calendar date of each calendar month. D. The Service Contractor will send written notice of termination to each beneficiary whose coverage ends because the period of time he or she was eligible to continue coverage expired, and to each beneficiary whom the Client has identified to the Service Contractor as having lost eligibility to continue coverage. Such notice will specify the reason for the coverage termination and the effective date of termination. GA -COBRA -ADMIN -(4-00) 2 (Rev. 09-02) 07202 Cobra (10) 2004 E. Not later than the fifteenth working day of each month the Service Contractor will remit to the Client in such manner as the Client may direct all payments received from Plan beneficiaries during the previous calendar month period for continued coverage. The Service Contractor shall provide to the client at least monthly a written accounting showing the name of each beneficiary, the type(s) of coverage billed for, the period(s) of time billed for, the amount billed, the amount received, and the date each amount was received. Such accounting will also list any Plan beneficiaries whose continued coverage was terminated during the previous calendar month, and the reason for each termination. F. The Service Contractor will perform tasks incidental to the administration of continued coverage for Plan beneficiaries, such as processing notices of change of address, resolving billing problems, and, if applicable, quoting benefits and premium rates for individual conversion coverage. G. The Service Contractor shall perform the services described in this Agreement in an administrative support capacity only, and shall take no part in determining or assisting the Client in determining a Plan beneficiary's initial or on-going eligibility for continued coverage. If in the normal course of its business the Service Contractor receives any information which indicates or tends to indicate that a Plan beneficiary is not eligible to continue coverage, it shall notify the Client of that fact as soon as reasonably possible. Except in those cases stated in paragraph C or D of this Section 1, the Service Contractor shall not terminate the continued coverage of any Plan beneficiary unless it has first received written authorization to do so from the Client. H. The Service Contractor shall have no responsibility to notify any Plan beneficiary or dependent or former dependent of any Plan beneficiary of his or her right to continue coverage under the Plan. The Client is solely responsible for giving such notice and for providing the Service Contractor with the information described in paragraph A of this Section 1. Section 2. Delays in Performance The Service Contractor shall not be responsible for delay in the performance of its duties under this Agreement or for non-performance hereunder if such delay or non-performance is caused or contributed to in whole or in part by the failure of the Client to promptly furnish any required information. Section 3. Payments to the Service Contractor The Service Contractor shall bill the Client in accordance with the Payment Schedule for the services the Service Contractor performs under this Agreement. The Client shall pay the billed amount to the Service Contractor within thirty working days of the date of such bill. The Service Contractor shall have the right to adjust its fees for the services performed under this Agreement on the annual anniversary of this Agreement and annually thereafter. Section 4. General Provisions A. The Service Contractor shall use reasonable care and diligence in the exercise of its powers and the performance of its duties under this Agreement, but shall not be liable for any mistake of judgment or other action taken in good faith, or for any loss unless resulting from its gross negligence. B. The Client shall indemnify the Service Contractor and hold the Service Contractor harmless against any and all loss, federal excise tax, damage and expense, including court costs and attorneys' fees, resulting from or arising out of claims, demands or lawsuits brought against the Service Contractor as a result of or in any way growing out of its performance of services under this Agreement, including compensatory, punitive or other damages. GA -COBRA -ADMIN -(4-00) 3 (Rev. 09-02) 07202 Cobra (10) 2004 C. All or some of the duties of the Service Contractor under this Agreement may, at the Service Contractor's sole discretion, be performed by a contractor of its choosing. D. The Service Contractor shall consult with the Client, or the Client's designated Plan Administrator or legal counsel in matters that are beyond the ordinary or in the event a Plan Participant disputes any action taken by the Service Contractor in connection with its administration of continued coverage for that participant. In the defense of any legal action against the Service Contractor brought as a result of or in any way growing out of such administration, the Service Contractor will furnish the Client, its Plan Administrator and/or legal counsel all pertinent information regarding the matter in dispute. The Service Contractor shall not be obliged to undertake the defense of any such legal action. E. The Service Contractor shall be entitled to rely upon any communication believed by the Service Contractor to be genuine and to have been signed or presented by the proper party or parties. F. The Service Contractor shall not be bound by any notice, direction, requisition or request unless and until it receives it in writing at its home office in St. Louis, Missouri. Notices or communications to the Client shall be sent to the Client at the following address: CITY OF ROUND ROCK, TEXAS Attn: Linda Gunther 221 East Main Street Round Rock, TX 78664 Either party may change its address from time to time by notice given to the other in accordance with this paragraph F. G. The Service Contractor shall have no power or authority to alter, modify or waive any of the terms or conditions of the Plan, or to waive any breach of any such terms or conditions, or to bind the Client or to waive any of its rights, in any way whatsoever. H. The Service Contractor shall have no power or authority to act for or on behalf of the Client other than as herein expressly stated, and no other or greater power or authority shall be implied by the grant or denial of power or authority specifically mentioned in this Agreement. The Service Contractor shall hold as the property of the Client all papers, books, files, correspondence and records of all kinds which at any time shall come into its possession or under its control and which relate to the transactions it performs under this Agreement. The Service Contractor shall surrender such records to the Client upon termination of this Agreement or upon prior request. The Service Contractor may periodically destroy such material as it would destroy its own records of a similar nature in the normal course of its business. J. The Client shall have the right at all reasonable times to inspect at the offices of the Service Contractor all documents that relate to the Service Contractor's performance of its duties under this Agreement. All costs of such inspection(s) shall be borne by the Client. K. Failure by the Client or the Service Contractor to insist upon compliance with any provision of this Agreement at any time or under any circumstances shall not operate to waive or modify such provision or render it unenforceable as to any other time or circumstance, and no waiver of any of the terms or conditions of this Agreement shall be valid or of any force or effect unless contained in a writing signed by a person duly authorized to sign such waiver. GA -COBRA -ADMIN -(4-00) 4 (Rev. 09-02) 07202 Cobra (10) 2004 L. No alteration or modification of the terms and conditions of this Agreement shall be valid or of any force or effect unless in each instance it is contained in a writing expressing such alteration or modification and executed for the Client and Service Contractor by their officers duly authorized to sign such alteration or modification. M. This Agreement, including any appendices or supplements thereto, shall constitute the entire contract between the parties and shall govern the rights, liabilities and obligations of the parties hereto except as it shall be modified in accordance with paragraph K or L. N. Any assignment of this Agreement or of any rights hereunder shall be void and of no force or effect. O. It is understood that under this Agreement the Service Contractor performs purely ministerial functions for the Client within a framework of policies, interpretations, rules, practices and procedures made by the Client. Any review by the Service Contractor of any action it has taken with regard to continuation of coverage for a Plan beneficiary is made as a service for the Client, who retains the final responsibility for determining what action(s) to take in the administration of the Plan. P. Under no circumstances shall the Service Contractor be considered the named fiduciary under the Plan. Section 5. Controlling Law This Agreement shall be construed and enforced according the laws of the State of Texas and venue shall lie in Williamson County. Section 6. Separability If any provision of this Agreement is determined to be illegal or invalid for any reason by law or a court of competent jurisdiction, such illegality or invalidity shall not affect the remaining parts of this Agreement, and they shall be construed and enforced as if said illegal or invalid provision(s) had not been included herein, provided the basic purposes of the Agreement can be effectuated through the remaining valid and legal provisions. Section 7. Counterparts This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, and said counterparts shall constitute but one and the same instrument. Section 8. Termination A. If any state or other jurisdiction enacts a law which prohibits the continuance of this Agreement, or existing law is interpreted to so prohibit the continuance of this Agreement, the Agreement shall terminate automatically as to such time or jurisdiction on the effective date of such law or interpretation. B. Either party may terminate this Agreement as of any anniversary of its effective date by giving at least 31 days' prior written notice to the other party. C. The Service Contractor may terminate this Agreement if the Client defaults in the timely payment of any amount due under this Agreement and, after having been given notice of such default, fails to cure its default within ten working days of the date of such notice. Termination of this Agreement for the reason described in this paragraph C shall be effective immediately upon the Client's receipt of written notice of termination from the Service Contractor. GA -COBRA -ADMIN -(4-00) 5 (Rev. 09-02) 07202 Cobra (10) 2004 In witness whereof, the parties have caused this Agreement to be executed by their respective officers duly authorized to do so, to be effective as of December 1, 2002. By: By: GA -COBRA -ADMIN -(4-00) CITY OF ROUND ROCK, TEXAS (Client) 1' i Manap (Date) GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY &ju Assistant Group Secretary February 2, 2004 6 (Rev. 09-02) 07202 Cobra (10) 2004 PAYMENT SCHEDULE To be attached to and made a part of the Agreement by and between: CITY OF ROUND ROCK, TEXAS and GREAT -WEST LIFE & ANNUITY INSURANCE COMPANY The Client shall make payments to the Service Contractor in advance for service fees listed below by the first day of each Plan Month in which the Service Contractor performs duties pursuant to this Agreement. A grace period of 30 days is granted after such monthly payment due date. The amount due will be determined as follows: 1. Initial set-up fee $1,250.00 2. First Year renewal fee Waived 3. Annual renewal fee after the first year $700.00 4. Monthly fees for: monthly billing service $10.50 per bill 5. Qualifying Event Notice $10.50 per notice GA -COBRA -ADMIN -(4-00) 7 (Rev. 09-02)