Item J1
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Mav 20, 2009
Division: Employee Services
Bulk Item: Yes
NolL..
Department: Employee Services
Staff Contact Person: Teresa Aguiar X4458
AGENDA ITEM WORDING: Discussion and approval to continue current contract agreements for
the County's Third Party Administrator - Wells Fargo and Utilization Review/Case
Management and Local Network Provider - Keys Physician Hospital Alliance.
ITEM BACKGROUND: On August 20, 2008, the BOCC discussed (and approved) a request to seek
proposals for Third Party Administration Services, Utilization Review, Large Case Management and
Network Provider Services for the County's Self-Insured Health Plan and investigate and evaluate
available alternatives. Request for Proposals completed in February 2009.
PREVIOUS REVELANT BOCC ACTION:
Third Party Administrator: 2001- RFP; Renewed contract with Current Provider, Wells Fargo (02/03;
03/04; 04/05). 2005 - BOCC approved waiver of RFP and renew contract with current Provider, Wells
Fargo (05/06; 06/07; 07/08). 4/16/2008 - BOCC approved waiver of RFP and renew contract with
current Provider Wells Fargo (08/09; 09110; 10/11). 8/20/08 - BOCC approved request to go out to bid
services.
Utilization Review/Case Management Provider: 2004 - BOCC approved to continue with KPHA and
change the discounted rate from 15% to an improved 25% (3/04 - 2/05; renewed: 05/06; 07/08). January
2007 BOCC approved extension of contract until 9/30/08. 4/16/2008 - BOCC approved waiver of RFP
and renew contract with current Provider, KPHA, (08/09; 09/10; 10/11). 8/20/08 - BOCC approved
request to go out to bid services.
CONTRACT/AGREEMENT CHANGES: Continue with the current contracts which will renew effective
May 20, 2009 and expire May 19,2012.
STAFF RECOMMENDATIONS: Approval to continue with the self-insured medical benefits plan and
continue current contracts.
Wells Fargo - Approx $200,659 yr
TOTAL COST: KPHA-Approx$25,580yr INDIRECT COST: BUDGETED:Yes -X-No
+ $55.00 hr Large Case Mgmt
COST TO COUNTY: same as above SOURCE OF FUNDS: Ad Valorem
REVENUE PRODUCING: Yes NO~MOUNT PER MONTH Year
--~ --
APPROVED BY: County Atty _ /Purchasing _ Risk Management_
DOCUMENTATION: Included ~ To Follow_ Not Required _
DISPOSITION:
AGENDA ITEM #
O,y,~~y ~~~~~~E
(305) 294-4641
Office of the Employee Services Division Director
The Historic Gato Cigar Factory
1100 Simonton Street, Suite 268
Key West, FL 33040
(305) 2924458 - Phone
(305) 292-4564 - Fax
TO:
.1'''-- ,----........--
,
BOARD OF COUNTY COMMISSIONERS
Mayor George Neguent, District 2
Mayor Pro Tem Syivia J. Murphy, District 5
Kim Wigington, District 1
Heather Carruthers, District 2
Mario DiGennaro, District 4
~~'ln ~~
..~ ::;;::~', .I+-t.!:
1 _~ ~ ....::"1,
'.'~~:=::.-'.:5
..... ; ~ ;-:;l ,"-,'1'
-t.y ~ ~.
Board of County Commissioners
FROM:
Teresa E. Aguiar,
Employee Services Director
DATE:
May 4, 2009
SUBJ:
Contract Renewals
Wells Fargo & KPHA
This item requests approval to continue with the self-insured medical benefits plan and renew the current
contracts with Keys Physician Hospital Alliance (KPHA), Local Network and Utilization Review/Case
Management Provider and Wells Fargo, Third Party Administrator for the County's Group Health Plan.
· Wells Fargo handles the claims processing for approximately 1,579 active employees and retirees.
Claims are sent directly to the Third Party Administrator which reviews them for eligibility and
processes them for payment along with the Explanation of Benefits (EOB's).
· KPHA is the County's local network provider and negotiates with physicians, hospitals and other
ancillary health services for discounted fee arrangements. KPHA also provides Pre-admission
Certification and Medical Case Management services for the County.
A request for proposals was advertised late 2008 and completed in February, 2009. Ten proposals were
received and evaluated by a committee comprised of the Division Director of Employee Services, Senior
Administrator of Benefits, Senior Coordinator of Benefits and Interisk Consulting Services. Proposals
consisted of both self-insured and fully-insured services.
As explained on the attached evaluation from Interisk, it is in the County's best interest to continue its
self-insured medical benefits plan and continue with its current providers, KPHA and Wells Fargo. It is
therefore recommended that the Board approve the request to renew with the current providers for one
year beginning May 20,2009 through May 19,2012. If you have any questions on this item, please do
not hesitate to contact me at X4458.
MONROECOUNTYFLO~DA
Evaluation of Medical Benefits RFP Responses
May 2009
This report provides the result of the evaluation of responses to the County's Request for
Proposals (RFP) for its Group Medical Benefits Plan.
The RFP Process
The purpose of the RFP was to approach the insurance market place and solicit proposals
for administration services for its current self-insured plan and other creative insurance
plans including fully insured programs for the County's Medical Benefits Plan. The RFP
document was distributed in accordance with the county's purchasing procedure.
The original RFP distribution was made in 2008;
Addendums were published in 2009; and
The Return Date was February 2009
Ten (10) proposals were received. The response is considered representative of the
market place based upon the geographic location of the County and the availability of
provider networks and hospital facilities.
Proposals included self-insured administration services, fully insured programs and
Medicare Supplement programs.
All proposals were reviewed by the County's Evaluation Committee and the County's
consultant in accordance with the terms published in the RFP. Each of the proposals is
separately commented on in this report.
Background of the Medical Benefits Self-insured Program
The County has self-insured its medical benefits for the past twenty-five years and has
enjoyed favorable results. Funding for the plan has controlled cost through a
combination of provider networks, utilization of managed care for more serious and high
valued claims, pre-certification of various procedures and continual monitoring of benefit
payments and has thus resulted in lower than average funding increases and in some
instances no increase in internal department allocations at all. The stability of plan
benefits and cost is considered a success.
Highlights of some of the Plan's features are:
· Medical claims for FY 09/10 are projected at approximately $12 million;
· The County pays 100% of the employee cost for its approximately 1579 employees;
· Employees pay 100% of dependent cost;
· Retirees pay a varying cost based upon their date of hire and years of service;
· The Keys Physician Hospital Alliance (KPHA) is the primary provider network;
· A second network - Dimension is used for Dade, Broward & Palm Beach Counties;
· A third wrap around network - Multiplan is used countrywide for out of area provider
servIces
Results of RFP Review
Fully Insured Proposal
A fully insured proposal was received from Blue Cross and Blue Shield of Florida. The
plan utilizes a standard Blue Cross benefits plan referred to as Plan #107 which is stated
as similar to the County's current self-insured benefit plan. However, there are
differences such as a forty hour work week eligibility (the County's plan is twenty-five
hours). Members will also need to use Blue Cross network providers which may require
some of them to change existing physician relationships. Blue Cross utilizes a proprietary
computerized claims payment system containing Blue Cross established allowable
payment amounts for various claim codes. The Blue Cross proposal also does not cover
open claims not yet paid by the County's self-insured plan. These claims could add a
significant additional cost to their quoted rates and cost...
Their fully-insured rates are listed as: employee $725.40 per month; employee/spouse
$1501.58 per month; employee/child(ren) $1363.76 per month; and employee/family
$2303.14 per month. Their rates were only guaranteed for one year and would be
recalculated annually. Extending these rates for the 1579 employees based on the
County's medical census develops and annual cost of$17,812,947.12 which is over $5.5
million higher than the expected cost of the County's FY 08/09 self-insured plan. For
these reasons, it is recommended that the Blue Cross fully-insured plan be removed from
further consideration.
Medicare Supplement Plans
A proposal was made by the Valery Insurance Agency for Medicare Supplement
coverage and will apply only for the County's members and retirees over age sixty-five
(65) and then only for supplemental coverage. No specific rates or premium charges
were shown in the proposal and while the County solicited creative alternative proposals,
2
this proposal will not provide primary medical benefits for employees and their
dependents. It is recommended that this proposal be removed from further consideration.
Administrative Services for Self-insured Plan
Cost for self-insured administration services ranged from a low of $2 11,270 for partial
services to a high of$I,016,370.
All proposals were fully reviewed and considered and cost calculations were verified.
Blue Cross Blue Shield of Florida
Blue Cross submitted three proposals for administrative services. The first one was
submitted by Blue Cross directly and does not include any involvement or payment to an
insurance agent. Blue Cross proposes use of their standard benefit plan #107 which is
similar to the County's current benefit plan with the same changes mentioned above
regarding a twenty-five hour work week eligibility, use of the Blue Cross network
providers and use of the proprietary Blue Cross computerized claim payment system and
discount scale.. The result may be different payment recoveries than under the current
County Plan. The proposal also did not include any cost for handling of the run out
claims from the County's current plan. The calculation based on the Blue Cross rate of
$51.12 per employee per month for 1579 employees develops an annual cost of $968,622
which is considerably higher than the expected cost of the current plan's FY 08/09
administrative cost. All calculations were confirmed with the proposer. For these
reasons, it is recommended that the Blue Cross proposal be removed from further
consideration.
The second and third Blue Cross proposals contained the identical information as their
original direct proposal except that the cost of agent commission was added to each one.
The resulting calculation is an additional administrative cost of $47,748 annually which
increases the total to $1,016,370 and is considerably higher than the current plan's
expected cost. The proposals submitted by the Gehring Group and the Arthur 1.
Gallagher insurance brokers affirm the information in the Blue Cross direct proposal and
provide information showing additional services that they will provide for their
commission. The Blue Cross organization is large and experienced and the additional
services may not be needed. It is recommended that each of these proposals be removed
from further consideration.
UMR Proposals
UMR is the Administrative Services line of United HealthCare. They submitted two
proposals, one through the Gables Financial Group and another through the Sapoznik
Insurance Agency. Both proposals utilize the United HealthCare provider network. The
United HealthCare network while formidable may still require some employee or
dependants to change provider relationships. Both proposals include commission to be
3
paid to the insurance agent. The cost structure and services proposed are similar with the
exception of some optional services. The commission amount for the Sapoznik Insurance
Agency proposal is shown as $6.00 per employee per month ($113,688 annually).
The Gables Financial Group proposal shows a commission rate of $4.00 per employee
per month, but shows a total of$1 13,688 annually which equates to $6.00 per employee
per month. The printed number of $1 13,688 was used as the commission number for the
comparison. Gables Financial Group's proposal also did not contain required RFP
responses to thirty-eight (38) questions and two required signature pages were not
included. Without the answer to the missing questions a complete evaluation is not
possible.
The cost calculation for both the Sapoznik Insurance Agency and the Gables Financial
Group is $796,637 annually including claim administration, commission to agents, set up
fees, document fees, utilization review, network access, HIP AA charges, run out claims
handling from the current self-insured plan and reporting charges. Total expected cost
for both the Sapoznik Insurance Agency and Gables Financial Group is significantly
higher than current administration charges and it is recommended that they both be
removed from further consideration.
SIP Self-insured Plans. LLe
The proposal submitted by SIP Self-insured Plans, LLC did not include a specific
network, but proposed to takeover the existing primary KPHA network. The KPHA
network submitted a joint proposal with another proposer and it is not known if KPHA
would agree to have SIP Self-insured Plans, LLC as the claim administrator or if so, at
what cost. Without the additional information, a full evaluation cannot be completed.
Other elements of the proposal were not included in the RFP response including the cost
of run out claims from the County's existing benefit plan. The cost calculated using the
partial cost structure is $306,115 and is higher than the County's current cost for its
benefit plan. It is recommended that SIP Self-insured Plans, LLC be removed from
further consideration.
FHA-TPA
The proposal submitted by FHA - TP A also did not contain a network designation or fee.
They propose to takeover the existing KPHA, Dimension and Multiplan networks. Since
the KPHA network made a joint proposal with another proposer, it is not known whether
KPHA would agree to utilizing FHA - TP A as a claim administrator or if so, at what cost
for the network access. Without the proper network designation and cost, the proposal is
considered incomplete and could not be accepted without further information including
the terms of the network arrangement.
The proposal also did not contain any response to handling the run out claims from the
County's current self-insured plan. The cost could be significant since run out claims can
4
average as much as twenty-five percent (25%) of annual claim count. FHA- TP A also did
not sign the required RFP response form designating a network and the cost. They also
did not include required references as part of their proposal and there was no way to
verity their quality of service.
The annual cost, not including any charge for the KPHA network access, is calculated at
$211,270. While the partial cost calculation is below the current cost of administrative
services, it is not considered a complete proposal and may result in additional cost for
network access and would result in use of a different computerized claim payment
system. The difference in the partial cost is not considered sufficient to offset the change
to an unknown claim administrator.
Wells Fargo and Kevs Phvsician-Hosvital Alliance (KPHA) Proposal
Wells Fargo and KPHA, the County's current claim administrator and network provider,
submitted a proposal for all services presently provided to Monroe County. The total
cost is $249,924 annually. Their proposal will maintain the current networks in place and
there will be no need for new enrollment. All existing provider relationships will be
maintained. A three year (3 year) cost guarantee is included.
Wells Fargo and KPHA have provided administrative services and medical management
for the last twelve (12) years. Fees have not increased in the last nine (9) years. The
proposal states the rates will hold at the same levels for another three (3) years for the
same program. A current employee survey taken in February, 2009 indicated employee
and retiree satisfaction with the current medical benefits program and the claim
administration services.
As part of their combined proposal Wells Fargo, the County's current claim
administrator's proposal contained an alternate network option utilizing the same
Dimension organization. The alternate network arrangement offers greater savings
though a higher discount in hospital costs. The expected reduction in plan cost based on
using the alternate Dimension network is a projected savings for FY 09/10 of
approximately $350,000. The additional cost of accessing the alternate Dimension
network is approximately $28,422 based on current enrollment and claim information
indicating that it is a worthwhile decision to accept the alternate network proposal.
Continuing with the current benefits program has its advantages for Monroe County. The
network will be consistent with the present program, eliminating the need to change
providers with an alternative program. The claim reporting system will be the same as
presently provided and the County's employees appear satisfied with the benefits
provided. Fees paid by the County will remain constant for three years with those
presently paid for the same program. Should the optional Dimension network be chosen,
the long run affect would be a cost savings to the County.
5
Recommendation
The County's Review Committee recommends continuation of its self-insured medical
benefits plan; adoption of the Wells Fargo claim administration services proposal with
the alternate Dimension Plus Network; continuation of the current Wells Fargo claim
administration contract; continuation of the current KPHA contract for Utilization
Review and Case Management; and establishing a new contract with the Dimension Plus
Network.
6
Q
....
-
(I)
Q
>-
LL.
...
.2
c
~
D.
"0
Q)
...
::::I
VI
C
:z
Q)
(f)
....
o
-
VI
o
()
"0
Q)
-
()
Q)
'[
D.
---0 0 0
~ 0 ~
0 0 0
0 ,.... ,....
0 ("') U) ("')
0 CJ5 w CJ5
0 ....- >- ....-
0 c: o.
N ....- ("')
....- fF> ....-
0 0 0
0 0 0
0 0 0
0 ,.... ,....
0 ("') U) ~
0 CJ5 W <0
0 ....- >- ....-
0 0 0
N ....- C'i
....- fF> ....-
0 0 0
~ 0 0
0 N N
0 N N
0 <0 U) <0
0 as w as
0 <0 >- <0
0 0) 0)
N fF> N
....- T-
O 0 0
0 0 0
0 0 0
0 ,.... ,....
0 C'{ 0 C'{
0 ....- Z T-
O ....- T-
O N N
N fF> N
T- T-
O 0 0
0 ~ 0
0 ,.... r-:
0 <0 T-
O <0
0 as 0 as
0 <0 Z <0
. 0 ("') ("')
N fF> N
T- T-
O 0 0
0 ~ 0
0 ,.... r-:
0 ("') ("')
0 <0 U) <0
0 CJ5 w CJ5
0 0) >- 0)
0 ,.... ,....
N fF> N
T- T-
O 0 0
0 0 0
0 r-: r-:
0 ("') ("')
0 <0 U) <0
0 CJ5 w CJ5
0 0) >- 0)
0 ,.... ,....
N fF> N
....- ....-
0 0 0
0 0 0
0 ..; ..;
0 N N
0 0) U) 0)
0 cr> w cr>
0 '<t >- '<t
0 N N
N fF> N
....- T-
S ii5
Q) 0
10 u,
E - -
~ .sa;
~ U) ou)
't!- 0 :::.::: ~o
U 0:: 1:1 ....-
U) 0 Q)O
::'E ~ ~ UN
:5 ::'E .~~
0 W ~-
U <( z a. 0
.G;
-'.r.
~ Ol
:J ro
.r. =
1::: ro
<(<.9
a.
:J
e
<.9
Ol
c:
~
Q)
<.9
(/l
(/l
o
un
Q) Q)
:J .::
-0
co~
<(
a.
~
<l:
J:
u.
1:1
Q)
:;
l!!u
:;I..J
a;....J
U) (/l
, c:
a. ro
Ci50:::
en
c:
.:z:.
'c
N
8.:>-
ro Ol
U)<(
co
1n~
..0 ro
ro c:
<.9U::
o
E1
ro
u.
.!!2
a;
s:
<0
;;I;
as
,....
N
N
....-
fF>
co
g (/l
.- :J
0.0:::
o c:
.r. 0
;t;:: -00
;: c:
..... Q)
(/l E
o ._
uo
--.
-
""-
Run-In Claims
Pay atdms "'-'
1nc."uon daN
C_s.wc.800
;/I
Mano"._ R.ptH'ts
COBRA ___
R.s_Ibklort1l1
dlllms durlllfl poIky
-
ID CDrds "DtxunNnts
N_
Out <>1_ with
"*'- mu. Ooss
N_
Out<>lsta,. without
mu. Cross N_
UtIN_lInd_
--
8hM Cn", ",.,.".,.,
_tllS fu/1 IN
c-dl_ with
County R. PI<m
Fully /mutW/ RaNs
Em"'- 0rJIy
Em"'-1J_
Emp/DyHIChIId(,..,)
Em~
Pro/<<tH Amr1 Cast
Projected Fully insured Cost for FY 09/10
Blu. C/'O$. *
Fully IntlUIWd
PI""
T reditionBf
insurance using
Blue Cross Benefit
'Plan #107
Blue Cross
-r--L---~- I _+- _~ __+-_~__
_t._L:otmdUd~~___~__~ ~-t~--
--t-_--L:-~-.--i.--~-t---
+ ::: . I... ',i_. .l~
-I. +,.......
-l- . I unknown -l. I
I
I
I
I
IYes per plan #107
I i
_1- -i."" ~.:..~
lu
1- -
)
I
I
!
t
I
I
~
_.---t-----
I
I
;Yes
I Yes. claims paid
: at out of state '
Blue Cross
_~ ~~~ork fee
'Negotiated per
Plan #107 details
I
I
Blue Cross
-t----
,
Yes
Yes
$725.40
$1.501.58
$1.363.76
!-~-_.-
----r- r-
$2.303.14
.../! -
--
I
- r-
t
, Numb&r
t' Units
Hj
I
i_
I
(
Ann'f Cost
I
pepm I
pepm r' 180
t_u- I
pepm : 112 $1.832.89344i
- .L---.L_.------L
i pepm i 81 : $2.236.652081
+-------r---.-t--.-~-
I
1206 i $10.497.98881
I
$3.243.412.8O!
! $17.812.9471,
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Wells Fargo Effective Date: May 20,2009
Expiration Date: May 19,2012
Contract PurposelDescription:Approval to amend existing contract for one year with provisions
to renew for two additional consecutive terms.
Contract Manager:Maria Fernandez-
Gonzalez
4448
Employee Services
(Name)
(Ext. )
(Department)
for BOCC meeting on Mav 20 2009
Agenda Deadline: Mav 5 2009
CONTRACT COSTS
Total Dollar Value of Contract: approx $200,659 Current Year Portion: $_
yr
Budgeted? Y es~ No 0
Grant: $_
County Match: $_
Account Codes: 502-08002-530-2]JL-_
- - -
-----
- - - -
-----
- - - -
-----
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes
Date In Needed ~ ~ Review~r
Division Director :) -lf~oq Y esD No~. ~
RiskManagement 5:J1:Q1 YesONo[jl . . ..~~
O.M.B./Pu~~~ing 5~Y--cti YeSONoJ - ~ ~~
County Attorney S. 4- J.6"1 Y esO No~ ~ f. !fzv
Comments:
Date Out
S-~61.
~~
5&LOJ
S- - '1- J.IO']
OMB Form Revised 9/1 1/95 MCP #2
..
SECOND AMENDMENT
TO ADMINISTRATIVE SERVICE AGREEMENT
BETWEEN MONROE COUNTY AND
WELLS FARGO THIRD PARTY ADMINISTRATORS
THIS SECOND AMENDMENT, made and entered into this _ day of
2009, by and between Board of County Commissioners of Monroe County (hereinafter called "County")
and Wells Fargo Third Party Administrators, hereinafter referred to as "Wells Fargo".
WHEREAS, on June 15, 2005, the County entered into an agreement with Acordia National,
Inc., part of Wells Fargo & Company, whereby Acordia agreed to act as the third party administrator for
the County's medical, dental and vision plans ("Agreement"); and
WHEREAS, in or about February 2006, Acordia changed its name to Wells Fargo Third Party
Administrators; and
WHEREAS, a Request For Proposals was completed in February, 2009; and
WHEREAS, the parties have mutually agreed to continue the Agreement; and
WHEREAS, it is in the best interest of the County and serves a public purpose to continue with
the services provided by Wells Fargo; and
WHEREAS, Wells Fargo wishes to continue with the service it provides County.
NOW THEREFORE, in consideration of the mutual promises and considerations, the parties
agree to amend the Agreement as follows:
I) Section 19 shall be amended as follows:
19) The terms of this Agreement shall be effective May 20, 2009 and continue for
a period of one year. This Agreement will be automatically renewed for
successive one-year periods until either party gives the other notice of
cancellation in accordance with the terms set forth below. If either party desires
to modify or terminate this Agreement, it shall notify the other in writing at least
thirty (30) days prior to the effective date of such modification or termination. In
the case of proposed modification the party receiving the notification of the
proposed modification shall itself notify the other party within ten (10) days after
receipt of notice of its agreement to the proposed modification. Failure to do so
shall terminate this Agreement as of the end of the Employer's Plan Year.
2) In all relevant places in the Agreement, the name of Acordia National, Inc. IS
changed to Wells Fargo Third Party Administrators.
..
3) In all other respects the terms and conditions of the original agreement remain in
full force and effect.
IN WITNESS WHEREOF, the Employer and Contractor have caused this amendment to
agreement to be executed this day of ,2009.
ATTEST: DANNY L. KOLHAGE
Board of County Commissioners of Monroe County
By:
Deputy Clerk
By:
Mayor
Witness
XJ4. tt,j
I I
Richard H. Legg
Managing Sr. Vice President & COO
By
FIRST AMENDMENT
TO ADMINISTRATIVE SERVICE AGJ~EEMENT
BETWEEN MONROE COLJNTY AND
WELLS FARGO THIRD PARTY ADMINISTRATORS
fL ~.()
THIS FIRST AMENDMENT, made and entered into this lftL day of ~
?008, by and between Board of County Commissioners of Monroe County (hereinafter called" ounty")
and Wells Fargo Third Party Administrators, hereinafter referred to as "Wells Fargo".
WHEREAS, on June 15, 2005, the County entered into an agreement with Acordia National,
Inc., part of Wells Fargo & Company, whereby Acordia agreed to act as the third party administrator for
the County's medical, dental and vision plans ("Agreement"); and
WHEREAS, in or about February 2006, Acordia changed its name to Wells Fargo Third Party
Administrators; and
WHEREAS, the Agreement between the parties is to terminate on September 31, 2008; and
WHEREAS, the parties have mutually agreed to continue the Agreement; and
-
WHEREAS, it is in the best interest of the County and serves a public purpose to continue with
the services provided by Wells Fargo; and
WHEREAS, Wells Fargo wishes to continue with the service it provides County.
NOW THEREFORE, in consideration of the mutual promises and considerations, the parties
agree to amend the Agreement as follows:
I) Section 19 shall be amended as follows:
.',~..
,.
19) The terms of this Agreement shall be effective October 1, 2008 and continue
for a period of one year. This Agreement will be automatically renewed for
successive one-year periods until either party gives the other notice of
cancellation in accordance with the terms set forth below. If either party desires
to modifY or terminate this Agreement, it shall notifY the other in writing at least
thirty (30) days prior to the effective date of such modification or termination. In
the case of proposed modification the party receiving the notification of the
proposed modification shall itself notify the other party within ten (10) days after
receipt of notice of its agreement to the proposed modification. Failure to do so
shall terminate this Agreement as of the end of the Employer's Plan Y car.
2)
In all relevant places in the Agreement, the name of Acordia, Inc. is changed to
Wells Fargo Third Party Administrators.
'"
.1) In all other respects the terms and conditions of the original agreement rcmain in
full f()rce and effect.
.. IN WITNESS WHEREOF. the Employer and Contruetor have caused this amendment to
agrccmentto be cxecuted this~_k ~W rf oLOQ8">----- _, 2008.
A TTEST: DANNY L. KOLHAGE
Gd
Deputy Clerk
Board of COllnty (' missioners of Monroe County
By:
Mayor
--
Wells Fargo Insurance Services
By Kef f/~J
PresIdent
-
MONAOE COUNTY ATTORNEY
t!:[ROVEP ASif;/(j..RM:
- ~.i.
YNTH/A L All
ASSISTANT COUNTY ATTORNEY
'1ate_-!:-L- AfJoe
.
.
('~
ADMINISTRATIVE SERVICE AGREEMENT
TIllS AGREEMENT, made and entered into this ~ 6 ] of[~C'(')5 ]by and
between Monroe County (hereinafter "Employer") and ACORDIA NATIONAL, INC. (hereinafter
"Acordia National") of 602 Vtrginia Street, East, Charleston, WV 25301, is hereinafter set forth:
WITNES SETH
WHEREAS, Employer has established an employee welfare benefit plan (hereinafter
called "Plan") for the purpose of providing medical, dental, vision, utilization review, Consolidated
Omnibus Budget Reconciliation Act of 1985 ("COBRA"), Health Insurance Portability and
Accountability Act of 1996 ("HIP AA"), and other benefits for its employees;
WHEREAS, Employer desires to engage the services of Acordia National as agent for
the Employer for the purpose of effecting claim administration under its Plan; and
NOW, TIJEREFORE, in consideration of the nmtual covenants and promises
hereinafter contained, the parties hereto agree as follows:
1) The effective date of the Employer's Plan shall be October 1, 2005, and shall terminate
September 30, 2006.
2) The Plan Year shall be from October 1 to September 30 of each year.
3) The Employer's Tax Identification Number is 596000749.
4) The Benefit Committee designed under the Plan is comprised of County
Administrator, Director of Human Resources, and Director of Office of Management and Budget.
The Employer agrees to notifY Acordia National in writing if the members of the Benefit
Committee change. Such notification shall be provided to Acordia National within ten (10) days
of adoption of the change and shall include the composition of the Benefit Committee, as
changed, and the effective date of any membership changes.
5) The Employer hereby acknowledges that no person shall be authorized to make
exceptions, unless the Employer provides written authorization to Acordia National. Employer
further agrees that any authorized exception to the Plan terms shall be given effect only if
communicated to Acordia National in writing.
6) The Employer agrees to provide Acordia National with any amendment or
restatement to the Plan on or before the effective date(s) of any such amendment or restatement.
7) For each Plan Year, the Employer shall sufficiently fund benefits under the
Acardia 10/05-9/06
1
.......
\-~.
-
"
Employer's Plan on a timely basis. "Timely" shall be defined as within thirty (30) days of Acordia
National's notification, oral or written, that benefit claims have been processed for payment.
These claims will be funded in their entirety and in chronologie order with oldest dates always
funded and released first. In the event Employer shall fail to make available sufficient monies to
fund its claims in a timely manner, a ten percent (100.10) surcharge shall be added to the monthly
administrative fee due Acordia National, which surcharge shall become chargeable beginning on
the thirty-first (31 st) day after Acordia National's notification, as described herein, or may
terminate this agreement. Employer acknowledges and agrees that Acordia National shall not
have any duty or responsibility to release claim payments if Employer has not sufficiently funded
the same.
8) Employer acknowledges and agrees that Acordia National shall not have any
financial duty or responsibility to see that the Employer deposit meets the Employer's Plan
requirements; however, Acordia National shall keep the Employer advised as to the amount of
deposit needed to meet said requirements on a timely basis. Employer further acknowledges and
agrees that Acordia National shall not be deemed a fiduciary for the Plan within the meaning of
the Employee Retirement Income Security Act of 1974 ("ERISA"). Accordingly, the services to
be performed by Acordia National hereunder shall be limited to the ministerial services set forth
herein and the performance by Acordia National shall be subject in all respects to review by
Employer within the framework of Plan provisions as well as policies, interpretations, rules,
practices and procedures established by Employer. Acordia National shall not have any
discretionary authority or control with regard to the management of Plan assets. To the extent
pennitted by law, Acordia National shall not incur any liability for. any acts or for failure to act
except for its own willful misconduct in administering the Plan.
9) If required by Acordia National, Employer shall pay Acordia National an initial fee
ofS 0.00 for the purpose of establishing administrative services in connection with the Employer's
Plan, which fee shall be due and payable upon execution of this Agreement and which shall be
non-refundable to the Employer in the event this Agreement is terminated.
Acardia 10/05-9/06
2
....""'.
,-';;,<,
,_J
e
[.~..'
";f!II1
Additionally, the monthly capitation fee for administrative services will be:
Medical Claims Administration
lllP AA Administration
Fee Negotiation
$ 10, 19 Per Employee Per Month
$ 0,40 Per Employee Per Month
25% of savings
The above monthly capitation fee shall apply to the renewal effective October 1, 2005, and
will remain in effect for renewals effective October 1,2006 and October 1,2007.
Payment of the fees established above is due from the Employer on or before the 10th day
of each month, beginning on the lOlh day of October, 2005. The fee quoted is a three (3) year
guarantee effective October 1, 2005 and may only be increased by Acordia National if there are
additional services rendered by Acordia National on behalf of the Employer necessitated by a
change in federal or state law with a thirty (30) day notification. Employee counts for the
purpose of monthly administrative fee billing may not be reduced by more than 100.10 of the billed
enrollment unless an explanation is provided. Administrative fee adjustments must be done
monthly and cannot be adjusted retroactively in excess of 90 ninety days prior to the month
invoiced. Acordia National reserves the right to withhold any fee due to the client if there are any
outstanding fees.
Acordia National shall provide generic enrollment forms, claim forms and other
administrative and plan forms. In the event Employer desires customized administrative and plan
forms, Acordia National will direct the printing of same, however, the cost of such printing shall
be paid solely by the Employer.
10) Acordia National shall provide the following services in connection with the
administration of Employer's Plan(s):
a) Provide assistance to enroll all eligible Employees (as defined in the Employers
Plan) in Employers Plan, as agreed with Employer;
b) Provide for Employer's review sample prototype Plan documents, as requested by
Employer;
c) Conduct informational programs for all eligible Employees to fully explain the
benefits available under the Employer's Plan, as requested by Employer;
d) Respond to telephone and mail inquiries from Plan participants regarding benefits
Acardia 10/05-9/06
3
.ct
~}:~<
It
-
available to them and their dependents;
e) Provide infonnation concerning Plan benefits and participants, based upon
infonnation provided by Employer;
f) Review and analyze all claims and determine whether the charges of health care
providers submitted are within reasonable payment guidelines and/or are related to
diagnostic related groups, preferred provider organization agreements or other
industry standards;
g) Correspond with claimants, as necessary, to process claims and to ascertain
whether other coverage exists which might pay the claim in whole or part;
h) Receive, review, and administer aU claims for benefits under the Employers Plan,
including the evaluation of claims made;
i) Aid the employer in developing an efficient claims control program;
j) Provide information, on request, for the completion by the Employer of aU
necessary IRS and ERISA filings; and
k) Provide Employer with a monthly report of claims paid.
11) Acordia National shall provide COBRA administration services, if desired by
Employer (check one blank below). It is agreed and understood that COBRA administration
services are not provided for 125 Reimbursement Account Plans.
Applicable
Non-applicable X
In the event Employer desires Acordia National to provide COBRA administration
services, Acordia National agrees to:
a) Provide initial notification of continuation of coverage option to aU
employees
b) Provide notification, enrollment infonnation and enrollment forms to aU
qualified beneficiaries within fourteen (14) days of notification by Employer
of a qualifYing event;
c) Provide monthly billing and collection services for all qualified beneficiaries
who elect to continue coverage under the program and supply monthly
reports of premiums collected by Employer;
d) Track participating beneficiaries and notify them of their right to convert if
a conversion option is available under Employer's Plan;
Acardia 10/05-9/06
4
Process all claims for continuing beneficiaries under a segregated category
and report, through regular monthly reporting series, claims experience of
continuing beneficiaries (COBRA claims will be aggregated during the
normal check processing cycle but reported separately at month's end);
On an annual basis, at the beginning of Employer's Plan Year, provide rates
to be charged continuing participants for coverage in the new Plan Year;
Provide for Employer's review sample prototype language to be included
in the Plan document to ensure compliance with COBRA legislation;
Provide for Employer's review sample prototype language for inclusion in
Empl~yer's Summary Plan Description and coordinate, at Employer's
option., the printing of new plan booklets at Employer's expense; and
Mail all correspondence to Plan participants or qualified beneficiaries
directly to the last known address of the employee and/or dependent by
first class mail.
In consideration for receipt of these services from Acordia National, Employer agrees to:
a) NotifY Acordia National within thirty (30) days of qualifYing events for
which the Employer has knowledge. QualifYing events include:
termination of employment for any reason short of gross misconduct; an
employee's reduction of work hours; the Employer's filing for
reorganization under Chapter XI of the Bankruptcy Code; an employee's
divorce or legal separation; death of an employee; an employee's child
ceasing to be a dependent; and a beneficiary's entitlement to Medicare. If
the Employer is not notified and does not have knowledge of a qualifying
event, the employee has sixty (60) days from the qualifYing event in which
to notify Acordia National of the same to be eligible for the continuation of
coverage option; and
b) Notify Acordia National of any address changes or other pertinent
information regarding employee participation in the Employer's Plan(s) to
allow Acordia National to properly fulfill the requirements of COBRA
legislation.
It is acknowledged by Employer that future legislation related to continuation of benefit
coverage, or other matters not currently required by COBRA legislation and COBRA regulations
fit
f~.
-
6.€......
f1.
e)
t)
g)
h)
i)
Acardia 10/05-9/06
5
on the date of this Agreement may necessitate an adjustment m the fee for COBRA
administration.
12) In the event Employer does not desire COBRA administration services by Acordia
National, but instead the development of COBRA rates applicable to its Plan, Acordia National shall
provide the same upon terms, and for a fee, to be agreed upon between Employer and Acordia
National.
13) Acordia shall provide the following services related to HIP AA administration for
the Employers Plan:
Applicable X
Non-applicable
Provide for the Employers review prototype modifications to the plan
document and SPD (Booklet) to address HIP AA requirements;
Track the applicable eligibility information and maintain credited coverage
information on both a current and future basis;
Coordinate the receipt of all certificates of coverage, or other proof of
coverage, for all new employees enrolling in the benefit plan;
Perform the administrative requirements to analyze the determination of
pre-existing conditions and establish the waiting periods that would apply
for all new employees and existing employees having pre-existing
conditions;
e) Distribute to all required parties the notifications and correspondence
documenting pre-existing conditions;
f) Issue certificates of coverage for all employees and their dependents upon
tennination or upon request;
g) Prepare and distribute standard reports documenting completed HIP AA
activities; and
h) Serve as an information resource for HIP AA questions.
i) Distribute Privacy Practices Notices to all participants enrolled as of the
effective date of Employer's required compliance on or before said effective
date to new participant upon enrollment and to all participants upon material
revision to the Notice;
e
\8
j)
a)
b)
c)
d)
Distribute notices of the availability of the Privacy Practices Notice to
ACGcdia 10/05-9/06
6
-
participants once every three (3) years~
k) Coordinate the distribution, execution and maintenance of Business Associate
Agreements~
I) Maintain designated record sets~
m) Maint~in records of all releases of Protected Health lnformatioo ("PHI) for
purposes other than treatment, payment or health plan operations~
n) Administer access to PIn and maintain a logging system to track and document
activities. These documents include:
1. Request for restriction of PHI;
2. Request for accounting of disclosures;
3. Request to access PHI. (Employees requesting access to PIll will be
charged $0. SO per page in advance prior to sending out this
information);
4. Request to amend PHI;
5. Request for confidential comnnmications;
6. Complaint fonns~ and
7. Authorization for release ofPHI.
0) Assist with the certification of the Group Health Plan;
p) Update policies and related privacy practices for approval of the Employer's
Privacy Officer, and
q) Provide training infonnatioo related to HIP AA Privacy requirements.
Employer agrees to pay to Acordia National the actual costs of mailing initial
notices, three-year notices and any other mass mailing associated with HIP AA
Privacy compliance. Should Employer request: customized documents in lieu
of the prototypes provided by Acordia National. Employer agrees to pay
Acordia National a separate fee for providing such customized documents such
fee to be agreed to by the parties.
14) This will serve to confirm our understanding that the Employer desires to utilize the
subrogation and related services offered by HeaIthcare Recoveries. Inc. In connection with the
Employers health plan Services provided by HRI shall commence 1st day of October, 1999.
Applicable X 'y;r
Non-applicable
-
Acardia 10/05-9/06
7
.
~!.
-
tja
-
15) In the absence of a designation by the Employer and except for disposition of
disputed claims, Acordia National shall determine the manner in which payment of benefits shall
be made as it shall deem it to be necessary and appropriate, in accordance with the provisions of
Employer's Plan, and shall not be responsible in the exercise of such judgment in the absence of
willful misconduct on the part of Acordia National
16) The Employer shall name Acordia National as an additional insured under its
fidelity bond which shall be conditioned upon faithful perfonnance of its duties hereunder, and
such fidelity bond which shall in all respects comply with the requirements of the Employee
Retirement Income Security Act of 1974, as amended.
11) Notwithstanding any other provision herein, Employer hereby agrees and
acknowledges that responsibility for all Plan documents, language or modifications remains at all
times with the Employer.
18) (a) Acordia National agrees to defend, indemnifY and hold bannless Employer against
all claims, damages, liabilities and expenses actually and reasonably incurred or imposed on it in
connection with any actual or threatened claim, action, suit, proceeding, settlement or compromise
thereof which arises from Acordia's administration of claims under Employer Plan(s) other than in
accordance with Plan provisions as well as the willful misconduct of Acordia National, its employees,
representatives or agents. The right to be defended, indemnified and held hannless shall extend to
Employers affiliates as well as the employees of Employer, their estates, executors, administrators,
guardians, conservators and heirs and shall apply after the employee ceases employment with Employer
with respect to acts or omissions of Acordia prior to such cessation.
(b) Employer agrees to defend, indemnifY and hold harmless Acordia National
against all claims, damages, liabilities and expenses actually and reasonably incurred or imposed
on Acordia National in connection with any actual or threatened claim, action, suit, proceeding,
settlement or compromise thereof which arises from the Employer or Benefit Committee's actions
or omissions to act relating to the Plan or any benefits provided thereunder or the breach by the
Employer or Benefit Committee of any provision of this Agreement. The right to be defended,
indemnified and held harmless shall extend to Acordia National's affiliates as well as the
employees of Acordia National, their estates, executors, administrators, guardians, conservators
and heirs and shall apply after the employee ceases employment with Acordia National with
respect to acts or omissions prior to such cessation.
19) The terms of this Agreement shall be from the effective date hereof and continue
Acardia 10/05-9/06
8
1;8>.
~;~./-.~
v;
(I
.....
/"'~
for a period of one year. This Agreement shall be automatically renewed for successive one-year
periods until either party gives the other notice of cancellation in accordance with the terms set
forth below. If either party desires to modify or terminate this Agreement, it shall notify the other
in writing at least thirty (30) days prior to the effective date of such modification or termination.
In the case of proposed modification the party receiving the notification of the proposed
modification shall itself notify the other party within ten (10) days after receipt of notice of its
agreement to the proposed modification. Failure to do so shall terminate this Agreement as of the
end of the Employer's Plan Year.
20) This Agreement may be tenninated by either the Employer or Acordia National at
any time provided the terminating party gives the other party thirty (30) days prior written notice.
The prior written notice will state the prospective effective date of the termination. Termination
of this Agreement will not terminate the rights or obligations of either party arising out of the
period during which this Agreement was in effect. Upon the expiration of this Agreement, and if
the same is not renewed, Acordia National shall return all files of closed or pending claims
covered by this Agreement to the Employer.
21) Employer agrees that during the term of this Agreement and for a period of three
years after its termination it will not induce any employee of Acordia National to leave Acordia
National's employment or directly or indirectly assist any other person or entity in requesting or
inducing any such employee of Acordia National to leave such employment.
22) All notices hereunder shall be in writing and mailed by certified mail, return receipt
requested. Notices to the Employer shall be at the address first above written and to Acordia
National at 602 Vtrginia Street, East, Charleston, WV 25301-3043, Attention: President, or at
such other addresses as the parties may from time to time designate in writing.
23) The Employer and Acordia National agree that this Agreement and the Acardia
National Trust for Employee Welfare Benefit Plans shall be administered and construed according
to the laws of the State of Florida.
24) In the event this Agreement is terminated, the parties will have the option of
agreeing to completion of claims administration services for claims existing at termination for a
period following termination of this Agreement upon terms negotiated between the parties and is
typically a percentage of paid claims..
25) This Agreement together with the Plan constitute the entire Agreement between
the Employer and Acordia National.
Acardia 10/05-9/06
9
26) The undersigned hereby represents and warrants on behalf of the Employer that
the Employer (a) has duly approved the adoption of the Plan, this Agreement, and (b) has
authorized the Undersigned to execute this Agreement
27) General Conditions:
a) Acordia National shall maintain all books, records, and documents directly
pertinent to perfonnance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Each party to this Agreement or their authorized representatives
shall have reasonable and timely access to such records of each other party to this Agreement for
public records purposes during the term of the Agreement and for four years following the
termination of this Agreement. If an auditor employed by the County or Clerk. determines that
monies paid to Acordia National pursuant to this Agreement were spent for purposes not
authorized by this Agreement, the Acordia National shall repay the monies together with interest
calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to Acordia
National.
-
b) Administrative Action and Interpretation: In the event that any administrative
proceeding is instituted for the enforcement or interpretation of this Agreement, the County and
Acordia National agree that venue will lie before the appropriate administrative body in Monroe
County, Florida.
The County and Acordia N ationa! agree that, in the event of conflicting
interpretations of the tenns or a term of this Agreement by or between any of them the issue shall
be submitted to mediation prior to the institution of any other administrative or legal proceeding-
c) Severability. If any term. covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable
to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and
provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant,
condition and provision of this Agreement shall be valid and shall be enforceable to the fullest
extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and
provisions of this Agreement would prevent the accomplishment of the original intent of this
Agreement. The County and Acordia National agree to reform the Agreement to replace any
stricken provision with a valid provision that comes as close as possible to the intent of the
stricken provision.
d) Attorney's Fees and Costs. The County and Acordia National agree that in the
event any cause of action or administrative proceeding is initiated or defended by any party
relative to the enforcement or interpretation of this Agreement, the prevailing party shall be
entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an
award against the non-prevailing party, and shall include attorney's fees, courts costs,
investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings
initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules
of Civil Procedure and usual and customary procedures required by the circuit court of Monroe
County.
e) Adjudication of Disputes or Disagreements. County and Acordia National agree
that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions
Acardia 10/05-9/06
10
between representatives of each of the parties. If no resolution can be agreed upon within 30 days
fa after the first meet and confer session, the issue or issues shall be discussed at a public meeting of
\':;111 the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction
of the parties, then any party shall have the right to seek such relief or remedy as may be provided
by this Agreement or by Florida law.
(t) Cooperation. In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of this
Agreement, County and Acordia National agree to participate, to the extent required by the other
party, in all proceedings, hearings, processes, meetings, and other activities related to the
substance of this Agreement or provision of the services under this Agreement. County and
Acordia National specifically agree that no party to this Agreement shall be required to enter into
any arbitration proceedings related to this Agreement.
g) Authority. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
h) Claims for Federal or State Aid. Acordia National and County agree that each
shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission. .
e
i) Binding Effect. The terms, covenants, conditions, and provisions of this
Agreement shall bind and inure to the benefit of the County and Acordia National and their
respective legal representatives, successors, and assigns.
.
j) Nondiscrimination. County and Acordia National agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court
order. eounty or Acordia National agree to comply with all FederCll and Florida statutes, and all
local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to:
1) Title VI of the eivil Rights Act of 1964 (pL 88-352) which prohibits discrim1nation on the
basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as
amended (20 use ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of
sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 use s. 794), which
prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as
amended (42 use 5S. 6101- 6107) which prohibits discrimination on the basis of age; 5) The
Drug Abuse Office and Treatment Act of 1972 (pL 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health
Service Act of 1912, 5S. 523 and 527 (42 USC 5S. 69Odd-3 and 290ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patent records; 8) Title VITI of the Civil Rights Act of
1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing
of housing; 9) The Americans with Disabilities Act of 1990 (42 use 5. 1201 Note), as maybe
Acardia 10105-9/06
11
e,
"'-
amended from time to time, relating to nondiscrimination on the basis of disability~ 10)
Monroe County Code Ch. 13, Art. VI, prohibiting discrimination on the bases of race, color, sex,
religion, disability, national origin, ancestry, sexual orientation, gender identity or expression,
familial status or age~ and 11) any other nondiscrimination provisions in any Federal or state
statutes which may apply to the parties to, or the subject matter of, this Agreement.
k) Covenant of No Interest. County and Acordia National covenant that neither
presently has any interest, and shall not acquire any interest, which would conflict in any manner
or degree with its performance under this Agreement, and that only interest of each is to perform
and receive benefits as recited in this Agreement.
1) Code of Ethics. County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public officers and
employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to,
solicitation or acceptance of gifts~ doing business with one's agency~ unauthorized compensation;
misuse of public position, conflicting employment or contractual relationship~ and disclosure or
use of certain infonnation.
-
m) Public Access. The County and Acordia National shall allow and pennit
reasonable access to, and inspection ot: all documents, papers, letters or other materials in its
possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and
made or received by the County and Acordia National in conjunction with this Agreement~ and
the County shall have the right to unilaterally cancel this Agreement upon violation of this
provision by Acordia National.
n) Non-Waiver of Immunity. Notwithstanding he provisions of Sec. 768.28, Florida
Statutes, the participation of the County and Acordia National in this Agreement and the
acquisition of any commercial liability insurance coverage, self-insurance coverage, or local
government liability insurance pool coverage shall not be deemed a waiver of immunity to the
extent of liability coverage, nor shall any contract entered into by the County be required to
contain any provision for waiver.
0) Privileges and Immunities. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief: disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of
any public agents or employees of the County, when performing their respective functions under
this Agreement within the territorial limits of the County shall apply to the same degree and extent
to the performance of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
8'ig
.,
p) Legal Obligations and Responsibilities: Non-Delegation of Constitutional or
Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any
participating entity from any obligation or responsibility imposed upon the entity by law except to
the extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
Acardia 10/05-9/06
12
. q) Non-Reliance by Non-Parties. No person or entity shall be entitled to rely upon
(~ the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party
claim or entitlement to or benefit of any service or program contemplated hereunder, and the
County and Acordia National agree that neither the County nor the Acordia National or any
agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise
indicate that any particular individual or group of individuals, entity or entities, have entitlements
or benefits under this Agreement separate and apart, inferior to, or superior to the community in
general or for the purposes contemplated in this Agreement.
r) Attestations. Acordia National agrees to execute such documents as the County
may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a
Drug-Free Workplace Statement.
s) No Personal Liability. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
-
t) Execution in Counterparts. This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken together shall
constitute one and the same instrument and any of the parties hereto may execute this Agreement
by singing any such counterpart.
u) Section Headings. Section headings have been inserted in this Agreement as a
matter of convenience of reference only, and it is agreed that such section headings are not a part
of this Agreement and will not be used in the interpretation of any provision of this Agreement.
IN WITNESS WHEREOF, the Employer and Acordia National have caused this
Agreement to be executed by their respective proper corporate officers. .
ATIEST: DANNY L. KOLHAGE, CLERK
C~
Dep Clerk
MONROE COUNTY BOARD
OF COUNTY COMMISSIONERS:
By ~jJa >n ~~. -'V Ma. n;....: M S hat MONROE COUN I . ATl
yor LllJUe . pe ROVED A F
ZANNE A. HUT"
ASS TANJS~J.Y E)
Jate __' '__~/.J.-VI.t>.:;.
AITEST:
Acardia 10/05-9/06
ACORDIA NATIONAL I //
By K-J-rJ-. V''-J
Its Chief Operating ~
/YI c t.((c1-eAy.-~
13
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Keys Physician Hospital Effective Date: May 20.2009
Alliance "KPHA"
Expiration Date: May 19.2012
Contract Purpose/Description:Approval to amend existing contract for one year with provisions
to renew for two additional consecutive terms.
Contract Manager:Maria Fernandez-
Gonzalez
4448
Employee Services
(Name)
(Ext.)
(Department)
for BOCC meeting on Mav 20 2009
Agenda Deadline: Mav 5 2009
CONTRACT COSTS
Total Dollar Value of Contract: approx $25,580 Current Year Portion: $_
yr + $55.00 hr Large Case Management
Budgeted? Yes[;gl No D Account Codes: 502-08002-530-~-_
Grant: $_
County Match: $_
- - - -
-----
- - - -
-----
- - - -
-----
ADDITIONAL COSTS
Estimated Ongoing Costs: $~yr For:
(Not included in dollar value above) (eg. maintenance. utilities. janitorial. salaries. etc.)
CONTRACT REVIEW
Changes
J)4t~11 Needed r-l1I" ^n~ReViewer
Division Director ~. YesD NOL!l. ~~. ..~ U:4 "D(.
Y esO No0' Sl1J. 5-,,:0
~)'i YesONod --q .~ ~161
County Attorney 5:1::l...lO'I YesO NoGf ar 1. ~ S- - 4- ;).DiJI/
Comments: f\ f Che {'~c~ {lv'Yl~ ~ ~ \ , L + ~. V ~
Date Out
Risk Mana~ment 5W
{)LL. ~\\ ~
O.M.B./Purch~sing
OMB Form Revised 9/11/95 MCP #2
..
FOURTH AMENDMENT
TO EMPLOYER-PROVIDER NETWORK AND
UTILIZATION REVIEW AND CASE MANAGEMENT
SERVICES AGREEMENT
THIS FOURTH AMENDMENT, made and entered into this _20th day of
_May_ 2009, by and between Board of County Commissioners of Monroe County
(hereinafter called "County") and Keys Physician-Hospital Alliance ("KPHA").
WHEREAS, on March 1, 2004, County and KPHA entered into an agreement
for the provision of utilization review and case management services ("Agreement");
and
WHEREAS, the term of the Agreement was subsequently extended by
amendments dated May 18,2005, January 1,2007, and April 16, 2008; and
WHEREAS, a Request for Proposals ("RFP") was completed in February, 2009;
and
WHEREAS, after review of the proposals submitted in response to that RFP,
the County has determined that it is in the best interests of the County and serves a
public purpose to continue with the services provided by KPHA; and
WHEREAS, KPHA wishes to continue with the service it provides County,
NOW THEREFORE, in consideration of the mutual promises and
considerations, the parties agree to amend the Agreement as follows:
1) Section 10. TERM shall be amended as follows:
The terms of this Agreement shall be effective May 20, 2009 and
continue for a period of one year. Thereafter, the Agreement shall
automatically renew for two (2) consecutive one (1) year terms.
KPHA agrees to provide the Employer with at least ninety (90) days
written notice of the intent to terminate, non-renew, or amend this
Agreement. The County agrees to provide KPHA with at least
ninety (90) days written notice of the intent to terminate or non-
renew this agreement. Any modifications of the terms of this
agreement may occur upon the mutual agreement of the parties.
2) In all respects the terms and conditions of the original agreement
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of
the date first written above.
Board of Coun ty Commissioners
Of Monroe County
ATIEST: DANNY L. KOLHAGE
By:
Mayor
By:
Deputy Clerk
Date:
t-tA , I /~ f vI' )
.. ~ \..,...../ j
, r..
Print Name I'
Date: 3- 1/09
, . /
Robin Lockwood, President
t~t/ A.. , L () {j: LV 0 d
Print Name
KPHA: -:t:- < ()
<;?t~ . ~4~reI?;Y
cl
,
Date:
)-Lj-l)1
~.. ~...'?;dl/.~}f{/
/~/ <,_~+'- Y /f< /-<--,y>/'
c'/'-" ,
/. /
~ ~
'> ~/ j,..tp
MONROE COUNTY ATTORNEY
~% i-S{!;;JRM
CYNTHIA L ALL
ASSISTANT COUNTY ATTORNEY
Date S- - '1- iJ.. ()~,
EMPLOYER-PROVIDER NETWORK
AND
UTILIZATION REVIEW AND CASE MANAGEMENT SERVICES
AGREEMENT
TillS AGREEMENT is entered into as of this first day of MARCH 2004 by and between
Keys Physician-Hospital Alliance ("KPHA") and the County of Monroe ("County"), hereon
referred to as "Employer".
RECITALS
WHEREAS, the KPHA has established a network of participating health care providers,
which providers, pursuant to the terms and conditions of provider agreements with KPHA, have
agreed to deliver medical services in a cost effective manner to persons covered under the health
benefit plans and policies of Employer.
WHEREAS, KPHA has agreed to provide utilization review and case management services
to Employer and personnel, dependents, Cobra beneficiaries and eligible retirees covered under
the health benefit plans and policies of Employer.
WHEREAS, Employer administers the health care benefit plans and has the express
authority, by signing this Agreement, to bind the Employer to all of the terms and conditions of
this Agreement.
WHEREAS, Employer desires and agrees to offer KPHA Provider Network to persons
covered under the Employers health benefits plans;
Now, THEREFORE, the parties agree as follows:
1. RECITALS. The foregoing recitals are hereby incorporated by reference and made a
substantive part hereof.
2. LIST OF PARTICIPATING PROVIDERS. KPHA shall provide Employer with a list of
Participating Providers, to include hospitals, physicians, dentists, pharmacies, and other
ancillary health services, and shall provide Employer with periodic updates of the Network
roster of Participating Providers from time to time. Such updates will be at least semi-
annually and in such a printed format as distributable to persons covered under the
Employers health benefits plans.
OUT-OF COUNTY PROVIDERS. KPHA agrees to negotiate and contract with
"Dimension Network" in Dade, Broward and Palm Beach Counties for discounted fee
arrangements with physicians, hospitals, and other ancillary health services as needed for the
benefit of the Employer. If the "Dimension Network" is not utilized, or becomes
unacceptable to the Employer, KPHA will propose other alternative arrangements for such
out of county services.
KPHA agrees to negotiate and contract with or work collaboratively with a national network
for discounted fee arrangements with physicians, hospitals, and other ancillary health
services as needed for the benefit of the Employer. If the current network is not utilized, or
becomes unacceptable to the Employer, KPHA will propose other alternative arrangements
for such out of county services.
3. UTILIZATION MANAGEMENT AND QUALITY ASSURANCE. KPHA shall provide
for Employer Utilization Review services to include
Review of inpatient admissions and of continued hospital stay
Discharge planning
Data collection and reporting
Review of supportive or treatment services
Review of office visits, ambulatory surgery and diagnostic or other outpatient services
Participation in the review of billing practices and appropriateness of charges of network
providers in conjunction with the Claims Administrator if requested
Large Case Management services
The monthly capitation fee for such services will be $1.35 per employee per month. This fee
will be payable by the County to KPHA by the 20th of each month beginning on the 20th day
of March, 2004. The number of enrollees will be determined on the 1st business day of each
month.
KPHA shall provide for Large Case Management services for a fee of$55.00 per hour on an
as-needed basis. Large Case Management services may be pre-approved by the County on a
case by case basis and billings for such fees incurred shall be provided monthly with details
of all charges.
Utilization Review and Large Case Management services will be perfonned according to pre-
set protocols developed in conjunction with the claims administrator's (Acordia National)
standards and will be documented in the claims administrators' computer system.
4. WELLNESS PROGRAMS AND OTHER EDUCATIONAL SERVICES. KPHA shall
design and implement with the coordination of Employer's staff, the Worksite WelIness
Program and other similar services to the Employer and Covered Persons to promote healthy
lifestyles and preventative health care. The Worksite Wellness Program will include, at no
additional charge to Employer or Covered Persons, a health risk assessment for each
employee and may include, for a charge by a Participating Provider, Health Physical
Packages. Health Fair coordination and implementation or other services as negotiated and
deemed to promote healthy lifestyles and preventative health care may also be included in
this service.
2
5. PARTICIPATING PROVIDER COMPENSATION. Employer shall compensate
Participating Providers for covered services minus any plan participant responsibilities.
Employer has the responsibility for implementation of the applicable claims payment
submitted by Participating Providers for services rendered or for any billing or other function
related to the health care services provided by Participating Providers to Covered Persons.
All claims for covered services, whether payable by the Employer or a Covered Person will
receive a discount off of provider billed charges as specified in Attachment A. This discount
will be rescinded if an appropriately documented and non-contested claim is not paid to the
Participating Provider within thirty (30) days of being received by the claims administrator
(Acordia National).
NON-APPROPRIATIONS CLAUSE. Monroe County's performance and obligation to
pay under this contract is contingent upon an annual appropriation by the BOCC. Monroe
County may not deny payment for valid and accurate claims properly submitted and rendered
during the plan year.
PROVIDER REIMBURSEMENT TERMS. Physician UCR charges will be based upon
the "P.H.C.S" fee schedule, formerly known as "HIAA". The above agreed upon discount
will be applied to the billed charge, not to exceed the UCR charge for a service.
KPHA further agrees that no other self-insured employer contracting with KPHA will be
provided with better overall terms than what is being here agreed. If however, better terms
are provided to another self-insured employer contracting with KPHA, such terms will also
be extended to the Employer.
CLEAN CLAIM. A "Clean Claim" means a claim submitted by the Provider/Hospital that
has been properly and accurately completed on the appropriate paper or electronic claim
form, HCF A 1500 and/or DB 92 together with any information that was requested in writing
by Acordia National within 15 days of Acordia National's receipt ofa claim.
NOTIFICATION OF CLAIM STATUS. Payor/Plan shall notify Provider/Hospital within
15 days of receipt of a claim that said claim is not considered "Clean" and reasons therefore.
Failure to do so shall deem the claim being considered "Clean" and set for-timely payment.
DISPUTED CLAIMS. If the Payor/Plan does not object in writing to a claim within IS
days of receipt by the Payor/Plan, the claim will be considered clean and complete. If the
Payor/Plan disputes any portion of the billing for services rendered, Payor/Plan will promptly
seek to resolve the dispute and return the claim to the regular processing status. Should the
claim remain in dispute for more than 30 days, Payor/Plan will pay the Provider/Hospital
90% of the fees as outlined in the "Provider Agreement Amendment! Reimbursement
Addendum" within 7 days with payment for the remaining 10% subject to the outcome of
the dispute. Those items requiring further resolution prior to the remaining payment shall be
reconciled by the Payor/Plan and the Provider/Hospital and the appropriate payments or
adjustments made within 60 days.
3
6. COVERED PERSON IDENTIFICATION. Employer shall supply Covered Persons with
identification cards or other means of identification which clearly identifies KPHA, reflects
the Covered Person's coverage under the applicable Employers health benefit plan, and
reflects the Covered Person's eligibility to receive services from Participating Providers in
accordance with the terms of this Agreement. Employer shall also provide such other
services as may be required in order for Participating Providers promptly to verify the status
of individuals as Covered Persons, the terms of the Covered Person's health care benefits,
including but not limited to the applicable terms of coverage, deductible status and co-
insurance.
7. NETWORK EXCLUSIVITY. During the course of the agreement Employer agrees not to
participate or enter agreements to utilize other provider networks other than that agreed upon
with KPHA and the Employer. Employer during the term oftrus Agreement shall not seek to
negotiate with individual network members for care or services outside of contractual
provisions without prior notification to KPHA.
8. BOOKS AND RECORDS. KPHA shall make available to claims administrator (Acordia
National) and County of Monroe (employer) all records and other data relating to both the
network and utilization review and case management services for the purposes of periodic
audits of KPHA's services. Information/data will be maintained, as required, to assure
confidentiality and compliance with all applicable regulations.
9. RESPONSIBILITY FOR HEALTH CARE SERVICES. Employer agrees that KPHA
shall not have any responsibility or liability for any act, omission, or decision related to
medical services rendered by Participating Providers to a Covered Person.
10. TERM. This Agreement shall continue in effect for one (1) year from the date first above
written. Thereafter, the Agreement shall renew for two (2) consecutive one (1) year terms.
KPHA agrees to provide the Employer with at least ninety (90) days written notice of the
intent to terminate, non-renew, or amend this Agreement. The Employer agrees to provide
KPHA with at least ninety (90) days written notice of the intent to tenninate or non-renew
this agreement. Any modification of the terms of this agreement may occur upon the mutual
agreement of the parties.
BREACH AND CURE. Notwithstanding the foregoing, this Agreement may be terminated
by either party upon a material breach of this Agreement by the other party, providing that
the breaching party does not cure the breach within thirty (30) days following receipt of a
written notice from the non-breaching party specifying the nature of the breach and
requesting that it be cured.
11. GENERAL PROVISIONS.
A. THIRD PARTIES: The terms and provisions of this Agreement are for the benefit of
the parties hereto and are not intended to provide any other person with any right or cause
of action on account thereof
4
B. NOTICES: Any notice required to be given pursuant to the terms and provisions thereof
shall be in writing and shall be hand-delivered, with return receipt thereof, or sent by
certified or registered mail, return receipt requested and first-class postage prepaid to the
addresses as follows:
Employer: County of Monroe
Manager- Employee Benefits
Gato Building
1100 Simonton Street, Room 2-268
Key West, Florida 33040
KPHA: Keys Physician-Hospital Alliance
clo Lower Florida Keys Physician Hospital Organization, Inc.
P.O. Box 9107
Key West, Florida 33041-9107
Attn.: Nicki Will, Secretary
C. ASSIGNMENT: This Agreement may not be assigned, subcontracted, delegated,
transferred by either party without the express written consent of the other party, and any
attempted assignment, subcontract, delegation or transfer shall be void.
D. INDEPENDENT CONTRACTORS: None of the provisions of this Agreement are
intended to create, nor shall be deemed to, or cons1rued to create any relationship
between KPHA and Employer other than that of independent entities contracting with
each other hereunder solely for the purposes of effecting the provisions of this
Agreement. Neither of the parties hereto, nor any of their respective officers, directors, or
employees shall be construed to be the agent, employee, or representative of the other.
E. GOVERNING LAW: This Agreement shall be governed in all respects by the laws of
the State of Florida without regard to Florida's choice of law statutes or decisions. Any
action by any party, whether at law or in equity, relating to this Agreement shall be
commenced and maintained, and venue shall be proper, only in Monro~ County, Florida.
F. ORDINANCE 10-1990: KPHA warrants that it has not employed, retained or otherwise
had acted on his behalf any former County officer subject to the prohibition in Sec. 2 of
Ordinance no. 10-1990 or any County officer or employee in violation of sec. 3 of
Ordinance 10-1990, and that no employee or officer of the County had any interest,
fmanciaIly or otherwise, in KPHA except for such interest, permissible by law and fully
disclosed by affidavit attached hereto. For breach or violation of this paragraph, the
County may, in its discretion, terminate this agreement without liability and may also, in
its discretion, deduct from the contract or purchase price, or otherwise recover, the full
amount of any fee, commission, percentage, gift or consideration paid to the former
County officer or employee.
5
G. CONFLICT OF INTEREST: KPHA assures the County that to the best of its
knowledge information and belief, the signing of this agreement does not create conflict
of interest.
H. OWNERSHIP OF INFORMATION: All Utilization Review and Case Management
docwnents which are prepared in the performance of this agreement are to be, and shall
remain, the property of the County and shall be transferred to the County or to a
replacement Utilization Review/Case Management service provider upon request and no
later than thirty (30) days after termination of this agreement. Any patient identifying
infonnation shall not be disclosed without written consent of the patient.
I. INSURANCE REQUIREMENTS: KPHA is required to maintain the types of
insurance identified in Attachment B.
1. SEVERABILITY: If any provision of this Agreement is held to be illegal, invalid, or
unenforceable, under present or future laws effective during the term hereof, such
provision shall be fully severable. In such event, tbis Agreement shall be construed and
enforced as if the illegal invalid or unenforceable provision had never been a part hereof,
and the remaining provisions shall remain in full force and effect unaffected by such
severance- provided that if the illegal, invalid or unenforceable provision is material to
the overall purpose and operation of this Agreement, then this Agreement shall terminate
upon the severance of such provision.
K. COUNTERPARTS: This Agreement and any amendment hereto may be executed in
multiple originals, all counterparts together constituting one and the same instrument.
1. ENTIRE AGREEMENT: This Agreement, along with its exhibits, contains all the
terms and conditions agreed upon by the parties hereto regarding the subject matter of
this Agreement and supersedes any prior Agreements, promises, negotiations, or
representations either oral or written, relating to the subject matter oftbis Agreement.
M. HOLD HARMLESS: KPHA shall indemnify and hold the County harmless from and
against any and all losses, penalties, damages, professional fees, incl~ding attorney fees
and all costs of litigation and/or judgment arising. out of any willful misconduct or
negligent act, error or omission of KPHA incidental to the performance of this agreement
or work performed thereunder. This indemnity shall extend to amounts the County
becomes legally obligated to pay and shall be limited by any sovereign immunity limit
applicable to the underlying claim plus costs of litigation.
In witness wherof, the Employer and KPHA have caused this Agreement to be executed by
their respective corporate officers, effective as of the fIrst day of March 2004.
6
~=~-~~.
~[l"~",I,.,::J",\"<C: "".
g/:?->~" '/~~
;/' --.:/ C ..-J rc-.. <""'/~
/A'",r, ':, /,~, 'I;', <';:"" ' ;, .'~ '~,~' 23 iI", "l, ~\
r':;'Jir-::";'j /,.\. '"'1\\
/";'\\ >"""';:>,,(1)
r~'~-~---t'~__~_ ('~-')~;.:.~_t.
'i; F:-cc.-' ::""'" .c.....',' I "y f
"\;~~,:;:~i:; !I~.,~.)' /
Employer:
Board of County Commissioners
~:;t("~
By:
(Ct:Al) Its:
ATTE3T; DANI-.'Y L I<Ol.HAGlCURI<
8y..o-.J..JC.~~. )
oe>UTY CLaII(
Keys Physician-Hospital Alliance
~~
\) ~ &,,-\,
.
.A1..yo r
,
By:
Its:
~//
N A.H
Date ASSISTANT~~~ff~ANEY
7
Attachment A
Reimbursement Schedule
*KPHA Members
75% of billed charges with the cap of the 90lb percentile of the P.H.C.S.
(formerly known as HIAA) Fee Schedule.
*In County Providers (IPN)
75% - 85% of billed charges with the cap of the 90tll percentile of the
P.H.C.S. (formerly known as HIAA) Fee Schedule.
Out-of-County Providers (IPN) 70% of billed charges with the cap of the 90dJ percentile of the P.H.C.S.
(formerly known as HlAA) Fee Schedule.
Dimension Providers
Dimension Network Fee Schedule.
MultiPlan Providers
MultiPlan Network Fee Schedule.
Fisherman's Hospital
75% of billed charges.
Lower Keys Medical Center
75% of billed charges.
*HCPS codes shall be reimbursed at 75% of billed charges.
A Ust of specific providers and discount percentages will be provided to Acordia National by KPHA for
Implementation.
.~
James Roberts, County Ad trator
v- I r:-o~
Date
~~
Robin Lockwood, M.D.
KPHA President
3 - 3.0- 4-
Date
~;Y
8
1996 Edition
.
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
General Insurance Requirements
for
Other Contractors and Subcontractors
e
As a pre-requisite of the work governed, or the goods supplied under this contract (including the
pre-staging of personnel and material), the Contractor shall obtain, at his/her own expense,
insurance as specified in any attached schedules, which are made part of this contract. The
Contractor will ensure that the insurance obtained will extend protection to all Subcontractors
engaged by the Contractor. As an alternative, the Contractor may require all Subcontractors to
obtain insurance consistent with the attached schedules.
The Contractor will not be permitted to commence work governed by this contract (including
pre-staging of personnel and material) until satisfactory evidence of the required insurance has
been furnished to the County as specified below. Delays in the commencement of work,
resulting from the failure of the Contractor to provide satisfactory evidence of the required
insurance, shall not extend deadlines specified in this contract and any penalties and failure to
perform assessments shall be imposed as if the work commenced on the specified date and time,
except for the Contractor's failure to provide satisfactory evidence.
The Contractor shall maintain the required insurance throupout the entire term of this contract
and any extensions specified in the attached schedules. FaIlure to comply with this provision
may result in the immediate suspension of all work until the ~ed insurance has been
reinstated or replaced Delays in the completion of work resulting from the failure of the
Contractor to maintain the required insurance sha1l not extend deadlines specified in this contract
and any penalties and failure to perform assessments shall be imposed as if the work had not
been suspended, except for the Contractor's failure to maintain the required insurance.
The Contractor shall provide, to the County, as satisfactory evidence of the required insurance,
either:
· Certificate of Insurance
or
· A Certified copy of the actual insurance policy.
The County, at its sole option, has the right to request a certified copy of any or all insurance
policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non-renewal,
material change, or reduction in coverage unless a minimum of thirty (30) days prior notification
is given to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving
the Contractor from any liability or obligation assumed under this contract or imposed by law.
Administration Instruction
#4709.3
14
A'l'TACIDIERT B
.
.
1996 Edition
The Monroe County Board of County Commissioners, its employees and officials will be
included as "Additional Insured" on all policies, except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in writing on the
County prepared form entitled "Request for Waiver of Insurance Requirements" and
approved by Monroe County Risk Management.
Administration I.nstruction
#4709.3
ArtACIIKEHT lr
1996 Edition
.
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Kevs Phvsician-Hosoital Alliance
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less
than:
.
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-
insurer, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
of Insurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
wet
Administration Instruction
#4709.3
88
A1TACBHENT B
.
e
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Kevs Physician HOSDitaI Alliance
1996 Bdition
Recognizin~ that the work governed by this contract involves the furnishing of advice or services
of a professIonal nature, the Contractor shall purchase and maintain, throughout the life of the
contract, Professional Liability Insurance which will respond to damages resulting from any
claim arising out of the performance of profes$ional services or any error or omission of the
Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$500,000 per Occurrence/$I,OOO,OOO Aggregate
PR02
Administration Instruction
#4709.3
ATrACBKDr B
78
.
.
1996 Edition
.
VEffiCLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Kevs Physician-Hospital Alliance
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
· Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
VL2
Administration Instruction
#4709.3
A7TACIDtEHT B
82
.
.
1996 Edition
EMPLOYEE DISHONESTY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Kevs Phvsfcian-Hosoital Alliance
The Contractor shall purchase and maintain, throughout the term of the contract, Employee
Dishonesty Insurance which will pay for losses to County property or money caused by the
fraudulent or dishonest acts of the Contractor's employees or its agents, whether acting alone or
in collusion of others.
The minimum limits shall be:
$10,000 per Occurrence
EDt
Administration Instruction
#4709.3
45
ATl'AC8KEHT B
1996 Edition
e
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Kevs Phvslcfan-Hospltal Alllance
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract
and include, as a minimum:
.
· Premises Operations
· Products and Completed Operations
· Blanket Contractual Liability
· Personal Injury Liability
· Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$500,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable sha1l be:
$250,000 per Person
$500,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date of this contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
GL2
Administration Instruction
#4709.3
ArrAcmt:INr B
ss
.
.
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a
contract to provide any goods or services to a public entity, may not submit a
bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any
public entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list."
ArrAC8K:EIrr B
e
ETHICS CLAUSE
Contractor warrants that he/It has not employed, retained or otherwise had act on his/Its behalf
any former County officer or employee In violation of Section 2 of Ordinance No. 10-1990 or any
County officer or employee In violation of Section 3 of Ordinance No. 10-1990. For breach or
violation of this provision the County may, In Its discretion, terminate this contract without liability
and may also, In Its discretion, deduct from the contract or purchase price, or otherwise recover,
the full amount of any fee, commission, percentage, gift, or consideration paid to the former
County officer or employee.
e
.
I,
NON-COLLUSION AFFIDAVIT
~ b ~ i\ lr'j{- JL U-l')C d i f'r' .ff tne city
W.a.rt-
according to law on my oath, and under
of
~\J
penalty of perJury. depose and say that;
1) I am 'Kulo,'f't l.D6k::UJ<::xJct l ("1 (). the bidder making the
Proposal for the project descrIbed as follows:
2) The prices In this bid have been arrived at Independentfy without collusIon, consultation,
communication or agreement for the purpose of restricting competition, as to any matt... relating to such
prices wIth any other bIdder or wIth any compctltor; .
3) Unless otherwlH required by law, the prices which have been quoted In thIs bid have not
been knoWIngly disclosed by the bidder and will not knowlngfy be dIsclosed by the bIdder prIor to bId
opening. dlrectty 01' Indirectly, to any other bIdder Of' to any competItor; and
fat
4) No attempt has been made or will be made by the bidder to Induce any other person,
partnershIp or COl'poratlon to subInIt, or not to submit, a bid for the purpose of restricting competition;
!S) The statements contained In this affidavit arc fnIe and correct, and made with full
knowledge that Monroe County relics upon the truth of the statements contained In this affidavit In
awarding contracts for said proJect.
ST~TE OF -H~rl:d.~
~~
(SIgnature of Bidder)
~I~~ \01
, D~TE
COUNTY OF .J't)D'\ ~.
pERsoN~LLY ..v>PE~RED BEFORE ME, the undersigned authority,
--('.=,\0;", lex ~~. fha, after first being sworn by me, (name of Indlvldual
signing) affixed hIs/her signature In the space provided above on this
~:~ dayaf ~{-h
r~.'_~ ~
~~RYPUBUC l 0.---
OM8 - MCP FORM #1
200\ Y
My commission expires:
- - -
e
. GIHA I. ALFONSO .
HoIIry PuOl1c - .. at FiorfdII
4' . ~~e..-._a._
4 CC,,"nllllll'CII , OOU3382
Bonded 8t' Natfon., Notary Alan.
-
.
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
~~c.~ ~~ ~\.o.G-N - ~_~O ~~ ~T-A\ 11-\ llAW~e-
(Name ofB . ess) \ I .
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohIbited in the workplace and specifying the actions that
will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of dru~ abuse in the workplace, the business's policy of
maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance
programs, and the penalties that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under bid a
copy of the statement specified in subsection (1).
e
4. In the statement specified in subsection (1), notify the employees that, as a condition ofworJdng on the
commodities or contractual services that are under bid. the employee will abide by the terms of the
statement and will notify the employer of any conviction ot: or plea of guilty or nolo contendere to, any
violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any
state, for I violation occurring in the workplace no later than five (5) days aft:ec such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation
program if such is available in the employee's community, or any employee who is so convicted.
6. Make I good faith effort to continue to maintain a drug-free workplace through implementation of this
section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
AU-~'
Bidder's Signature
~ - '3- Cl - <+--
Date
~
OMB-MCP#5
.
CONTRACT AMENDMENT
This amendment to agreement is made and entered into this 18th day of May, 2005, between
the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter
referred to as "EMPLOYER" and KEYS PHYSICIAN-HOSPITAL ALLIANCE, hereinafter referred
to as "KPHA" ,
WHEREAS, EMPLOYER and KPHA entered into an agreement on March I, 2004 for the
purpose of providing a provider network, utilization review and case management; and
WHEREAS, it is now neCessary for the KPHA to retain large case ana utilization review
documentation in their syStem; , , - ~
Now therefore, the parties agree as follows:
I. Paragraph four under #3 - Utilization Management and Quality Assurance of the agreement
dated March 1,2004 shall be revised, effective May 1,2005, to read as follows:
"Utilization Review and Large Case Management services will be performed according to pre-
set protocols developed in conjunction with the claims administrator's (Acordia National)
standards and all documentation will be maintained by the KPHA."
.
2, All other provisions of the Agreement entered March 1,2004, not inconsistent herewith, shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this agreement amendment the day first
~~ve.
, ',.1..' "~'"
, !'~\':\~,TIi'P.~t. DANNY L. KOLHAGE CLERK
... \\~7,~ t, ,
': :..,;~/,r1~:}~,i',~
'~~
"".'.-_r:-'.... . . , .
. ,<~;o. "
. "~)lj /' " "
puty lerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
~~~ >n ~
Mayor Dixie M, Spehar
KEYS PHYSICIAN-HOSPITAL ALLIANCE
By ~ ~L~;I~ "1/
ROBIN LOCKWOOD, M D., Pr~1'
SECOND AAIENDMENT
TO
EMPLOYER-PROVIDER NETWORK AND
UTILIZATION REVIEW AND CASE MA.J.l\fAGEMENT SERVICES
AGREEMENT
THIS SECOND A.J.'\1ENDMENT is entered into on the 11-*ky of January 2007, to the
Agreement between Keys Physician-Hospital Alliance ("KPHA") and Monroe County
("County") dated the first day of March, 2004.
WHEREAS, the Agreement between the parties was to terminate on March I, 2007 ; and
WHEREAS, the parties have mutually agreed to continue the Agreement; and
WHEREAS, it is in best interest of COlmty and serves a public purpose to continue with
the services provided KPHA, and
WHEREAS, KPHA wishes to continue with the service it provides to County.
NOW THEREFORE, in consideration of the mutual promises and considerations, the
parties agree to amend the Agreement as follows:
1. SECTION 10. TERM shall be amended as follows:
"10. TERM. This Agreement shall continue to be in effect from March 1,2007 until
September 30, 2008."
2. The remaining terms of the Agreement, not inconsistent herewith, shall remain in
full force and effect.
IN WITNESS WHEREOF, the parties hereto have been executed this Agreement as of
the date first written above.
- -' ,\.
Board of County Commissioners
Of Monroe County 4
By:~4
Mario Di Gennaro, Mayor
Date: JAN 1 7 2007
Witness t~ KP~: /1:: .
cJ~
Signature
fA.), tV tV L ~ .i-~ 0 $-1. c.....
Print Name
Address: lC.PI-J A
DATE: '-/7- 7
;t~ fivLv29
Signature of person with Authority to
Sign on behalf of Corporation
l'-:::u J:Jt!'u L __' \ V'--L{_ r: [l(j
Print Name\' , L' J. rd
DATE: (- 11 - .,
j
.. ,
THIRD AMENDMENT
TO EMPLOYER-PROVIDER NETWORK AND
UTILIZATION REVIEW AND CASE MANAGEMENT
SERVICES AGREEMENT
JI_fL-- J ./1
THIS THIRD AMENDMENT, made and entered into this ~ day of ~
2008, by and between Board of County Commissioners of Monroe County (hereinafter
called "County") and Keys Physician-Hospital Alliance ("KPHA").
WHEREAS, the Agreement between the parties was to terminate on September
31,2008;and
WHEREAS, the parties have mutually agreed to continue the Agreement; and
WHEREAS, it is in the best interest of the County and serves a public purpose
to continue with the services provided by KPHA; and
WHEREAS, KPHA wishes to continue with the service it provides County, and
NOW THEREFORE, in consideration of the mutual promIses and
considerations, the parties agree to amend the Agreement as follows:
1) Section 10. TERM shall be amended as follows:
19) The terms of this Agreement shall be effective October 1, 2008
and continue for a period of one year. Thereafter, the Agreement
shall automatically renew for two (2) consecutive one (1) year
terms. KPHA agrees to provide the Employer with at least ninety
(90) days written notice of the intent to terminate, non-renew, or
amend this Agreement. The County agrees to provide KPHA with
at least ninety (90) days written notice of the intent to terminate or
non-renew this agreement. Any modifications of the terms of this
agreement may occur upon the mutual agreement of the parties.
2) In all respects the terms and conditions of the original agreement
remain in full force and effect.
.. ~
e
.
..
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of
the date first written above.
Board of County Commissioners
Of Monroe C nty
ATTEST: DANNY L. KOLHAGE
Bya~
/
Deputy Clerk
APR 1 6 2008
By:
Charles ",,- onny" McCoy, Mayor
Date:
Witness ~~/~
7~~~
SigQatur/4.;( /PY/ ~
Print Name~
Date: ~
,
KPHA:
~~
Robin Lockwood, President
--1(' L l,j Ll> <<- f~&, cl
Print Name
/f-'2f- Od
Date: