3rd Amendment 10/19/2011 C' ( < =-k Or!9r��/
THIRD AMENDMENT
TO
SELF - INSURED WELFARE BENEFIT PLAN
ADMINISTRATIVE SERVICE AGREEMENT
THIS THIRD AMENDMENT TO ADMINISTRATIVE SERVICE AGREEMENT
( "Amendment "), made and entered into this 19th day of October, 2011 by and between Monroe County
(hereinafter called "Employer ") and WELLS FARGO THIRD PARTY ADMINISTRATORS of Charleston,
West Virginia, (hereinafter called "Wells Fargo Third Party Administrators ");
WITNESSETij
WHEREAS, the Employer presently receives third party administration (TPA) services from Wells
Fargo Third Party Administrators for certain of Employer's employee benefit plans; and
WHEREAS, the services provided by Wells Fargo Third Party Administrators are defined in an
Administrative Service Agreement between the Employer and Wells Fargo Third Party Administrators dated
June 15, 2005, as amended on April 16, 2008 and May 20, 2009 (the "Agreement "); and
WHEREAS, the current Agreement is in force and effect until May 20, 2012, however, paragraph 21
of the Agreement specifies that the Agreement may be terminated by either of the parties on thirty (30) days
written notice; and
WHEREAS, the parties now wish to specify the terms and conditions by which Wells Fargo Third
Party Administrator will continue to handle claims during a runout period following termination of the
Agreement in accordance with paragraph 24 of the Agreement.
NOW, THEREFORE, the parties hereto agree as follows:
The administrative fee for Wells Fargo Third Party Administrators, Inc. service for Medical run -out claims
shall be:
1) Ten percent (10%) of total paid claims for the period starting November 1, 2011
through October 31, 2012, which shall be the runout period. Invoices shall be issued
on the 15 and 30 of every month. The Employer agrees to pay Wells Fargo Third
Party Administrators within thirty (30) calendar days following receipt of the proper
invoice of the amount due during the previous billing period. If payment in full is
not received by Wells Fargo Third Party Administrators, Inc. by the due date, the
payment will be considered past due and interest equivalent to twelve percent (12 %)
per year will be charged and paid on the unpaid balance upon the 46 day after
receipt of invoice, or the maximum amount permitted by law, whichever is less.
Wells Fargo Third Party Administrators will immediately suspend its services until
payment is received by Wells Fargo Third Party Administrators.
2) This administrative fee supersedes the stated motive fee in the Agreement
between Employer and Wells Fargo Third Party Administrators.
3) The services that will be provided by Wells Fargo Third Party Administrators under
this Amendment during the runout period shall consist of those services specified in
paragraphs 10(f) -(h) and paragraph 14 of the Agreement.
4) No run -out claims will be processed until this agreement is fully executed. Upon
execution, all requests for payment of claims will continue to be processed in the
same manner in which claim payments were processed during the term of the
Agreement. Run -out claims must be funded each week. If they are not funded
weekly, the run -out agreement will be automatically terminated and services will
cease without Notice by Wells Fargo Third Party Administrators to Employer.
IN SS WHEREOF, the Employer and Wells Fargo Third Party Administrators have caused this
agreeme o be executed this /gay of October 2011.
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Al 1'bST: D ANNY L. KOLHAGE Board of County mi ners of Monroe County
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Deputy Clerk By
WELLS FARGO THIRD PARTY ADMINISTRATORS
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M CF OPERATING OFFICER
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MONROE COUNTY ATTORNEY
A RO Ep S FORM:
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ASSISTANT COUNTY ATTORNEY
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