Item C47
- , BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 18. 2002 Division: Mana2:ement Services
Bulk Item: Yes ......L No - Department: Group Insurance
AGENDA ITEM WORDING: Approval of the Group Insurance Pro2:ram contract for Third
Party Administration Services with Acordia National effective October 1. 2002 throu2:h
September 30. 2003.
ITEM BACKGROUND: Previous contract with Acordia National effective October 1. 1999
throu2:h September 30. 2000 with automatic renewals for FY 00-01 & FY 01-02.
PREVIOUS REVELANT BOCC ACTION: BOCC directed on March 13. 2001 that a Request
for Proposals be done. On Januarv 16. 2002 BOCC 2:ranted approval of recommendations
re2:ardin2: the proposals received for Claims Administration (Acordia National) from the RFP
distributed Julv 13. 2001.
CONTRACT/AGREEMENT CHANGES: Renew contract with Third Party Administrator
Acordia National effective October 1,2002 through September 30, 20~ with automatic renewals ,
for FY 03-04 & FY 04-05.
STAFF RECOMMENDATIONS: Approval
TOT AL COST: $255.149.00 BUDGETED: Yes --X- No
-
COST TO COUNTY: $255.149.00
REVENUE PRODUCING: Yes - No-X AMOUNT PER MONTH - Year
-
APPROVED BY: County Atty ~ OMB/Purchasing _ Risk Management _
DIVISION DIRECTOR APPROVAL: c:/ ~D ~ '"
James L. Roberts
DOCUMENT A TION: Included X To Follow Not Required_
DISPOSITIOl'l : AGENDA ITEM # C L/7
Revised 2/27/01
.
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Acordia National Effective Date: 1 % 1/2002
Expiration Date: 09/30/2003
Contract Purpose/Description: Third Party Administration Services for the processing of our
Group Insurance Program claims.
Contract Manager: Maria Z. Fernandez 4448 Administrative Services
(Name) (Ext. ) (Department)
for BOCC meeting on 09/18/02 Agenda Deadline: 09/04/02
CONTRACT COSTS
Total Dollar Value of Contract: $255.149.00 Current Year Portion: $
Budgeted? Yes[g] NoD Account Codes: 502-08002-530310- -
-
Grant: $N/A - - - -
----
County Match: $NI A - - - -
----
- - - -
----
ADDITIONAL COSTS
Estimated Ongoing Costs: $NI Alyr For:
(Not included in dollar value above) (eg. maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
Date In Needed
Division Director 1-q-a->-- YesD No '1- 'l-~
Risk Management q-,Cf~ YesD NoEJ q ~-c>>-
O.M.B./Purchasing t!'tP-D
County Attorney '/3/0d 9fldV
Comments:7;toJ'~,,(l.sj"~'(,(J....t - C:>
OMB Form Revised 9/11/95 MCP #2
ADMINISTRATIVE SERVICE AGREEMENT
THIS AGREEMENT, made and entered into the day of
by and between Monroe County (hereinafter called "Employer")
and ACORDIA NATIONAL of602 Virginia Street, East, Charleston, WV 25301, is
hereinafter set forth:
WITNESSETH
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, THEREFORE, in consideration ofthe mutual covenants and
promises hereinafter contained, the parties hereto agree as follows:
1) The effective date of the Employer's Plan shall be October 1.
2) The Plan Year shall be from October 1 thru September 30 of each
year.
3) The Employer's Tax Identification Number is 596000749
4) For each Plan Year, the Employer shall provide monies sufficient
to pay benefits under the 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. In the event Employer shall fail to provide sufficient monies to
fund its claims in a timely manner, a ten percent (10%) surcharge shall be
added to the monthly administrative fee due Acordia National, which
surcharge shall become chargeable beginning on the thirty-first (31 5t) day
after Acordia National's notification, as described herein. Employer
acknowledges and agrees that Acordia National shall not have any
financial duty or responsibility to release claim payments if ~mployer has
not sufficiently funded the same.
5) 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 polices, interpretations, rules, practices and procedures
established by Employer. Acordia National shall not have any
2
discretionary authority or control with regard to the management of Plan
assets. To the extent permitted 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.
6) The monthly capitation fee for administrative services will be:
October 1,2002
Medical Claims Administration $10.19 PEPM*
Dental Claims Administration $ 1.80 PEPM*
Vision Claims Administration $ 0.41 PEPM*
Pre-certification Administration PERFORMED BY KPHA
HIP AA Administration $ 0.40 PEPM*
. Per Employee, Per Month
The above monthly capitation fee shall apply to renewal effective October 1,
2002, and will remain the same for renewals effective October I, 2003 and October 1,
2004.
Payment of the fees established above is due from the Employer on or before the
10th day of each month, beginning on the lOth day of October, 2002. The fee quoted is a
three (3) year guarantee effective October 1, 2002. The cost of any additional services
rendered by Acordia National on behalf of the Employer necessitated by a change in
federal or state law will also be charged to the Employer in addition to the monthly fee.
Employee counts for purposes of monthly administrative fee billing may not be reduced
by more than 10% of the billed enrollment unless an explanation is provided.
Administrative fee adjustments must be done monthly and cannot be adjusted
3
retroactively in excess of90 days prior to the month invoiced. Acordia National reserves
the right to withhold any fees due to the client if administrative fees are outstanding.
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.
7) 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 Employer's Plan) in Employer's Plan, as agreed
with Employer;
b) Design and obtain other coordinating or supplemental types
of insurance coverage, where necessary, as requested by Employer
in writing;
c) Assist and advise employer in revising Plan Document.
Provide prototype Plan Documents and Identification Cards (ID
Cards) for the Employer. Arrange for printing and preparation of
such documents. The cost of the printing will be the responsibility
of the Employer;
d) Conduct information programs for all eligible Employees
to fully explain the benefits available under the Employer's Plan,
as requested by Employer;
4
e) Respond to telephone and mail inquiries from Plan
participants regarding benefits available to them and their
dependents.
f) Provide information concerning Plan benefits and
participants, based upon information provided by Employer;
g) 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 in~ustry
standards;
h) Correspond with claimants, as necessary, to prove claims
and to ascertain whether other coverage exists which might pay the
claim in whole or part;
i) Receive, review, and administer all claims for benefits
under the Employer's Plan, including the evaluation of claims
made; standard evaluation of the eligibility status of all claimants,
coordination of and at least annual auditing of the Utilization
Review and Case Management function, provide the County with
results of Utilization Review audit, appropriate Coordination of
Benefits evaluation of all claims, supply data to Health Recoveries,
Inc. necessary for subrogation and other functions usual to the
efficient and cost effective administration of claims;
5
j) Aid the employer in developing an efficient claims control
program;
k) Provide information, on request, for the completion by the
Employer of all necessary IRS and ERISA filings;
I) Provide Employer with a monthly report of claims paid;
m) Do all things necessary to properly effect the
responsibilities of a claims administrator under the Employer's
Plan, provided that all such actions/non-actions not otherwise
required by this Agreement shall first be approved by Employer.
n) Provide assistance and resources to Monroe County in
identifying, analyzing and maintaining the Employer's Plan in
accordance with state and federal laws, industry standards,
regulations and changes that affect the Plan;
0) Report all potential excess claims to the excess insurer, and
provide Employer with monthly updates;
p) Make documents available to the Employer and/or their
Consultants for periodic audit of files for accuracy and efficiency
of Acordia National's claims administration, and;
q) Process, authorize, and issue payment of all complete and
eligible claims within twenty (20) days of receipt;
r) Provide the County with adequate training and make
available access to its on-line computerized claim system.
6
s) Acordia agrees that this contract is not assignable by
Acordia without prior written permission from Monroe County.
8) Acordia National shall provide COBRA administrative services, if desired by
Employer (check one blank below). It is agreed and understood that COBRA
administration services are provided for medical and dental plans only and 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 all employees;
b) Provide notification, enrollment information and
enrollment forms to all qualified beneficiaries within 14 days of
notification of 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;
7
e) 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);
f) 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;
g) Provide prototype language to be included in the Plan
document to ensure compliance with COBRA legislation;
h) Provide prototype language for inclusion in Employer's
Summary Plan Description and coordinate, at Employer's option,
the printing of new plan booklets at employer's expense; and
i) 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; and employee's reduction of work hours, the
8
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 ofthe same to
be eligible or 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 Planes) 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 on the date of this Agreement may necessitate an adjustment in the fee for
COBRA administration.
9) 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.
10) Acordia shall provide the following services related to HIP AA
administration for the Employer's Plan:
9
a) Provide for the Employer's review, prototype modifications
to the plan document and SPD (Booklet) to address HIP AA
requirements;
b) Perform programming required to the Multi-Claim System
to track the applicable eligibility information and maintain credited
coverage information on both a current and future basis;
c) Coordinate the receipt of all certificates of coverage, or
other proof of coverage, for all new employees enrolling in the
benefit plan;
d) 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) Develop and 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 termination or upon request;
g) Prepare and distribute standard reports documenting
completed HIP AA activities; and
10
h) Serve as an information resource for HIP AA questions.
11) Subrogation and Fee Negotiation:
a) This will serve to confirm our understanding that the
Employer desires to utilize the subrogation and related services
offered by Healthcare Recoveries, Inc. in connection with the
Employer's health plan.
b) The administrative fee for Acordia National's Fee
Negotiation Services with health care providers shall be 25% of
savmgs.
12) 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 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.
13) To the extent required by law to purchase such coverage, each Employer
shall name Acordia National as an additional insured under its fiduciary bond which shall
be conditioned upon faithful performance of its duties hereunder, and such fiduciary bond
shall in all respects comply with the requirements of the Employee Retirement Income
Security Act of 1974, as amended.
14) Acordia agrees to defend, indemnify and hold harmless Employer against
all claims, damages, liabilities and expenses actually and reasonably incurred or imposed
on Employer in connection with any actual or threatened claim, action, suit, proceeding,
settlement or compromise thereof which arises from Acordia's administration of claims
11
under Employer Plan(s) other than in accordance with Plan provisions as well as the
negligence, willful misconduct of Acordia, its employees, representatives, or agents. The
right to be defended, indemnified and held harmless shall extend to Employer's affiliates
as well as the employees of Employer, their estates, executors, administrators, guardians,
conservators and heirs and shall apply after the employee cease employment with
Employer with respect to acts or omissions of Acordia prior to such cessation.
15) The terms of this Agreement shall be from the effective date hereof and
continue for a period of one year. This Agreement shall be renewed for two (2)
successive one-year periods at the sole discretion of the Employer, unless 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 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.
16) This Agreement may be terminated by either the Employer or Acordia
National at any time provided that Acordia National gives the Employer ninety (90) days
prior written notice or that the Employer gives Acordia National at least 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 ofthe period during which this Agreement was in
effect. Upon the termination of this Agreement, and if the same is not renewed, Acordia
12
National shall return all files of closed or pending claims covered by this Agreement to
the Employer or their designee.
17) 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.
18) Monroe County's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Board of County Commissioners.
19) Acordia National Warrants that it is not employed, retained or otherwise
had acted in its 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 Ordinance
10-1990 and that no employee or officer of the County had any interest, financially or
otherwise, in Acordia National except for such interest, permissible by law and fully
disclosed by affidavit attached hereto. For breach or violation ofthis 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, give or consideration paid to the former
County officer or employee.
19) 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 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
13
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 of36
months from the date of being placed on the convicted vendor list.
20) 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 Virginia Street, East, Charleston, WV 25301,
Attention: President, at such other addresses as the parties may from time to time
designate in writing.
20) The Employer and Acordia National agree that this agreement shall be
administered and construed according to the laws of the State of Florida. In the event
that any matter of disagreement arises, it shall be decided by a court of competent
jurisdiction with venue in Monroe County, Florida.
21) 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 ninety (90) day period following termination of this Agreement upon
terms negotiated between the parties.
22) This Agreement, together with the written proposal submitted by Acordia
and the Plan constitute the entire Agreement between the Employer and Acordia
National.
14
IN WITNESS WHEREOF, the Employer and Acordia National have
caused this Agreement to be executed by their respective proper corporate officers,
effective as of the of ,20_.
COUNTY OF MONROE
By
Its
ATTEST:
ACORDIA NATIONAL
By
Its
ATTEST:
15
) 996 Edition
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Acordia National
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 shall 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 55
1996 Edition
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Acordia National
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less
than:
$500,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$500,000 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.
WC2
Administration Instruction
#4709.3 89
1996 Edition
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Acordia National
Recognizing 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 professional services or any error or omission of the
Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$500,000 per Occurrence/$l ,000,000 Aggregate
PR02
Administration Instruction
#4709.3 78
,
1996 Edition
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Acordia National
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 82
1996 Edition
EMPLOYEE DISHONESTY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Acordia National
.
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:
$100,000 per Occurrence
ED2
Administration Instruction
#4709.3 46
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Walgreens Health Effective Date: 10/0 12002
Initiatives, Inc.
Expiration Date:09/30/2003
Contract Purpose/Description: Renewal for prescription benefit management services.
Contract Manager: Maria Z. Fernandez 4448 Management Services
(Name) (Ext. ) (Department)
for BOCC meeting on Sentember 18 2002 Agenda Deadline: 09/0412002
CONTRACT COSTS
Total Dollar Value of Contract: $18,000.00 Current Year Portion: $
Budgeted? Y es~ NoD Account Codes: 501-08003-530316- -
-
Grant: $N/ A - - - -
----
County Match: $N/ A - - - -
----
- - - -
----
ADDITIONAL COSTS
Estimated Ongoing Costs: $N/ Nyr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Date Out
Date In Reviewer
Division Director
Risk Management
~
C~
PRESCRIPTION SERVICE AGREEMENT
I
PRESCRIPTION SERVICE AGREEMENT
This Prescription Service Agreement ("Agreement") is entered into this 1 sl day of October, 2002 by and
between LOWER FLORIDA KEYS PHYSICIANlHospital ORGANIZATION, INC., a Florida not
for profit corporation doing business as Keys Physician-Hospital Alliance (t1KPHAtI), and WHP
HEALTH INITIATIVES, INC., an Illinois corporation, doing business as Walgreens Health Initiatives
("WHP").
RECITALS
WHEREAS, KPHA operates a provider network which, as its primary objective, arranges for the
delivery of health care services to persons enrolled in health care plans;
WHEREAS, KPHA has entered or will enter into agreements (all referred to as "Payor Agreements")
with managed care plans such as health maintenance organizations, self-insured employers, third party
administrators, or preferred provider organizations (individually and collectively referred to as "Plans") to
provide health services to Members of such Plans; and
WHEREAS, WHP manages prescription benefit programs that include the dispensing of prescription
drugs by and through its network of retail community pharmacies (hereinafter "Participating
Pharmacy(ies)") and arranges for prescription benefit management and claim processing services for
Plans; and
WHEREAS, WHP also manages a prescription benefit that includes the dispensing of prescription drugs
by mail service pharmacy (hereinafter "Participating Mail Service Pharmacy"); and
WHEREAS, KPHA desires to arrange for the provision of Prescription Services to Plan Members (and
their eligible dependents) through WHP's network of Participating Pharmacies and by Participating Mail
Service Pharmacy, as well as prescription benefit management and claim processing services by and
through WHP; and
WHEREAS, WHP is willing to make available Prescription Services to Members through its network of
Participating Pharmacies and by Participating Mail Service Pharmacy and to provide pharmacy benefit
management and claim processing services to Plans-upon the terms and conditions hereinafter set forth.
NOW, THEREFORE, in consideration of the mutual promises and covenants set forth in this
Agreement, and other good and valuable consideration, the parties to this Agreement agree as follows:
1. DEFINITIONS
For purposes of this Agreement, the following words and phrases shall have the meaning specified.
1.1 "Agreement" means this Prescription Service Agreement between KPHA and
WHP.
1.2 "A verage \Vholesale Price" means the wholesale cost of the dispensed medication on the date
dispensed as defined in the latest edition of any of the following:
F:\R WM\CIlI1(ra":ls\3"~KII P A 1f)()C\09/05l0:?1
The Drug Topic Red Book with supplements, the American Druggist Blue Book with
supplements, Medispan and weekly updates, or any other reference which may be agreed to
in writing by the parties to this Agreement. This price is based on 100 tablets or capsules,
one pint of liquid, or the closest quantity to that prescribed for ointments, creams,
suppositories, or other medication not packaged in lOOs or pints.
1.3 "Certificate of Coveraee" means the description of Plan Benefits for a particular Plan.
1.4 "Copavment" means those charges collected directly by WHP from a Member as additional
payments for Covered Services.
1.5 "Covered Services" means those properly authorized Prescription Services that are expressly
covered under the Members' Plan.
1.6 "Group Service Contract" means an agreement between a Plan and an Employer, including, but
not limited to, an administrative services only type agreement, under which Subscribers and eligible
dependents, if any, are entitled to become Members of the Plan in accordance with the terms of such
agreement.
1.7 "Individual Subscriber" means an individual who has entered into an Individual Subscription
Agreement with a Plan.
1.8 "Individual Subscriber Aereement" means an agreement between a Plan and an Individual
Subscriber by which such individual and his or her eligible dependents, if any, are entitled to become
Members of the Plan in accordance with the terms of such agreement. Individual Subscription
Agreements shall include agreements between a Plan and a Subscriber entitled to benefits under Title
XVIII of the Social Security Act, as amended.
1.9 "MAC List" means WHP's Choice list of generic drugs and their associated prices at which Plan
will pay WHP for dispensing services provided by Participating Pharmacies and the Participating Mail
Service Pharmacy hereunder. The MAC List is subject to periodic review and modification by WHP.
1.10 "Member" means an eligible Subscriber and his or her eligible dependents that have been
enrolled in a Plan under a Group Service Contract or an Individual Subscriber Agreement.
1.11 "Participatine Phvsician" means any physician licensed to practice in the State of Florida who
satisfies the participation criteria established by KPHA and who has entered into a contractual
arrangement with, or is otherwise engaged by, KPHA to provide Covered Services to Members.
1.12 "Pavor Aerccment" means an agreement by and between a Plan and KPHA under which
KPHA agrees to provide or arrange for the provision of certain health care services, and/or provide or
arrange for the provision of other non-health care services, including, for example, utilization review and
quality assurance programs, for the benefit of Subscribers.
1.13 "Plan" means a health maintenance organization, preferred provider organization, insurer,
employer and/or other third party payor for health care services.
1.14 "Plan Benefits" means the medical services or supplies to which Members are entitled pursuant
to an Individual Subscription Agreement or a Group Service Contract and which are described in a
Certificate of Coverage.
F:\R WMIConlraClsl.\"'\KH P A I . DOCI091051021
1.15 "Prescription Services" means dispensing of medications, general support and consultative
services regarding pharmacy benefit design and implementation, administrative and claims processing
services, standard reporting packages, marketing, quality management and utilization management
functions, as applicable to pharmacy benefits.
2. PRESCRIPTION SERVICES ENGAGEMENT
2.1 Provision of Services. KPHA hereby engages WHP, and WHP hereby agrees to be engaged, to
provide Prescription Services, pursuant to this Agreement. WHP shall provide all Covered Services that
are Prescription Services to Members of Plans with which KPHA has entered Payor Agreements. For all
Members, WHP agrees to: (i) coordinate the provision of Covered Services; and (ii) monitor all Covered
Services received by Members, all in accordance with the terms of this Agreement, each Plan's rules and
regulations, and each Plan's utilization management program. All Covered Services provided by WHP to
Members shall be within the limits of WHP's competence and shall meet the applicable community
standards of care. WHP shall maintain adequate personnel and facilities to fulfill the contractual
obligations hereunder. WHP is not licensed or otherwise authorized to practice pharmacy and nothing
herein shall require WHP to directly perform services for which a pharmacy license is required; provided,
however, that to the extent this Agreement requires the provision of services which require a pharmacy
license, WHP shall arrange for the provision of those services through a Participating Pharmacy or the
Participating Mail Service Pharmacy.
2.2 Responsibilities of WHP.
(a) WHP shall provide Prescription Services described in this Agreement and/or otherwise mutually
agreed to by the parties in writing, including, but not necessarily limited to, general support and
consultative services regarding pharmacy benefit design and implementation, administrative and claims
processing services, standard reporting packages, marketing, quality management and utilization
management functions. Upon request, WHP will provide personnel to participate in quarterly meetings
to review drug utilization and quality assurance.
(b) WHP shall provide its standard WHP identification card and introductory materials for issuance
to Members. Upon a Plan's request and a mutual written consent of the parties, WHP shall provide
customized identification cards and/or introductory materials for a mutually agreeable fee, prior to
providing such cards and/or materials.
(c) WHP shall provide to Participating Pharmacies and Participating Mail Service Pharmacy via
the on-line system at the time of dispensing all information necessary (as specified in Section 2.4) for said
pharmacies to provide prescription services to Members upon the following terms and conditions:
(I) Upon presentation by a Member or his/her agent of the Identification or (in the case of
prescriptions by mail) receipt of appropriate prescriptions and any required copayment,
Participating Pharmacies or Participating Mail Service Pharmacy, whichever the case may be,
shall compound and dispense all qualified prescriptions and covered drugs pursuant to the
pharmacy benefit information provided by the Plan to WHP and communicated to said
pharmacies via the on-line system at the time of dispensing, subject to legal restrictions and
professional ethics and professional judgment.
(2) Participating Pharmacies shall collect any applicable copayment fee or deductible from
each Member or dependent for each covered prescription, as indicated by the on-line system at
the time of dispensing, except when the reimbursement rate set forth in Attachment A is less than
applicable copayment. In such cases, Participating Pharmacies shall collect the lessor of the usual
F:\R W1\1\Contrach\.\"\KIIPA I 1)( lc\O<)/()S/021
and prevailing retail charge or the Member's copayment. In the case of mail order prescription
services, each Member shall transmit with the order to the Participating Mail Service Pharmacy
the applicable copayment fee for each prescription or refill covered by this Agreement.
(3) Participating Pharmacies and/or Participating Mail Service Pharmacy may withhold
prescription services to a Member for good cause, including, but not necessarily limited to, the
Member's failure to pay for services rendered (e.g., copayment); requests by Member for
quantities of drugs in excess of prescribed amounts or refill limitations pursuant to the pharmacy
benefit information; or where, in the professional judgment of the dispensing pharmacist, the
prescription should not be filled.
(4) Mail Order prescriptions will be sent to Members from the Participating Mail Service
Pharmacy facility via United Parcel Service, United States Postal Service or any other method the
Participating Mail Service Pharmacy may select. Risk of loss or damage to covered drugs
provided hereunder shall be on the Participating Mail Service Pharmacy until said drugs have
been delivered to Member. The cost of shipping shall be borne by the Participating Mail Service
Pharmacy, except for the following costs: (i) FlAil will'lJaTf31 lHtY "iHerea3es 3hil'I'ing t:6sts
getH:UTiRg after the effective date 6f this Ag~c.nlc.nt a3 a .cst.lL of .at.;. i.i".",~",:> b LI.", U..ilc:J
$tlt~f. PQstal ~@r"ic@ "Sf private fRail tlaelatgeftlH1slen;'"Mft-(ii)' Members shall pay Participating
Mail Service Pharmacy additional expense due to expedited delivery requested by Member.
(5) Participating Pharmacies and Participating Mail Service Pharmacy shall be (and WHP
shall cause them to agree to be) bound by and subject to the obligations of WHP hereunder as
applicable, including without limitation those set forth in Sections 2. 1, 2.2(c), 2.3, 3, 4, 6, 8 and
11 hereof, as fully as if the Participating Pharmacies and Participating Mail Service Pharmacy
were named in addition to WHP.
(d) WHP shall be responsible for the reasonable costs associated with its development and printing
of standard marketing materials that WHP provides to Plan in connection with this Agreement provided,
however, that all costs associated with the distribution of such materials to Members shall be the sole
responsibility of Plan.
(e) WHP may add or terminate Participating Pharmacies to or from its network in its sole discretion;
subject to the requirement that Participating Pharmacies be conveniently available to Members on a
countywide basis in Monroe County, Florida.
2.3 Discrimination Prohibited. WHP agrees to provide Prescription Services to Members in the
same manner, in accordance with the same standard of care, and with the same promptness with which
WHP provides Prescription Services to WHP's other patients. In addition, WHP shall not discriminate
against a Member on the basis of such Member's age, race, creed, national origin, sex or sexual
preference.
2.4 Responsibilitv of Plans.
(a) Each Plan shall provide WHP with Member enrollment, eligibility and benefit coverage
information, including, but not necessarily limited to, copayment, covered drugs, days' supply and
participating physicians (including any updates, deletions or additions to the foregoing information as
changes occur). This information shall be transmitted by WHP to Participating Pharmacies and the
Participating Mail Service Pharmacy at the time of dispensing through the on-line electronic transmission
link ("on line system") maintained between WHP and said pharmacies. Each Plan shall be responsible
for the accuracy, completeness and reliability of eligibility and benefit coverage information provided to
F:\R WM\ConlraclS\1"\KHI' A I 1 )0009/05/021
WHP. Plans may not retroactively deny payment for valid and accurate claims properly submitted and
properly approved on-line at the time of dispensing.
(b) Each Plan will provide all Members with a standard identification card issued by WHP
(hereinafter "Identification"), which shall contain, but not necessarily be limited to, the Members
identification number and full name of Member. Eligibility to receive the prescription benefit is
established at the time of dispensing through the on-line system. Each Plan shall be responsible for
collecting the Identification from the Member upon termination of the Member's eligibility or upon
termination of this Agreement.
(c) Each Plan authorizes WHP, as its prescription benefit manager, to perform formulary
management' and other services described in this Agreement, subject to the following terms and
conditions:
(1) Plan represents that its benefit plan design(s) in no way prohibits Plan from implementing
formulary management services performed by WHP or the Participating Pharmacies hereunder,
such as, but not necessarily limited to, generic or therapeutic prescription drug substitutions and
any other measures that may be appropriate to effectuate formulary management. Either KHP A
or Plan will notify WHP in advance of any benefit plan design changes that may materially affect
WHP's ability to perform formulary management and/or other services described in this
Agreement.
(2) To the extent WHP has provided Plan with a formulary in connection with the services
provided hereunder, Plan may not sell, distribute, or otherwise provide such formulary to any third
party without WHP's prior written consent. On or prior to termination of formulary management
services by WHP, Plan will cease all use of WHP's formulary and return to WHP all copies in its
possession, and Plan will instruct all Members and other parties to whom Plan has provided
WHP's formulary to discontinue use of such formulary and to destroy all copies in their
possession on or before the effective date of termination. Upon WHP's request, Plan will provide
proof to WHP that it has complied with all of the terms and conditions set forth in this paragraph.
(3) For those clinical programs that may require certain medical claims information (such as,
but not necessarily limited to, retrospective drug utilization review), and subject to Section 6.1.,
below, Plan will provide to WHP and/or its designee all complete and accurate Member related
medical claims and record information that WHP reasonably requests, in a format and time frame
mutually acceptable to the parties.
(4) Both KHP A and each Plan acknowledge that compliance with the terms and conditions of
this Section 2.4. is a condition precedent to participation in any manufacturer incentive
arrangements described in Attachment A, attached hereto and incorporated herein.
(d) Subject to Section 8.2., below, Plan will accurately describe and represent the role of WHP and_
the Participating Pharmacies and the Participating Mail Service Pharmacy in providing services hereunder
in all communications, including marketing and advertising materials, to Members and potential Members.
. Formulary management at a minimum shall consist of WHP: (i) providing on-line messages at the time of
dispensing to Participating Pharmacies and Participating Mail Service Pharmacies concerning preferred medications
and (ii) contacting Participating Physicians regarding preferred and non-preferred medications. Any additional
formulary management services will be performed in accordance with the mutual agreement of the parties hereto.
F:\R WM\Comracls\.1"\K Ill' t\ I . ()( lC\O'-J105/021
3. COMPENSATION
3.1 WHP's Compensation. WHP's compensation for Prescription Services rendered to Members
shall be as set forth in Attachment A to this Agreement.
3.2 No Recourse Ae:ainst Members: Collection of Copavments and Deductibles. WHP shall not
bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any
recourse against Members, Plans or any persons or entities other than the Plans for Covered Services
unless otherwise specified in any amendments hereto. This provision shall not prohibit WHP's,
Participating Pharmacies' or Participating Mail Service Pharmacies' collection of copayments and
deductibles permitted under the Plan or the collection of payment for any Prescription Services delivered
to a Member if such service is not a Covered Service, unless such services are not Covered Services
because of WHP's failure to comply with this Agreement or KPHA's or each Plan's rules and regulations
(subject to notice as provided in Section 4.1 hereof). WHP agrees to use reasonable efforts to collect
from Members applicable copayments, and upon request from a Plan, WHP will prepare reports
regarding copayments billed and collected, on forms developed by WHP and reasonable acceptable to
KPHA and the Plans. WHP further agrees that: (i) the provisions of this Section 3.2 shall survive the
termination of this Agreement regardless of the cause giving rise to such termination and shall be
construed for the benefit of Members; and (ii) the provisions of this Section 3.2 supersede any oral or
written agreement to the contrary now existing or hereafter entered into between WHP and any Member
or persons acting on any Members' behalf.
3.3 Refunds. WHP shall refund to a Plan any and all sums collected by WHP from Members to
which WHP was not entitled under this Agreement, provided that Plans shall provide prior (or if a refund
is recovered by setoff then contemporaneous) written documentation of the basis for the claimed refund
due. Such refunds shall take the form of cash payments or setoffs against amounts owed to WHP by a
Plan. When appropriate, the Plan shall return to the Member such sums improperly charged by WHP.
3.4 Hilline: Procedure. WHP shall comply with all billing and reporting procedures established by
KPHA and the Plans as set forth in the Agreement or the attachments hereto and in each Plan's rules and
regulations as promulgated from time to time, subject to notice in accordance with Section 4 hereof.
3.5 Payment. Each Plan shall be solely responsible for payment of Prescription Services provided
by Participating Pharmacies and Participating Mail Service Pharmacy to Members, in addition to the
administrative fees and other costs and charges set forth in Attachment A to this Agreement.
(a) WHP shall invoice each Plan on the fourth (4th) business day following the close of each twice-
monthly billing cycle. Said invoices shall include, but not necessarily be limited to, prescription claims,
administrative fees and/or any other costs and charges specified in this Agreement.
(b) Each Plan shall pay all complete, undisputed invoices sent to it within thirty (30) days of WHP's
issuance thereof. Payment dates as used in this Agreement shall mean the date payment is to be delivered _
to the location designated in this Agreement as follows:
WHP Health Initiatives, Inc.
P.O. Box 93741
Chicago, IT... 60673-3741
All sums owed by a Plan shall bear interest of one and one-half percent (1-1/2%) per month from the date
payment is due until paid; however, in no event shall such interest rate be greater than the rate permitted
by law.
F:\R WM\C\lnlr~c,,\Y'\KHP.-\ I DOC\09105/021
(c) Subject to the notice and cure provisions of Section 9.3 hereof, in the event that a Plan defaults on
any payment obligation specified in this Agreement WHP shall have the right, at its sole option, to
suspend and/or terminate all prescription benefits and services provided to such Plan and its Members.
WHP may notify Participating Pharmacies and Participating Mail Service Pharmacy on-line that
prescription services to such Plan and its Members have been suspended or terminated, as the case may
be, due to Plan's failure to meet its payment obligations as set forth in this Agreement. Upon such
notification, Participating Pharmacies and Participating Mail Service Pharmacy may cease providing
prescription services to such Plan and its Members and shall have the right, along with WHP, to pursue
any legal remedy directly against such Plan for any breach of said Plan's payment obligations.
4. COMPLIANCE WITH RULES AND REGULATIONS
4.1 KPHA and Plan Rules. WHP agrees to be bound by and comply with KPHA and Plan policies,
procedures and rules as promulgated from time to time, which, as now in effect and as hereafter adopted
and amended, are incorporated in this Agreement for all purposes; provided that KPHA and Plans must
give WHP sixty (60) days prior written notice of such policies, procedures and rules (unless such notice
is waived in writing by WHP). Such policies, procedures and rules shall not be interpreted to require
WHP to provide additional services to KPHA or Plans which are not expressly set forth in or otherwise
required to be provided by WHP under this Agreement.
5. NOTIFICATION OF WHP STATUS
WHP shall notify KPHA in writing as soon as reasonably possible upon the occurrence of any of the
following events:
(a) The pharmacy license of any Participating Pharmacy or the Participating Mail Service Pharmacy
in the State of Florida is suspended, revoked, terminated, or subject to terms of probation or other
restrictions;
(b) there is a change in WHP's business address;
(c) any act of nature or any event beyond WHP's reasonable control likely to interrupt all or a
portion of the WHP's practice for a period of sixty (60) consecutive calendar days, or which may have a
material adverse effect on the WHP's ability to perform his obligations for this period;
(d) any change in the nature or extent of services rendered by WHP which could be relevant to the
performance of obligations by WHP hereunder;
(e) any material change or addition to the information and disclosures submitted by
WHP as part of the application for a contract with KPHA to provide Covered Services to Members;
(D any other act. event, occurrence or the like that might materially affect WHP's ability to carry out
its duties and obligations to Members.
6. MEDICAL RECORDS AND FACILITIES
6.1 Confidentialitv of Records.
(a) The parties will maintain the confidentiality of all medical, prescnptlOn, and other patient-
identifiable health information specifically relating to Members ("Patient Information") in accordance
F:\R WM\Contracts\.V'\KHP A I .1)0009/05/021
with applicable laws and regulations, including the Health Insurance Portability and Accountability Act of
1996 ("HIPAA"), as may be amended from time to time. The parties acknowledge that WHP will have
access to Patient Information in order to provide services and/or perform the obligations undertaken
hereunder and that Patient Information may be obtained from and/or distributed to KPHA, Plan,
Participating Pharmacies, and/or any other third party in connection with services provided hereunder,
including any and all disclosures made by WHP, such as, but not limited to, those made in connection
with provider audits conducted by WHP or its agents or service providers, and disclosures made at
KPHA's or Plan's request, such as, but not limited to, those made to third party administrators or to a
new vendor upon transition of services following termination of this Agreement.
(b) Plan and KPHA acknowledge that certain management reports, reporting packages, utilization
data, prescription claims information and/or clinical or formulary-related programs may contain Patient
Information. Plan further acknowledges that (i) its request to WHP to disclose Patient Information to any
third party (i.e. broker, healthcare consultant and/or third party administrator) constitutes Plan's direction
and authorization to disclose such information to the third party; and (ii) WHP will disclose such
information pursuant to Plan's direction until such time as WHP receives written notice from Plan to
cease further disclosures. KPHA and Plan acknowledge the requirements and obligations under HIPAA
regarding the disclosure of Patient Information to third parties on their behalf. Accordingly, if and when
required, KPHA and/or Plan agree to enter into "Business Associate" contracts (as such term is defined in
Title 45, Section 160.103, of the Code of Federal Regulations) with such parties as well as any other
agreements required by state, federal law and regulations. In the event that WHP is a party to a broker or
consultant arrangement in connection with the services provided hereunder, WHP is solely responsible
for any and all fees that may be due such broker or consultant. Further, in conjunction with any such
payments, KPHA and Plan acknowledge that WHP may disclose non-patient identifiable health
information related to such Plan's claim volume to such brokers or consultants.
(c) This Section 6.1. will survive the termination of this Agreement.
6.2 Sharin2 of Records. WHP shall cooperate with and support KPHA's utilization review and
management, and quality control programs, subject to applicable confidentiality requirements, subject to
laws on patient records confidentiality prohibiting such participation.
6.3 Re2ulatorv Compliance. WHP shall maintain and provide to Plans, the Horida Department of
Insurance or the Florida Department of Health and Rehabilitative Services all necessary records and
information which may be required for compliance by Plans with applicable state law, including, without
limitation, the Horida HMO Act, Chapter 641, Horida Statutes, and the regulations promulgated
thereunder, and to Plans and the Department of Health and Human Services as may be required for
compliance by Plans with applicable federal law including, with limitation, 42 U. S.c. 3 OOe, et seq.,
Section 1876 of the Social Security Act, as amended, and 42 CFR Part 417.
Specifically, since the value or cost of services provided under this Agreement may be $10,000 or more
within a twelve-month period, then, to the extent that the cost of such services is reimbursable by the_
Medicare program, WHP agrees to comply with the Access to Books, Documents and Records of
Subcontractors provision of Section 952 of the Omnibus Budget Reconciliation Act of 1980 (PL 96-499)
and 42 CFR Part 420. Subpart D, Section 420.300 et seq. In accordance with these provisions, WHP
will, upon proper written notice, allow the Comptroller General of the United States, the Secretary of
Health and Human Services, and their duly authorized representatives access to this Agreement and to the
WHP's books. documents and records necessary to certify the nature and extent of costs of Medicare
reimbursable services provided under this Agreement. Such access will be allowed, upon request, until
the expiration of four (4) years after the Medicare reimbursable services are furnished pursuant to this
Agreement. If WHP carries out any of the duties of this Agreement through a subcontract with a related
F:\R WM\Cllnlracls\3"'\KH P;\ I . DOC\09/05/0zl
party with a value or cost of $10,000 or more over a twelve (12) month period, such subcontract shall
contain a clause which requires the subcontractor to comply with the above statutes and regulations.
6.4 Inspection of Facilities. KPHA and Plans shall, upon prior written notice, have reasonable
access to Participating Pharmacy and Participating Mail Service Pharmacy facilities at reasonable times
convenient to KPHA, Plans, and said pharmacies within two (2) weeks of such request, unless a later date
is mutually agreed on, to allow the designated representatives to inspect said pharmacies' facilities, to
confirm that these facilities are in keeping with generally accepted pharmacy standards in the relevant
community and applicable state law, or standards that may reasonably be established by KPHA, provided
that standards established by KPHA shall be reasonably acceptable to WHP, Participating Pharmacies
and Participating Mail Service Pharmacy and consistent with applicable state law.
6.5 Inspection of Records. KPHA and Plans shall have the right, upon request and during normal
business hours, to inspect and to copy at their expense books, records (including any accounting,
administrative and medical records) maintained by WHP pertaining to claims for Prescription Services
under this Agreement. WHP shall make its books and records relating to Members or relating in any way
to KPHA and Plans available to representatives of federal, state or local regulatory authorities pursuant to
any examination of Plans by such authorities. Plans warrant that each has the authority from Members
(and their eligible dependents) for Plans and KPHA to obtain and possess prescription information, which
may be deemed confidential.
7. INSURANCE AND NOTICE OF CLAIMS
7.1 Notice of Claims. WHP agrees to notify KPHA as soon as reasonably possible of any claim or
cause of action by or relating to a Member filed against WHP within five (5) working days of WHP's
receipt of notice that such a claim or cause of action has been filed. WHP shall provide KPHA with any
information regarding such claim or cause of action reasonably requested by KPHA, subject to applicable
laws regarding patient confidentiality which prohibit the release of such information.
7.2 Insurance. WHP may satisfy, in whole or in part, the insurance requirements detailed in
Attachment C, by a plan of self-insurance. A certificate of insurance coverage will be provided to KPHA
upon written request.
8. ADMINISTRA TION
8.1 Grievance and Disputes. WHP agrees to cooperate with KPHA in resolving any Member
grievances related to the provision of Covered Services. KPHA shall notify WHP concerning all
Member complaints involving WHP, and WHP shall notify KPHA and the applicable Plan of any
complaints, and in consultation with KPHA and the applicable Plan shaIl use WHP's best efforts to
resolve any complaints in a fair and equitable manner. Subject to the notice provisions of Section 4
hereof, WHP agrees to participate in and cooperate with KPHA's and Plan's Member grievance
procedures and comply with all final determinations rendered in accordance with those procedures.
8.2 Advertisinl!. For those Plans with which KPHA has Payor Agreements, KPHA may include
WHP's name, address, telephone number and type of service in a roster of Participating Providers, it
being understood by the parties that this roster may be inspected by and is intended for the use of current
and prospective Members, Subscribers, Participating Providers, and other providers. WHP shall not
engage in any direct marketing activities with respect to a Plan with which KPHA has a Payor Agreement
and shall not use the trademarks and trade names employed by KPHA or Plans with which KPHA has
Payor Agreements without the prior written approval of KPHA or such Plans, respectively; provided,
however, that WHP may reference KPHA's or Plan's name or service mark to inform Members and the
F:\R WMIConlracts\3"'\KH PAl. ()( )C\09105/021
general public (i) of WHP's role in providing Prescription Services and (ii) that Participating Pharmacies
and Participating Mail Service Phannacy are participating providers to KPHA, Plan and Members.
8.3 Sil!ns and Displavs. Participating Pharmacies may (but shall not be required to) display in a
visible and prominent place any reasonable card, plaque or similar identifying logo provided by KPHA or
Plans to identify such pharmacies as Participating Pharmacies hereunder to Subscribers.
8.4 Coordination of Benefits. WHP shall cooperate in the effective implementation of any
provisions of the Plan relating to coordination of benefits and other third party claims. WHP shall bill,
when requested by KPHA, any third party payor for services provided to Members. WHP shall, when
permitted by law, reimburse KPHA in the event that payments are received from such payors for Covered
Services provided to Members, or assign to KPHA all payments owed by such payors, and execute any
further documents that reasonably may be required or appropriate to permit KPHA to bill and process
forms for any third party on WHP's behalf or to bill such payors directly, as determined by KPHA.
KPHA and Plans shall notify WHP of their respective policies and procedures regarding coordination of
benefits, which shall be subject to the provisions of Section 4 hereof.
9. TERM AND TERMINATION
9.1 Term. The initial term of this Agreement shall commence on October 1, 2002, and shall
continue in effect for one (1) year from the date hereof, unless and until terminated pursuant to this
Section 9. Upon expiration of the initial term, this Agreement shall automatically renew for two
additional, successive one (1) year terms, unless otherwise terminated by either party for any reason by
written notice to the other party delivered at least ninety (90) days prior to the end of the then current
term.
9.2 Immediate Termination. KPHA, in its absolute discretion, may terminate this Agreement
immediately in the event that the pharmacy license of any Participating Pharmacy or the Participating
Mail Service Pharmacy in the State of Florida is revoked or if WHP is convicted of a felony or any crime
related to the practice of medicine or pharmacy, but with respect to revocation of a pharmacy license,
only in the event that the revocation of such license results in inadequate geographic network coverage or
an inability to conveniently serve the needs of Members.
9.3 Termination for Cause. KPHA or WHP may terminate this Agreement for cause upon thirty
(30) days written notice (with the exception of non payment), with an opportunity to cure, which notice
shall set forth the grounds for termination. "Cause" shall mean for purposes of this Agreement: (i) a
material breach of any provision of this Agreement; and (ii) commission of an act of fraud or theft against
the other party. Notwithstanding the foregoing, in the event of nonpayment by a Plan in accordance with
the terms hereof, which is not cured within ten (10) days after notice by WHP to KPHA and such Plan,
WHP may terminate this Agreement as to such Plan only, upon notice to KPHA and such Plan.
9.4 Termination Without Cause. KPHA or WHP may terminate this Agreement or any
Amendment hereto for any reason upon sixty (60) days' prior written notice to the other party.
Notwithstanding the foregoing or any termination rights set forth in this Agreement, WHP may
immediately terminate or refrain from implementing any formulary management or other clinical program
services in any geographic area (in their entirety or for specific drugs only) if, in WHP's sole
determination, the implementation or continued provision of such services is or may be in violation of
applicable laws, rules, or regulations governing the practice of pharmacy or prescription benefits
management, or may otherwise present an issue related to the practice of pharmacy or prescriptions
benefits management.
F:\R WM\Contracls\3"\KH PAl. [)( )(\09105/021
9.5 Endaneerment of Members. KPHA may terminate this Agreement effective upon written
notice to WHP upon a determination in good faith by KPHA that the continuation of the Agreement may
result, or is resulting, in imminent danger to the health safety and welfare of any Member.
9.6 Oblieations Upon Termination. In the event of termination of this Agreement or termination of
WHP by KPHA, the rights and obligations of each party hereunder shall cease unless otherwise provided
by this Agreement. In the event of termination of this Agreement for any reason, WHP will use WHP's
best efforts to cooperate with transition of Members to ensure continuity of care.
9.7 Department of Insurance Order. This Agreement shall be cancelable upon the issuance of an
order by the Department of Insurance pursuant to Section 641.234, Florida Statutes, or any successor
statute.
10. RELA TIONSHIP OF PARTIES
10.1 Independent Contractors. In the performance of their responsibilities, duties and obligations
under this Agreement, KPHA, WHP, and Plans are at all times performing as independent contractors.
No act, work commission, or omission by either party, its agents, servants, contractors, or employees,
pursuant to the terms and conditions of this Agreement shall be construed to make or render KPHA,
WHP, or Plans an agent, servant, employee of, or joint venture with, the other.
10.2 Indemnitv. WHP, KPHA and Plans shall indemnify, defend and hold harmless the others,
including their respective shareholders, directors, officers, employees, agents, representatives, parent and
affiliated companies from and against any liability arising from the sole negligence of WHP, KPHA or
Plans, as the case may be, in carrying out its respective duties and obligations under this Agreement.
KPHA and Plans acknowledge and agree that neither WHP nor its shareholders, directors, officers,
employees, agents, representatives, parent and affiliated companies shall have any liability whatsoever to
KPHA, Plans or Members for the acts or omissions of any Participating Pharmacy and/or Participating
Mail Service Pharmacy in connection with such pharmacies' provision of services to KPHA, Plans and
Members, including, but not necessarily limited to, any of the following: (i) any actual or alleged
malpractice, negligence or misconduct of said pharmacies; or (ii) the sale, compounding, dispensing,
failure to sell, manufacture or use of any drug dispensed to a Member hereunder. WHP and Plans
acknowledge and agree that neither KPHA nor its shareholders, directors, officers, employees, agents,
representatives, parent and affiliated companies shall have any liability whatsoever to WHP or Plans for
the acts or omissions of any Plan or provider in KPHA's provider network, including, but not necessarily
limited to, any of the following: (i) nonpayment by a Plan of any amounts becoming due hereunder; or (ii)
any actual or alleged malpractice, negligence or misconduct of said Plans and/or providers. This Section
10.2 shall survive the termination of this Agreement for any reason.
11. TRADE SECRETS. SOLICIT A TION OF SUBSCRIBERS
11.1 Non-disclosure of Trade Secrets and Proprietary Information. WHP agrees that-
information regarding Members is a highly confidential trade secret of KPHA and Plans entitled to
protection, and WHP agrees not to reveal any information regarding Members to any other person or
entity during the term of and after the term or expiration of this Agreement without the written consent of
KPHA or Plans, unless required by law, and except as necessary in WHP's provision of services and
WHP's performance of the terms of this Agreement. WHP and KHP A further agrees that the means or
methods by which KPHA, WHP and Plans operate their respective business, including but not limited to
contract terms, bidding information, methods of operation, levels of costs, utilization and profits, and the
procedures, forms and techniques for servicing aCCOUnlS, are highly confidential trade secrets entitled to
protection, and each party agrees not to reveal such means and methods of information to any other
F:\R WM\ConlraCls\3"'\KH PAl. [)( )C\09/051021
person or entity during the term of and after the termination or expiration of this Agreement without the
written consent of the respective other party, unless required by law and except as such infonnation is in
the public domain other than as a result of a breach hereof. Without limiting the foregoing, Member
information may only be disclosed in compliance with applicable laws and regulations regarding the
confidentiality of patient information.
In the event of an actual or threatened breach by a party of this Agreement, KPHA, WHP or Plans, as the
case may be, shall be entitled to an injunction restraining the breaching party from the prohibited conduct.
If the court should hold that the duration and/or scope of the covenants contained in this Section are
unreasonable, then, to the extent permitted by law, the court may prescribe duration and/or scope that is
reasonable; and KPHA, Plans and WHP agree to accept such determination, subject to their rights of
appeal. Nothing herein shall be construed as prohibiting a party from pursuing any other remedies
available for such breach or threatened breach, including the recovery of damages from a breaching party.
In any action or proceeding to enforce the provisions of this Section, the prevailing party shall be
reimbursed by the other party for all costs and attorneys' fees incurred in such action or proceeding.
11.2 Solicitation of Subscribers. During the term of this Agreement WHP shall not take any action or
make any communication to Subscribers which undermines or could undermine the confidence of
Subscribers or the public in the Plans, or KPHA. During the effective term of this Agreement and any of
its amendments, and for a period of one (1) year .following the termination or non-renewal of this
Agreement or any of its amendments for any reason, WHP shall not directly cause any Subscriber to
disenroll from a Plan. By way of example but not limitation, WHP shall not solicit Subscribers through
meetings, visits, telephone calls, or individual letters.
12. MISCELLANEOUS
12.1 Notices. Any notice required or permitted to be given hereunder to either party shall be deemed
given if sent by registered or certified mail, return receipt requested, or by overnight mail delivery for
which evidence of delivery is obtained by the sender, to such party at:
KPHA: Keys Physician-Hospital Alliance
5900 College Road
Key West, Horida 33040
Attention: President
WHP: WHP Health Initiatives, Inc. with a copy to: WHP Health Initiatives, Inc.
Attn: Client Services Attn: Mark Mincy
520 Lake Cook Road, Suite 200 7316 Greenbriar Parkway
Deerfield, Illinois 60015 Orlando, Florida 32819
12.2 Limitation of Assienment. This Agreement shall not be assigned by either party without the
prior express written consent of the other party, which consent shall not be unreasonably withheld.
12.3 Bindine on Successors in Interest. The provisions of, and obligations arising under, this
Agreement shall extend to, be binding upon and inure to the benefit of the successors and assigns of each
party.
12.4 Severabilitv: Chanees in Law. If any part of this Agreement is determined to be invalid, illegal,
inoperative, or contrary to law or professional ethics, the part shall be reformed, if possible, to conform to
law and ethics; the remaining parts of this Agreement shall be fully effective and operative to the extent
reasonably possible. If any restriction contained in this Agreement is held by any court to be
F:\R WM\ConlraCls\3"'\KH PAl DOC\09/o5/021
unenforceable or unreasonable, a lesser restriction shall be enforced in its place and the remaining
restrictions shall be enforced independently of each other.
12.5 Confonnance With Law. Each party agrees to carry out all activities undertaken by it pursuant
to this Agreement in conformance with all applicable federal, state, and local laws, rules, and regulations.
12.6 Liaison. Each party agrees to use its best efforts in the implementation of this Agreement, to
establish and use channels of communication with the other party and with representatives of Members
and Plans, and to maintain effective liaison with each other, Members and Plans all to the end that the
provisions of this Agreement may be carried out in the most efficient manner possible.
12.7 Time of the Essence. Time shall be of the essence with respect to each and every term,
covenant, and condition of this Agreement.
12.8 Entire Al!reementJ Amendment. This Agreement, including the Attachments, Exhibits and
Schedules now and hereafter incorporated herein, supersedes all previous contracts related to the subject
matter hereof and constitutes the entire agreement between the parties. Oral statements or prior written
materials not specifically incorporated in this Agreement shall not be of any force and effect. In entering
into and executing this Agreement, the parties rely solely upon the representations and agreements
contained in the Agreement and no others. No changes in or additions to this Agreement shall be
recognized unless and until made in writing and signed by an authorized officer or agent of WHP and
KPHA.
12.9 Attachments. The following attachments are incorporated into and made a part of this
Agreement by reference:
Attachment A: Fee Schedule of Prescription Services
Attachment B: Plan Joinder Agreement
Attachment C: Insurance Requirements
12.10 Governinl! Law. This Agreement has been executed and delivered and shall be construed and
enforced in accordance with the laws of the State of Florida. Any action by any party whether at law or in
equity, shall be commenced and maintained and venue shall exclusively be in Monroe County, Florida.
12.11 Third Party Beneficiaries. Plans, Participating Pharmacies and Participating Mail Service
Pharmacy shall be third party beneficiaries of this Agreement. However, with the exception of Plans,
Participating Pharmacies and Participating Mail Service Pharmacy, this Agreement shall not be construed
to create any third party beneficiaries, including without limitation, Members.
12.12 Waiver of Breach. No provision of this Agreement shall be deemed waived unless evidenced
by a written document signed by an authorized officer or agent of WHP and KPHA. The waiver by
either party of a breach or violation of any provision of this Agreement shall not operate as, or be.
construed to be, a waiver of any subsequent breach of the same or other provision of this Agreement.
12.13 Section and Other Headinl!s. The section and other headings contained in this Agreement are
for reference purposes only and shall not affect in any way the meaning or interpretation of this
Agreement.
12.14 Cumulative Remedies. Remedies provided for in this Agreement shall be in addition to and not
in lieu of any other remedies available to either party and shall not be deemed waivers or substitutions for
any action or remedy the parties may have under law or equity.
F:\R WM\ConlraCls\J"'\KH P A I . DOa09l051021
12.15 Gender and Number. When the context of this Agreement requires, the gender of all words
shall include the masculine, feminine, and neuter, and the number of all words shall include the singular
and plural.
12.16 Execution. This Agreement and any amendments may be executed in multiple originals, each
counterpart shall be deemed an original, but all counterparts together shall constitute one and the same
instrument.
12.17 Force Maieure. Neither party shall be liable nor deemed to be in default for any delay or failure
in performance under this Agreement or other interruption of service or employment deemed resulting,
directly or indirectly, from acts of God, civil or military authority, acts of public enemy, war, accidents,
fires, explosions, earthquakes, floods, failure of transportation, strikes or other work interruptions by
either party's employees, or any similar or dissimilar cause beyond the reasonable control of either party;
provided, however, in the event the provision of Covered Services is substantially interrupted, KPHA
shall have the right to terminate this Agreement upon ten (10) days prior written notice to WHP.
12.18 Authoritv. Each signatory to this Agreement represents and warrants that he possesses all
necessary capacity and authority to act for, sign, and bind the respective entity on whose behalf he is
signing.
12.19 Enforcement. In the event either party or a Plan files suit in any court, or commences arbitration
as herein provided, to enforce the terms of this Agreement, the prevailing party shall be entitled to recover
all reasonable costs incurred in connection therewith, including reasonable attorney's fees. In addition,
the parties and Plans agree that any dispute as to amounts due hereunder may, with the consent of the
parties and involved Plan be submitted to binding arbitration in accordance with the rules and procedures
of the National Health Lawyers Association, Alternative Dispute Resolution Service, Rules of Procedure
for Arbitration, and judgment on the decision of the arbitrator may be entered in any court of competent
jurisdiction.
12.20 Public Entitv 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.
F:\R WM\Contracts\J"'\KH PAl. DOO09/05/021
IN WITNESS WHEREOF the parties have caused this Agreement to be executed by their duly
authorized officers or agents.
WHP HEALTH INITIATIVES, INC. KEYS PHYSICIAN-HOSPITAL
ORGANIZATION, INC.
D/B/A KEYS PHYSICIAN-HOSPITAL
ALLIANCE
~~ By:
~By: ,
(Sign ure) (Signature)
r
Name Printed: I .. . Name Printed:
I.. i1N>..,h 'Y \) \"'-'r..,>'.::.o^
,
Title: rf'C!.,.J~11\-' Title:
Date: '11" k}- Date:
F:\RWM\Conlracls\3"\KHPA I DOC\091O:'i/021
A'ITACHMENT A
Pricine Arranl!ements
I. REIMBURSEMENT RATES FOR SERVICES
A. REIMBURSEMENT FOR CLAIMS BY PARTICIPATING PHARMACIES: For each retail
pharmacy prescription or refill covered by this Agreement, Plan will pay WHP at the rates set forth in
this Section I.A:
1. Brand Name Drugs: the lesser of (i) 85% of the Average Wholesale Price, as defined
herein, of the dispensed medication plus a dispensing fee of $2.25; or (ii) the dispensing Participating
Pharmacy's usual and prevailing retail charge. Reimbursement will be reduced by the applicable
copayment fee received.
2. Generic Drugs: for generic drugs covered by the Maximum Allowable Cost ("MAC") List,
as defined herein, reimbursement will be the lesser of (i) the MAC plus a dispensing fee of $2.50; or (ii)
the dispensing Participating Pharmacy's usual and prevailing retail charge; for those generic drugs not
covered by or included on the MAC List, reimbursement will be the lesser of (i) 85% of the Average
Wholesale Price of the dispensed medication plus a dispensing fee of $2.50; or (ii) the dispensing
Participating Pharmacy's usual and prevailing retail charge.
B. REIMBURSEMENT FOR CLAIMS BY PARTICIPATING MAIL SERVICE PHARMACY: For
each mail service pharmacy prescription or refill covered by this Agreement, Plan will pay WHP at the
rates set forth in this Section I.B:
1. Brand Name Drugs: 82% of the Average Wholesale Price of the dispensed medication.
Reimbursement will be reduced by the applicable copayment fee received.
2. Generic Drugs: 55% of the Average Wholesale Price of the dispensed medication.
Reimbursement will be reduced by the applicable copayment fee received.
II. Incentives and Rebate Guarantees
A. Both Plan and KHP A hereby appoint WHP as their exclusive agent, and certifies that WHP is
authorized to act on their behalf, for the purpose of negotiating and arranging, either directly or
indirectly, incentive opportunities in connection with prescription drugs dispensed to Members under
this Agreement. Accordingly, both Plan and KHPA acknowledge that WHP may receive rebates or
other incentive payments from certain drug manufacturers or others, either directly or indirectly, in
connection with prescription drugs dispensed hereunder.
B. In the event that the development and implementation of any such incentive program requires
either Plan or KHPA to execute any documents in addition to this Agreement, Plan and KHPA agree-
to cooperate fully with WHP in the execution thereof. Both Plan and KHPA warrant and represent
that neither party has a direct or indirect arrangement, either oral or written, with any drug
manufacturers or others for incentives based upon prescription drugs dispensed to Members. Neither
Plan nor KHPA may, during the term of this Agreement, either directly or indirectly, negotiate,
arrange, or contract with any drug manufacturer or other entity for incentives on prescription drugs.
C. In connection with and subject to the terms and conditions of this Attachment A and Section
2.4(c). of the main body of the Agreement, WHP will make payments to the respective Plan on a per
F:\R WM\ConlraCls\J"'\KH PAl .IX:>a09/0S/021
paid prescription claim basis ("WHP Payment") based on the services provided under this
Agreement, regardless of the amount of Manufacturer Incentives received by WHP. WHP will make
such WHP Payments in the amount of $0.80, with the initial WHP Payment to be made
approximately nine (9) months after the end of the first quarter (or portion thereof) of services
provided hereunder, with subsequent WHP Payments to be made quarterly thereafter. Both Plan and
KHP A acknowledge that the amount of WHP Payments described herein is based upon the value of
incentives WHP expects to receive as a result of Plan's adoption and use of WHP's formulary. In
accordance therewith, either Plan or KHP A will notify WHP in writing of any changes to the
formulary and WHP will implement any such changes approximately 30 days following WHP's
receipt of such written notification; provided, however, that to the extent WHP determines, in
WHP's sole discretion, that any such changes may adversely impact the value of incentives WHP is
likely to receive hereunder, WHP will initiate renegotiations with KHPA of the WHP Payment
amount. Notwithstanding anything to the contrary elsewhere in this Agreement, if no agreement can
be reached within thirty (30) days, the WHP Payments will cease accruing effective thirty (30) days
following WHP's receipt of written notification of the formulary change.
D. Notwithstanding the foregoing, and in addition to any other remedies to which WHP may be
entitled, WHP will cease forwarding to Plan any and all amounts described in Paragraph C above
immediately upon the occurrence of any of the following:
(1) breach by either Plan or KHPA of any their obligations set forth in this Agreement;
(2) receipt by WHP of notice from KHP A that Plan intends to terminate this Agreement in
its entirety or any portion thereof which in WHP's sole discretion may adversely impact the
value of incentives WHP receives hereunder; or
(3) WHP's exercise of its right to terminate any clinical program services under Section 9.4.
of this Agreement if, in WHP's sole discretion, such termination, may adversely impact the value
of incentives WHP receives hereunder.
E. KPHA represents that to the extent any Plan's funding for the provision of prescription services to
their Members is received from Medicaid, Medicare, or any other state or federal health care program,
such funding is in accordance with the risk or capitation contract provisions of the Social Security Act
or comparable state health care programs. In the event circumstances arise in which either Members'
drug utilization is required to be reported for Manufacturer Incentives purposes by an entity other than
WHP or Members' prescription claims are to be filed for reimbursement with Medicaid, Medicare, or
any other state or federal health care program, said Plan or KPHA will immediately notify WHP,
clearly identifying all involved Members. KPHA and Plan agree that to the extent WHI has received
any Manufacturer Incentives improperly as a result of KPHA's or said Plan's failure to provide such
notice, KPHA and Plan will pay WHP, upon request, the full amount of any Manufacturer Incentives
to be refunded and any penalties resulting therefrom.
III. Administrative Fees and Associated Costs or Charges
For services provided hereunder, Plan will pay WHP an administrative fee of $0.52 per paid
claim. Upon the written request of Plan, WHP will provide the following additional services at
the rates indicated.
Prior Authorization (per authorization, if applicable) $ 1.00
Direct Member Reimbursement (DMR) (per check) $ 1.75
Paper Eligibility Submission (per record, if applicable) $ 0.75
Deductible/Plan Max Tracking (per claim, if applicable) $ 0.10
ID Cards-Replacement Cards (per replacement PPD) N/C
F:\RWM\Conlracts\.''''\KHPA 1.1)()C\09l051021
On-line Client Access (per user per month, first 2 ID's at no charge) $ 50.00
Individual Mailings (postage per PPD) $ 0.55
Any other additional services may incur additional charges. WHP is not required to supply any
additional reports or information unless and until it has been agreed to in writing by both parties.
Taxes. In addition to the pricing terms stated in this Attachment A or elsewhere in this Agreement, each
KPHA Plan shall be solely responsible for payment of any applicable wholesale distributor tax or any
other excise or value added tax based upon purchases at wholesale associated with the provision of
prescription services by Participating Pharmacies and Participating Mail Service Pharmacy to Members in
connection with this Agreement. Each KPHA Plan shall also reimburse WHP any applicable federal,
state, or local sales tax liability for prescriptions dispensed or goods and services provided by any
Participating Pharmacy or Participating Mail Service Pharmacy to Plan and its Members. Sales tax is
defined as an excise tax based on consumer retail sales or gross revenues whether designated a sales tax,
gross receipts tax, retail occupation tax, vale added tax, health care provider tax or tax otherwise titled or
styled. It includes any tax in existence or hereafter created whether or not the bearer of the tax is the
retailer or consumer.
F:\R WM\Contrac(s\J"'1K H PAl. DOC\09/05/021
ATTACHMENT B
PHARMACY SERVICES JOINDER AGREEMENT
This Pharmacy Services Joinder Agreement ("Joinder Agreement") is entered into this _ day of
, 2002, by and between The Board of County Commissioners of Monroe County,
Florida, (hereinafter referred to as the "Plan") and WHP Health Initiatives, Inc., an Illinois corporation,
doing business as Walgreens Health Initiatives (hereinafter referred to as "WHP").
JOINDER OF PLAN. Plan hereby adopts and joins the Prescription Service Agreement between Keys
Physician-Hospital Alliance (KPHA) and WHP Health Initiatives, Inc., dated , 2002 (the
Agreement), as a "Plan" defined therein, and agrees to perform the obligations of the Plan set forth
therein as respects its Members, as defined in the Agreement, including without limitation the payment
obligations of Plan thereunder, and provided that any modification or amendments to the Agreement shall
not be effective as against the Plan unless approved by the Plan.
TERM. This Joinder Agreement shall become effective on October 1, 2002 and continue thereafter for
an initial term of one (1) year. Thereafter, this Joinder Agreement may be renewed for two (2)
consecutive one (1) year terms at the sole option of the Plan. WHP agrees to provide the Plan with at
least (90) days written notice of its intent to terminate, non-renew, or amend this Joinder Agreement,
except as otherwise states in Sections 9. and 12.9. of the Agreement. The Plan agrees to provide WHP
with at least ninety (90) days written notice of its intent to terminate, non renew, or amend this Joinder
Agreement. If WHP or KPHA terminate or materially amend their agreement, the Plan is given the
option of contracting directly with WHP on the same terms and provisions.
NOTICES. Any notices required to be given pursuant to the terms and provisions hereof 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 paid to the addressee as follows:
Plan: County of Monroe
Manager: Employee Benefits
Public Service Building
5100 College Road, Stock Island
Keys West, FL 33040
WHP: WHP Health Initiatives, Inc.
Attn.: Client Services
520 Lake Cook Road
Suite 400
Deerfield, IL 600] 5
Copy to: WHP Health Initiatives, Inc.
Attn.: Mark Mincy
7680 Universal Blvd.
Suite 460
Orlando, FL 32819
ASSIGNMENT. This Joinder 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.
F:\R WMIConlraClsI3"\KH PAl. DOCI09/05/021
ORDINANCE 10-1990. WHP warrants that it has not employed, retained, or otherwise has acted on
behalf of any former County of Monroe officer subject to the prohibition Sec. 2 of Ordinance no. 10-1990
or any County of Monroe officer or employee in violation of Sec. 3 or Ordinance 10-1990, and that no
employee or officer of the County of Monroe has any interest, financially or otherwise, in WHP except
for such interest, permissible by law and fully disclosed by affidavit attached hereto. For breach or
violation of this paragraph, the County of Monroe may, in its discretion, terminate this Joinder 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 of Monroe officer or employee.
CONFLICT OF INTEREST. WHP assures the County of Monroe that to the best of its knowledge,
information and belief, the signing of this Joinder Agreement does not create a conflict of interest.
OWNERSHIP OF INFORMATION. Subject to federal and state laws pertaining to patient
confidentiality, all Drug Utilization Review and Disease State Management documents and reports which
are prepared in the performance of this Joinder Agreement will be made available to the Plan upon
written request for use as the Plan deems appropriate. Any patient identifying information shall not be
disclosed without written consent of the patient.
RIGHT TO AUDIT. Upon prior written and reasonable notice, WHP is required to allow the Plan to
audit or review documents in support of the billings, made to the County.
NON-APPROPRIATION. Monroe County's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Board of County Commissioners.
In Witness Whereof, Plan and WHP have caused this Agreement to be executed by their respective
corporate officers, on the day set forth below.
WHP Health Initiatives, Inc. Board of County Commissioners
of Monroe County, Florida
By: By:
Its: Its:
Date: Date:
F:\R WM\Conlracls\3"'\KH PAl. DOC'\09l051021
1996 Edition
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
General Insurance Requirements
for
Other Contractors and Subcontractors
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 hislher 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 throughout 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 required insurance has been
reinstated or replaced. Delays in the completion of work resulting from the failure of the
Contractor to maintain 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 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
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 Instruction
#4709.3 15
1996 Edition
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
WHP Health Initiatives. Inc.
d/b/a/ Wale:reens Health Initiatives
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 shall 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 55
1996 Edition
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
WHP Health Initiatives. Inc.
d/b/a Wall!reens Health Initiatives
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less
than:
$500,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$500,000 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 oflnsurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County. .
--
WC2
Administration Instruction
#4709.3 89
1996 Edition
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
WHP Health Initiatives. Inc.
d/b/a Walereens Health Initiatives
Recognizing 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 professional services or any error or omission of the
Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$500,000 per Occurrence/$l,OOO,OOO Aggregate
PR02
Administration Instruction
#4709.3 78
.
1996 Edition
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
WHP Health Initiatives. Inc.
d/b/a Walereens Health Initiatives
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 82
1996 Edition
EMPLOYEE DISHONESTY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
WHP Health Initiatives. Inc.
d/b/a Wale:reens Health Initiatives
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 ofthe Contractor's employees or its agents, whether acting alone or in collusion of others.
The minimum limits shall be:
$100,000 per Occurrence
ED2
Administration Instruction
#4709.3 46