Item C43
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Februarv 18. 2004
Division:
Manaeement Services
Bulk Item: Y es ~ No
Department: Group Insurance
AGENDA ITEM WORDING: Approval of contract ameqdment with Acordia National for
monthly claim administration fees for dental and vision coveraee. This amendment is reauired
effective Januarv 1. 2004 as our dental and vision coveraee is no loneer provided bv Acordia
National therefore eliminatine the need for administrative fees. except for the handline of run-
out claims.
ITEM BACKGROUND: Current contract effective October 1. 2002 throueh September 30.2003
with renewals for FY 03-04 & FY 04-05.
PREVIOUS RELEVANT BOCC ACTION: BOCC approved on April 17. 2003 to have dental
and vision coveraee available to employees throueh a third party. Effective January 1. 2004 the
dental and vision coveraee is provided bv American General.
CONTRACT/AGREEMENT CHANGES: The per employee per month (PEPM) fee for dental
and vision administration will expire December 31. 2003 and run-out claims will be processed
from January 1. 2004 throueh March 31.2005 at a cost of 10% of paid claims.
STAFF RECOMMENDATIONS: Approval
TOTAL COST:
$256.000.00
BUDGETED: Yes-X-
No
COST TO COUNTY:
$256.000.00
SOURCE OF FUNDS: Primarily Ad Valorem
REVENUE PRODUCING: Yes
No X
AMOUNTPERMONTH_ Year
APPROVED BY: County A~ OMB~:.'ing _ /} ~sk M";'gement~
DIVISION DIRECTOR APPROVAL: ~ U.e-~
Sheila A. Barker
DOCUMENTATION:
Included
To Follow_
Not Required_
DISPOSITION:
/, i jr;
AGENDA ITEM #~
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Acordia National Effective Date:October 1. 2003
Expiration Date:Seotember 30.2004
Contract Purpose/Description:Approval of contract amendment with Acordia National for
monthly claim administration fees for dental and vision coverage.
Contract Manager:Maria Z. Fernandez
(Name)
4448
(Ext. )
Administrative Services
(Department)
for BOCC meetin
18 2004
A enda Deadline: Febru 3 2004
Total Dollar Value of Contract: $256.000.00
Budgeted? YeslZl No 0 Account Codes:
Grant: $N/ A
County Match: $N/ A
CONTRACT COSTS
Current Year Portion: $_
502-08002-53'0310-_-_
- - - -
-----
-
--
- -
--
-
--
- -
--
ADDITIONAL COSTS
Estimated Ongoing Costs: $-"yr For: _
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Date In
~~~~
Date Out
~A
)/3/01
dd7
Division Director
Risk Management ~1 YesO No~
O.M.B./Purchasing
County Attorney
Comments:_
OMB Form Revised 9/11/95 MCP #2
AMENDMENT TO
ADMINISTRATIVE SERVICES AGREEMENT
TIllS AGREEMENT, made and entered into this 18th day of February, 2004 by and between Board
of County Commissioners of Monroe County (hereinafter called "Employer") and ACORDIA NATIONAL,
of Charleston, West Virginia, (hereinafter called "Acordia National);
WIINE~~EIH
WHEREAS, the Employer presently receives third party administration (TP A) services from
Acordia National for certain of Employer's employee benefit plans; and
WHEREAS, the services provided by Acordia National are defined in an administrative services
only agreement between the Employer and Acordia National dated July 1, 1996; and
WHEREAS, said agreement has been amended on June 18, 1997; July 16, 1997; February 11,
1998; June 10, 1998; April 14, 1999; and
WHEREAS, a new administrative service agreement was entered September 8, 1999, between the
parties; and
WHEREAS, said agreement was renewed October 1,2003; and
WHEREAS, the Employer revised its employee benefits plan effective January 1,2004;
NOW, THEREFORE, the parties hereto agree as follows:
1) The administrative fee for Acordia National's TP A services for run-out claims shall
be 10% of total paid dental and vision claims for January 1, 2004 through March
31,2005.
2) The per employee per month (pEPM) fee for dental and vision expires December
31,2003.
3) This administrative fee supersedes the stated administrative fee in any prior
agreements between employer and Acordia National.
4) All services between Employer and Acordia National remain the same as agreed
upon in the administrative services agreement dated September 8, 1999, as
renewed October 1,2003.
IN WITNESS WHEREOF, the Employer and Acordia National have caused this amendment to
agreement to be executed this L-.J day of r 1,20L-.J.
ATTEST: DANNY L. KOLHAGE
CLERK
Board of County Commissioners of Monroe County
By:
By:
Deputy Clerk
Mayor
ACORDIA NATIONAL
Witness
By
Its
, I
RENEWAL AGREEMENT
This renewal agreement is entered into by and between Board of County Commissioners of
Monroe County, Florida; 1100 Simonton Street, Room 2-268; Key West, Florida 33040 (hereafter
Employer) and Acordia National of 602 Virginia Street, East Charleston, WV 25301.
WHEREAS, on October 1,2002, the Employer and Acordia National entered into an agreement
(hereafter the original agreement) whereby- Acordia National performs claim. achninistration for the
Employer's employee welfare benefit plan; and
WHEREAS, the current contract will expire on September 30, 2003 and the Employer desires to
extend the original agreement for another year, therefore, the parties agree as follows:
1. This first one-year renewal term will commence immediately upon the expiration of the
current contract. Therefore this renewal will become effective October 1, 2003, and will
expire September 30, 2004.
2. In all other respects the terms and conditions of the otiginal agreement remain in full
force and effect.
the parties hereto have executed this Renewal Agreement this ~ day of
~O
e:
~ BOARD OF COUNTY COM:M:rSSIONBRS
OF MONROE COUNTY, FLORIDA
Deputy Clerk
By~~J~.>n ~
Mayor/Chairma.i1
By
~CO~j{~ ;
President 71;
ADMINISTRATIVE SERVICE AGREEMENT
rl-
TillS 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
i
-I
;
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
j-
Insurance Portability and Accountability Act of 1996 ("HIP M"), 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 of the mutual covenants and
promises hereinafter contained, the parties hereto agree as foliows:
1)
2)
The effective date of the Employer's Plan shall be October 1.
The Plan Year shall be from October 1 thru September 30 of each
year.
3)
4)
The Employer's Tax Identification Number is 596000749
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 (31st) day
after AcordiaNational's notification, as desqribed herein. Employer
acknowledges and agrees that Acordia National shall not have any
financial duty or responsibility to release claim payments if Employer 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 AcordiaNatioI:j.al shall be subject in all
respects to review by Employer within the framework of Plan provisions
as well as polices, interpretations, rules, practi<;:es and procedures
established by Employer. Acordia National sh~ll not have any
2
Medical Claims Administration
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. 200~
$10.19 PEPM*
$ 1.80 PEPM*
$ 0.41 PEPM*
PERFORMED BY KPHA
$ 0.40 PEPM*
Dental Claims Administration
Vision Claims Administration
Pre-certification Administration
HIP AA Administration
· 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 1,2003 and October 1,
2004.
Payment of the fees established above is due from the Employer on or before the
lOth day of each month, beginning on the 10th 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 desrres customized administrative
andplan 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 Em pI oyer's Planes):
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 necessazy,as requested by Employer
in writing;
c) Assist and advise employer in revising Plan Document.
Provide prototype plan Documents and Identification Cards (ill
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 industry
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 ofclaims
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
0)
p)
q)
r)
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;
1)
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.
,
,
i.
I
n)
Provide assistance and resources to Monroe County in
,
I
I'.
I
I
;
identifying, analyzing and maintaining the Employer's PIan in
accordance with state and federal laws, industry standards,
regulations and changes that affect the Plan;
Report all potential excess claims to the excess insurer, and
provide Employer with monthly updates;
Make documents available to the Employer and/or their
Consultants for periodic audit of files for accuracy and efficiency
ofAcordia National's claims administration, and;
Process, authorize, and issue payment of all complete and
eligible claims within twenty (20) days of receipt;
Provide the County with adequate training and make
available access to its on-line computerized claim system..
6
s) Acordiaagrees 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;
I
I.
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
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 infomnation and maintain credited
coverage information on both a current and future basis;
c) Coordinate the receipt of all certificates of coverage, or
other proofof coverage, for all new ezpployees 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
savings.
12) In the absence of a designation by the Employer and except for disposition
;
!
I
I
i
,
I
I
I
i
I
I
I
i
I
!
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 Planes) other than hi 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 (to) 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 ()rAcordia
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 of the 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, Commissio!lers.
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 of this paragraph, the
County may, in its discretion, terminate this agreement without liability and may also, in
its discretion, deduct from the contract or purchase price, or otherwise recover, the full
amount of any fee, commission, percentage, 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 I SI- of rf) &-- , 2oLht.
ATTEST:
ArrEST:
Its
AC~NATIO~
By UJ -I! 1f
Its C///e~ f)~e:/(A//~ tJ,cRLG".A-
15
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Februarv 18. 2004
Division:
Manae:ement Services
Bulk Item: Yes -X- No
Department: Group Insurance
AGENDA ITEM WORDING: Approval of contract amendment with Acordia National for
monthly claim administration fees for dental and vision coverae:e. This amendment is reauired
effective Januarv 1. 2004 as our dental and vision coverae:e is no lone:er provided bv Acordia
National therefore eliminatine: the need for administrative fees. except for the handline: of run-
out claims.
ITEM BACKGROUND: Current contract effective October 1. 2002 throue:h September 30. 2003
with renewals for FY 03-04 & FY 04-05.
PREVIOUS RELEVANT BOCC ACTION: BOCC approved on April 17. 2003 to have dental
and vision coverae:e available to employees throue:h a third p~rtv. Effective January 1. 2004 the
dental and vision coverae:e is provided bv American General.'
CONTRACT/AGREEMENT CHANGES: The per emploveeper month (PEPM) fee for dental
and vision administration will expire December 31.2003 and :run-out claims will be processed
from January 1. 2004 throue:h March 31. 2005 at a cost of 100/'0 of paid claims.
STAFF RECOMMENDATIONS: Approval
TOTAL COST:
$256.000.00
BUDGETED: Yes ~
No
COST TO COUNTY:
$256.000.00
SOURCE OF FUNDS: Primarily Ad Valorem
REVENUE PRODUCING: Yes
No X
AMOUNTPERMONTH_ Year
APPROVED BY: County Atty* OMB/Purc asing _ Risk Management ~
DIVISION DIRECTOR APPROVAL: ~ ~ ~
Sheila A. Barker
DOCUMENTATION:
Included
To Follow_
Not Required_
AGENDA ITEM # t lf3
DISPOSITION:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Acordia National Effective Date:October 1. 2003
Expiration Date:Seotember 30.2004
Contract Purpose/Description:Approval of contract amendmeljlt with Acordia National for
monthly claim administration fees for dental and vision cover~ge.
Contract Manager:Maria Z. Fernandez
(Name)
4448
(Ext. )
Administrative Services
(Department)
for BOCC meeting on Februarv 18 2004
Agenda Deadlirle: Februarv 3.2004
CONTRACT COSTS
Total Dollar Value of Contract: $256.000.00
Budgeted? Yes[8J No D Account Codes:
Grant: $N/A
County Match: $N/ A
Current Year Portion: $_
502-08002-530310-_-_
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-----
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For: _
(Not included in dollar value above) (eg. maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
Date In
~A
JI3/o1
YeSDNO@/~' tl~ ddo'j
YesDNo@ ~ ~~~~ _
Changes
Needed r-1 ~...
YesD Nol.i:::r" ~
Date Out
Risk Management J.l3&..i
YesDNo~
Division Director
O.M.B./Purchasing
County Attorney
Comments:_
OMB Form Revised 9/11/95 MCP #2
AMENDMENT TO
ADMINISTRATIVE SERVICES AGREEMENT
THIS AGREEMENT, made and entered into this 18th day of February, 2004 by and between Board
of County Commissioners of Monroe County (hereinafter called "Employer") and ACORDIA NATIONAL,
of Charleston, West Virginia, (hereinafter called "Acordia National);
W!INE~~EIH
WHEREAS, the Employer presently receives third Partb' administration (TP A) services from
Acordia National for certain of Employer's employee benefit plans; and
WHEREAS, the services provided by Acordia National are defined in an administrative services
only agreement between the Employer and Acordia National dated July 1, 1996; and
WHEREAS, said agreement has been amended on June 18, 1997; July 16, 1997; February 11,
1998; June 10, 1998; April 14, 1999; and
WHEREAS, a new administrative service agreement was entered September 8, 1999, between the
parties; and
WHEREAS, said agreement was renewed October 1, 2003; and
WHEREAS, the Employer revised its employee benefits plljn effective January 1, 2004;
NOW, THEREFORE, the parties hereto agree as follows:
1) The administrative fee for Acordia National's TP A services for run-out claims shall
be 10% of total paid dental and vision clailns for January 1,2004 through March
31,2005.
2) The per employee per month (PEPM) fee for dental and vision expires December
31,2003.
3) This administrative fee supersedes the state~ administrative fee in any prior
agreements between employer and Acordia National.
4) All services between Employer and Acordia National remain the same as agreed
upon in the administrative services agreement dated September 8, 1999, as
renewed October 1,2003.
IN WITNESS WHEREOF, the Employer and Acordia National have caused this amendment to
agreement to be executed this L-] day of r 1, 20L-].
ATTEST: DANNY L. KOLHAGE
CLERK.
Board of County Commissioners of Monroe County
By:
By:
Mayor
Deputy Clerk
ACORDIA NATIONAL
By
Witness
Its
RENEWAL AGREE:MENT
This renewal agreement is entered into by and between Board of County Commissioners of
Monroe County, Florida; 1100 Simonton Street, Room 2-268; Key West, Florida 33040 (hereafter
Employer) and Acordia National of 602 Virginia Street, East Charleston, WV 25301.
WHEREAS, on October 1, 2002, the Employer and Acordia National entered into an agreement
(hereafter the original agreement) whereby Acordia National performs claim administration for the
Employer's employee welfare benefit plan; and
WHEREAS, the current contract will expire on September 30,2003 and the Employer desrres to
extend the original agreement for another year, therefore, the parties agree as follows:
1. This first one-year renewal term will commence immediately upon the expiration of the
current contract. Therefore this renewal will become e:ttfective October 1,2003, and will
expire September 30, 2004.
2. In all other respects the terms and conditions of the olriginal agreement remain in full
force and effect.
the parties hereto have executed this Renewal Agreement this ~ day of
~
<.1 ~
~ BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
Deputy Clerk
By~~Ja.>n ~
Mayor/Chairman
By
::07W;; Vl. ;
President ~
ADMINISTRATIVE SERVICE AGREEMENT
ISI-
THIS AGREEMENT, made and entered into the. day of
~ ~ by and between Monroe County (hek'einafter called "Employer")
and ACORDIA NATIONAL of602 Virginia Street, East, Charleston, WV 25301, is
hereinafter set forth:
WITNESSETH
WHEREAS, Employer has established an ehlployee 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 ("HIPAA"), 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 of the mutual covenants and
promises hereinafter contained, the parties hereto agree as follows:
1)
2)
The effective date of the Employer's Plan shall be October 1.
The Plan Year shall be from October 1 thru September 30 of each
year.
3)
4)
The Employer's Tax Identification Number is 596000749
For each Plan Year, the Employer sh~ll 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 st) 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 Employer 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
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Medical Claims Administration
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
$10.19 PEPM*
$ 1.80 PEPM*
$ 0.41 PEPM*
PERFORMEU BY KPHA
$ 0.40 PEPM*
Dental Claims Administration
Vision Claims Administration
Pre-certification Administration
HIP AA Administration
. 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 1,2003 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 10th 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
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retroactively in excess of 90 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 desrres 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 Planes):
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;
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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 claim~ and determine whether the
charges of health care providers submitted are within reasonable
payment guidelines and/or are related to diagnostic related groups,
preferred provider organization agreements or other industry
standards;
Correspond with claimants, as necessary, to prove claims
h)
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;
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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;
1) Provide Employer with a monthly report of claims paid;
m) Do all things necessary to properly effect the
responsibilities of a claims administr~tor 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 maintainirtg 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 updfltes;
p) Make documents available to the Employer and/or their
Consultants for periodic audit of filesl for accuracy and efficiency
of Acordia National's claims adminis!tration, 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.
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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 an~ understood that COBRA
administration services are provided for medical arid 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, enrollmient 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 reportsiofpremiums 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 cOlltinuing 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
10
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
ofthree 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, Commissio~ers.
19) Acordia National Warrants that it is not emp~oyed, 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 of this paragraph, the
County may, in its discretion, terminate this agreement without liability and may also, in
its discretion, deduct from the contract or purchase price, or otherwise recover, the full
amount of any fee, commission, percentage, 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
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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 ofthis 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.
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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 /SI- of ()J~ ,2on;;t.
COUNTY OF iOE
By
Mayor Charles 'Sonny" McCoy.
Its
ATTEST:
AC~NATIO~
By if -;J 1J
Its C/!/€.c t1;::J~/CA//rJ, (}FRLGA-
ATTEST:
15