Item C33
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Seotember 17.-2003
Division:
Mana!!ement Services
Bulk Item: Yes ----X- No
Department: Grouo Insurance
AGENDA ITEM WORDING: Aooroval of contract renewal with Acordia National for Third
Party Administration Services effective October 1. 2003 throu!!h Seotember 30. 2004.
ITEM BACKGROUND: Current contract effective October 1. 2002 throu!!h Seotember 30. 2003
with renewals for FY 03-04 & FY 04-05. The County is currentlv oreoarin!! RFP's for a fullv-
insured and self-insured oro!!ram. If uoon comoletion of the RFP the County desires to
terminate the current Acordia National contract a (30) day written notice must be !!iven.
PREVIOUS RELEVANT BOCC ACTION: BOCC directed that RFP be done March 2001 and
aooroved Acordia National as claims administrator Januarv 2002.
CONTRACT/AGREEMENT CHANGES: This is the first-year renewal of the contract with no
chan!!es.
STAFF RECOMMENDATIONS: Aooroval
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 Atty ~OMB/Purchasing ~.. Risk Management ~
DIVISION DIRECTOR APPROVAL: ,*112 0 ~
. Sheila A. Barker
DOCUMENTATION:
Included
To Follow_
Not Required_
DISPOSITION:
AGENDA ITEM r-:( ~ 7
Revised 1/03
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:Third Party Administration for the processing of our Group
Insurance Program claims.
Contract Manager:Maria Z. Fernandez
(Name)
4448
(Ext. )
Administrative Services
(Department)
for BOCC meeting on Seotember 17 2003 Agenda Deadline: Seotember 2. 2003
CONTRACT COSTS
Total Dollar Value of Contract: $256.000.00
Budgeted? Yes[g] No 0 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, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes
Date In Needed /'
Division Director YesO NoO(,
Risk Management ~J YesO Noff
O.M.B./Purchasing lj~;j~;?)YesD No~
County Attorney if ,-IJ3 Y esO No~
Comments:_
OMB Form Revised 9/11/95 MCP #2
Date Out
9)8/0;1
f/r/o )
~D3
#3
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 administration 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:
I. 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 original agreement remain in full
force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Renewal Agreement this
, 2003.
day of
ATTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
By
Deputy Clerk
Mayor/Chairman
ACORDIA NATIONAL
By
President
ADMINISTRATIVE SERVICE AGREEMENT
1St-
TIDS 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 "Plann) for the purpose of providing medical, dental, vision, utilization
review, Consolidated Omnibus Budget Reconciliation Act of 1985 C.'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 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 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 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 AcordiaNational 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*
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
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 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 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 (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;
Correspond with claimants, as necessary, to prove claims
h)
i)
and to ascertain whether other coverage exists which might pay the
claim in whole or part;
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
pro gram;
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.
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
ofAcordia 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
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)
,
i
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. lfthe
Employer is not notified and does not have knowledge of a
qualifying event, the employee has sixty (60) days from the
qualifying event in which to notify Acordia National of the same to
be eligible or the continuation of coverage option; and
b) Notify Acordia National of any address chang~s 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
h) a) Provide for the Employer's review, proto~
11) Subr to the plan document and SPD (Booklet) to addre1
a) requirements;
b) Perform programming required to the Mul
to track the applicable eligibility information and:
coverage information on both a current and future
b) c) Coordinate the receipt of all certificates of
other proofof coverage, for all new employees ern
benefit plan;
12) In th d) Perform the administrative requirements to
of disputed claims, determination of pre-existing conditions and estab
benefits shall be mE periods that would apply for all new employees an
with provisions of] employees having pre-existing conditions;
judgment in the abs e) Develop and distribute to all required partil
13) Tot] notifications and correspondence documenting pre
shall name Acordia conditions;
be conditioned upo: f) Issue certificates of coverage for all emplo~
shall in all respects dependents upon termination or upon request;
Security Act of 197 g) Prepare and distribute standard reports doc!
14) Aco completed HIP AA activities; and
all claims, damages
on Employer in cor
settlement or comp
10
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.
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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,
S,l- (l~
effective as of the / of , 2on;t
ATTEST:
ATTEST:
COUNTY OF 1!OE
By
Mayor Charles 'Sonny" McCoy
"> 'I;',
Its
. .. f\':i,::-~~:;;\
(s~Lr
c::;-,..
..~,..:- :>.~.-
ACORDIANATIO~ . .
By ~-# 7
Its C/!€,c ~/I~/CA//~ tJFRLG".A--
15