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HomeMy WebLinkAboutHealth Plan 2nd Amend SECOND AMENDMENT TO THE PLAN SUPERVISORY AGREEMENT FOR CITY OF CARMEL APPROVED, AS TO FORM BY: ~ APPENDIX A ADMINISTRATIVE AND ADDITIONAL SERVICE FEES Effective for Renewal Period from February 1, 2001 through January 31, 2002 The following information is being provided to the undersigned pursuant to Prohibited Transaction Class Exemption 84-24 issued by the U.S. Department of Labor in order to exempt the proposed transactions between the Plan, the Employer and Plan Supervisor from any applicable prohibited transaction or provisions of ERISA. The following information is being provided to permit the Employer, as Plan Administrator to determine the compensation received by the Plan Supervisor in the form of commissions, service fees and other similar payments is reasonable, that the services provided are necessary for the operation of the Plan and the provision of services by the Plan Supervisor is in the best interest of the Plan. The commission, service fees, compensation arrangements and other similar payments to be provided under the Agreement are as set forth below. It is understood, however, that PPO Access Fees and other vendor fees, if applicable, are subject to the terms and conditions of the underlying agreement and may be subject to change at times other than the renewal date of this agreement. I. Pursuant to the Agreement for Plan Supervisor, the Employer shall remit to Plan Supervisor the following administrative fees and other costs: Description of Service · Medical Administration Fee · Dental Administration Fee $10.75 per employee per month $1.50 per employee per month II. In addition to the basic administrative services listed above, the Employer has agreed that the following services (i.e., those for which the box has been checked) are to be performed by the Plan Supervisor pursuant to the terms and conditions set forth in the Agreement. COBRA Addendum Description of Fee · COBRA Administration Fee $.85 per employee per month 4' HIPAA Addendum Description of Fee · HIPAA Administration Fee $.50 per employee per month Health Care Management Addendum Description of Fee · Inpatient Utilization Review & & Large Case Management Fee $2.70 per employee per month Flexible Benefits Addendum Description of Fee · Flex Administration Fee $4.25 participant per month Preferred Provider Arrangement Addendum (CoreSource Contracts) Description of Fee · Sagamore Access Fee $3,05 per participant per month Preferred Provider Arrangement Addendum (Employer Contracts) Description of Fee · N/A Subrogation Services Addendum Description of Fee. · Subrogation Fee See Attached Addendum Prescription Drug Card Administration Addendum Description of Fee · Per Transaction Charges $.50 per prescription Other Services and Expense Reimbursements Description of Fee · CoreSource Edge · PPO Interface Fee · Broker Fee · Re-enrollment Fee · Plan Set-upFee · Identification Card Fee · Hospital Bill Audits N/A $.25 per participant per month $2.50 per employee per month $335.00 annual fee $30000 one time fee $.60 each after 70/yr. (mailed to client) $1.00 each after 70/yr. (mailed to employee) Actual Cost Size of Original Hospital Bill Amount of Fee $0 - $20,000 $14.30 per thousand of original bill 2 $20,001 - $50,000 Over $50,000 $13.20 per thousand of original bill $12.10 per thousand of original bill · Physician Reviews · Medical Records Fees · Printing Costs · Directory Costs · Other Miscellaneous Expenses · Plan Amendments · Restatement of PlanDocument · Standard Reporting Package Actual Cost Actual Cost Actual Cost Actual Cost Actual Cost $50.00 per amendment $50O.00 Included in medical administrative fee III. Commissions on insurance policies, as described in the attached Renewal Acceptance Confirmation, if applicable, are payable as set forth below. Premium Commission Payable To: CoreSource Broker Specific Stop Loss Single $19.92 0% 15% Specific Stop Loss Family $48.02 0% 15% Aggregate Stop Loss $6.24 0% 15% Other Insured Coverages Life Refer to contract for applicable rates AD & D Refer to contract for applicable rates VSP Refer to contract for applicable rates [The next page is a signature page] 3 ACKNOWLEDGMENT AND APPROVAL The undersigned Plan Administrator hereby certifies that he (1) is authorized to sign on behalf of the Employer and the Plan, (2) acknowledges receipt of the foregoing explanation of services and fees and has read and understands it, and (3) approves the purchase of such insurance (if applicable) and the payment to Plan Supervisor of such sales commissions, service fees and other compensation arrangements as listed. EMPLOYER ~'nat~rre Print Name PLAIN ADMINISTRATOR Print Name Title: ,/4/[~/J,/O,~ Title: ~a~/r~ ~_- Date:-..~' '- ~ - D / Date: Signature Sue Kauth Print Name Title: Vice President, Operations Date: q' - / 6, - O / ADDENDUM TO AGREEMENT FOR PLAN SUPERVISOR FOR SUBROGATION REIMBURSEMENT SERVICES The Plan Supervisor will provide subrogation services as listed below to further assist the Employer and/or Plan in the administration of the Plan. The Employer and/or Plan are generally entitled to seek reimbursemem on behalf of the Plan for medical, dental and/or disability claims it paid which arise due to illness or injury that was due to the action or inaction of annther party, PLAN SUPERVISOR'S DUTIES Specific functions to be performed by the Plan Supervisor for the Employer will include the following: I. Use its best efforts to identify claims in which Employer may have a subrogation interest, Plan Supervisor shall review submitted claims to determine if medical diagnoses indicate treatment may be due to an illness or injury as described above. 2. Request the Participant to provide all necessary information regarding the illness or injury as described above. 3. Evaluate information provided by a Participant and other sources to determine whether a subrogation interest exists. 4. Pursue subrogation claims i~ excess of' $1000 with all parties involved in the claim. If necessary, coordinate litigation to pursue Employer's and/or Plan's subrogation claims in excess of $1000 with an attorney selected or approved by the Employer. Remit to Employer or Plan the funds recovered fi.om third parties, less the amount payable to Plan Supervisor as compensation for its services, as further set forth below. 6. Report to Employer as required the status of open subrogation claims. EMPLOYER'S DIYrlES The Employer sh~ll have the following duties: 1. Assist Plan Supervisor as reasonably necessary for Plan Supervisor to carry out its duties under this Addendum. 2. Notify Plan Supervisor of any inquiries or information k receives regarding the activities undertaken by Plan Supervisor under this Addendum. The Plan Supervisor may assign or subcontract a portion of its duties under this Addendum to the A~eement to others, including but not limited to, its parent company, Tmstmark Insurance Company. CO1V[PENSATION In the event Plan Supervisor collects a subrogation claim without the assistance of outside counsel, Employer and/or Plan will pay Plan Supervisor a fee equal to 25% of the gross amount recovered. The Plan Supervisor is entitled to withhold its fee at the time the net proceeds are forwarded to the Employer or the Plan. In the event Plan Supervisor collects a subrogation claim which required the assistance of outside counsel Employer and/or Plan will pay Plan Supervisor a fee not to exceed 50% of the gross amount recover-ed: The .fee includes all litigation expenses, if any, and attorney's fees. The Plan Supervisor and Employer will agree, in writing, on the fee to be paid for the collection of such claim. The Plan Supervisor is entitled to withhold its fee at the time the net proceeds are forwarded to the Employer ortho Plan. CANCELLATION This Addendum to the Agreement may be cancelled at any time, with or without cause, upon .providing forty-five (45) days prior written notice by one parry to the other. In any case, tt shall terminate contemporaneously with the termination of the Agreement (See Paragraphs 8.03 and 8.04 of the Agreement), subject, however, to establishing an orderly disposition of active subrogation claims. At the time of termination, the parties shall agree on a specific course of action for disposition of active subrogation claims, and such action may include, at the option of the Plan Supervisor, its continued prosecution of any or all active suh!-ogation claims to an orderly conclusion.