Coresouce Third Party ProviderCoreSource
Plan Supervisor - 1999
Human Resources
AGKEEMENT FOR PROFESSIONAL SERVICES
APPROVEDi
FORM BY:
THIS AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement"), is made effective the
first day of Februa~, 1999, by and between the City of Carmel, Indiana, acting by and through its Board
of Public Works and Safety, Indiana, hereinafter referred to as "City", and. CoreSource, Inc., a Delaware
Corporation, hereinafter referred to as "CoreSource" and/or "Plan Supervisor".
RECITALS
WHEREAS, the City has developed the City of Carmel Employee Health Benefit Plan, as
amended from time to time (the "Plan"), a copy of which has been previously provided to CoreSource;
and
WHEREAS, the City requires assistance in the implementation and administration of the Plan; and
WHEREAS, CoreSource is experienced in providing the professional services required of a plan
supervisor, which assists in the implementation and administration of a health'benefit plan; and
WHEREAS, the City desires to engage CoreSource as an independent contractor to provide the
professional services of a plan supervisor.
NOW THEREFORE, in consideration of the foregoing recitals and the mutual covenants and
conditions set forth herein, the City and CoreSource mutually agree as follows:
SECTION 1. iNCORPORATION OF RECITALS
The foregoing recitals are hereby incorporated into this Agreement and made a part
hereof.
SECTION 2. SCOPE OF SERVICES
A. Plan Supervisor
1. The Plan Supervisor shall have certain duties for the proper administration of the Plan. In
performing its duties under this Agreement, the Plan Supervisor shall act solely as an independent
contractor of the City.
2. The Plan Supervisor shall arrange for payment of approved claims under the Plan by
providing written orders and authorizations delivered to a person authorized to disburse funds of the Plan
for payment of said claims.
3. The Plan Supervisor shall, as directed by the City, arrange for the purchase of policies of
insurance to provide any of the benefits provided for in the Plan, or policies of stop-loss or aggregate
deductible or a similar type of insurance to protect the Plan.
4. The Plan Supervisor shall issue a written order to a person with authority to disburse funds
of the Plan to pay all expenses of the operation of the Plan.
· CoreSource
Plan Supervisor - 1999
Human Resources
5. The Plan Supervisor shall assist the City in the enrollment of eligible employees and their
covered beneficiaries for Participation in the Plan.
6. The Plan Supervisor shall provide the City with monthly reports. Such monthly reports
shall include:
(a)
the amounts of any premiums collected or charges made for stop loss coverage for
the Plan;
(b) receipts of the Plan;
(c)
all written authorizations made by the Plan Supervisor to persons authorized to
disburse funds of the Plan in payment of claims or operation expenses of the Plan,
including, but not limited to, a detailed explanation of any claim or series of claims
with respect to an individual in excess of Fifty Thousand Dollars ($50,000.00) per
family; and
(d) an itemized statement of fees due the Plan Supervisor.
7. The Plan Supervisor shall maintain a fidelity bond in the amount set forth in Appendix B,
covering the Plan Supervisor and any of its agents or employees who may collect, disburse or otherwise
handle or have possession of any funds of the Plan or who may have authority to authorize or order
disbursements of claims or operation expenses on behalf of the Plan.
8. The Plan Supervisor shall accept any claim for benefits made in the appropriate manner,
and after due review, investigation and verification of the statements contained in the claim application,
determine the eligibility of the applicant for benefits.
9. If the facts of any claim, or those facts as determined by the Plan Supervisor in its
investigation of the claim, entitle the claim applicant to receive payment of benefits from the Plan, the
Plan Supervisor shall arrange for the proper payment of such claim from the Plan.
10. If the facts of any claim, or those facts as determined by the Plan Supervisor in its
investigation of the claim, do not entitle the applicant to receive payment of benefits from the Plan, the
Plan Supervisor shall deny the claim for benefits. If appealed, the Plan Supervisor shall refer the denied
claim to the City with the Plan Supervisors reasons for the denial. The City shall be solely responsible for
determining an individual's entitlement to benefits under the Plan.
11. The City shall, upon written request of the claimant, review any previously denied claim in
accordance with the claims appeal procedure of the Plan. The City shall be responsible for the review of
all denied claims for benefits which are requested to be reviewed. '
12. The Plan Supervisor shall not be liable for, nor advance any funds on account of, any
failure or refusal to pay any claim for benefits made according to the terms of the Plan, nor shall the Plan
Supervisor be considered in any way an insurer or underwriter of any liability of the City to provide
benefits.
CorcSourcc
Plan Supervisor - 1999
Human P~esourccs
B. COBRA Administration
1. CoreSource shall assist the City in the day-to-day requirements of the Public Health
Service Act, hereinafter referred to as COBRA. Specific functions to be performed by CoreSource for the
City will include the following:
(a)
distributing COBRA Notification of Election Right offers based on information
supplied by the City; such notices shall be distributed such that a Certificate of
Mailing is provided to document compliance with regulations;
tracking all COBRA Notice of Election Rights offers and terminating offers as
appropriate;
(c)
tracking all payments made by COBRA recipients and terminating or extending
coverage as appropriate;
(d)
generating past due notices and termination notices when appropriate, applicable to
payments;
(e)
funding the City's claim/expense account with premium checks received from
COBRA recipients; and
(f) processing and payment of claims for COBRA recipients.
C. HIPAA Administration
1. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposed certain
administrative requirements upon the City as the sponsor of an Employee Benefit Plan. It is the intent of
the Plan Supervisor to assist the City with compliance with the provisions of HIPAA by providing
services as outlined below:
(a)
issuing Certificates of Creditable Coverage based upon information regarding
terminated employees and dependents supplied by the City and covered employees
for terminations from June 1, 1997 through the termination of this Agreement; such
Certificates of Creditable Coverage shall be in a format prescribed by federal
regulations;
(b)
reviewing Certificates of Creditable Coverage or other forms of acceptable
evidence regarding creditable coverage which are submitted with enrollment forms
by the City for employees hired from June 1, 1997 through the termination of this
Agreement;
(c)
determining whether the City's pre-existing condition elimination periods have
been satisfied by previous creditable coverage of new hires based upon infomration
submitted;
(d)
advising new hires if pre-existing condition limitations or exclusions contained
within the City's benefit plan will apply to them and for how long; and
CoreSource
Plan Supervisor - 1999
Human Resources
(e)
maintaining documentation files of evidence of creditable coverage and any
correspondence with employees.
2. City responsibilities include:
(a)
reporting terminations from the benefit plan to the Plan Supervisor in a timely
manner;
(b)
reporting any other terminations that may necessitate the production of a Certificate
of Creditable Coverage to the Plan Supervisor in a timely manner;
(c)
obtaining information regarding previous creditable coverage from newly hired
employees; the City shall work directly ~vith the employee to obtain any
information required and/or requested by the Plan Supervisor in order to
demonstrate creditable coverage;
(d) timely forwarding any such information received to the Plan Supervisor;
(e)
advising new hires of their enrollment rights as mandated by HIPAA and their
options for special enrollments if they waive coverage; and
maintaining documentation of enrollment information, including any Certificates of
Creditable Coverage or other evidence of previous coverage.
The City shall be responsible for any expenses incurred in obtaining information regarding
creditable coverage for a newly hired employee.
D. Utilization Review
1. Utilization review is a program designed to help ensure that individuals enrolled in the
Plan receive necessary and appropriate health care while avoiding um~ecessary expenses when a hospital
confinement, home health care or the use or purchase of durable medical equipment is proposed.
CoreSource will provide:
(a)
pre-certification of the medical necessity for all non-emergency hospital
admissions, home health care and services for durable medical equipment before
medical services are provided;
(b) retrospective review of the medical necessity for all emergency hospital
admissions;
(c)
concurrent review, based on the admitting diagnosis, of the number of days of
hospital confinement requested by the attending physician; and
(d) certification of the length of confinement and discharge plarming.
CoreSourc¢
Plan Supervisor - 1999
Human Resources
2. This program is not designed to be the practice of medicine or to be a substitute for the
medical judgment of the attending physician or other health care provider. If a particular course of
treatment is not certified, it means that the Plan will not consider that course of treatment appropriate for
the maximum reimbursement under the Plan. If a particular course of treatment is certified, it means only
that the course of treatment is deemed to have met all criteria.
E. Subrogation
1. The Plan is generally entitled to be reimbursed for medical claims paid by it which arise
due to accidents that are the responsibility of another party due to that party's negligence or other
wrongful acts: i.e., a right of subrogation. The City wishes CoreSource to include as part of its services
the identification and pursuit of certain of the City's subrogation claims. CoreSource will:
(a)
determine if subrogation is an issue by using its best efforts to identify claims in
which the City may have a subrogation interest and reviewing provider's bills and
claim forms to determine if the medical diagnosis indicates treatment may be due to
an accident;
(b)
place the Covered Person who has filed a claim for benefits in which the City has a
subrogation interest on notice of the City's interest and request information
regarding the claim, the accident giving rise to the claim, the party or parties
responsible for the Covered Person's injury and the name of the Covered Person's
attorney or other representative (if applicable);
(c)
if applicable, put the Covered Persons attorney or other representative on notice
regarding the City's subrogation claim;
(d)
research and investigate the information obtained from the Covered Person and
other sources reasonably available to it necessary to pursue the City's subrogation
claim;
(e)
pursue subrogation claims through negotiations with the Covered Person, the
Covered Person's attorney or other representative and/or the party responsible for
the Covered Person's injury and, if necessary, coordinate litigation to pursue the
City's subrogation claims with an attorney of the City's choice;
(f) obtain authorization from the City prior to settlement of any subrogation claim;
(g)
remit to the City, or to a claims account on behalf of the City, funds recovered
through its pursuit of subrogation claims, less the amount payable to CoreSource
pursuant to paragraphs 2 and 3 below; and
report to the City on a regular basis, as the City directs, the status of open
subrogation claims.
2. In the event CoreSource collects a subrogation claim for the City without retaining an
attorney to represent the interests of the City, the City will pay CoreSource a fee for its services under this
CoreSource
Plan Supervisor - 1999
Human l~esources
Agreement equal to twenty-five percent (25%) of the gross amount recovered for such claim. CoreSource'
fee is payable xvithin thirty (30) days after CoreSource remits the recovered mounts to the City or to the
claims account.
3. In the event CoreSource collects a subrogation claim of the City's, but such collection
requires retaining an attorney to represent the interests of the City, the City will pay CoreSource a fee for
its services under this Agreement, not to exceed fifty percent (50%) of the gross amount recovered for
such claim, which includes all litigation expenses, if any, and attorney's fees. CoreSource will consult
with City on the selection of an attorney to represent the City's interests. CoreSource and the City will
agree, in writing, at the time an attorney is retained to represent the interests of the City, on the fee to be
paid for the collection of such claim. CoreSource' fee is payable within thirty (30) days after CoreSource
remits the recovered amounts to the City or to the claims account.
F. Flexible Spendin~ Account Administration
1. The City offers Flexible Spending Accounts to eligible employees on an optional basis.
CoreSource shall assist in the administration of such accounts, to include the following services:
(a)
administering Flexible Spending Accounts in compliance with Section 125 of the
Internal Revenue Code ("Section 125") in order to maintain the preferred tax status
of such accounts;
(b)
reimbursing ali expenses of participating City employees as are authorized by
Section 125 provisions for Flexible Spending Accounts, and for which funds have
been or are being deferred by the employee, upon presentation of a claim and
required documentation;
(c)
printing and mailing reimbursement checks on a weekly basis for all claims
processed the preceding week; and
(d)
printing and mailing a Flexible Spending Activity Statement to each participating
employee three (3) months prior to the end of each Plan year.
2. City responsibilities include:
(a)
scheduling enrollment meetings and forwarding enrollment forms to the Plan
Supervisor on a timely basis;
(b)
explaining Flexible Spending Accounts and offering enrollment options to new
hires;
(c)
updating enrollments annually in November, to be effective January 1 of the
following year;
(d)
making payroll deductions as requested by participating employees, and forwarding
monies so collected to the Plan Supervisor on a timely basis; and
Plan Supervisor- 1999
Human Resources
(e)
serving as liaison between the Plan Supervisor and participating City employees, as
necessary, for the purpose of explaining Flexible Spending Accounts and gathering
and disbursing relevant information.
G. Other Services
CoreSource shall prepare monthly billing statements and arrange for the City's payment of its
group life insurance and vision insurance, as mutually agreed upon by the City and CoreSource.
SECTION 3. COMPENSATION OF THE PLAN SUPERVISOR
3.1 CoreSource shall be entitled to compensation for its services to the Plan and the City under this
Agreement. Compensation shall be paid on a monthly basis from the Plan assets or paid directly by the
City. For the Term hereof, the amount of the fees shall be determined as set forth in the fee schedule
attached hereto as Appendix A.
3.2 The City shall have the sole authority to purchase any insurance contract or armuity policy to
provide benefits or compensate the City under the Plan. The City acknowledges that CoreSource may be
compensated by an insurance company on the basis of a commission paid on each sale of such insurance
contract or annuity policy and that any sales commission will be expressed as a percentage of gross annual
premium payments. The City also acknowledges that CoreSource may receive additional compensation
from an insurance company for administrative services rendered by it on behalf of the insurance company.
3.3 The City acknowledges, by the execution of this Agreement, that it has read this Agreement and
approves it. In addition, the City acknowledges it will read any policy or transaction involving the Plan
and CoreSource, prior to the execution of any such policy or transaction. The execution of any such
policy or transaction by the City shall signify its acceptance of such policy or transaction.
SECTION 4. DUTIES AND RESPONSIBILITIES OF THE CITY
4.1 Upon the request of the Plan Supervisor, the City shall provide the Plan Supervisor with a
complete list of ail employees (and their covered dependents) of the City xvho are eligible for benefits
from the Plan and for group life insurance and vision insurance. The City shall notify the Plan Supervisor
of all changes to the list of eligible employees (and their covered dependents), whether by reason of
termination, change in classification or otherwise as they occur.
4.2 The City shall be responsible for notifying the Plan Supervisor of the date an employee ceases to
be "actively at work" by reason of a disability, whether short-term, long-term or permanent. If a disabled
employee returns to active work, the City shall notify the Plan Supervisor of the date of his or her return.
4.3 The City shall collect the premiums and/or contributions, if any, made by the members of the Plan
in the manner it may deem appropriate and shall transfer the funds it collects to the Plan on a monthly or
more frequent basis as it determines necessary or advisable.
4.4 The City shall assist in the enrollment of the eligible employees in the Plan.
4.5 The City shall cooperate with the Plan Supervisor with regard to the proper settlement and review
of claims for benefits and shall transmit any inquiries pertaining to the Plan to the Plan Supervisor.
CoreSource
Plan Supervisor - 1999
Human Resources
4.6 The City shall cooperate with the Plan Supervisor in the preparation and distribution of all
documents to the eligible employees (and their covered dependents), including the Employee Plan
Booklet, claim forms, enrollment cards, reports to eligible employees and other documents as may be
necessary or convenient for the proper administration of the Plan or to satisfy legal requirements.
4.7 All documents prepared for distribution to the eligible employees shall be prepared and
appropriately distributed at the expense of the City.
4.8 The City shall authorize payment of such expenses as are properly due in connection with the
Plan.
4.9 The City shall be solely responsible for funding the payment of benefits and expenses under the
Plan, either through:
(a) the collection of premiums or contributions from covered employees or dependents,
(b) the purchase of insurance;
(e) payment from the City of Carmel Medical Escrow Fund; or
(d) a combination thereof.
The Plan Supervisor shall notify the City as needed of the dollar amount necessary to satisfy the
Plan's benefit and expense obligations, and the City shall remit to the Plan Supervisor the amount
necessary to satisfy this obligation within ten (10) days of its receipt of notice from the Plan Supervisor.
To the extent that Plan benefits and expenses are payable solely from the City of Carmel Medical
Escrow Fund, the City shall remit amounts under this Section 4.9 to a common claims account maintained
by the Plan Supervisor. Any amount so remitted shall remain the sole and exclusive property of the City
until paid from the common claims by the Plan Supervisor, and neither the Plan, nor its participants or
beneficiaries, shall have any interest in such common claims account. Earnings, if any, on the common
claims account shall be used to offset the expenses of maintaining and admirfistering the conunon claims
account. Any earnings remaining after the application of the preceding sentence shall be allocated pro
rata among all employers on whose behalf the common claims fund is maintained.
Nothing in this Section 4.9 shall require the Plan Supervisor to advance funds for the payment of
benefits under the Plan. In the event the City fails to satisfy its funding obligation as provided in this
Section 4.9, the Plan Supervisor shall suspend payment of benefits until the City remits sufficient funds to
pay such benefits. Absent a good faith dispute or termination of the Plan, if the City does not remit to the
Plan Supervisor the amount necessary to satisfy the City's funding obligation within forty-five (45) days
of its receipt of notice from the Plan Supervisor, the Plan Supervisor shall notify the Plan's participants
and beneficiaries in writing of such failure. The City shall hold harmless the Plan Supervisor for any
liability resulting from the Plan Supervisor's duties and obligations under this Section 4.9.
Plan Supervisor ~ I999
4.10 With respect to subrogated claims, the City will:
(a)
identify for CoreSource a person or persons that CoreSource can communicate with to
resolve issues with respect to the City's subrogation claims and whose decisions will be
binding on the City;
(b)
assist CoreSource as reasonably necessary for CoreSource to carry out its duties and
obligations under this Agreement; and
(c)
notify CoreSource of any inquiries it receives regarding the activities undertaken by
CoreSource under this Agreement.
SECTION 5. MISCELLANEOUS
5.1 Term
Subject to the termination provisions set forth in Section 5.3 hereinbelow, this Agreement shall be
in effect from February 1, 1999 through January 31, 2001, and shai1, on the first day of each February
thereafter, automatically renew for a period of two (2) calendar years, unless otherwise agreed by the
parties hereto.
5.2 Approval Date
The Approval Date is the date on which the last of the parties hereto approves and executes this
Agreement.
5.3 Termination
The obligation to provide the Services under this Agreement may be terminated by the City or
Plan Supervisor without cause upon sixty (60) days written notice to the other party and with cause upon
receipt of notice to terminate the Agreement.
Ail duties and responsibilities of the Plan Supervisor shall terminate as of the effective date of
termination given on the written notice, except with respect to any claims for benefits received by the Plan
Supervisor prior to the termination of this Agreement.
Upon termination of this Agreement by either party, the Plan Supervisor, within thirty (30) days
after the date of termination and the date of completion of all claims activities, shall deliver to the City, or
its designee, all books and records in its possession and control regarding the administration of the Plan,
all claim files, all reports and other papers pertaining to the Plan.
5.4 Binding Effect
City and Plan Supervisor and their respective partners, successors, executors, administrators,
assigns and legal representatives of each are bound by this Agreement to the other party to this
Agreement, and to the partners, successors, executors, administrators, assigns and legal representative of
such other party in all respects of all covenants, agreements and obligations of this Agreement.
CoreSource
Plan Supervisor - 1999
Human Resources
5.5 No Third Party Beneficiaries
Nothing contained herein shall be construed to give any rights or benefits hereunder to anyone
other than the City or Plan Supervisor.
5.6 Relationship
The relationship of the parties hereto shall be as provided for in this Agreement, and the Plan
Supervisor shall in no fashion be deemed to be an employee of the City. In that regard, the Plan
Supervisor and all of its employees shall not be employees of the City. Furthermore, the Plan Supervisor
shall have all responsibility to pay to or for its employees all statutory benefits and obligations and any
other benefits or obligations at its discretion.
5.7 Insurance.
The Plan Supervisor shall procure and maintain with an insurer licensed to do business in Indiana
reasonably acceptable to the City, insurance ("Insurance"), for protection from claims for damages
because of errors and omissions, and from claims or damages because of criminal acts or activities
resulting from the actions of its employees. The Plan Supervisor shall secure and maintain Professional
Liability Insurance and such insurance as will protect the Plan Supervisor and the City from claims
resulting from the Plan Supervisor's errors and omissions. The coverage mounts shall be no less than
those amounts set forth in Appendix B which is attached hereto. The Plan Supervisor shall cause its
insurers to name the City as an additional insured on ail insurance policies and to provide that such
policies will not be canceled without thirty (30) days prior notice to the City. The Plan Supervisor shall
submit a certificate to the City evidencing the insurance coverages required hereunder.
5.8 Indemnification
City shall indemnify and hold harmless the Plan Supervisor and its respective officers, employees
and agents from all loss, liability, claims, judgments and liens, includi.ng costs and expenses and attorney
fees, arising out of any act other than an act of gross negligence or willful misconduct of the Plan
Supervisor or any of its colleagues, associates, agents, employees or subcontractors in the performance of
this Agreement. The failure to do so shall constitute a material breach of this Agreement.
Notwithstanding anything to the contrary, the City's liability with respect to its obligation to indemnify
and hold CoreSource/Plan Supervisor harmless shall be limited to the maximum of the lesser of (a) the
amount of insurance coverage for such claim and in effect at the time of the claim or (b) the amount
allowed under the Indiana Tort Claims Act, as amended, at the time of the claim.
The Plan Supervisor shall indemnify and hold harmless the City and its respective officers,
employees and agents from all loss, liabihty, claims, judgments and liens, including costs and expenses
and attorney fees, arising out of any act, other than an act of gross negligence or willful misconduct of the
City or any of its colleagues, associates, agents, employees or subcontractors in the performance of this
Agreement. The failure to do so shall constitute a material breach of this Agreement.
5.9 Discrimination Prohibition
Plan Supervisor represents and warrants that it and its professionals shall comply with all existing
laws of the United States and the State of Indiana prohibiting the discrimination against any employee or
CoreSource
Plan Supervisor - 1999
Human Resources
applicant for employment or subcontract work in the performance of any project contemplated by this
Agreement with respect to hire, tenure, terms, conditions or privileges of employment or any matter
directly or indirectly related to employment or subcontracting because of race, religion, color, sex,
handicap, national origin, ancestry, age, disabled veteran status or Vietnam era veteran status.
The City reserves the right to collect a penalty as provided in IC 5-16-6-1 for any person
discriminated against.
5.10 Severability
If any provision of this Agreement is held to be invalid, illegal or unenforceable by a
court of competent jurisdiction, the provisioff shall be stricken, and all other provisions of this Agreement
which can operate independently of such stricken provision shall continue in full force and effect.
5.11 Notice
Any notice, invoice, order or other correspondence required to be sent under this Agreement shall
be in writing and either hand delivered or sent by first-class U. S. mail addressed to the parties at the
following addresses:
CITY:
City of Carmel
One Civic Square
Carmel, IN 46032
Attention: James Brainard, Mayor
PLAN SUPERVISOR:
CoreSource, Inc.
PO Box 879
Anderson, IN 46015
Attention: Sue Kanth, Vice President Operations
5. I2 Governint Law
This Agreement shall be governed by and construed in accordance with the laws of the State of
Indiana and all municipal ordinances and codes of the City of Carmel, Indiana, as the same shall be in full
force and effect upon the Approval Date.
5.13 Waiver
The delay or partial inaction on the part of the City or Plan Supervisor in exercising or pursuing its
fight and remedies provided hereunder or by law shall not operate to waive any such rights or remedies.
5.14 Appendices
All appendices and/or exhibits referenced herein, whether marked "Appendix", "Exhibit", or some
other title, shall be considered part of this Agreement.
5.15 Prior Agreements
This Agreement contains all of the agreements of the parties hereto with respect to the subject
matter hereof, and no prior agreement, understanding or representation regarding same shall be effective
Plan Supervisor - 1999
Human Resources
for any purpose. No provision of this Agreement may be amended or added to except by an agreement in
writing signed by the parties hereto or their respective successors in interest.
5.16 Representation and Warranties
Parties represent and warrant that they are authorized to enter into this Agreement and the party
executing the Agreement has the authority to bind the party which they represent.
5.17 Entire Agreement
This Agreement represents the entire understanding bet~veen the Plan Supervisor and the City with
respect to the subject matter hereof and supersedes all prior negotiations, representations and/or contracts
either oral or written regarding same.
5.18 Headints
All heading and sections of this Agreement are inserted for convenience only and do not form part
of this Agreement or limit, expand or otherwise alter the meaning of any provisions hereof.
5.19 Assi~nent
In the event of the resignation of the Plan Supervisor or its inability to serve, the City may appoint
a successor to the position.
5.20 Taxes
If at any time during the operation of the Plan, the federal government or any state or any political
subdivision of any instrumentality of either shall assess any tax against the Plan, or any trust related to the
Plan in any way, and the Plan Supervisor is required to pay such tax, the Plan Supervisor shall report the
payment of the tax to the City and make a charge against the Plan and the City for reimbursement of such
payment.
5.21 Modification of Agreement
This Agreement may be amended by the City and the Plan Supervisor at any time by
mutual written consent of both parties and as set forth in written form.
Remainder of page is intentionally left blank.
Apr-27-99 09:16A carmel city 317 571 2409 P.14
CorcSourc¢
Plan Supervisor - 1999
Human Resources
IN WITNESS WHEREOF, the parties hereto have made and executed this agreement on the
day and year first written above.
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
CORESOURCE, INC.
BY:
rainard, Presiding~
~a~An~nn~urk~M~mhar
Date: ~'Z ~
Billy V~atke~:, Member
Date: t~tg~z'-z~
BY:
Signature
Printed Name:
Title:
Date: "J- ~
ATTEST:
~) }~e ,.a Cord?/~I~Treasurer
CoreSource
Plan Supervisor - [999
Human Resources
APPENDIX A
FEE SCHEDULE
For the period February 1, 1999 through January 31, 2001.
Medical and Rx Administrative Fees
Dental Administrative Fees
Utilization Review Fees
Sagamore PPO
PPO Interface Fee
Broker Fee
C OBP,& Administration
HIPAA Administration
Flexible Spending Administration
(U~eimbursed Medical Expense and
Dependent Care Accounts)
Section 125 Plan Documentation Preparation
1. Booklets
Professional Services
- Compliance consultation for non-routine matters
- Actuarial
- Benefit Consulting
- Computing Services
$10.25 per employee per month
$1.00 per employee per month
$1.95 per employee per month
$2.75 per employee per month
$.25 per employee per month
$2.50 per employee per month
$.60 per employee per month
$.25 per employee per month
$4.25 per employee per month
(only for employees electing to
participate)
$150.00
COSTS FOR OTHER PRODUCTS AND SERVICES
Provided at cost;
minimum order of 50
Charged on an hourly rate in
accordance with the current
published fee schedule at the time
requested
3. Medical claim forms after initial
4. Dental claim forms after initial
Provided at cost; minimum
order of 1,000
Provided at cost; minimum
order of 500
APPENDIX A (continued)
ComSource
Phn Supervisor - t999
Human Resources
5. Plan amendments
6. Summary Plan Description 5-year update
(incorporated amendments only)
7. Plan Document Restatement
Month-End Reports (included in Administration Fees)
- Fund Account Statement
- Monthly Check Register
- Claim Void Audit
- Benefit Analysis
- Coverage Analysis
- Paid Claims Analysis
- Paid Claims Register
- Specific Analysis
- Group Aggregate Analysis
- Membership List
9
9. Quarterly Reports (included in
Administration Fees)
- Contracted Savings
- Utilization Savings
10. Ad-Hoc Reports (up to a total of 4 reports)
Each additional ad-hoc report request
Cost Containment Reports (minimum 3 day
turnaround)
Including but not limited to:
- Average Length of Stay by Hospital
- Claim Lag Study
- Excess Dollar Analysis
- Individual Payment
- Claim Detail Analysis
- Procedure Code Analysis
- Paid Benefit Analysis
11. Custom Reports (minimum 1 week turnaround)
Requires special programming
$50.00 per amendment
Quoted basis; $150.00
minimum plus printing costs
$500 minimum
No Charge
No Charge
No Charge
$50.00 per request
$75.00 per hour
CorcSourc4
Plan Supervisor - 1999
Human Resources
APPENDIX B
INSURANCE COVERAGES
Worker's Compensation & Disability
Statutory Limits
Employer's Liability:
Bodily Injury by Accident
Bodily Injury by Disease
Bodily Injury by Disease
$100,000 each accident
$ 500,000 policy limit
$100,000 each employee
Property damage, contractual liability, products-completed operations:
General Aggregate Limit (other than
Products/Completed Operations): $2,000,000
Products/Completed Operations: $2,000,000
Personal & Advertising Injury Limit:
Each Occurrence Limit:
Fire Damage (any one fire):
Medical Expense Limit
(any one person):
Comprehensive Auto Liability
Owned, hired and non-owned
Bodily Single Limit:
Injury and property damage
$1,000,000
$1,000,000
$ 50,0O0
$ 5,000
Each accident
$1,000,000
Umbrella Excess Liability
Each occurrence and aggregate
Maximum Deductible
$5,OOO,O0O
$ 10,000
Owner's Protective Insurance
Per Occurrence:
Aggregate:
$5,000,000
$5,000,000
Professional Liability Insurance:
Aggregate
Per incident
Deductible
$2,000,000
$2,000,000
$ 100,000
Fidelity Bond
$1,000,000
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
City of Carmel
May7,1999
Sue Kauth, Vice President Operations
CoreSource, Inc.
P.O. Box 879
Anderson, Indiana 46015
Ms. Kauth:
On May 5, 1999, the Board of Public Works and Safety approved a contract to do business with
your company. Enclosed is a copy of the signed agreement.
Please call Clerk-Treasurer Diana Cordray at 571-2414 if you have any questions.
Sincerely,
Rebecca L. Martin
Deputy Clerk
cc: file, dept
ONE CIVIC SQUARE CARMEL, INDIANA 46032 317/57 D2400