HomeMy WebLinkAbout1999-08-21 City CouncilCity of Palo Alto
City Manager’s Report 2
TO:
FROM:
HONORABLE CITY COUNCIL
CITY MANAGER DEPARTMENT: HUMAN RESOURCES
DATE:
SUBJECT:
JUNE 21, 1999 CMR:255:99
APPROVAL OF CONTRACT
ADMINISTRATORS, INC. FOR
SERVICES FOR THE CITY OF
DENTALPLAN.
WITH SELECT BENEFIT
CLAIMS ADMINISTRATION
PALO ALTO’S SELF-FUNDED
RECOMMENDATION
Staff recommends that Council:
o
Approve and authorize the Mayor to execute the attached contract with Select Benefits
Administrators, Inc. of Portland, Oregon in the amount of $46,800 for one year to
provide third-party claims administration services for the City of Palo Alto’s dental
plan.
Authorize the City Manager or her designee to exercise the option to renew the contract
for the second and third years, provided Select Benefits Administrators is responsive
to the City’s needs, and the quality of its work is acceptable during the first year of the
contract.
DISCUSSION
Project Description
The work to. be performed under the contract is for third-paW claims payment administration
services for the City’s self-funded dental plan, currently provided by The TPA, Inc.
On March 1, 1994, the City entered into a contract with FIRST HEALTH Strategies, Inc.
(FIRST HEALTH), a subsidiary company of First Data, for third-party claims administration
services for the City’s self-funded dental plan. On May 23, 1997, First Data sold FIRST
HEALTH to HealthCare Compare Corp (HCCC), a managed health care services company.
On January 1, 1998, HCCC sold all clients with less than $100,000 of annual fees to The
TPA. FIRST HEALTH transferred the claims paying responsibilities to The TPA as of
April 1, 1998.
CMR:255:99 Page 1 of 3
Under The TPA, the City’s claims paying services deteriorated. Claims processing
"turnaround time" exceeded 90 days for more than six (6) months. There has been and
continues to be unacceptable error rates in the claims paying accuracy provided by The TPA.
Further, there are ongoing eligibility errors, bank reconciliation problems and financial and
statistical reporting problems. In December 1998, staff determined that The TPA did not
provide the level of quality demanded by the City.
Selection Process
Staff sent a Request For Proposals (RFP) to 23 companies on December 14, 1998. The
proposal period was 39 days. A total of six (6) companies submitted proposals: Aetna, Delta
Dental, HCM Benefits, Select Benefit Administrators, Sierra Administrators and United
Administrators.
The proposals ranged from $46,800 to $115,011. Those firms not responding indicated that
they did not submit a proposal because they felt their proposal would not be competitive,
were not accepting any new business at the current time, or were not interested.
A selection advisory committee consisting of representatives from employee bargainin units
and Human Resources staff reviewed the proposals, and three firms were selected as finalists
and invited to participate in oral interviews. The committee carefully reviewed each firm’s
qualifications relative to the following criteria:
¯Claims paying system and ability to administer the current "incentive model" plan
design
°Usual, Customary & Reasonable (UC&R) database
o Banking arrangements
¯Eligibility administration
°Statistical reports and Explanation of Benefit (EOB) format
¯Financial performance guarantees
°Customer service capability
Select Benefit Administrators, the low bid, was selected because it demonstrated the ability
to provide the high level of claims administration services required by the City.
RESOURCE IMPACT
There will be a slight increase in dental plan administration costs ($3,803) with this contract.
Funds for dental plan administration costs are available in the 1999-2001 Proposed Budget
in the General Benefits and Insurance Internal Service Fund.
POLICY IMPLICATIONS
This request does not represent a change in existing policies.
CMR:Page 2 of
ENVIRONMENTAL REVIEW
This is not a project under the California Environmental Quality Act
ATTACHMENTS
Attachment A: Contract with Select Benefit Administrators, Inc.
PREPARED BY: Leonard Zucker,of Employee Benefits
DEPARTMENT HEAD:
JAY C. )S
Director of FIuman Resources
CITY MANAGER APPROVAL:
EMILYI~L~S~N - - -
Assistant City Manager
CMR:Page 3 of
AGREEMENT
BETWEEN THE CITY OF PALO ALTO
AND SELECT BENEFIT ADMINISTRATORS, INC.
FOR DENTAL CLAIMS ADMINISTRATION SERVICES
THIS AGREEMENT is~made and entered into this day of
, 1999, by and between the CITY OF PALO ALTO,
a municipal corporation of California ("CITY") and SELECT BENEFIT
ADMINISTRATORS, INC. (Taxpayer Identification Number 93-1234430),
an Oregon corporation, with offices at 7460 SW Hunziker Street,
Suite C, Tigard, Oregon ("CONTRACTOR").
W I T N E S S E T H:
WHEREAS, CITY desires certain services,
administration and payment of dental claims; and
including
WHEREAS, CITY desires to engage CONTRACTOR to provide
these services by reason of its qualifications and experience for
performing such services, and CONTRACTOR has offered to provide the
required services on the terms and in the manner set forth herein;
NOW, THEREFORE, in consideration of their
covenants, the parties hereto agree as follows:
mutual
SECTION 1 - DEFINITIONS
I.i CITY
The term "CITY" and "Plan Sponsor" shall mean the City of
palo Alto, California.
1.2 CITY MANAGER
The term "City Manager" shall mean the duly appointed
City Manager of the City of Palo Alto, California, or his or her
designated representative.
1.3 CITY CLERK
The term "City Clerk" shall mean the duly appointed City
Clerk of the City of Palo Alto, California, or his or her
designated representative.
1.4 RISK MANAGER
The term "Risk Manager" shall mean the duly appointed
Risk Manager of the City of Palo Alto, California, or his or her
designated representative.
990611 sdl 0052271
1.5 PROJECT
The term "Project" shall mean the services described in
Exhibit "A", entitled "Scope of Services and Time Schedule",
attached hereto and made a part hereof by this reference.
SECTION 2 -PROJECT COORDINATION
2.1 CIT~
The City Manager shall be representative of CITY for all
purposes under this Agreement. JAY ROUNDS or his designee is
designated as the Project Manager for the City Manager, and he or
she shall supervise the progress and execution of this Agreement,
and shall be assisted by LEONARD ZUCKER, the Benefits Manager.
2.2 CONTRACTOR
CONTRACTOR shall assign a single Project Director to have
overall responsibility for the progress and execution of this
Agreement for CONTRACTOR. CONTRACTOR shall assign staff personnel
from its Tigard, Oregon or its Roy, Utah offices or both, in the
performance of its obligations hereunder. NANCY A. LOURIS is
designated as the Project Director for CONTRACTOR. Should
circumstances or conditions subsequent to the execution of this
Agreement require a substitute Project Director for any reason, the
Project Director designee shall be subject to the prior written
approval of the Project Manager.
SECTION 3 - DUTIES OF CONTRACTOR
3.1 SERVICES TO BE FURNISHED
CONTRACTOR shall provide all specified services as set
forth in Exhibit A.
3.2 LAWS TO BE OBSERVED
CONTRACTOR shall:
3.2.1 Procure all permits+and licenses, pay all
charges and fees, and give all notices which may be necessary and
incident to the due and lawful prosecution of the services to be
performed by CONTRACTOR under this Agreement;
3.2.2 Keep itself fully informed of all existing
and future federal, state, and local laws, ordinances, regulations,
orders, and decrees which may affect those engaged or employed
under this Agreement, any materials used in CONTRACTOR’s
performance under this Agreement, or the performance of the
services under this Agreement;
3.2.3 At all times observe and comply with, and
cause all of its subcontractors and employees, if any, to observe
2
990611 sdl 0052271
and comply with, the laws, ordinances, regulations, orders and
decrees mentioned above; and
3.2.4 Immediately report to the Project Manager
in writing any discrepancy or inconsistency it discovers in the
laws, ordinances, regulations, orders, and decrees mentioned above
in relation to any plans, drawings, specifications or provisions of
this Agreement.
3.3 RELEASE OF REPORTS AND INFORMATION
Any reports, information, data or other material given
to, or prepared or assembled by, CONTP<ACTOR or its subcontractors,
if any, under this Agreement shall be the property of CITY and
shall not be made available to any individual or organization by
CONTRACTOR or its subcontractors, if any, without the prior written
approval of the City Manager.
3.4 COPIES OF REPORTS AND INFORMATION
If CITY requests additional copies of reports, drawings,
specifications or any other material which CONTRACTOR is required
to furnish in limited quantities as part of the services under this
Agreement, CONTRACTOR shall provide such additional copies as are
requested and CITY shall compensate CONTRACTOR for the costs of
duplicating of such copies at CONTRACTOR’s actual cost.
3.5 FINAL REPORT
Except as hereinafter provided, CONTRACTOR shall provide
CITY with three (3) copies of any final report required under this
Agreement, as set forth in Exhibit "A", upon completion and
acceptance of the report by CITY.
3.6 QUALIFICATIONS OF CONTRACTOR
CONTRACTOR represents and warrants that it has the
expertise and professional qualifications to furnish the dental
claims administration services described in this Agreement.
3.7 COMPLIANCE WITH ADA
CONTRACTOR states that it is aware of the requirements of
the federal Americans with Disabilities Act of 1990, and the
Government Code and the Health and Safety Code of the State of
California, relating to access to public buildings and accommo-
dations for disabled persons, and relating to facilities for
disabled persons. CONTRACTOR shall comply with or ensure by its
advice that compliance with such provisions will be effected
pursuant to the terms of this Agreement.
SECTION 4 COMPENSATION
For the full performance of the services described herein
by CONTRACTOR, CITY shall pay CONTRACTOR the amount of~ four dollars
3
990611 sdl 0052271
($4.00) per employee per month. The parties acknowledge that there
are currently approximately 975 employees, which would annualize to
a total amount of Forty-Six Thousand Eight hundred dollars
($46,800.00). City shall be solely responsible for determining the
number of employees, and shall make that determination monthly so
that each month’s compensation will reflect the then-current
employee census. The annual compensation rate may be adjusted
upwards for fiscal year 2001-2002 (July i, 2001 to June 30, 2002)
provided the parties mutually agree to the terms and conditions of
renewal. If the parties fail to reach agreement on the 2001-2002
terms on or before June 30, 2001, this Agreement shall terminate
immediately notwithstanding the requirements of Section 8.
SECTION 5-- DUTIES OF CITY
CITY shall provide any and all reasonable and necessary
services in connection with the administration and payment of
dental claims under its dental health plan ("Plan") as the Plan
Sponsor.
SECTION 6 - TERM
The services to be performed hereunder shall commence on
August i, 1999, or as soon as practicable thereafter, and shall
continue to June 30, 2002, subject to budget appropriations being
approved by the City Council and, for the period from July i, 2001
to June 30, 2002, further subject to the parties reaching agreement
as to the terms and conditions of renewal for fiscal year 2001-
2002.
SECTION 7 - RENEWAL OF TERM
[INTENTIONALLY LEFT BLANK]
SECTION 8 -TERMINATION OR SUSPENSION OF AGREEMENT
8.1 RIGHT TO SUSPEND OR TERMINATE
The City Manager may suspend this Agreement, in whole or
in part, or terminate this Agreement, with or without cause, by
giving sixty (60) days’ prior written notice thereof to CONTRACTOR.
Upon receipt .of such notice, CONTRACTOR shall immediately
discontinue its performance under this Agreement.
CONTRACTOR may terminate this Agreement or suspend work
on the Project, with or without cause, by giving sixty (60) days’
prior written notice thereof to CITY. CONTRACTOR shall discontinue
its performance under this Agreement after the expiration of the
notice period.
8.2 PAYMENT
Upon such suspension or termination by CITY, within
thirty (30) days after the effective date of suspension or
termination, CONTRACTOR shall be paid for all services actually
4
990611 sdl 0052271
rendered to CITY to the date of such suspension or termination;
provided, however, if this Agreement is suspended or terminated for
fault of CONTRACTOR, CITY shall be obligated to compensate
CONTRACTOR only for that portion of CONTRACTOR’s services which are
of benefit to CITY, as such determination may be made by the City
Manager in the reasonable exercise of his or her discretion.
8.3 RETURN OF MATERIALS
Upon such suspension or termination, CONTRACTOR shall
turn over to the City Manager immediately any and all copies of
studies, sketches, drawings, computations, and other data, whether
or not completed, prepared by CONTRACTOR or its subcontractors, if
any, or given to CONTRACTOR or its subcontractors, if any, in
connection with this Agreement.Such materials shall become the
permanent property of CITY.
8.4 OTHER PROVISIONS
8.4.1 CITY shall promptly cease to represent that
CONTRACTOR is a service provider with respect to the Plan, and CITY
shall promptly notify the Plan participants and beneficiaries of
this fact upon the termination or expiration of this Agreement.
8.4.2 CITY shall promptly return to CONTRACTOR any
information and materials, excluding Plan records, bearing
CONTRACTOR’s names and marks upon the termination or expiration of
this Agreement. Alternatively, such information or materials may
be destroyed by CITY.
SECTION 9 - INDEPENDENT JUDGMENT
Failure of CITY to agree with CONTRACTOR’s independent
findings, conclusions, or recommendations, if the same are called
for under this Agreement, on the basis of differences in matters of
judgment, shall not be construed as a failure on the part of
CONTRACTOR to meet the requirements of this Agreement.
SECTION I0 - ASSIGNMENT;
SUBCONTRACTORS AND EMPLOYEES
PERSONAL SERVICES;
I0.i ASSIGNMENT
Both parties shall give their personal attention to the
faithful performance of this Agreement and shall not assign,
transfer, convey, or otherwise dispose of this Agreement or any
right, title, obligation, or interest in or to the same or any part
thereof without the prior written consent of the other party, and
then only subject to such terms and conditions as the other party
may require. A consent to one assignment shall not be deemed to be
a consent to any subsequent assignments. Any assignment without
such approval shall be void and, at the option of the other party,
shall terminate this Agreement and any license or privilege granted
herein. This Agreement and any interest herein shall not be
assignable by operation of law without the prior written consent of
5
990611 sd10052271
the other party. An assignment by CONTRACTOR to a subsidiary or
affiliate corporation of CONTRACTOR shall not be deemed an
assignment or a transfer, conveyance, or disposition under this
provision.
10.2 PERSONAL SERVICES
It is agreed that this Agreement is for the personal
services of CONTRACTOR and cannot be performed by any other person
or organization.
10.3 SUBCONTRACTORS; EMPLOYEES
CONTRACTOR shall be responsible for employing or engaging
all persons necessary to perform the services of CONTRACTOR
hereunder. No subcontractor of CONTRACTOR will be recognized by
CITY as such; rather, all subcontractors are deemed to be employees
of CONTRACTOR, and it agrees to be responsible for their
performance. CONTRACTOR shall give its personal attention to the
fulfillment of the provisions of this Agreement by all of its
employees and subcontractors, if any, and shall keep the work under
its control. If any employee or subcontractor of CONTRACTOR fails
or refuses to carry out the provisions of this Agreement or appears
to be incompetent or to act in a disorderly or improper manner, the
employee or subcontractor shall be discharged immediately from the
work under this Agreement on demand of the Project Manager.
SECTION ii -NOTICES
All notices hereunder shall be given in writing and
mailed, postage prepaid, by certified mail, addressed as follows:
To CITY:Office of the City Clerk
Post Office Box 10250
Palo Alto, CA 94303
To CONTRACTOR: Select Benefit Administrators, Inc.
.7460 SW Hunziker Street, #C
Tigard, OR 97223
ATTN: Nancy A. Louris
SECTION 12 -INTEREST OF CONTRACTOR
In accepting this Agreement, CONTRACTOR covenants that it
presently has no interest, and shall not acquire any interest,
direct or indirect, financial or otherwise, which would conflict in
any manner or degree with the performance of the services
hereunder. CONTRACTOR further covenants that, in the performance
of this Agreement, no subcontractor or person having such an
interest shall be employed. CONTRACTOR certifies that no one who
has or will have any financial interest under this Agreement is an
officer or employee of CITY. It is expressly agreed that in the
performance of the professional services required under this
Agreement, CONTRACTOR, and any of its subcontractors or employees,
6
990611 sdl 0052271
shall at all times be considered independent contractors and not
agents or employees of CITY.
SECTION 13 -INDEMNITY
CITY has the final discretionary authority to determine
what benefits will be paid by the Plan, accordingly, CITY shall
indemnify and defend CONTRACTOR against any third-party (employee/
claimant and their representatives only) claims relating to the
Plan and any expense or liability (including reasonable attorneys’
fees) arising from such claims; provided, however, CITY shall not
be required to indemnify and defend CONTRACTOR hereunder if and to
the extent that such claim, expense, or liability is due, in whole
or in part, to CONTRACTOR’s negligent performance of or failure to
perform its obligations under this Agreement. Except as provided
in the preceding sentence, each party shall be responsible for its
own acts and omissions and those of its respective agents, and
shall each indemnify the other against any claims, expense, or
liability (including reasonable attorneys’ fees) arising out of its
own act or omissions. Rights of indemnification hereunder shall
survive the termination of this Agreement.
SECTION 14 -WORKERS’ COMPENSATION
CONTRACTOR, by executing this Agreement, certifies that
it is aware of the provisions of the Labor Code of the State of
California which require every employer to be insured against
liability for workers’ compensation or to undertake self-insurance
in accordance with the provisions of that Code, and certifies that
it will comply with such provisions before commencing the
performance of the work of this Agreement.
SECTION 15 - INSURANCE
15.1 INSURANCE COVERAGE
CONTRACTOR, at its sole cost and expense, shall obtain
and maintain, in full force and effect throughout the entire term
of this Agreement, the insurance coverage described in Exhibit "B",
attached hereto and made a part hereof by this reference, insuring
not only CONTRACTOR and its subcontractors, if any, but also, with
the exception of workers’ compensation, employer’s liability, and
professional liability insurance, naming as additional insureds
CITY, its Council members, officers, agents and employees, and each
of them, concerning this Agreement and the Project.
All insurance coverage required hereunder shall be
provided through carriers with an Best’s Key rating of A:VII or
higher that are admitted to do business in the State of California.
Any and all subcontractors of CONTRACTOR under this Agreement shall
obtain and maintain, in full force and effect throughout the term
of this Agreement, identical insurance coverage, with CITY named as
additional insured under such policies as required above.
7
990611 sdl 0052271
15.2 EVIDENCE OF COVERAGE
Certificates of such insurance, preferably on the forms
provided by CITY, shall be filed with CITY concurrently with the
execution of this Agreement. The certificates shall be subject to
the approval of the Risk Manager and shall contain an endorsement
stating that the insurance is primary coverage and will not be
canceled or altered by the insurer except after filing with the
City Clerk thirty (30) days’ prior written notice of such
canc~llation or alteration, and that the City of Palo Alto is named
as an additional insured except in policies of workers’
compensation, employer’s liability, and professional liability
insurance. Current certificates of such insurance shall be kept on
file at all times during the term of this Agreement with the City
Clerk.
15.3 NO LIMIT OF LIABILITY
The procuring of such required policy or policies of
insurance shall not be construed to limit CONTRACTOR’s liability
hereunder nor to fulfill the indemnification provision and
requirements of this Agreement under Section 13 hereof.
Notwithstanding the policy or policies of insurance, CONTRACTOR
shall be obligated for the full and total amount of any damage,
injury, or loss caused by the services performed or not performed
under this Agreement, including such arising after the Agreement
has terminated or expired.
SECTION 16 - AUDITS
CONTRACTOR agrees to permit CITY to audit, at any
reasonable time during the term of this Agreement and for three (3)
years thereafter, CONTRACTOR’s records pertaining to matters
covered by this Agreement. CONTRACTOR further agrees to maintain
such records for at least three (3) years after the expiration of
the term of this Agreement.
SECTION 17 -AGREEMENT BINDING
The terms, covenants, and conditions of this Agreement
shall apply to, and shall bind, the heirs, successors, executors,
administrators, assigns, and subcontractors of both parties.
SECTION 18 -WAIVERS
The waiver by either party of any b~each or violation of
any term, covenant, or condition of this Agreement, or of the
provisions of any ordinance or law, shall not be deemed to be a
waiver of any other term, covenant, condition, ordinance, or law or
of any subsequent breach or violation of the same or of any other
term, covenant, condition]-ordinance, or law. The subsequent
acceptance by either party of any fee or other money which may
become due hereunder shall not be deemed to be a waiver of any
preceding breach or violation by the other party of any term,
8
990611 sdl 0052271
covenant, or condition of this Agreement or of any applicable law
or ordinance.
SECTION 19 -COSTS AND ATTORNEYS’ FEES
The prevailing party in any action brought to enforce the
terms of this Agreement or arising out of this Agreement may
recover its reasonable costs and attorneys’ fees expended in
connection with such an action from the other party.
SECTION 20 - NO IMPLIED WAIVER
No payment, partial payment, acceptance, or partial
acceptance by CITY shall operate as a waiver on the part of CITY of
any of its rights under this Agreement°
SECTION 21 -NONDISCRIMINATION; PENALTY
21.1 DUTY OF CONTRACTOR
As set forth in the Palo Alto Municipal Code, no
discrimination will be made in the employment of any person under
this Agreement because of the age, race, color, national origin,
ancestry, religion, disability, sexual preference or gender of that
person. If the value of this Agreement is, or may be, five
thousand dollars ($5,000) or more, CONTRACTOR agrees to meet all
requirements of the Palo Alto Municipal Code pertaining to
nondiscrimination in employment, including completing the requisite
form furnished by CITY and set forth in Exhibit "D".
CONTRACTOR agrees that each contract for services with
an independent provider will contain a provision substantially as
follows:
"[Name of Provider] will provide CONTRACTOR
wLth a certificate stating that [Name of
Provider] is currently in compliance with all
Federaland State of California laws covering
nondiscrimination in employment; and that
[Name of Provider] will not discriminate in
the employment of any person under this
Agreement because of the age, race, color,
national origin, ancestry, religion,
disability, sexual preference or gender of
such person."
21.2 PENALTY FOR DISCRIMINATION
If CONTRACTOR is found in violation of the
nondiscrimination provisions of the State of California Fair
Employment Practices Act or similar provisions of Federal law or
executive order in the performance of this Agreement, it will be in
default of this Agreement. Thereupon, CITY will have the power to
cancel or suspend this Agreement, in whole or in part, or to deduct
the sum of twenty-five dollars ($25) for each person for each
9
990611 sdl 0052271
calendar day during which such person was subjected to acts of
discrimination, as damages for breach of contract, or both. Only
a finding of the State of California Fair Employment Practices
Commission or the equivalent federal agency or officer will
constitute evidence of a breach of this Agreement.
If CONTRACTOR is in default of the nondiscrimination
provisions of this Agreement, CONTRACTOR will be found in material
breach of this Agreement. Thereupon, CITY will have the power to
cancel or suspend this Agreement, in whole or in part, or to deduct
from the amount payable to CONTRACTOR the sum of two hundred fifty
dollars ($250) for each calendar day during which CONTRACTOR is not
in compliance with this provision as damages for breach of
contract, or both.
SECTION 22 - AGREEMENT CONTAINS ALL UNDERSTANDINGS;
AMENDMENT
This document represents the entire and integrated
agreement between CITY and CONTRACTOR and supersedes all prior
negotiations, representations, and agreements, either written or
oral. This document may be amended only by written instrument,
signed by both CITY and CONTRACTOR. CITY’s City Manager is
authorized to execute any amendments on behalf of the CITY.
SECTION 23 - GOVERNING LAW
This Agreement will be governed by the laws of the State
of California, excluding its conflicts of law.
In the event that an action is brought, the parties agree
that trial of such action will be vested exclusively in the state
courts of California or in the United States District Court for the
Northern District of California in the County of Santa Clara, State
of California.
CONTRACTOR and CITY shall attempt to resolve conflicts or
disputes under this Agreement in a fair and reasonable manner and
agree that if resolution cannot be made to attempt to mediate the
conflict by a professional mediator (except for payment disputes
which may be submitted directly to arbitration). If mediation does
not settle any dispute or action which arises under this Agreement
or which relates in any way to this Agreement or the subject matter
of this Agreement, it shall be subject to arbitration under the
rules governing commercial arbitration as promulgated by the
American Arbitration Association and arbitrability shall be subject
to the Federal Arbitration Act. Any arbitration proceedings shall
take place in Santa Clara County, California unless the parties
agree otherwise.
All provisions of this Agreement, whether covenants or
conditions, will be deemed to be both covenants and conditions.
If a court of competent jurisdiction finds or rules that
any provision of this Agreement or any amendment thereto is void or
990611 sdl 0052271
10
unenforceable, the unaffected provisions of this Agreement and any
amendments thereto will remain in full force and effect.
All exhibits referred to in this Agreement and any
addenda, appendices, attachments, and schedules which, from time
to time, may be referred to in any duly executed amendment hereto
are by such reference incorporated in this Agreement and will be
deemed to be a part of this Agreement.
This Agreement may be executed in any number of
counterparts, each of which will be an original, but all of which
together will constitute one and the same instrument.
This Agreement is subject to the fiscal provisions of the
Charter of the City of Palo Alto and the Palo Alto Municipal Code.
This Agreement will terminate without any penalty (a) at the end of
any fiscal year in the event that funds are not appropriated for
the following fiscal year, or (b) at any time within a fiscal year
in the event that funds are only appropriated for a portion of
the fiscal year and funds for this Agreement are no longer
available. This Section shall take precedence in the event of a
conflict with any other covenant, term, condition, or provision of
this Agreement.
//
//
//
//
//
//
//
//
//
//
//
II
II
//
//
//
11
99~11 sd1~52271
IN WITNESS WHEREOF, the parties hereto have executed this
Agreement the day and year first above written.
ATTEST:CITY OF PALO ALTO
City Clerk
APPROVED AS TO FORM:
Mayor
City Attorney
APPROVED:
Assistant City Manager
Director of Finance
SELECT BENEFIT ADMINISTRATORS,
INC.
Name :
Title:
Risk Manager
APPROVED AS TO CONTENT:
Director of Human Resources
Attachments:
EXHIBIT "A" :
EXHIBIT "B" :
EXHIBIT "C" :
By:
Name:
Title:
(Compliance with Corp. Code § 313 is
required if the entity on whose behalf
this contract is signed is a corporation.
In the alternative, a certified corporate
resolution attesting to the signatory
authority of the individuals signing in
their respective capacities is
acceptable)
SCOPE OF SERVICES AND TIME SCHEDULE
INSURANCE
CERTIFICATION OF NONDISCRIMINATION
12
990611 sd1~52271
CERTIFICATE OF ACKI~OWLEDG~ENT
(Civil Code ~ 1189)
~-i~[~q 999, before me, ~i~0ho ~.-~-~~IO~ ,On
a Notary Public in and for said County and ~tate, personally
.appeared ~/ ~ Lo~ , personally known to meto be the person whose name is subscribed to the within instrument
and acknowledged to me that he/she executed the same in his/her
authorized capacity, and that by his/her signature on the instru-
ment, the entity upon behalf of which the person acted, executed
the instrument.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my official seal the day and year in this certificate first
above written.
o F,o,A
~ KIYOKO S TAYLOR
k~~/ NOTARY PUBLIC-OREGON
~ COMMISSION NO. 305484
Public~i~ and for said
County and State
13
990611 sdl 0052271
EXHIBIT "A"
SCOPE OF SERVICES AND TIME SCHEDULE
CONTRACTOR shall perform the services described in this
Exhibit "A" in-accordance with the terms of. City’s dental health
plan ("Plan") and within the framework of directives, policies,
interpretations, rules, practices and procedures made by City to
the extent that such are consistent with all applicable laws and
regulations. Notwithstanding any other provision of this Agreement
or the Exhibit(s), CONTRACTOR’s services shall not include the
services of legal counsel, investment advisors, or certified public
accountants.
After its receipt and processing of all necessary Plan data
and other information, CONTRACTOR shall provide the fol!owing
administrative services in connection with the Plan:
no Provide information, based on records provided by the
Plan, concerning Plan eligibility and benefits provisions
to all claimants and their health care providers by
telephone during normal business hours, including toll-
free access if separately agreed upon, and by mail in
response to written inquiries. Such information shall
not constitute a determination of benefits that will be
paid under the Plan, or a guarantee or certification to
anyone that any amount will be paid. Benefit deter-
minations can only be made after a complete claim is
submitted and fully processed by CONTRACTOR, and are
subject to all eligibility requirements, limitations,
exclusions and other provision of the Plan in effect when
a claim is processed.
B.Perform the following claims administration services:
I.Receive and review claims
documents.
and claims-related
o
o
Verify eligibility and calculate amounts payable
under the Plan in light of Plan provisions
concerning medical necessity, reasonableness of
charges and preferred provider or other service
arrangements.
Correspond with claimants and/or their providers to
obtain any required additional information and to
determine whether other coverage for the claim
exists under other benefit plans, insurance
contracts, health maintenance organizations, or
government-sponsored benefit programs.
1940112 syn 0070528
mo
Fo
Prepare and mail explanations of benefits (or
denials of benefits) and benefit payment checks
drawn on one or more demand deposit accounts. Such
accounts shall be designated by CITY, which shall
ensure that the accounts contain sufficient funds
at all times for the continuous and timely payment
of benefits claims processed by CONTRACTOR
hereunder.
Provide any insurance carrier from which CITY or
the Plan obtains stop-loss or other coverage with
information reasonably required by the carrier for
payment of claims under such coverage. CONTRACTOR
assumes no responsibility or liability for the non-
payment of such claims by any insurance carrier.
Seek reimbursement of overpayments of Plan benefits
and offset such erroneous payments against
subsequent claims in accordance with Plan
provisions and applicable law. CONTRACTOR shall
have no obligations to take legal action against
anyone to recover overpayments or to otherwise
enforce any provisions of the Plan.
o Conduct the claims review and appeals procedure in
accordance with Plan provisions° CONTRACTOR shall
advise the Plan Sponsor of all appeals of denied
claims and the Plan Sponsor shall make all final
benefit determinations in such cases.
Provide one copy of CONTRACTOR’s current form of plan
document and/or summary plan description and all related
standard administrative forms and assist with the design
and printing of claims forms, ID cards, and other
supplies designed specifically for the Plan.
Provide all reports included, from time to time, in
CONTRACTOR’s standard reporting package.
Provide the Plan Sponsor with any data maintained by
CONTRACTOR that is required by the Plan in the
preparation of required reports and filings.
Attend- meetings with the Plan Sponsor as reasonably
requested and necessary for the provision of services
under this Exhibit.
Correspond with claimants and their representatives
regarding possible third-party (employee/claimant and
their representatives) liability for expenses paid by the
Plan on claimants’ behalf; request repayment of those
expenses in accordance with any subrogation provisions of
the Plan. CONTRACTOR shall have no responsibility or
liability for the refusal of claimants or their
representatives to reimburse the Plan for such expenses.
940112 syn 0070528
2