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Home My WebLink AboutR-2001-150 RESOLUTION NO. 2001-150 A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA AUTHORIZING THE CITY MANAGER TO ACCEPT THE PROPOSAL TO PROVIDE THIRD PARTY CLAIMS ADMINISTRATION, UTILIZATION MANAGEMENT, MEDICAL CARE MANAGEMENT, NETWORK ACCESS, COBRA ADMINISTRATION, HIPAA ADMINISTRATION, DENTAL CLAIMS ADMINISTRATION, VISION CLAIMS ADMINISTRATION, MENTAL HEALTH CLAIMS ADMINISTRATION, EMPLOYEE ASSISTANCE PROGRAM ADMINISTRATION, DISABILITY CLAIMS ADMINISTRATION, SUPPLEMENTAL PLANS CLAIMS ADMINISTRATION, STOP- LOSS COVERAGE AND CASE MANAGEMENT AS SET FORTH IN THE PROPOSAL FROM MAXON ADMINISTRATORS, INC; AUTHORIZING THE PROPER CITY OFFICIALS TO EXECUTE APPROPRIATE DOCUMENTS ACCEPTING THE TERMS AND CONDITIONS PROVIDED IN THE PROPOSAL; PROVIDING FOR CONFLICTS; FURTHER, PROVIDING AN EFFECTIVE DATE. WHEREAS, the Charter of the City of Dania Beach, Part III, Article 3, Section 4, Subsection (J), provides that contracts for the purchase of supplies, services, equipment and materials for the city government in excess of fifteen thousand dollars ($15,000.00) shall not be entered into or let except by authorization and approval of the city commission, after advertisement for bids in a newspaper published in Broward County, Florida, with such publication to be published weekly for two (2) consecutive weeks with the first publication to be not less than fifteen (15) days prior the reception of bids; and WHEREAS, the city manager has determined that certain municipal insurance services will expire on September 30, 2001, and WHEREAS, the city manager, after having followed the Charter bid requirements, has determined that replacement of such services can be made at the least cost to the city by awarding the bid to the Maxon Administrators, Inc., and the city manager is hereby authorized to pay the total sum from the health fund; 1 RESOLUTION NO. 2001-150 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA BEACH, FLORIDA: Section 1. That the proper City officials are authorized to execute appropriate documents to accept the proposal of Maxon Administrators, Inc. on behalf of the City of Dania Beach for various insurance services as specified in the bid identified above. Section 2. That this resolution shall be in force and take effect immediately upon its passage and adoption. PASSED and ADOPTED this 28th day of August, 2001. PATRICIA FLURY MAYOR— COMMISSIONER ATTEST: ROLL CALL: COMMISSIONER BERTINO - YES cu�® COMMISSIONER MCELYEA - YES CHARLENE J H SON COMMISSIONER MIKES - YES ACTING CITY Ct4RK VICE-MAYOR CHUNN - YES MAYOR FLURY - YES APPROVED AS TO FO /AND CORRECTNESS: BY: r / TH MAS J. B'lRO CITY ATTORNEY • 2 RESOLUTION NO. 2001-150 AGREEMENT FOR THIRD PARTY ADMINISTRATION SERVICES This AGREEMENT effective October 1,2001 by and between MAXON ADMINISTRATORS, INC., a Third Party Administrator having its offices at 2101 West Commercial Blvd., Fort Lauderdale, FL 33309("ADMINISTRATOR"), and The City of Dania Beach, Florida, the Sponsor of a Self-Funded Plan of Benefits including Hospitalization, Medical, Prescription Drug, Dental, Vision, and Short Term Disability Benefits, having its offices at 100 W. Dania Beach Blvd., Dania Beach, FL 33304("SPONSOR"). WHEREAS SPONSOR wishes to retain an administrator for its self-funded plan of benefits("Plan"), and WHEREAS, the ADMINISTRATOR is in the business of administering self-funded plans of benefits, It is hereby agreed as follows: l. SCOPE OF SERVICES The ADMINISTRATOR hereby agrees to perform the following functions: A. Claims Administration 1. Examine for coverage, eligibility, and allowable fees, all claims submitted for reimbursement according to the terms of SPONSOR'S Plan. 2. Keep and maintain files substantiating the basis on which such claims are approved or rejected, as well as the claim history of individual claimants. 3. Calculate benefits according to the terms of SPONSOR'S Plan and prepare and transmit drafts drawn on the SPONSOR'S bank account for payment of approved claims signed by persons authorized by the SPONSOR. ADMINISTRATOR's standard draft format shall be used. ADMINISTRATOR shall notify SPONSOR of checks drawn prior to mailing. 4. Furnish to the SPONSOR copies of drafts and other information as may be reasonably required. 5. Prepare and refer files on disputed claims with recommendations to the SPONSOR for disposition. 6. Arrange for any needed investigations and medical examinations. The cost of such investigations and medical examinations will be considered a claim cost and as such will be borne by the SPONSOR. 7. Assist the SPONSOR at any hearings or legal proceedings initiated by claimants. Maxon%Dania Beach Agreement Page I ® B. Provide Claims Management Reports Using Maxon's Standard Reporting Formats (See Exhibit A l. Monthly claim experience; 2. Quarterly lag study; 3. Draft and Claimant listing(upon draft printing); 4. Monthly Draft Register. C. Coordination with Preferred Provider Networks ADMINISTRATOR shall reprice claims according to schedules provided by Sponsor's designated Provider Network, Florida Health Choice. D. Managed Care ADMINISTRATOR shall provide Hospital pre-certification and utilization review, discharge planning and case management services. E. COBRA Administration ® ADMINISTRATOR shall provide COBRA administration services. These services shall include database maintenance, issuance of statutory notifications, coverage tracking, collection of applicable premiums, qualifying event tracking and termination processing. F. Mental Health and Substance Abuse& Employee Assistance Program ADMINISTRATOR shall provide mental health and substance abuse and employee assistance program services through its subcontractor Psych Care, Inc. These services will include medical management and network access. These services are subject to cancellation by either party at any time. G. Stop Loss Placement and Coordination ADMINISTRATOR will solicit quotations for stop loss coverage when necessary and coordinate with Sponsor's selected carrier according to the carrier's policies and procedures. ADMINISTRATOR will collect stop loss premiums from Sponsor and remit to the carrier. ADMINISTRATOR'S compensation, related to this paragraph, shall be paid by the carrier. Stop loss rates are guaranteed for one year. H. Government Reporting ADMINISTRATOR will maintain provider data necessary for submission of Form 1099 to IRS. Such data shall be timely transmitted to providers and IRS. ADMINISTRATOR will provide claims data necessary for year end reporting to the Florida Insurance Department. Maxon;'Dania Beach Agreement Page 2 I. Timeliness ADMINISTRATOR is Y responsible for the timely performance of each of its services. P Timeliness shall be as defined by section 627.613 of the Florida Statutes. Failure to timely perform such services, including but not limited to claims processing, PPO repricing and processing of payments, shall obligate ADMINISTRATOR to indemnify and hold harmless the SPONSOR from any liability for such failure. 2. INDEPENDENT CONTRACTOR FACILITIES, ERRORS AND OMISSIONS,BONDING INSTRUCTIONS OF SPONSOR The relationship of the ADMINISTRATOR to the SPONSOR shall be that of independent contractor and nothing herein contained shall create or be deemed to create the relationship of employer and employee between the SPONSOR and the ADMINISTRATOR. The ADMINISTRATOR shall provide, at its own cost and expense, all personnel, suitably located facilities, and materials as may be needed for the prompt and effective performance of its services. The ADMINISTRATOR will not be responsible for costs arising from litigation initiated by claimants, which all shall be borne by the SPONSOR, unless the litigation arises due to error or omission by the ADMINISTRATOR. The ADMINISTRATOR will maintain an Errors and Omissions policy in the amount of $2,000,000. ® The ADMINISTRATOR will maintain an Employees' Forgery and Dishonesty Bond in the amount of$1,000,000. Except with the prior written permission of the SPONSOR or as otherwise provided for in this Agreement, the ADMINISTRATOR shall not: l. Enter into any agreement or any obligation on behalf of the SPONSOR, 2. Circulate any advertising material attributable to or on which the name of the SPONSOR appears, or 3. Waive any provision of any benefit coverage. The ADMINISTRATOR shall, in all matters, have the right to rely on the written advice or instructions of the SPONSOR signed by a representative of the SPONSOR authorized in writing by the SPONSOR to give such advice or instructions. 3. RECORDS The ADMINISTRATOR agrees to keep and maintain, in satisfactory manner, full and complete claim files and records relative to its administration of claims pursuant to the terms of this Agreement. Such records shall be kept confidential by the ADMINISTRATOR and remain the property of SPONSOR and will be routinely available for examinations and copying by SPONSOR at SPONSOR'S expense during normal business hours, and shall be delivered to SPONSOR promptly upon termination of the Agreement. ADMINISTRATOR shall have the right to destroy records and claims upon Maxon/Dania Beach Agreement Page 3 the expiration of six years from the date on which the claim or claims recorded therein shall have been rejected or approved. Claim files retained by ADMINISTRATOR after the expiration date of this Agreement or any renewal thereof or six years from the final disposition, whichever is earlier, shall be stored at SPONSOR'S expense. If files are returned to the SPONSOR or its designee at the termination of this Agreement or any renewal thereof SPONSOR agrees that ADMINISTRATOR shall have access to those files for a period of six years after termination. 4. WAIVER No waiver by the SPONSOR of any default in performance on the part of the ADMINISTRATOR or any breach or series of breaches of any of the terms, covenants or conditions of this Agreement shall constitute a waiver of any subsequent breach or a waiver of said terms, covenants or conditions. 5. NON-ASSIGNMENT The ADMINISTRATOR may not assign this Agreement or its interest hereunder without the express written approval of the SPONSOR. This Agreement is for the sole benefit of the SPONSOR and the ADMINISTRATOR and shall not be construed as granting any rights in favor of any other persons. 6. CHOICE OF LAW: VENUE ® This Agreement shall be governed by the laws of the State of Florida. Venue for any disputes shall lie in the appropriate court of competent jurisdiction. 7. COMPENSATION As full compensation for all services to be performed pursuant to this Agreement, SPONSOR will pay ADMINISTRATOR as provided in the"Request for Proposal" submitted by ADMINISTRATOR, a copy of which is attached and incorporated by this reference, except that ADMINISTRATOR's monthly claims administration medical fees shall be as follows: Claims incurred on or after 10/01/01: Per employee/former employee/COBRA billing unit $13.75 Claims incurred priorto 10/01/01: Per claim transaction $35.00 (Claim transaction is a payment or correspondence) The fee for the first 10 transactions is waived. 8. TERM Except as it relates to Stop Loss coverage and Paragraph l.F. herein the term of this contract shall be for two years. It will automatically renew from year to year unless terminated by either party by written notice sixty(60)days prior to the termination date of the contract. If this agreement does terminate, ADMINISTRATOR agrees to adjudicate claims submitted after the termination date, which were incurred prior to the termination date for a period of six months after such termination. Maxon,/Dania Beach Agreement Page 4 9. CAPTIONS The captions are inserted only as a matter of convenience and reference and in no way define, limit or describe the scope or intent of this Agreement nor in any way affect the terms hereof. 10. ENTIRE AGREEMENT The terms of this Agreement, including its attachments and exhibits, represent the entire agreement between the parties. Any modification, rescission or waiver of the terms of this Agreement shall be effective only if evidenced by a subsequent writing,which is exicuted and acknowledged by the parties. A copy of the"Request for Proposals" submitted by the ADMINISTRATOR is attached. In the event of conflict between its terms and the terms of this agreement, the terms of the request for proposal shall prevail, except as agreed between the parties or as provided below: a. As to paragraph I.C. Coordination with Preferred Provided Networks,the terms of this agreement shall prevail. b. As to paragraph I.D. Managed Care, the terms of this agreement shall prevail. c. As to paragraph I.F. Mental Health and Substance Abuse& Employee Assistance Program, the terms of this agreement shall prevail. ® d. As to paragraph 7. Compensation,the terms of this agreement shall prevail. ACCEPTED: MAXO ADMINISTRATOR , INC. Or OF D I BEA By. By. David Ru zahl,-Pr,6sident *beunn, a or *harlenekJo By•s n City Clerk, Da is Beach it, Manager (SEAL) Signed_day of_� ,2002. 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O .-INM V Y1 .p►� p, p•„IryM VN .p h•pP O.-IN My = O O '"••i •y.r 11 11 ...4 ,••1 N r V N N N N'N N N N M M M M M M M M M M v.T v v v LL- ry NNN IV N N m NfV IV N N1y Nry NN NNry 14 NfV IV NNN NNIV fV IV NN IV N Z N N N N I V N N f V N N f V N N f V N t V N ry N N N N ry N/V N N N N I V ry 1 V I V N f V N I V v .tvv .t vv v .r vv v .s .r .t vvvvvvv vv V vvvv vvv .�.ty vv M M M M M f•1 M M M?,I M M M M•1 M J IL a0000a 00000 0000000 00MM1+1MM MMMMMM MMMMM < 0 0 0 0 p C3 0 0 0 0 0 0 0 0 0 0 0 0 p Vt K -j 1 = O O �. < 1 V1 C !� 1 %n f. > O 1 •-.J ly1 1� I < Z IL• I VI V1 0 O 0 1 aL K Z O Z I V W O < 1 W> IL O C I S W W = I w lr cr AGENDA REQUEST FORM CITY OF DAN IA Agenda Date: 08-28-01 Agenda Item #: Title: RESOLUTION FOR APPROVING RECOMMENDATIONS FOR EMPLOYEE BENEFITS PROGRAM Requested Action: Adoption of Resolutions approving Siver Insurance Consultants recommendations for various Employee Benefit Program coverages. Summary Explanation & Background: On 7/3/01 the City issued a Request for Proposals for the following services: Group Medical and Prescriptions, Group Mental Health and Substance Abuse and Employee Assistance Program, Life and AD&D, Voluntary Products (Dental, Vision, Disability, Hospital Indemnity, Cancer& Dread Disease, Long Term Care), and Administration of Cafeteria Benefit (Section 125) Plan. Proposals were due and received on 8 August 2001 from 24 respondents. Siver Insurance Consultants has reviewed all proposals and developed the attached Employee Benefits Program Proposal Analysis Report to summarize the proposals and explain their recommendations. The City's Health Plan is based upon cost savings achieved by use of: (1) a Preferred Provider Organization to provide discounted medical and psychological services. (2) utilization review and pre-certification of certain services. (3) steering employees to providers with higher discounts • through the use of supplemental plans. (4) additional discounts negotiated by National Healthcare Networks. The plan was conceived with the idea of keeping our health care dollars in the plan rather than paying premiums to outside providers. Staff has reviewed and concurs with Siver's recommendation with the following exceptions: (1) The Hospital Supplement and Medical Upgrade options should not be eliminated as should continue as currently established as they provide significant discounts (cost savings) for the plan. Consultants will identify providers with the best available discounts for listing in these options. (2) Acceptance of the life and AD&D proposal submitted by Highmark is subject to verification that it includes the same provisions as our current plan. Staff noted some discrepancies in their proposed plan and the current plan. (3) Voluntary Cancer and Dread Disease coverage should not be offered as this drains employee dollars that might otherwise be used for plan options and was not a high priority item in the employee survey. (4) The currently long term disability plan should remain in effect rather*than paying premiums to Colonial Life. The currently plan is administered by the third party administrator. Exhibits (List): 1. Employee Benefits Program Proposal Analysis Report 3. Copies of recommended proposals are available in Administrative Services Purchasing Approval: Prepared By: Sheryl Chapman Source of Additional Information: (Name & Phone) Brenda Sadler, Siver Insurance Consultants, Tel: 727-577-2780 E-mail: kdoak@siver.com Recommended for Approval By: Sheryl Chapman, Administrative Services Director • Commission Action: Passed ❑ Failed ❑ Continued ❑ Other ❑ Comment: City Manager City Clerk • • • SUMMARY OF SAVINGS TO THE CITY OF DANIA BEACH HEALTH PLAN PROVIDED BY NATIONAL HEALTHCARE NEGOTIATED DISCOUNTS Calendar Year Billed by NHN "' Net Allowed NHN Net Savings Provider Discounts Charge Service Fee to City 1/1/96-12/31/96 521,883.21 204,273.23 317,609.98 51,068.31 153,204.92 1/1/97-12/31/97 335,034.11 193,261.36 141,772.75 48,315.34 144,946.02 1/1/98-12/31/98 277,586.98 136,625.86 140,961.12 34,156.47 102,469.40 1/1/99-12/31/99 272,972.15 157,821.05 115,151.10 39,455.26 118,365.79 1/1/00-12/31/00 326,230.78 219,866.97 106,363.81 54,966.74 164,900.23 1/1/01-7/31/01 222,781.16 166,200.26 56,580.90 41,550.07 124,650.20 (7 Mos.) 1,956,488.39 1,078,048.73 878,439.66 269,512.18 808,536.55 Total Savings to the City of Dania Beach *" NHN discount amounts are comprised of special discounts negotiated with providers who are otherwise non-PPO providers under the City's Health Plan, as well as substantially increased discounts negotiated by NHN with some providers who also participate with the Health Plan under the commercial PPO (Florida Health Choice). For example, the FHC discount may be 30% compared to the NHN discount of 70% with the same physician/hospital. •