HomeMy WebLinkAboutHR1994-0090 - Original - Blue Cross of Washington and Alaska - Administrative Service Contract - 01/01/1994 BLUE CROSS OF WASHINGTON AND ALASKA
CONTRACT ADMINISTRATION AGREEMENT
This Agreement is effective this first day of January, 1994, by and
between City of Kent (hereinafter referred to as the "Plan Sponsor") , and Blue
Cross of Washington and Alaska (hereinafter referred to as the "Contract
Administrator") .
WHEREAS, the Plan Sponsor has established an employee benefit plan
(hereinafter referred to as the "Plan") which provides for payment of
certain welfare benefits to and for certain eligible individuals as
defined by the Plan Document, such individuals being hereinafter referred
to as "Participants, Dependents and Beneficiaries"; and,
WHEREAS, the Plan Sponsor has chosen to self-insure the benefit program(s)
provided under the Plan; and
WHEREAS, the Plan Sponsor desires to engage the services of the Contract
Administrator to provide administrative services for the Plan;
NOW THEREFORE, in consideration of the mutual covenants and conditions as
contained herein the parties hereto agree as follows:
SECTION I DUTIES AND RESPONSIBILITIES OF THE PLAN SPONSOR
1.01 The Plan Sponsor shall provide the Contract Administrator with
a copy of the Plan Document and any other documents describing
the benefit program(s) which the Contract Administrator may
rely upon in performing its responsibilities under this
Agreement.
1.02 The Plan Sponsor shall have final discretionary authority to
determine the benefit provisions and to construe and interpret
the terms of the Plan.
1.03 The Plan Sponsor shall have final discretionary authority to
determine eligibility for benefits and the amount to be paid
by the benefit program(s) .
1.04 Unless specifically delegated to the Contract Administrator by
this Agreement, the Plan Sponsor shall be responsible for the
proper administration of the Plan including:
a. providing the Contract Administrator a complete and
accurate list of all individuals eligible for benefits
under the benefit program(s) upon which the Contract
Administrator shall be entitled to rely until it receives
documentation of any change thereto;
b. notifying the Contract Administrator on a monthly basis
of changes in eligibility;
C. distributing to all eligible Participants, Dependents and
Beneficiaries all appropriate and necessary materials and
documents, including but not limited to benefit program
booklets, summary plan descriptions, material
modifications, the Plan Document, amendments to the Plan
Document, identification cards, enrollment applications
and notice forms necessary for the operation of the Plan;
d. providing the Contract Administrator with any additional
information necessary to perform its functions under this
Agreement as may be requested by the Contract
Administrator from time to time;
e. maintaining adequate funds from which the total cost of
all claims for each preceding week will be paid to the
Contract Administrator by wire transfer. Funds must be
provided within forty-eight (48) hours of phone
notification by the Contract Administrator to a person
designated by the Plan Sponsor.
1.05 The Plan Sponsor shall be responsible for all taxes,
assessments and fees levied by any local, state or federal
authority in connection with the Contract Administrator's
duties pursuant to this Agreement.
1.06 The Plan Sponsor shall be responsible for the Plan's
continuing compliance with federal, state and local laws and
regulations, including but not limited to the Internal Revenue
Code, the Employee Retirement Income Security Act of 1974
(ERISA) , and the Consolidated Omnibus Budget Reconciliation
Act of 1985 (COBRA) . The Plan Sponsor, and not the Contract
Administrator, is the "plan administrator" for purposes of 29
USC Section 1002(16) (a) and 26 USC Section 4980B(g) (3) and
the "plan sponsor for purposes of 29 USC Section 1161, et
seq. The Plan Sponsor shall be responsible for determining
whether it is subject to COBRA and for notifying Participants,
Dependents and Beneficiaries of their COBRA rights both
initially and upon the occurence ffor qualifying
continuation for
of
calculating and collecting premiums
coverage and for promptly notifying the Contract Administrator
when an individual is no longer eligible for COBRA
continuation of coverage.
1.07 The Plan Sponsor shall be responsible for defending any legal
action brought against the Plan, including a claim for
benefits by or on behalf of any individual or entity,
including but not limited to any Participant or former
Participant, Dependent, Beneficiary, any fiduciary or other
party. This responsibility includes the selection and payment
of counsel. The Plan Sponsor shall not settle any legal
action or claim without the prior consent of the Contract
Administrator if the action or claim could result in the
Contract Administrator being liable, including for example,
any liability for contribution to or indemnification of the
Plan Sponsor or other third party either directly or
indirectly.
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SECTION II DUTIES AND RESPONSIBILITIES OF THE CONTRACT ADMINISTRATOR
2.01 The Contract Administrator agrees to perform the following
administrative services for the Plan Sponsor:
a. assist in the preparation and printing of the Plan
Document, benefit program booklets, identification cards,
and other materials necessary for the operation of the
Plan;
b. process all eligible claims incurred after the effective
date of this Agreement which are properly submitted in
accordance with the procedures set forth in the Plan
Document. Checks will be issued on the contract
Administrator's check stock, but the responsibility for
funding benefits is the Plan Sponsor's and the Contract
Administrator is not acting as an insurer. The Contract
Administrator shall make reasonable efforts to determine
that a claim is covered under the terms of the benefit
program(s), to apply the coordination of benefits
provisions, identify subrogation claims, and make
reasonable efforts to recover subrogated amounts
administratively, and prepare and distribute benefit
payments to Participants, Dependents and Beneficiaries
and/or service providers;
C. perform reasonable internal audits;
d. answer inquiries from the Plan Sponsor, Participants,
Dependents and Beneficiaries, and service providers
regarding the terms of the Plan, although final authority
for construing the terms of the Plan's eligibility and
benefit provisions is the Plan Sponsor's;
e. prepare and provide to the Plan Sponsor monthly reports of
claims paid under the Plan in accordance with Attachment C;
f. prepare and provide the Plan Sponsor with an annual report
of the operations of the Plan in accordance with
Attachment C;
g, provide information to the Plan Sponsor for preparing Form
55001s; however, the Plan Sponsor shall be solely
responsible for insuring timely filing of the Form 5500's;
h. coordinate with any stop-loss insurance carrier;
J. when "preferred provider" benefits are provided, maintain
a network of hospital and professional providers; paid
claims will reflect any negotiated provider discounts;
J. perform utilization management services including,
preadmission review, admission review, length of stay
assignment, focused concurrent review, discharge planning,
individual case management and retrospective review.
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SECTION III LIMITS OF THE CONTRACT ADMINISTRATOR'S RESPONSIBILITY
3.01 It is recognized and understood by the Plan Sponsor that the
Contract Administrator is not an insurer and that the Contract
Administrator's sole function is to provide claims
administration services and the Contract Administrator shall
have no liability for the funding of benefits.
3.02 If during the course of an audit performed internally by the
Contract Administrator pursuant to Section 2.O1,c. or by the
Plan Sponsor pursuant to Section V of this Agreement any error
is discovered, the Contract Administrator shall use reasonable
efforts to recover any loss resulting from such error.
3.03 The Contract Administrator is a independent
contracant to tor with
respect to the services being performed
Agreement and shall not for any purpose be deemed an employee
of the Plan Sponsor.
3.04 This Agreement is between the Contract Administrator and the
Plan Sponsor and does not create any legal relationship
between the Contract Administrator and any Participant,
Dependent, Beneficiary or any other individual.
3.05 It is recognized by the parties that errors may occur and it
is agreed that the Contract Administrator will not be held
liable for such errors unless they resulted from its gross
negligence or willful misconduct. The Plan Sponsor agrees to
defend, indemnify, and hold harmless the Contract
Administrator from all claims, damages, liabilities, losses,
and expenses arising out of the Contract Administrator's
performance of administration services under the terms of this
Agreement, so long as they did not arise out of the Contract
Administrator's gross negligence or willful misconduct.
SECTION IV FEES OF THE CONTRACT ADMINISTRATOR
4.01 By the first of each month, The Plan Sponsor shall pay the
Contract Administrator in accordance with the fee schedule set
forth in Attachment D which is incorporated herein by
reference.
4.02 LATE PAYMENTS
a. If, for any reason whatsoever, the Plan Sponsor fails to
make a timely payment required under this Agreement, the
Contract Administrator may suspend performance of
and
services to the Plan Sponsor, including processing
payment of claims, until such time as the Plan Sponsor
makes the required payment, including interest as set
forth in b. below.
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b. The Contract Administrator will charge interest to the
Plan Sponsor on all late payments, including amounts paid
to reinstate this Agreement after termination pursuant to
Section 8.05, at the average annual prime rate posted
b
Seattle First National Bank plus two (2) percent
amount of the late payments for the number of days late.
Interest will be in addition to any other amounts payable
under this Agreement.
C. In the event of late payment, the Contract Administrator
may terminate this Agreement pursuant to Section 8.05.
Acceptance of late payments by the Contract Administrator
shall not constitute a waiver of its right to cancel this
Agreement due to delinquent or nonpayment of fees.
SECTION V AUDIT
5.01 Within thirty (30) days of written notice from the Plan
Sponsor, the Contract Administrator shall allow an authorized
agent of the Plan Sponsor to inspect or audit all records and
files maintained by the Contract Administrator which are
directly pertinent to the administration of the Plan. Such
documents shall be made available at the administrative office
of the Contract Administrator during normal business hours.
The Plan Sponsor shall be liable for any and all fees charged
by the auditor. Any agent or auditor that has access to the
records and files maintained by the Contract Administrator
shall agree not to disclose any proprietary or confidential
information used in the business of the Contract Administrator.
SECTION VI SUBROGATION
6.01 The Contract Administrator shall make reasonable efforts to
pursue subrogation claims administratively on behalf of the
Plan. However, the Contract Administrator shall have no
affirmative duty to pursue subrogation claims beyond those
specified in section 2.0l,b. The Plan Sponsor shall have the
sole discretion to bring any legal claim or action to enforce
the Plan's subrogation provisions. The Contract Administrator
will cooperate with the Plan Sponsor in the event the Plan
Sponsor brings any legal action to enforce the subrogation
provisions of the Plan. Any costs and attorneys' fees
incurred in pursuing such subrogation claims shall be the
responsibility of the Plan Sponsor.
SECTION VII TERM OF AGREEMENT
7.01 The term of this Agreement shall be the period from 12:01 a.m.
on January 1, 1994, to midnight on December 31, 1994
(hereinafter referred to as the "Agreement Period") .
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7.02 Except as stated otherwise in section 8.03 below, the terms
and conditions of this Agreement and the fee schedule set
forth in Attachment D are established for the Agreement Period.
7.03 The Plan Sponsor acknowledges that the fee schedule set forth
in Attachment D and the services provided for in this
Agreement are based upon the terms of the Plan and the
enrollment as they exist on the effective date of this
Agreement. Any substantial change, whether required by law or
otherwise, in the terms and provisions of the PMn or in
enrollment may require that the Contract Administrator incur
additional expenses. The parties agree that any substantial
change, as determined by the Contract Administrator, shall
result in the alteration of the fee schedule, even if the
alteration is during the Agreement Period. The phrase "any
substantial change" shall include, but not be limited to:
a. a fluctuation of ten (10) percent or more in the number
of Participants, Dependents and Beneficiaries as set
forth on the census information included in Attachment B
which is herein incorporated by reference and made a part
of this Agreement;
b. the addition of benefit program(s) or any change in the
terms of the Plan's eligibility rules, benefit provisions
or record keeping rules that would increase
administration costs by more than $2,000;
C. any change in claims administrative services, benefits or
eligibility required by law;
d. any change in administrative procedures from those in
force at the inception of this Agreement which is agreed
upon by the parties;
e. any additional services which the Contract Administrator
undertakes to perform at the request of the Plan Sponsor
which are not specified in this Agreement such as the
handling of mailings or preparation of statistical
reports and surveys not specified in this Agreement.
SECTION VIII TERMINATION
8.01 The Plan Sponsor may terminate this Agreement at any time by
giving the Contract Administrator thirty (30) days written
notice.
8.02 This Agreement will terminate on the last day of the Agreement
Period or the last day of any extension of the Agreement
Period granted by the Plan Administrator— Effective 7-1-94
this provision (8.02) is hereby deleted.
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8.03 Either party may terminate this Agreement effective
immediately by giving written notice to the other if a party
becomes insolvent, makes a general assignment for the benefit
of creditors, files a voluntary petition of bankruptcy,
suffers or permits the appointment of a receiver for its
business or assets, or becomes subject to any proceeding under
any bankruptcy or insolvency law, whether foreign or
domestic. A party is insolvent if it has ceased to pay its
debts in the ordinary course of business; cannot pay its debts
as they become due; or the sum of its debts is greater than
the value of its property at a fair valuation.
8.04 If loss of services is caused by, or either party is unable to
perform any of its obligations under this Agreement, or to
enjoy any of its benefits because of natural disaster, action
or decrees of governmental bodies or
comsunications or failure not
the fault of the affected party,
lity to
perform shall not be deemed a breach. The party who has been
so affected shall immediately give notice to the other party
and shall do everything possible to resume performance. Upon
receipt of such notice, all obligations under this Agreement
shall be immediately suspended. If the period of
nonperformance exceeds thirty (30) days from the receipt of
such notice, the party whose performance has not been so
affected may, as its sole remedy, terminate this Agreement by
written notice to the other party effective immediately. In
the event of such termination, the Plan Sponsor shall remain
liable to the Contract Administrator for all payments due,
together with interest thereon as provided for in Section 4.02.
8.05 The Contract Administrator may, in its sole discretion,
terminate this Agreement effective as of a missed payment due
date in the event that the Plan Sponsor fails to make a timely
payment required under this Agreement.
8.06 In the event this Agreement is terminated prior to the end of
the Agreement Period, the Plan Sponsor shall remain liable to
the Contract Administrator for all delinquent sums together
with interest thereon as provided for in section 4.02 above.
Furthermore, because the Contract Administrator will have
incurred fixed costs which, but for the termination, would
have been recouped over the course of the Agreement
SPeriod,
as
liquidated damages, and not as a penalty,
the shall pay the Contract Administrator an amount equal to
two (2) months administration fee at the rate set forth in
Attachment D multiplied by the average number of Participants,
Dependents and Beneficiaries covered by the Plan for the
immediately preceding six (6) month period or such shorter
period if this Agreement has not been in effect for a period
of six (6) months. The Plan Sponsor shall remain liable for
claims incurred during the Agreement Period but not paid
during the Agreement Period and for the claims run-out
processing fee set forth in subsection C of Attachment D.
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8.07 Within one hundred twenty (120) days of termination by either
party, the Contract Administrator shall deliver to the Plan
Sponsor an interim accounting. Within fifteen (15) months of
termination the Contract Administrator shall deliver to the
Plan Sponsor a complete and final accounting of the status of
the Plan.
At the expense of the Plan Sponsor, the Contract Administrator
shall make available a record of deductibles and coinsurance
levels for each Participant, Dependent and Beneficiary and
deliver this information to the Plan Sponsor or its authorized
agent.
8.08 For the twelve (12) month period following termination of this
Agreement, the Contract Administrator shall continue to
process eligible claims incurred prior to termination at the
claims run-out processing fee rate set forth in Attachment D.
SECTION IX DISCLOSURE
9.01 It is recognized and understood by the Plan Sponsor that the
Contract Administrator is subject to all laws and regulations
applicable to contract administrators and health care service
contractors.
9.02 It is recognized and understood by the Plan Sponsor that the
Contract Administrator is not acting as an insurer and also is
not providing stop-loss insurance.
SECTION X OTHER PROVISIONS
10.01 Choice of Law
The validity, interpretation, and performance of this
Agreement shall be controlled by and construed under the laws
of the State of Washington, unless federal law applies. Any
and all disputes concerning this Agreement shall be resolved
in King County Superior Court. The party substantially
prevailing shall be entitled to recover its reasonable costs,
including attorneys' fees.
10.02 Trademarks
The Contract Administrator reserves the right to, the control
of, and the use of the words "Blue Cross of Washington and
Alaska" and all symbols, trademarks and service marks existing
or hereafter established. The Plan Sponsor shall not use such
words, symbols, trademarks or service marks in advertising,
promotional materials, materials supplied to Participants,
Dependents and Beneficiaries or otherwise without the Contract
Administrator's prior written consent which shall not be
unreasonably withheld.
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10.03 Independent Corporation
The Plan Sponsor hereby expressly acknowledges, on behalf of
itself and all of its eligible employees and their eligible
dependents, its understanding that this Contract
Administration Agreement constitutes an Agreement solely
between the Plan Sponsor and the Contract Administrator, that
the Contract Administrator is an independent corporation
operating under a license with the Blue Cross and Blue Shield
Association, an association of independent Blue Cross and Blue
Shield Plans (the "Association") permitting the Contract
Administator to use the Blue Cross Service Mark in the States
of Washington and Alaska, and that the Contract Administrator
is not contracting as the agent of the Association.
The Plan Sponsor further acknowledges and agrees that it has
not entered into this Contract Administration Agreement based
upon representations by any person other than the Contract
Administrator, and that no person, entity or organization
other than the Contract Administrator shall be held
accountable or liable to the Plan Sponsor for any of the
Contract Administrator's obligations to the Plan Sponsor
created under this Contract Administration Agreement. This
provision shall not create any additional obligations
whatsoever on the Contract Administrator's part other than
those obligations created under other provisions of this
Contract Administration Agreement.
10.04 Notice
Except for the notice given pursuant to section 1.04,e. , any
notice required or permitted to be given by this Agreement
shall be in writing and shall be deemed delivered three (3)
days after deposit in the United States mail, postage fully
prepaid, return receipt requested, and addressed to the other
party at the address as shown below.
10.05 Integration
This Agreement, including any appendices or attachments
incorporated herein by reference, embodies the entire
Agreement and understanding of the parties and supersedes all
prior oral and written communications between them. The terms
hereof may be modified only by a writing signed by both
parties hereto.
10.06 Assignment
Neither party shall assign this Agreement or any of its duties
or responsibilities hereunder without the prior written
approval of the other.
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SECTION XI ATTACHMENTS TO THE CONTRACT ADMINISTRATION AGREEMENT
11.01 The following attach to and become part of the body of this
Agreement and they are herein incorporated by reference.
Attachment A - Plan Document No. 7486T
Program Number 13595, -01, -99
Program Number 13596, -01, -99
Program Number 13597, -01
Attachment B - Census
Attachment C - Reporting
Attachment D - Fee Schedule
Attachment E - Right Of Conversion
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The parties below have signed as duly authorized officers and have hereby
executed this Agreement. If this Agreement is not signed and returned to the
Contract Administrator within sixty (60) days of its delivery to the Plan
Sponsor or its agent, the Contract Administrator will assume the Plan
Sponsor's concurrence and the Plan Sponsor will be bound by its terms.
IN WITNESS WHEREOF the parties hereto sign their names as duly authorized
officers and have executed this Agreement.
CITY OF KENT
BY: tiLrz�- t� DATE:
�/tle
A-TI-L-SI-sue: DATE:
Title
Address: Q
BLUE CROS�QASHINGTON AND ASKA
L J
BY: DATE: April 20, 1994
Title: President and
Chief Executive Officer
Address: P.O. Box 327
Seattle WA 98111-0327
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ATTACHMENT A
CITY OF KENT
(Plan Sponsor)
PLAN DOCUMENT
The employee benefit programs set forth in this Plan Document are available to
certain eligible individuals as defined within the benefit programs. All
benefits of this Plan Document are subject to the terms and conditions stated
herein and any endorsements or riders included or issued thereafter. The City
of Kent has the discretionary authority to determine eligibility for benefits
and to construe the terms used in this Plan Document.
Blue Cross of Washington and Alaska has been selected by the City of Kent to
administer the benefits of this Plan Document. Blue Cross of Washington and
Alaska is not the underwriter of this Plan Document. The City of Kent is
solely and totally responsible for: funding benefits under the benefit
programs; compliance with all applicable laws and regulations affecting the
benefit programs; and fiduciary liability for the benefit programs. If, for
any reason, the Contract Administration Agreement between Blue Cross of
Washington and Alaska and the City of Kent terminates, Blue Cross of
Washington and Alaska shall be relieved of its administrative duties under
this Plan Document, except as otherwise provided in the Contract
Administration Agreement.
This Plan Document attaches to and becomes a part of the Contract
Administration Agreement effective January 1, 1994.
PLAN DOCUMENT EFFECTIVE DATE: January 1, 1994
PLAN DOCUMENT NUMBER: 7486T
CITY OF KENT
4 Date:
By:
T t e
Date:
14TT�sT�.:
Title
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STANDARD PROVISIONS
PLAN DOCUMENT
The entire Plan Document consists of the following:
• The Plan Document face page and "Standard Provisions";
• The attached benefit booklets for:
• Program Number 13595, -01, -99
• Program Number 13596, -01, -99
• Program Number 13597, -01
• The enrollment applications of eligible persons on file with the City of
Kent.
• All attachments, endorsements, and riders included or issued hereafter.
LATE ENROLLMENT
This section explains the requirements that eligible individuals must meet if
they wish to become covered under one of the Plan Document benefit programs
but did not enroll when they were first eligible.
If we pay 100 percent of the cost of the coverage under this Plan Document for
employees and/or dependents, an eligible individual who is not enrolled when
first eligible or who fails to maintain continuous coverage, may be
retroactively enrolled at any later date provided application is made from the
later of the following:
• The date the individual was first eligible for coverage; or
• Retroactively sixty (60) days.
If we do not pay 100 percent of the cost of the coverage under this plan
document for employees and/or dependents, an eligible individual who is not
enrolled when first eligible or who fails to maintain continuous coverage may
be enrolled only during an open enrollment period which is determined by us.
Provided proper application has been made, coverage will begin on the
effective date of our open enrollment. To enroll at any other time, the
employee or dependent must submit proof of good health for our approval.
Coverage will become effective on the first subscription charge due date that
coincides with or next follows our approval of such proof.
Effective 7-1-94
If an individual is not enrolled within 60 days of the date he or she first
became eligible, coverage will not become effective until the first of the
month following our receipt of the completed enrollment application and
payment of applicable subscription charges.
Please see the "Enrollment" section of "Starting Out In Your Program" for
provisions concerning waiver of the completed enrollment application for
newborn children and adoptive children.
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Attachment B
Census Information
Administration Fees effective January 1, 1994 are based on the following:
Number of Active and Retired Enrollees:
Employee Spouse Children
Medical 517 333 525
Vision/Dental 575 365 605
Number of COBRA Enrollees:
Medical 7 5 4
Vision/Dental 5 4 2
Other Carriers Offered: Group Health Cooperative.
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Attachment C
Reporting
The following reports will be provided to the Plan Sponsor within the fees set
forth in Attachment D:
Report Title Frequency
Weekly Claims Recap Weekly
Detail Claim Runs Monthly
Premium/Claims Report Monthly
Large Claims Analysis Yearly
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Attachment D
Fees of the Contract Administrator
Pursuant to the Contract Administration Agreement, the Group shall pay the
Contract Administrator a fee, as set forth below, for administrative services.
A. Administration Fees:
Employee Employee, Spouse
Employee & Spouse & Children Children
13595, -01, -99 $17.79 $25.64 $30.50 $22.65
13596, -01, -99 $17.79 $25.64 $30.50 $22.65
13597, -01 $ 3.11 $ 4.90 $ 5.97 $ 4.18
B. Other Fees:
$2.00 per booklet
$.50 per I.D. card
Prescription drug charge - $1.00 per script
Conversion Contract Fee - $1,000 per conversion
C. Claims runout processing fee:
3% of runout claims processed
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Attachment E
Right of Conversion for Terminated
Plan Participants and their Dependents
The Plan Sponsor requests that the Contract Administrator provide a conversion
privilege to terminated Plan Participants and their dependents in
consideration of the following:
Responsibilities of the Contract Administrator
The Contract Administrator shall make available to Plan Participants and their
dependents an opportunity to obtain health care coverage (hereinafter referred
to as Conversion Contract) when they are no longer eligible for coverage under
the Plan due to:
• Termination of employment.
• Termination of benefits for the class in which the Plan Participant
or dependent belongs.
• A covered dependent's attainment of the limiting age.
• A covered spouse's legal separation or divorce.
:ontract
Death of a covered employee.
The Administrator shall not be required to issue a Conversion
Contract if the Plan Participant or dependent becomes covered under a group
health insurance policy within 31 days after termination of his or her
coverage under the Plan.
Application and payment of the applicable rate for the Conversion Contract
must be made by the Plan Participant or dependent within 31 days after such
individual's conversion privilege of its group health coverage contracts.
Rates for the Conversion Contract shall be determined by the Contract
Administrator and be the same as those then in effect for coverage offered
under the standard conversion privilege of its group health coverage
contracts. Rates will not be guaranteed and the Contract Administrator will
have the right to change the rate of any Conversion Contract.
Compensation
The Plan Sponsor shall pay the Contract Administrator a $1,000 conversion
privilege fee for each conversion contract issued to a former Plan Participant
or dependent. The Contract Administrator shall notify the Plan Sponsor of the
conversion privilege fees owed in connection with the weekly notification of
claims paid.
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CHANGE IN FAMILY STATUS
Other than at the annual open enrollment period, an employee may change an
enrollment election (i.e. , add or delete dependents) only if there has been a
change in family status. A new election may be permitted if one of the
following events occurs:
• The marriage or divorce of the employee.
• The death of the employee's spouse or a dependent child.
• The birth or adoption of a child of the employee.
• The termination of employment (or the commencement of employment) of the
employee's spouse.
• The change in employment status of the employee or the employee's spouse
from full-time to part-time status or from part-time to full-time status.
• The termination of the employee's employment.
• An unpaid leave of absence taken by the employee or employee's spouse.
• A significant change in the health coverage of the employee or employee's
spouse attributable to the spouse's employment.
Enrollment changes will be limited to those that are thesistent employeewith
maythe
add the
change in family status. (i.e. In case of marriage,
spouse to the existing medical program, but may not choose a different medical
program until the Group's open enrollment period.) Enrollment changes are
subject to the other terms and limitations of this program.
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