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HomeMy WebLinkAboutES04-321 - Original - First Choice Health Network - Employee Assistance Program - 01/01/2005 Records m4eemje KENT Wws MINOTOM Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed, if you have questions, please contact Mary Simmons, City kClerks Office. Vendor Name: GSo�1_ Contract Number: 3 a This is assigned by Mary Simmons Vendor Number: Project Name: ftko f Contract Effective Date: T Contract Termination Date: Contract Renewal Notice (Days): Number of days required notice for terminati6n or renewal or amendment Contract Manager: Department: Abstract: ADCL7832 07/02 TO INITIATE EMPLOYEE ASSISTANCE PROGRAM SERVICES PLEASE SIGN AND RETURN ONE COPY OF THE FOLLOWING GROUP SERVICE AGREEMENT First Choice Health Employee Assistance Program 600 University Street, Suite 1400 Seattle,WA 98101 FAX 206-268-6120 GROUP SERVICE AGREEMENT THIS AGREEMENT is entered this day of , 2004 by and between The First Choice Health Employge Assistance Program, a division of First Choice Health Network, (hereinafter "First Choice Health Employee Assistance Program" or "FCHEAP"), and Cily Lf Kent (hereinafter"Company"). This Agreement will be implemented on_,lanuary 1. 2005 and will remain in effect until either party cancels with 30 days written notice. WHEREAS, First Choice Health Employee Assistance Program makes available to employer groups an employee assistance program;and WHEREAS, Company desires to contract with First Choice Employee Assistance Program for the purpose of including the EAP services as part of its offerings to clients and will be responsible for payment to the EAP for services provided to client choosing to enroll in such program. NOW THEREFORE,the parties agree as follows: I. FIRST CHOICE HEALTH EAP OBLIGATIONS A. Empll=e Assistance Services Included. 1. Toll Free Phone Lines The First Choice Health Employee Assistance Program has toll free lines available to all employee family's 24 hours a day seven days a week. The lines are promptly answered and there is always a counselor available to assist families in crisis or distress In emergency situations,the EAP will utilize local resources such as police, fire or emergency mental health resource facilities to stabilize the situation or provide ongoing emergent care. 2 Typical Problems Addressed The First Choice Employee Assistance Program is a confidential resource located outside the workplace for employees and their family members to utilize whenever they are experiencing a wide range of concerns. There is no charge for to the employee or family member for any EAP services. The EAP is an employer-sponsored program. The following list is representative of frequently seen problems. Substance Abuse Marital Problems Parenting Issues Retirement Financial Concerns Anxiety&Stress Depression Work Conflict Gambling Issues Anger Control School Problems Eating Disorders FCHEAP20031eniplate 1 3. Assessment,and Referral Service (Please Check One Option Below) Professional assessment and referral services will be provided to employees through The First Choice Health Employee Assistance Program's Provider Network. The goal of EAP services will be to assess the presenting problem, solve that problem or conflict when possible, or develop a treatment plan and assist the employee family in implementing that treatment plan in the community. In many cases that care may be covered under the employee's health benefit plan. Under the terms of this Agreement and based upon the specific program design purchased by the Company,each employee who contacts the EAP will receive: XL one to three assessment visits one to six assessment visits Appointments will be offered in a geographic location that is near the employee family's home or work and at a time of convenience to the employee. Normally appoints are available within 24-48 hours of the imnal call requesting services. In an emergent situation,referral may/will be made immediately to community emergency services or other appropriate care facility (Special evaluations such as those required by the Department of Transportation and FAA with services provided by SAP's are usually paid by the employee and not covered under the EAP) 4. Employee Orientation Upon the request of the Company, First Choice Health Employee Assistance Program will provide on site orientation classes lasting about 20 minutes for all employees. These presentations are normally presented in parallel with the Supervisor Training. Included will be a brief review of program components and assurances of confidentiality. Company may elect to utilize the First Choice EAP Internet site for this level of training. Employee Orientations are provided at a rate of one training per every 30 employees. Out of area training will include the exact cost of travel and$250.00 per day. 5. Leadership Traituttg It is recommended that Leadership Training be held in conjunction with the Employee Orientation classes and be attended by all managers and supervisors. As a part of the Leadership Training, a Supervisor Manual will be distributed to all supervisors, a review of the EAP program will be presented, referral process reviewed, methods of identifying and approaching troubled employees, making mandatory referrals, encouraging employees and a variety of other topics are discussed. Supervisor Training is provided at a rate of one training per every 25-30 supervisors.Out of area training will include the exact cost of travel and$250.00 per day. Other Training Additional training on a variety of subjects can be provided under this contract at a rate of $504125 per hour depending upon topic plus any applicable travel costs 6. Premium Internet Training Premium Level Internet training is priced in the Addendum A portion of this contract. When purchased, the Company will have unlimited access for supervisors and employees to Web site based training provided at www.firstchoiceeap.com as part of services. This training includes topics such as Harassment Prevention, Workplace Diversity, Conflict Resolution, Drug Free Workplace and DOT level supervisor and employee training. FCHEAP2003template 2 7. Promotional Materials A variety of promotional materials will be provided the Company for distribution to employee families at the time of program initiation with additional supplies available on an annual basis. These materials will include: Letter of Introduction for each employee family. EAP Referral Cards for each employee with a 20% additional supply for supervisors and Human Resources to utilize in making referrals. Posters for each location,normally one per 50 employees. Program Pamphlets for each employee with 10% extra supply for Human Resources for use with new employees. Web Site Promotion: Handouts encouraging visits to First Choice EAP will be provided. Quarterly Newsletter will be sent to your corporate office for distribution to your employee families. Work Life Program Promotion: Posters and Handout for Elder Care,Legal, Child Care and Financial Services will be provided for distribution to all employees E-Mail Promotions will be sent on a quarterly basis to remind employees of the EAP. These e-mails may be printed or distributed electronically. 8. Leadership Consultation Managers, supervisors and Human Resources will be encouraged to contact the EAP for consultation regarding any difficult work place problem or for assistance to identify and approach troubled employees, discuss documentation, employee motivation and other concerns that may be appropriate. 9 Quality Assurance and Utilization Reporting Depending upon the size of the company, Utilization Reports will be prepared and sent on the following schedule: Over 100 employees on a quarterly basis 50 to 100 employees on a semiannual basis Under 50 on an annual basis Every employee who utilizes the EAP will be offered an opportunity to complete an Employee Evaluation of Service form. This form will ask for their rating and comments regarding the service they received from the EAP. A summary of comments will be provided the company on an annual basis. B. Insurance. First Choice Health Employee Assistance Program will maintain liability insurance in the amount of $1,000,000.00. In addition, First Choice Health Employee Assistance Program requires that its Providers carry a mimmum of$1,000,000.00 in malpractice insurance with$3,000,000.00 Aggregate. C. Cmpliance, First Choice Health Employee Assistance Program, in carrying out its obligations under this obligations under this Agreement, shall comply with all applicable federal and state laws and regulations. II. COMPANY'S OBLIGATIONS A. Payment for Services. The Company will make payments to First Choice Health Employee Assistance Program in accordance with Addendum A,attached to this Contract FCHEAP2003tmVIate 3 B. Group Enrollment Form. The Company will provide to First Choice Health Employee Assistance Program for each group enrolled a completed Group Enrollment Form as set forth in Addendum B. C. Utilization Reports. The Company will distribute to each employer group Utilization Reports, prepared by the First Choice Health Employee Assistance Program,in accordance with the schedule of distnbution as set forth under Section I of tlus Agreement. C. EAP Liason. The Company will assist First Choice Health Employee Assistance Program in group implementation as needed, and will act as a hason between the EAP and all groups enrolled pursuant to this Agreement. D. Compliance. The Company, in carrying out its obligations under this obligations under this Agreement, shall comply with all applicable federal and state laws and regulations, provided that nothing in this Agreement shall be construed as providing a type of medical benefit or service subject to the requirements of the Employee Retirement Income Security Act of 1974 (Pub L. 93-406, Sept. 2, 1974). III. CONFIDENTIALITY OF HEALTH INFORMATION The parties acknowledge that as a result of this agreement, either party may have access to and receive from the other party individually identifiable health information ("Health Information's as that tern is defined under the Health Insurance Portability and Accountability Act of 1996, Section 1171 of Public Law 104-191 C HIPAA`�,and Chapter 70.02 RCW,the Washington State health Care Information Access and Disclosure of 1991. Both parties agree to maintain the confidentiality of such Health Information and to not use or disclose such Health Information other than as may be permitted or required by federal or state law or regulations currently in effect, or becoming effective during the term of this Agreement, including, but not limited to, the federal HIPAA Privacy regulations To the extent either party, in carrying out its responsibilities under this Agreement, conducts Standard Transaction(s) as that term is defined under HIPAA, that party shall, without limitation, comply with the HIPAA regulations, "Administrative Requirements for Transactions," 45 CFR 162.200 et seq. IV. TERM AND TERMINATION The term of this Agreement will be effective on the date set forth at page 1, and shall continue in effect until either party cancels the Agreement with thirty(30) days prior written notice. V. INDEPENDENT CONTRACTOR STATUS First Choice Health Employee Assistance Program is an independent contractor and in no way should this contract be construed to create an employer-employee relationship. All payments made hereunder for services performed shall be made to the First Choice Health Employee Assistance Program as an independent contractor. VI. ASSIGNABILITY First Choice Health Employee Assistance Program will not assign or transfer any interest in this contract without written notice to the Company: PROVIDED HOWEVER, that claim for money FCHW2003twVlate 4 due or to become due to First Choice Health Employee Assistance Program under this contract may be assigned to a bank,trust company or other financial institution without such approval. VII. DISPUTE RESOLUTION In entering this agreement,it is assumed that a relationship of cooperation and understanding will be maintained between the parties. However, in the event of any dispute, or disagreement over the terms and conditions contained herein, such dispute will be settled through binding arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall occur within King County, Washington, unless the parties mutually agree to have such proceedings in some other locale. The arbitrator(s) may in any such proceeding award attorneys fees and costs to the prevailing party. VIII. AMENDMENTS This agreement contains the full understanding of the parties and supersedes and cancels all prior negotiations, correspondence or communication between the parties No oral modification to this Agreement shall be effective however, this agreement may be modified or amended by written signed agreement by both parties. IX.NOTICES Any notice by the Company to First Choice Health Employee Assistance Program,may be delivered by certified or registered mail postage prepaid addressed to: First Choice Health Employee Assistance Program 600 University Street,Suite 1400 Seattle,WA 98101 Notice by First Choice Health Employee Assistance Program to the Company may be delivered by certified or registered mail postage pre-paid, addressed to the group at the address designated by the Company via written notice. X. GOVERNING LAW This agreement is made pursuant to and shall be construed in accordance with the laws of the State of Washington. IN WITNESS WHEREOF, the parties hereto have executed this agreement on the date indicated above. FIRST CHOICE HEALTH CITY OF KENT EMPLOYEE ASSISTANCE PROGRAM By By Thomas Maschhoff N Vice President,EAP Services Ti FCHEAP2003template 5 ADDENDUM A PRICING GROUP RATE QUOTE X The Group Rate for an enhanced One to Three visit Employee Assistance Program as described in the Technical Proposal is $ 1.76 per month per employee family. This quote is based upon 750 employees. Total monthly cost will be 1,320.00. The Group Rate for an enhanced One to Sig visit Employee Assistance Program as described in the Technical Proposal is $ 2.68 per month per employee family. This quote is based upon 650 employees. Total monthly cost will be 2$ ,010.00. To include Unlimited Premium Internet Education please increase the above rate by $ 00 per employee family per month. Total monthly cost for a three visit EAP will remain 1,144.00. (The Clients of R.L.Evans Insurance Receive Premium Internet At No Additional Cost) The above price includes all services described in the Technical Proposal plus • Ten ON SITE Employee Orientation presentations. • Four ON SITE Supervisor Training programs • Unlimited 24/7 Employee Orientation to be provided at the First Choice EAP Web Site. • Unlimited 24/7 Supervisor Training to be provided at the First Choice EAP Web Site. • Eldercare Consultation&Referral • Debt Referral&Support • Homeowners Assistance Program • Sig Hours of On Site Trauma Debriefing • Secure Internet Counseling • Complete Mandatory support including compliance monitoring, communication and monthly reports • DOT Required Training for CDL employees and DOT Hazardous Materials Training • Development of a Splash Page and Unlimited Access to a variety of other training including Harassment Prevention, Violence Prevention, Conflict Resolution, Workplace Diversity, Drug Free Workplace and other training • Unlimited Internet Access to health screening tools and Health Risk Appraisals • Unlimited Leadership Consultation • Premium Level Education On Line as quoted above Additional Service Options X Legal Consultation and 25%decrease in normal rates $ .05 per employee family per month Nurse Line Services $ .88 per employee family per month Child Care Consultation&Referral $ .25 per employee family per month Optional Unlimited Premium On Line Training .00 per employee per month.Rate Quoted Above. On-Site Trauma Debriefings: $150.00 per hour plus local travel(Six Hours included at no cost) On-Site Mediation: $150.00 per hour plus local travel FCHEAP2003template 6 ADDENDUM B GROUP CONT&,CT INITIATION INFORMATION Please provide the following information at the time of contract signing: City of Kent Becky Fowler C` Benefits Ma nager er � g Tyr: 253-856-5290 Fal 253-856-6270 bfowler@ci.kent.wa.us C7Li y F�tl. Does your company have an Intranet? Yes X No ❑ If so,would you like us to develop a Splash Page to link your employees to our Web Site, at no additional cost? Yes X No ❑ Promotional Material Mailing Address: Billing Address (if different): City of Kent 220 0 Ave S Kent, WA 98032� If you have elected Premium Education,please select a Username and Password for your employees to use for access to this area of our Site. Our goal at First Choice Employee Assistance Program is to always "Make the Right Referral the First Time". Please assist us in this effort by providing the name of your specific Insurance Plan or Carriers for Mental Health Services, your limits for outpatient services, and any other information that will assist us in arranging the best care for your employee families. Please, be as specific as possible (PPO, HMO, Access, Advantage, Choice, etc). We will use this information to select a community provider who is covered under your health benefit plan, and will not release this information other than to a Network Treatment Provider. Name of specific Insurance Plan(s): Premera Blue Cross&Group Health Cooperative Is a special network used? Yes Of No ❑ Name: 'PQp Is your plan managed? Yes ❑ No By whom(please add the telephone number used for the approval of authorizations): May we list your company as a new group in our Newsletter? Yes R No ❑ MHEAP2003tem mate 7 Thank you very much. This information will be of great help in initiating your EAP Service and in serving your employees. FCHEAP2003toWlaW 8