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HomeMy WebLinkAboutES06-062 - Amendment - Flex-Plan Services, Inc. - Flex Spending Appeal Amendment - 03/16/2012 Records M _ - eme=rite KENT — Document W.SHINGTON 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 City Clerk's Office. Vendor Name: Ei-z% -?LPirK, y V l S Vendor Number: 3�39sl JD Edwards Number Contract Number: ES p(o- ply This is assigned by City Clerk's Office Project Name: P-i�Pti-- A rnt:Il7D tY\tA-2'7' Description: ❑ Interlocal Agreement ❑ Change Order Amendment ❑ Contract ❑ Other: Contract Effective Date: �73-I lo-atbl,), Termination Date: Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager. taK ��Qepartment: ES Detail: (i.e. address, location, parcel number, tax id, etc.): S,Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 CITY OF KENT FLEXIBLE SPENDING ARRANGEMENT CLARIFYING AMENDMENT ARTICLE I PREAMBLE 1.1 Adoption and effective date of amendment.The Employer adopts this Amendment to the CITY OF KENT FLEXIBLE SPENDING ARRANGEMENT(the"Plan')to clarify processes,procedures,and tnnelmes of the claims appeal process This Amendment shall be effective upon the effective date 1.2 Supersession of inconsistent provisions This Amendment shall supersede the provisions of the Plan to the extent those provisions are inconsistent with the provisions of this Amendment ARTICLE II EFFECTIVE DATE 2.1 Effective Date This Amendment is effective March 16,2012. ARTICLE III GENERAL RULES 3.1 Clarification of Flexible Spending Arrangement Appeals Process.Procedures, and Timelines. If a day care or health care flexible spending arrangement claim is denied in whole or in part,the participant will receive written notification The notification will include the reason(s)for the denial,a description of any additional information needed to process the claim,and an explanation of the claims procedure The participant has 180 days after receipt of the denial to submit a written request for reconsideration of the denial to the claims administrator. Any request may include documents or records in support of the appeal and the participant may review pertinent documents and submit issues and comments in writing The claims administrator will review the appeal and provide, within 30 days, a written response(extended by reasonable time if necessary) In this response,the claims administrator will explain the reason for the decision,with reference to the provisions of the Plan on which the decision is based,if necessary If the participant disagrees with the level one appeal decision they may submit a request for a level two appeal to be determined by the Employer The request for level two appeal must be submitted within 60 days of receipt of the level one denial notice The participant will be notified with the final decision within 30 days after the Employer receives the appeal(extended by reasonable time if necessary) The Employer has the exclusive right to interpret the appropriate Plan provisions Decisions of the Employer are conclusive and binding Both level one and level two appeals must be submitted by written request by email,fax,or mail to Flex-Plan. The participant must indicate either level one or two appeal on the email, fax,or letter. Email claims@flex-plan com Fax 425-451-7002 or 866-535-9227 Mail to:Flex-Plan Services,PO Box 53250,Bellevue WA 98015 This Amendment has been executed March 16,2012 Nam mployer: C Zent Y 1GNAT ER VKTH AUTHORITY TO ADOPT ©2012 Flex-Plan Services.Inc 1 CERTIFICATE OF ADOPTING RESOLUTION The Employer hereby certifies that the following resolutions were adopted by the Employer on March 16, 2012,and that such resolutions have not been modified or rescinded as of the date hereof, RESOLVED,that this Amendment to the CITY OF KENT FLEXIBLE SPENDING ARRANGEMENT effective March 16,2012,presented to this meeting is hereby approved and adopted and the Employer is hereby authorized and directed to execute and deliver one or more counterparts of the Amendment RESOLVED,that because this is a clarifying amendment the Employer may notify employees of the adoption of this Amendment to the Plan by delivering to each employee the Participant Communication presented to this meeting,which form is hereby approved The undersigned further certifies that attached hereto,are true copies of this Amendment to the Plan and the Participant Communication approved and adopted in the foregoing resolutions y Ge Date. a 1 PARTICIPANT COMMUNICATION for the CITY OF KENT FLEXIBLE SPENDING ARRANGEMENT March 16,2012 (Date Signed) (1) General. This communication has information regarding the CITY OF KENT FLEXIBLE SPENDING ARRANGEMENT(the"Plan') This Participant Communication supplements the Summary Plan Description ("SPD")previously provided to you (2) Clarification of Flexible Spending Arrangement Appeals Process,Procedures,and Timelines. If a day care or health care claim under the Plan is denied in whole or in part,you will receive written notification The notification will include the reason(s)for the denial.with reference to the specific provisions of the Plan on which the denial was based, a description of any additional information needed to process the claim and an explanation of the claims review procedure You must submit a written request for reconsideration of the denial to the claims administrator within 180 days after receipt of the denial Any such request should be accompanied by documents or records in support of your appeal You may review pertinent documents and submit issues and comments in writing The claims administrator will review the appeal and provide,within 30 days,a written response to the appeal (extended by reasonable time if necessary) In this response, the claim administrator will explain the reason for the decision, with specific reference to the provisions of the Plan on which the decision is based if necessary If you disagree with the level one appeal decision you may submit a request for a level two appeal to be determined by the Employer You must submit your request for level two appeal within 60 days of receipt of the level one denial notice You will be notified with the final decision within 30 days after the Employer receives the appeal(extended by reasonable time if necessary) The Employer has the exclusive right to interpret the appropriate plan provisions Decisions of the Administrator are conclusive and binding. You must file both level one and level two appeals by submittmg a written request by email,fax, or mail to Flex-Plan Indicate either level one or two appeal on the email,fax,or letter Email claims@flex-plan com Fax 425-451-7002 or 866-535-9227 Mail to.Flex-Plan Services,PO Box 53250,Bellevue WA 98015. 2