HomeMy WebLinkAboutES2013-0085 - Amendment - Premera Blue Cross - Administrative Service Contract - 01/01/2013 AMENDMENT TO ADMINISTRATIVE SERVICE CONTRACT
BETWEEN
PREMERA BLUE CROSS
AND
CITY OF KENT
This Amendment shall revise and extend the Administrative Service Contract
("Contract') between the above named group (the "Plan Sponsor") and Premera Blue
Cross (the "Claims Administrator") for the period from January 1, 2013 through
December 31, 2013 (the "Contract Period"). The changes to the Contract for the new
Contract Period shown below shall take effect on January 1, 2013.
■ Attachment B Census Information
The revised Attachment B attached to this Amendment is hereby made a part of the
Contract.
■ Attachment D Fees Of The Claims Administrator
The revised Attachment D attached to this Amendment is hereby made a part of the
Contract.
All other provisions of the Contract remain unchanged. This amendment forms a part of your
Contract. Please keep the amendment with your Contract.
City of Kent
BY G (//. DATE /a S
Title
ADDRESS qT' A"W `5%L h
PREMERA BLUE CROSS
BY; DATE, January 1, 2013
H.R. Brereton Barlow
President and Chief Executive Officer
P O Box 327
-- -- -Seattle, WA 98111-0327 — -- ---- --
ASCAM(07-2012)
An independent Lcemee of the Blue C mas Blue Stkid Assucletion
i
ATTACHMENT B - CENSUS INFORMATION
Administration Fees, effective January 1, 2013,are based on the following
Number of Active Members: 1,717
Employee Spouse Children
Medical 674 361 682
Number of Retiree Members: 82
Employee Spouse Children
Medical 77 5 0
Number of COBRA Members: 18
Employee Spouse Children
Medical 15 3 0
Other Carriers Offered: Group Health Cooperative
I
ASCAM(07-2012)
An Independent Licensee of the Blue Cross Slue Shield Association
ATTACHMENT D - FEES OF THE CLAIMS ADMINISTRATOR
i
Pursuant to the Administrative Service Contract, the Plan Sponsor shall pay the Claims Administrator the fees,as !
set forth below,for administrative services
Administration Fees:
$57 25 per employee per month(without stoploss)
$55 00 per employee per month (with stoploss) j
An additional $2 25 per employee per month administration fee will apply if stoploss coverage is not maintained
through LifeWise Assurance Company
Administration Fee Guarantee:
Year 1/1/2013—12131/2013 1/1/2014—12/3112014
Administration Fee $57 25 PEPM (Stoploss not purchased) $58 90 PEPM (Stoploss not purchased)
$55 00 PEPM (Stoploss purchased) $56 65 PEPM (Stoploss purchased)
Brokerage Fee $ 2 50 PEPM $ 2 50 PEPM
Total Administration $62 00 PEPM (Stoploss not purchased) TBD
Fee $57.50 PEPM (Stoploss purchased)
Fee For Class Action Recoveries
The Plan Sponsor shall pay the Claims Administrator a fee for its work in pursuing class action recovenes on
behalf of the Plan Sponsor as described in Subsection 3 7 Participation In Class Action Suits The fee shall be a
proportionate share of$10,000, based on the proportion of the amount recovered on behalf of the Plan Sponsor
compared to the total amount recovered by the Claims Administrator for all lines of business
3
\ REQUEST FOR MAYOR'S SIGNATURE
v K E N T Please Fill In All Applicable Boxes
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Originator: Becky Fowler Phone Ori Inator : 5290
Date Sent: 12/04/12 Date Required:
Return Signed Document to: Becky Fowler CONTRACT TERMINATION DATE: 12/31/2014
VENDOR NAME: Premera Blue Cross DATE OF COUNCIL APPROVAL:
Brief Explanation of Document:
Amendment to the Premera Blue Cross Administrative Services Agreement for Census
Information, update of the 2013 Broker/Consultant fees, and stop Io� �-�ge not
purchased. Council already authorized the Premera Blue Cross contac� in IQ12, a three
year agreement.
DEC 4 2012
Separate contracts are being processed for Broker Consultant fees and the city is going
out to bid on our stop loss coverage for 2013. City of Kent
Office of the Mayor
All Contracts Must Be Routed Through The Law Department
(Thtsarea,toIke completed by the Law Department)
Received:
Approval of Law Dept.:
Law Dept. Comments: -ENT L4-`�Vt DEP7-
Date Forwarded to Mayor: L y
Shaded Areas To Be Completed By Administratimt►vritaf—,e
�r I�
Received:
Recommendations and Comments:
r C('1'Qi�-t�T
Disposition: �" t r
Date Returned: