HomeMy WebLinkAboutCity Council Committees - Operations - 11/17/2015 Operations Committee Agenda
Councilmembers: Bill Boyce - Dana Ralph - Les Thomas, Chair
November 17, 2015
4 p.m.
Item Description Action Speaker Time Page
1. Call to order Chair Thomas 1
2. Roll Call Chair Thomas 1
3. Changes to the Agenda Chair Thomas 1
4. Approval of Check Summary Report dated YES Chair Thomas 2
10/16/2015 thru 10/31/2015
S. Approval of Meeting Minutes Dated YES Chair Thomas 2 1
November 3, 2015
6. Premera Blue Cross 2016 Administrative YES Becky Fowler 5 5
Services Contract
7. Group Health Cooperative 2016 Contract YES Becky Fowler 5 21
S. Stop Loss Contract — 2016 LifeWise YES Becky Fowler 5 37
Assurance Company
9. Lodging Tax Advisory Committee Board YES Ben Wolters 5 39
Member Expansion Ordinance
Unless otherwise noted, the Operations Committee meets at 4 p.m. on the first and third
Tuesday of each month in Kent City Hall, Council Chambers East, 220 4ch Ave S, Kent, 98032.
For additional information please contact Jennifer Hays at 253-856-5700.
Any person requiring a disability accommodation should contact the City Clerk's
Office at 253-856-5725 in advance. For TDD relay service call Washington
Telecommunications Relay Service at 1-800-833-6388.
This page intentionally left blank
� 1
KE �rNT q
OPERATIONS COMMITTEE MINUTES
November 3, 2015
Committee Members Present: Les Thomas, Chair, Dana Ralph and Bill Boyce.
The meeting was called to order by Les Thomas at 4:00 p.m.
1. ROLL CALL.
2. CHANGE TO AGENDA.
There were no changes to the agenda.
3. APPROVAL OF THE CHECK SUMMARY REPORTS DATED 9/16/2015 THROUGH
9/30/2015 AND 10/1/2015 THROUGH 10/15/2015.
B. Boyce moved to approve the check summary report dated 9/16/2015 through
9/30/2015 and 10/1/2015 through 10/15/2015. D. Ralph seconded the motion,
which passed 3-0.
4. APPROVAL OF MINUTES DATED OCTOBER 6, 2015.
D. Ralph moved to approve the Operations Committee minutes dated October 6, 2015.
B. Boyce seconded the motion, which passed 3-0.
S. AMENDMENT TO MAINTENANCE CONTRACT WITH PREFERRED COPIER
SYSTEMS FOR CITY MFD'S - AUTHORIZE.
Multimedia Manager Dea Drake made a request to extend the multifunction device
maintenance agreement that allows the City additional time to consider replacement
needs in conjunction with facilities space planning. The City and Preferred Copier
Systems agree that each will continue to perform as provided for under the original
Agreement and any prior Amendments on a month-to-month basis commencing
January 1, 2016, with a maximum extension through July 31, 2016.
B. Boyce moved to recommend to Council to authorize the Mayor to sign an
amendment extending the Goods and Services Agreement with Preferred Copier
Systems in an amount not to exceed $100,000 through July 31, 2016 for maintenance
of the City's fleet of Ricoh Multifunction Devices (MFD's) subject to terms and
conditions acceptable to the City Attorney and Information Technology Director. D.
Ralph seconded the motion, which passed 3-0.
6. JONES, LANG, LASALLE (JLL) AMENDMENT II.
Economic and Community Development Director Ben Wolters made a request to
members to allow ILL to represent the City in the proposed sale of the Riverbend Par 3
property for the uses approved by the City Council, for a two-percent commission of the
sales price of the property, to be paid upon closing. In the event ILL brings forward a
qualified buyer who agrees to the City's requirements, conditions, and approved uses
and the City fails to approve the transaction with the buyer, ILL will be entitled to a
one-time breakup fee of $75,000.
2
Operations Committee Minutes
November 3, 2015
Page: 2
D. Ralph moved to recommend to Council to authorize the Mayor to sign Amendment II
with Jones, Lang, Lasalle, (JLL) for the disposition of the Riverbend, Par 3 site subject
to terms and conditions acceptable to the Economic & Community Development
Director, Parks Director, and the City Attorney. B. Boyce seconded the motion, which
passed 3-0.
7. CONSOLIDATING BUDGET ADJUSTMENT ORDINANCE FOR ADJUSTMENTS
BETWEEN JULY 1, 2015 AND SEPTEMBER 30, 2015.
Finance Deputy Director Barbara Lopez requested to approve the consolidating budget
adjustment ordinance, reflecting an overall budget increase of $31,271,331. The
increase includes four items that make up approximately 90 percent of this amount,
they are:
1) $1.1 million of B&O revenues of extra over above $5 million that gets
transferred to the CIP fund;
2) nearly $18 million for the 2015 bond refunding that was completed;
3) $1 million for refunding the street operating monies that were in projects
with LID funding; and
4) LED lighting conversion project that council had authorized loans from the
insurance fund and sewerage fund the $1.8 million in loans need to be
transferred to budget as an expense.
The other 10 percent of the increase includes: police being authorized to use school
zone traffic camera monies for equipment, renovations to the corrections facility,
and service fees; SEPA mitigation contributions; and about $400,000 for some
strategic land acquisitions and sales activities.
These expenditures are funded by grants, existing fund balance, or other new
revenues.
B. Boyce moved to recommend Council to approve the consolidating budget
adjustment ordinance for adjustments made between July 1, 2015 and September
30, 2015 reflecting an overall budget increase of $31,271,331. D. Ralph seconded
the motion, which passed 3-0.
S. WRITE-OFFS OF UNCOLLECTABLE ACCOUNTS.
Finance Director Aaron BeMiller requested authorization to write-off $33,856.07 in
uncollectable accounts receivable. The accounts receivable balance as of September
30, 2015 is $4,213,690.25 and the requested write-off represents 0.8% of the
balance; $695.13 of the requested write-off consists of interest and finance
charges.
Of the $33,856.07, $19,493.19 represents businesses that have closed ($18,701.58in
gambling tax debt and $791.61 in unpaid fire permits). $11,956.77 is damage to city
property and the remaining $2,406.11 is comprised of miscellaneous department
services. All but one account have been referred to collections and are considered
3
Operations Committee Minutes
November 3, 2015
Page: 3
uncollectable, covering the period 2008 to 2011. The one account not referred to
collections was a bankruptcy from 2013.
There is no budget impact as a result of this motion as these accounts have already
been fully reserved as doubtful accounts and are not included in the net accounts
receivable amount.
D. Ralph moved to recommend to Council to authorize the Mayor to write-off
uncollectable accounts owed to the City in the amount of $33,856.07, subject to
final approval of the Finance Director and City Attorney. B. Boyce seconded the
motion, which passed 3-0.
7. SEPTEMBER 2015 FINANCIAL REPORT.
Mr. BeMiller provided a summary to the September monthly financial report. Currently,
staff is estimating a favorable variance in the general fund at the end of the year with
almost $3.2 million, a combination of expenditures lower than budgeted and revenues a
bit higher than budgeted. Assuming estimates hold true, there will be a general fund
balance of $10,478,000 at the end of 2015 which will be about 12.2 percent of current
year expenses.
As a reminder to a previous council workshop, Mr. BeMiller discussed the fiscal cliff
approaching for 2020 with the Panther Lake annexation sales tax credit going away,
several labor contracts under negotiation, as well as the impact of I-1366 on state
shared revenues.
Mentioned was the cost savings in Human Resources and Economic and Community
Development due to staff vacancies throughout the year.
To view detailed information for the August 2015 Financial Report please see the full
agenda where the August report is an attachment to the September report.
The meeting was adjourned at 4:46 p.m. by Les Thomas.
Jennifer Hays
Operations Committee Secretary
4
This page intentionally left blank
5
Human Resources
Chris Hills, Acting Director
• Phone: 253-856-5290
.ENT rWl FFax: 253-856-6255
Nxgrvu r.G51u
Address: 220 Fourth Avenue S.
Kent, WA. 98032-5895
DATE: November 17, 2015
TO: Operations Committee
FROM: Becky Fowler, Benefits Manager
SUBJECT: Premera Blue Cross 2016 Administrative Services Contract
MOTION: Recommend Council approve the second year, 2016 Premera
Blue Cross Administrative Services Contract for the city's self-insured
health plan be placed on the City Council consent calendar for the
December 8, 2015 meeting subject to approval of final terms and
conditions by the City Attorney.
SUMMARY: The city contracts with Premera Blue Cross as a third-party administrator
(TPA) to process claims and provide access to Premera Blue Cross's PPO network of
doctors and hospitals. Changes for 2016 include:
1. Switching the Case Management program to the Care Compass 360 program.
2. Adding Virtual Care for your own physician for phone, email, Skype and
otherelectronic care consultations or use Teladoc, a national provider service.
3. Changing networks to Heritage Prime Network. Projected savings on the
network change would be four — eight percent estimated at about $400,000 for
2016 and growing to $500,000 over the next three years.
BUDGET IMPACT: $11,583,040
BACKGROUND: The City is self-insured for this program and wires the weekly claims
cost to Premera Blue Cross for our medical and prescription expenses. The three year
contract beginning 2015 had no increase in administrative fees, a slight decrease for
2016, and an increase of three percent for 2017. Approximately 94 percent of the
city's employee population is covered under the self-insured Premera Blue Cross
program totaling 1775 lives. Included in this coverage is our LEOFF I retirees and their
dependents. The overall projected cost of our self-insured plan inclusive of
administration fees is approximately $11,583,040 for 2016 and is budgeted in the
health and wellness fund.
PREMEM 160
AMENDMENT 1 TO ADMINISTRATIVE SERVICE CONTRACT
BETWEEN
PREMERA BLUE CROSS
AND
CITY OF KENT
The Administrative Service Contract ("Contract") between the above named group (the
"Plan Sponsor") and Premera Blue Cross (the "Claims Administrator") was issued
January 1, 2016 through December 31, 2016.
This Amendment shall further revise and extend the Contract for the period from
January 1, 2016 through December 31, 2016 (the "Contract Period"). The changes to the
Contract for the new Contract Period shown below shall take effect on January 1, 2016.
The changes are:
Section 2 Duties And Responsibilities Of The Plan Sponsor
Subsection 2.6, Compliance With Law, is revised to add a reference to the Medicare Prescription
Improvement and Modernization Act of 2004 and to add a paragraph about notices about
whether the Plan's prescription drug coverage is equivalent to Medicare Part D. The subsection
now reads:
2.6 Compliance With Law
• The Plan Sponsor shall be responsible for the Plan's continuing compliance with all applicable federal,
state and local laws and regulations, as currently amended. These include but are not limited to:
• The Internal Revenue Code of 1986, as amended
• The Affordable Care Act.
• The Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA)
• The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
• Law and regulations governing the treatment and benefits of Members covered by Medicare. These
include, but are not limited to, the Medicare Secondary Payer law and regulations, the Medicare
Prescription Improvement and Modernization Act of 2004 (MMA), and the Medicare, Medicaid, and
SCHIP Extension Act of 2007 (MMSEA).
As required by MMSEA, the Plan Sponsor agrees to provide us the following information:
• Employer Tax Identification Number (TIN/EIN),
• Social Security Numbers (SSNs) of all Members (employees and dependents), and
• Medicare Health Insurance Claim Numbers (HICNs) for all Medicare-entitled Members.
To comply with the Medicare Secondary Payer law and regulations, the Plan Sponsor also agrees to
notify us promptly if the Plan Sponsor experiences a change in total employee count that would
change the order of liability according to federal guidelines.
MMA requires groups that provide prescription drug coverage to Medicare eligible individuals to
provide Medicare Part D Creditable Coverage Notices, and report creditable coverage status to the
Center for Medicare and Medicaid Services (CMS).
The Plan Sponsor, and not the Claims Administrator, is the "plan administrator" and the "plan sponsor"for
purposes of all federal laws that apply to the Plan Sponsor and impose duties or obligations on such
ASCAM (01-2016)
An Independent Licensee of the Blue Cross Blue Shield Association
7
entities. The Plan Sponsor shall be responsible for determining whether it is subject to COBRA and, if so,
for notifying Members of their COBRA rights both initially and upon the occurrence of a qualifying event,
for calculating and collecting premiums for COBRA continuation of coverage and for promptly notifying
the Claims Administrator when an individual is no longer eligible for COBRA continuation of coverage. If
the Plan Sponsor is subject to ERISA, the Plan Sponsor is responsible to prepare and maintain its ERISA
plan document.
• If the Plan Sponsor elects to opt out of compliance with certain federal mandates as allowed by federal
law, the Plan Sponsor is responsible to file its opt-out with federal regulators for each contract period and
to notify Members of the opt-out in accordance with federal law and regulations then in effect. The Plan
Sponsor agrees to hold the Claims Administrator and the Network harmless for any and all consequences
arising from the Plan Sponsor's failure to file an opt-out as required by law for a given contract period,
errors in the opt-out filing, or failure to notify a Member as required by federal law.
Section 3 Duties And Responsibilities Of The Claims Administrator
Subsection 3.1.h., about drug rebates, is revised to clarify how rebates are calculated and
distributed:
h. Claims Administrator will pay Plan Sponsor a prescription drug rebate payment equal to a specific amount
per paid brand-name prescription drug claim. Prescription drug rebates Claims Administrator receives
from its pharmacy benefit administrator in connection with Claims Administrator's overall pharmacy
benefit utilization may be more or less than the Plan Sponsor's rebate payment. The Plan Sponsor's
rebate payment shall be made to the Plan Sponsor on a calendar year quarterly basis unless agreed
upon otherwise.
The allowable charge for prescription drugs is higher than the price paid to the pharmacy benefit manager
for those prescription drugs.
The parties hereby agree that the difference between the allowable charge for prescription drugs and the
price paid to the pharmacy benefit manager, and the prescription drug rebate payments received by
Claims Administrator from its pharmacy benefit manager, constitutes our property, and not part of the
compensation payable to Plan Sponsor under this Contract, and that Claims Administrator is entitled to
retain and shall retain such amounts and may apply them to the cost of its operations and the prescription
drug benefit.
Section 7 Subrogation
The Subrogation section is revised to clarify the Claims Administrator's role and when fees are
charged when a subrogation case is taken to court.
7. SUBROGATION
The Claims Administrator shall have no affirmative duty to pursue subrogation claims. However, the Claims
Administrator may pursue subrogation claims when the Plan Sponsor purchases subrogation services as
described in "Attachment G—Extended Post-Payment Recovery Services" and in accordance with the associated
fee attachment, either directly or through a vendor. Claims Administrator will not initiate legal action to enforce
the plan's subrogation provision without prior approval from the Plan Sponsor. If Plan Sponsor brings any legal
action on its own, Plan Sponsor will be solely responsible for the case, and (1) The Claims Administrator will
cooperate with the Plan Sponsor, (2) Any court costs and attorneys' fees incurred in pursuing such subrogation
claims shall be the responsibility of the Plan Sponsor, and (3) If Claims Administrator had already opened a
subrogation case, Plan Sponsor shall pay Claims Administrator its subrogation fee set forth in "Attachment D—
Fees Of The Claims Administrator." (If Claims Administrator had not already opened a subrogation case, no fees
shall be due the Claims Administrator.
Section 8 Term of Contract
Subsection 8.2, Changes to Fees, is revised to allow administrative fees to be adjusted when a
Plan Sponsor that has a third party administrator in addition to Premera Blue Cross changes
that third party administrator. Administrative fees can also be adjusted if both parties to the
2
8
Contract agree that the fees were based in whole or in part on a mistake that materially impacts
them. The subsection now reads:
8.2. Changes to Fees
The Plan Sponsor acknowledges that the fee schedule set forth in "Attachment D—Fees Of The Claims
Administrator"and the services provided for in this Contract are based upon the terms of the Plan and the
enrollment as they exist on the Effective Date of this Contract.
a. Any substantial changes, whether required by law or otherwise, in the terms and provisions of the Plan or
in enrollment may require that the Claims Administrator incur additional expenses. The parties agree that
any substantial change, as determined by the Claims Administrator after consultation with the Plan
Sponsor, shall result in the alteration of the fee schedule, even if the alteration is during the Contract
Period. The phrase "any substantial change"shall include, but not be limited to:
1. a fluctuation of ten (10) percent or more in the number of Members as set forth on the census
information included in "Attachment B—Census Information"which is herein incorporated by
reference and made a part of this Contract,
2. 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,
3. any change in claims administrative services, benefits or eligibility required by law,
4. any change in administrative procedures from those in force at the inception of this Contract that is
agreed upon by the parties,
5. any additional services which the Claims Administrator undertakes to perform at the request of the
Plan Sponsor which are not specified in this Contract such as the handling of mailings or preparation
of statistical reports and surveys not specified in the Claims Administrator's standard Employer Group
Reporting set.
6. A change in the third-party administrator, if any, used by the Plan Sponsor with respect to the benefits
provided under this Contract. The Plan Sponsor will provide the Claims Administrator no less than
120 days' advance written notice of any such change.
b. The Claims Administrator may also adjust the fees during the Contract Period by giving thirty (30) days
advance written notice to the Plan Sponsor or its agent, if the Plan Sponsor agrees with the Claims
Administrator that the fees are based in whole or in part upon a mistake that materially impacts such fees.
Section 9 Termination
We have replaced a reference to "plan administrator" with "plan sponsor." The subsection
reads:
9.2. Contract Period Expiration
This Contract will terminate on the last day of the Contract Period or the last day of any extension of the Contract
Period granted by the Plan Sponsor.
We have added a subsection to clarify that the plan sponsor remains liable for delinquent
payments at termination:
9.6. Plan Sponsor Liability Upon Termination
In the event this Contract is terminated, the Plan Sponsor shall remain liable to the Claims Administrator for all
delinquent sums together with interest thereon as provided for in subsection 5.2.c..
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.
• The attachment's table of services and fees covered by the Extended Post-Payment
Recovery Services program is revised to clarify fees if a subrogation case is taken to
court.
3
9
• This attachment includes anew subsection describing fees for the CareCompass360°
Personal Health Support program. References to the PBC Disease Management and
Case Management programs are hereby removed.
Attachment F Care Facilitation
The revised Attachment D attached to this Amendment is hereby made a part of the Contract.
Disease Management and Case Management are removed from the list of services in the
attachment. These services are now included in the CareCompass360° program described in
Attachment H. The Clinical Review description in the list has been simplified. The revised
attachment is attached to this Amendment.
Attachment G Extended Post-Payment Recovery Services
The revised Attachment G attached to this Amendment is hereby made a part of the Contract.
We have revised the description of subrogation services to provide more detail about our duties
in a subrogation case.
Attachment H CareCompass3600
The Disease Management attachment (Attachment H) is hereby renamed CareCompass360° and
revised to describe the CareCompass360° Personal Health Support program. The new
Attachment is attached to this Amendment and hereby made a part of the Contract.
Attachment I Performance Guarantees
The revised Attachment I 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: DATE:
Title
ADDRESS:
PREMERA BLUE CROSS
BY: DATE: January 1, 2016
Jeffrey Roe
President and Chief Executive Officer
P.O. Box 327
Seattle, WA 98111-0327
4
10
ATTACHMENT B - CENSUS INFORMATION
Administration Fees, effective January 1, 2016, are based on the following:
Number of Active Members:
Employee Spouse Children
Medical/Rx 595 375 728
Number of COBRA Members:
Employee Spouse Children
Medical/Rx 8 1 0
Number of Retiree Members:
Employee Spouse Children
Medical/Rx 73 0 0
Other Carriers Offered: Group Health
5
11
ATTACHMENT D - FEES OF THE CLAIMS ADMINISTRATOR
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:
${ } per employee per month
The Administration Fee is itemized as follows:
Administration Fee Guarantee:
The base administration fee, not including other charges such as producer fees, is guaranteed as shown below
during the period from January 1, 2015 through December 1, 2017. This period shall be known as the
"administration fee guarantee period."
Year Amount Contract Period Begins Contract Period Ends
Year 1 $56.65 PEPM January 1, 2015 December 31, 2015
Year 2 $56.15 PEPM January 1, 2016 December 31, 2016
Year 3 $57.85 PEPM January 1, 2017 December 31, 2017
Other Fees:
Med/Rx Admin. Fee $48.42
B&O Tax $0.82
Network Mgmt. Fee $6.91
Producer Fee $3.00
Total $59.15
Claims Runout Processing Fee:
The charge for processing runout claims is an amount equal to the active administration fee at the time of
termination, times the average number of subscribers for the 3-month period preceding the termination date,
times two.
Value-Based Program Payments
Provider groups enter into agreements with Premera or other Blue Cross and/or Blue Shield Licensees (Host
Blues)for value-based programs. Such programs include the Blue Distinction Total Care program, Global
Outcomes Contracts, accountable care organizations, patient-centered medical homes, shared savings
arrangements, and global payment/total cost of care arrangements. Premera and the Host Blues may pay value-
based program providers for meeting the programs' standards for treatment outcomes, cost, quality and care
coordination. The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount
established for each value-based program provider group. The PMPM amount will be multiplied by the number of
the Plan Sponsor's members that are attributed to each provider group. The PMPM amounts differ between the
provider groups, and may change during the Contract Period.
Fee For Class Action Recoveries
The Plan Sponsor shall pay the Claims Administrator a fee for its work in pursuing class action recoveries on
behalf of the Plan Sponsor as described in Subsection 3.6—Participation In Class Action Suits. The fee shall be
6
12
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.
BlueCard Fee Amount:
BlueCard Fees are tracked and billed monthly in addition to claims expense.
Care Facilitation:
Included in Administration Fee. See "Attachment F—Care Facilitation"for an overview of services provided.
Personal Health Support
For members participating in personal health support, there is a separate fee of$245 per actively engaged
member per month of active engagement. See "Attachment I—CareCompass3600"for more information.
Extended Post-Payment Recovery Services:
Claims Administrator will perform the services listed below on a pay-for-performance, contingent fee ("Contingent
Fee") basis, which shall be calculated as a percentage of the gross amount recovered with respect to any
particular claim. See "Attachment G—Extended Post-Payment Recovery Services"for an overview of services
provided.
Post Payment Recovery
Contingent Fee
Category
Coordination of Benefits 25%
Subrogation 25% unless Claims Administrator, in its sole option
or discretion, engages outside counsel, in which
case the Contingent Fee amount shall be 35%,
whether or not the case involves litigation or other
dispute resolution process.
25% if, after Claims Administrator has worked a
subrogation case, the Plan Sponsor takes over
responsibility for the case and settles directly.
In all cases, Plan Sponsor is also responsible for
payment of any court costs, such as filing fees,
witness fees or court reporter fees.
Provider Billing Errors 25%
Credit Balance 25%
Hospital Billing and Chart Review 35%
7
13
ATTACHMENT F - CARE FACILITATION
Claims Administrator agrees to provide the following care facilitation programs for the fees shown in "Attachment
D—Fees Of The Claims Administrator."
Service Description
Care Management
Clinical review Prospective and retrospective review for medical
necessity, appropriate application of benefits.
Includes provision of evidence-based clinical practice and
Quality Programs preventive care guidelines to Members and providers,
chart tools, and quality of care program activities.
Prescription drug formulary Development of formulary and access to providers and
promotion Members on-line
Physician-based pharmacy Physician education on cost-effective prescribing
management
ePocrates Software to provide physicians with up-to-date drug and
plan formulary information.
Education for Members using multiple drugs to review
Polypharmacy prescriptions with their providers to decrease incidences of
adverse drug interactions
Follow-up with Members and physicians to minimize
Point-of-sale Pharmacy inappropriate or excessive drug therapies identified when
drugs are dispensed.
Demand Management Round-the-clock access for Members to RNs to answer
questions about health care.
8
14
ATTACHMENT G - EXTENDED POST-PAYMENT RECOVERY SERVICES
Claims Administrator, through its affiliate, Calypso, shall provide a set of Extended Post Payment Recovery
Services to the Plan Sponsor as described below. Claims Administrator will perform these services on a pay-for-
performance, contingent fee ("Contingent Fee") basis, which shall be calculated as a percentage of the gross
amount recovered with respect to any particular claim. Contingent Fees are shown in "Attachment D—Fees of
the Claims Administrator."
Post Payment Recovery Explanation of Services
Category
Claims Administrator's investigators and auditors will work to identify
and pursue overpayments due to Member's missing or inaccurate COB
Coordination of Benefits information. Claims Administrator utilizes questionnaires and
interviews with providers, employers and Members to determine if Plan
Sponsor's Plan is primary or secondary.
Claims Administrator's investigators, auditors and attorneys identify and
pursue overpayments due to Subrogation opportunities. Claims
Administrator's research to obtain accurate subrogation information and
determine group's subrogation rights include questionnaires and
interviews with providers, employers and Members. As Claims
Administrator deems necessary, Claims Administrator manages
Subrogation attorney and Member notification,-coordinates case documentation,
coordinates with potentially responsible parties and provides
representation for hearings.
Claims Administrator will notify Plan Sponsor in the event that Claims
Administrator recommends that the Plan Sponsor file suit. Plan
Sponsor retains the right to authorize or deny any legal action.
Claims Administrator's post-payment editing programs and
investigators and auditors perform additional screens and tests where
billing information is inconsistent with age/services rendered or where
Provider Billing Errors there appears to be up-coding or unbundling of services. A recovery
process is then employed to request and recover verified
overpayments.
This service requires an on-site review of the provider's financial
records and discussions with their staff. Credit balances are verified as
Credit Balance owed to Plan Sponsor and the source of the credit is determined. The
credit is reviewed with the provider and approved for payment back to
Claims Administrator or the Plan Sponsor.
This service requires an on-site review of the Member's medical charts
and interviews with provider staff by registered nurses. Calypso out-
sources the on-site review work to an independent vendor who ensures
that:
Hospital Billing and Chart • Service is consistent with diagnosis and billing is consistent
Review with services.
• There has been no unbundling of services, diagnosis up-coding
or billing maximization.
• Services rendered were prescribed by the physician and the
9
15
Post Payment Recovery Explanation of Services
Category
doctor's notes were signed.
Standardized billing and payment policies were used.
Calypso provides support for this vendor's efforts as well as processes
all recoveries.
10
16
ATTACHMENT H — CARECOMPASS3600
Claims Administrator agrees to make available to the Plan Sponsor certain services of the CareCompass3600
program, which are more particularly described in Appendix 1 attached hereto and incorporated herein. Claims
Administrator, in its sole and absolute discretion, may upgrade or otherwise modify its services.
Information and Data
For Plan Sponsors for whom the Claims Administrator does not have claims data as it determines
necessary for the prior 24-month period, the Plan Sponsor will attempt to obtain such data from the Plan
Sponsor's previous health plan(s), 90 days prior to the Plan Sponsor Effective Date. The Claims
Administrator will cooperate with Plan Sponsor's effort in obtaining such data. All such data shall be
provided by the Plan Sponsor in a mutually agreeable electronic format.
Inability to Provide Data. The Parties recognize that the provision of data referenced above is critical to
the success of the services. Therefore, the Plan Sponsor agrees that if any or all data referenced above
is unavailable or cannot be obtained in a timely fashion, this could, at the Claims Administrator's option,
affect the terms, range and availability of services available to the Plan Sponsor. In the event that at least
24 months of historical data is not available, then the Claims Administrator shall adjust reporting and
measurement requirements for such Plan Sponsor accordingly.
General Provisions
The parties understand, acknowledge and agree that the services provided to the Plan Sponsor
hereunder are designed for availability generally to the entire population of Plan Sponsor Members
eligible for such services and not for application to each and every such Member. The Claims
Administrator does not represent or warrant that the services provided pursuant to this Attachment will be
applied or provided to each and every eligible Member.
• Severability. In the event that any provision hereof is found invalid or unenforceable pursuant to judicial
decree or decision, the remainder of this Attachment shall remain valid and enforceable according to its
terms.
11
17
Appendix 1
Personal Health Support Services
Services of the Personal Health Support program may include:
• Telephonic personal health support, including a clinician designated as the participant's single point of
contact for personal health support.
• Engagement team triage
• Periodic reporting on program enrollment and activities
Eligible Health Conditions
Members eligible for services include those who are classified by Claims Administrator, in its sole discretion,
using its own methodology or criteria, as high-risk and/or polychronic (two or more of the chronic conditions
designated by Claims Administrator for the program). Claims Administrator may change the methodology for
determining eligibility or terms of or criteria for eligibility, at its sole discretion, from time to time.
Active Engagement
The separate monthly program fee is charged only for members who are actively engaged in personal health
support services during the month. "Active engagement" means that a member, or their authorized designee
(such as the parent of a minor child or an individual with power of attorney) has at least one two-way conversation
with their personal health support clinician in which health goals are discussed. The initial outreach contact to the
member does not count. No charges are made for a month in which there is no active engagement.
12
18
ATTACHMENT I - PERFORMANCE GUARANTEES
13
19
PERFORMANCE GUARANTEE AGREEMENT
BETWEEN
Premera Blue Cross of Washington
AND
City of Kent
EFFECTIVE 1/1/2016 THROUGH 12/30/2016 (The "Agreement Period")
This Performance Guarantee Agreement is between Premera Blue Cross of Washington ("the Company"), and
City of Kent ("the Group"). The Company will provide an acceptable level of service as described herein or will
pay the penalties also described herein.
SECTION 1. TERM
The term of this Agreement shall only be the Agreement Period.
Provided this Agreement is executed prior to or on the Effective Date, the Company's fulfillment of the
performance guarantees set forth in this Agreement shall be measured from the Effective Date.
In the event that this Agreement is not executed prior to or on the Effective Date, the Company's performance
shall be measured in accordance with Section 3.C.
The performance guarantees under this Agreement are contingent on the Company receiving timely payment of
administrative fees or subscription charges, as applicable, from the Group.
SECTION 2. PERFORMANCE GUARANTEES AND PENALTY AMOUNTS
The Company guarantees its performance as stated below. The maximum amount of accumulated penalties
for the Agreement Period shall be $2,500.00
Performance Guarantee Metrics:
1) Contract Services: Booklets
Premera will guarantee booklet proofs within 45 business days of receipt of the group renewal confirmation.
Additional drafts or final (electronic) booklets will be provided within 10 business days of producer/client edits to
initial draft and repeat with each revision as necessary. Printing and mailing of booklets are not subject to
performance guarantee.
This metric is non-standard and reporting will be Group specific settled annually
The estimated penalty for this metric will be $2,500.00
SECTION 3. EVALUATION OF PERFORMANCE AND PAYMENT OF PENALTIES
1 of 2
20
A) At the end of the Agreement, the Company shall compile the necessary documentation and perform the
necessary calculations to evaluate its fulfillment of each performance guarantee set forth in this Agreement and
make this information available to the Group.
B) If the Company fails to meet any of the performance guarantees set forth in Section 2, the Company shall
pay to the Group the financial penalty based on the percentage set forth in Section 2.
C) In the event that this Agreement is not executed by the Effective Date, the Company's performance shall be
measured from the first day of the month following the month this Agreement is executed. In such event the
applicable penalty amounts will be pro-rated for that portion of the year for which performance guarantee
metrics are in force.
D) Refer to Section 4 if the contract under which the Company provides insurance and/or administrative
services to the Group is terminated prior to the end of the term of this Agreement.
SECTION 4. TERMINATION OF AGREEMENT
If this Agreement terminates prior to the last day of the Agreement Period the Group is not entitled to any
penalties under Section 2 of this Agreement. This Agreement shall terminate upon the earliest of the following
dates:
A) the end of the Term of this Agreement;
B) the effective date of any state's or other jurisdiction's action which prohibits activities of the parties under this
Agreement;
C) the date upon which the Group either fails to meet its obligation to sufficiently fund the bank account from
which claims are paid (if applicable), or fails to make timely payments of either administrative fees or
subscription charges anytime during the plan year;
D) the date upon which the contract under which the Company provides services to the Group is terminated;
E) any other date mutually agreeable to the Company and Group.
2 of
21
Human Resources
Chris Hills, Acting Director
• Phone: 253-856-5290
.ENT rWl FFax: 253-856-6255
Nxgrvu r.G51u
Address: 220 Fourth Avenue S.
Kent, WA. 98032-5895
DATE: November 17, 2015
TO: Operations Committee
FROM: Becky Fowler, Benefits Manager
SUBJECT: Group Health Cooperative 2016 Contract
MOTION: Recommend Council approve the 2016 Group Health
Cooperative contract for the City's insured HMO plan be placed on the City
Council consent calendar for the December 8, 2015 meeting subject to
approval of final terms and conditions by the City Attorney.
SUMMARY: Renewal of the Group Health Cooperative of Puget Sound contract for
the City's insured health maintenance organization (HMO). The 2016 contract
reflects a 2.64 percent increase in the health care premiums charged by Group
Health Cooperative and is budgeted in the health and wellness fund.
BUDGET IMPACT: $500,000
BACKGROUND: The City purchases insurance with Group Health Cooperative of
Puget Sound. Group Health is a non-profit, health maintenance organization (HMO)
providing primary care medical and specialty center throughout the Pacific
Northwest. Approximately 43 employees and their families are covered under our
Group Health Cooperative plan.
22
I /\RGEGR(]|]P
SOLUTIONS
����������K��
��o �vuw ��v~�a��� �,
k��l�f�� {I��!i[[}t���� fn� �r(��0S Of 51 or more erQ�l���ees
� � - rr - _' / / ^/
Select, ONE OR MORE health plans:
GROUP HEALTH COOPERATIVE GROUP HEALTH OPTIONS,INC.
�
K 0e El Alliance El AcceoPPO 11 0ptionsNPO El AUio*M.s El Options
[] with MIA [] with HKA [] with UlA [] with HkA
Doyouwuntn banking arrangement with M,okh[qoity? Doyou*noto banking onnnyement with HenNhbqoity?
El Yes El No El Yes 1:1No
GENERAL GROUP lNF()RMATION
Fff°cdvedate: January 1 2016
Gmupnumbc'(d: 0036900
Gn`vp's legal name: City of Kent
Doing business cis(if oyp||ooh|,):
6mup's physical/mailing address: 2204th Ave 6 Kent, YVA98032
Name of CEO,president,o/owner:
Title:
Type ofbusiness: Municipality SIC 4:
Tax lD#: 81'OOO1254 How long|nbusiness?
Parent company:
8fNuLesbohs|diorioskthc'office locations tohecovered:
Primary group contact: Becky | Tidc Benefits &1ana
Business address: same
Phone 253-856-5290 Fox:253-856'8270 E-mciil:-bfowler@kentwa.gov
Billing contact name: Title:
Billing address(if different than business oddreo):
Phone: Fax: E-mail:
23
COBRA billing contact the same as billing contact? ❑ Yes ® No If no,please complete the following:
COBRA billing contact name: Becky Fowler Title: Benefits Manager
Billing address: 220 4th Ave S. Kent, WA 98032
Phone: 253-856-5290 Fax: 253-856-6270 E-mail: bfowler@kentwa.gov
To sign up far the MyGroupHealth for Employers website,please seethe instructions on https://employer,ghc.oig
EMPI-oYrF. Ef.IGIBiLI rY
Open enrollment month(s): November/December
This group defines a bona fide employee as one who works a minimum of 21 hours ® per week ❑ per month
Employees will be eligible for benefits upon(select one):
® Date of hire
❑ First of the month following ❑ Date of hire ❑ 30 days ❑ 60 days
❑ First of the month following or coincident with ❑ Date of hire ❑ 30 days ❑ 60 days
❑ Other—No longer than 90 days from date that employee is otherwise eligible to enroll.Any orientation period required for
an employee to be eligible to enroll may not exceed one calendar month (please specify)`,
Employee transfers from part-time to full-time(select one):
® Probationary period begins upon date employee transfers to full-time
❑ Probationary period Is retroactive to original date of hire
Rehire Policy: 191 None OR
❑ Waive probationary period if hired within: ❑ 30 days ❑ 60 days ❑ 90 days
❑ Other -
Coverage terminates: ❑ Date of termination Z End of month following termination
❑ Other _.
Note: Continuation of coverage is available upon request in accordance with Washington state law to employers who choose to
exercise this option for their employees who become ineligible for group coverage.
Other classes of eligible employees or dependents: Job share- 20 hours/wk
Note:Children are eligible until age 26,in accordance with federal and state laws.
Other classes or eligibility information`:_...__-___ ......
Note:State-registered domestic partners will be treated as spouses as required by Washington state law,
Other domestic partner coverage? ® Yes ❑ No
The employer agrees to make the following contribution toward the employee and dependent coverage:
Employee$or % 6% except Police 0% Dependents$or % 14°/a except Police 15%
"Attach additional sheets if necessary.
Page 2 of 7
24
GROUP PARI'ICIPAIION
3A. 'Total number of employees on payroll,regardless of hours worked
3B. Employees not eligible to enroll
i. Employees working fewer than the minimum hours(see Section 2)
, Employees who ore fulfilling their new hire probationary period +
iii. Employees who are temporary,seasonal,or substitute +
iv. Employees paid via IRS Form 1099 +
v. Employees whose class is ineligible for group coverage;
description of group's ineligible class:
(For example,government plan,other group coverage,collective bargaining agreement)
Total employees not eligible to enroll(the sum of I.through v.)
3C. Number of eligible employees not enrolling due to coverage under a government plan
(Medicare/Medicaid,TRICARF)or other group coverage with a valid waiver �.
3D. Total number of employees eligible to enroll (3A minus 3B minus 3C) -
3E. Total number of eligible employees enrolling
3F. Percent of eligible employees enrolling(3E divided by 3D) -
3G. Does your plan cover retirees?
❑ Yes ❑ No If yes,number of retirees eligible for benefits
3H. Number of COBRA/continuation of coverage subscribers,if applicable
31. Does the number of employees reported in 3A include all employees eligible
on a worldwide basis?
❑ Yes ❑ No If no,what is the total number of worldwide employees?
31 Does the number of employees reported in 3A include eligible employees employed outside
Washington state?
❑ Yes ❑ No If yes,please provide number of employees in each state
State: e --
#of employees: _
Note:Underwriting guidelines require that 75 percent of all eligible employees are enrolled in
company-sponsored health coverage,excluding those waiving coverage.
Page 3 of 7
25
EEDFRAL REC)UIREMENTS
Tip: Group Health asks that you consult legal counsel in answering the questions below.The summaries below are not intended
to be or replace legal advice.It is the group's responsibility to inform Group Health if facts change which would cause the group's
answers below to change.
4A. TEFRA/DEFRA: Is the group subject to the federal Medicare Secondary Payer(MSP)laws that prohibit discrimination against
individuals with group coverage based on their(or a spouse's)aurent employment status who has Medicare due to age:
Yes. I his plan will pay primary to Medicare as required by federal law.
❑ No. This group has fewer than 20 employees.
Tip: These laws do not apply to any employer who did not employ 20 employees or more for each working day in each
of 20 or more calendar weeks in either the current or preceding calendar year,For these small group plans,Medicare pays
primary to the group plan.
"Employees"include all full-time and part time employees as well as those employees on disability and subject to FICA taxes.
See 42 CFR 411.106 for further information about which individuals constitute an employee for this purpose.
4B. COBRA: Is the group subject to COBRA? ® Yes ❑ No
Tip: Generally,these laws apply to any non-church employer that employed 20 or more employees on at least 50 percent of
its working days in the preceding calendar year.
"Employees'are full-tirne and part-time common-law employees.Self-employed workers as defined In IRC§54.4980B-2
Q/A 5 for guidance on counting a part-time employee as a fraction of a full-time employee.
4C. OBRA: Is the group subject to the federal Medicare Secondary Payer(MSP)laws that prohibit discrimination against
individuals with group coverage based on their(or a family members)current employment status who have Medicare
due to disability?
® Yes. This plan will pay primary to Medicare as required by federal law.
❑ No. Under 100 employees.
Tip: Generally,these laws apply to any employer that employed at least 100 employees on 50% or more of its working days
in the preceding calendar year.See the tip in 4A above for a definition of"employee"for this purpose.
4D. ERISA: Is the group subject to ERISA?
❑ Yes. Enter the month the ERISA plan year ends: .._
❑x No. Give the legal reason for exemption: ® Government or public plan ❑ Church plan
❑ Other(please specify):
Tip: Generally,ERISA applies to all employer health plans except government,public,or church plans.Nonprofit status alone
does not exempt an employer from ERISA.
()7-1IER CARRIER INFORMATION
Do you offer another medical plan to your employees,other than a Group Heolth plan? 0 Yes ❑ No
If yes,please list the carrier name: Premera Blue Cross
Page 4 of 7
26
CONFIRMED RAI-E S AND IiENl:FII S SIFLE(:I ION
6A. Please sign attached rate confirmation sheet. Confirmed RQ/QR number: RO- 96073 _
66. Rate Stabilization Reserve Funding Agreement ❑ Yes ® No
If yes,Terminal Liability is held by: ❑ Client ❑ Group Health
6C Grandfathered plan:In order to be in compliance,Group Health documentation must establish the following grandfathered
plan since March 23,2010.Does the group meet the criteria below? ❑ Yes 0 N/A
• The plan was not amended to eliminate benefits for aspecific condition.
• The percentage of fixed amount cost-sharing percentage requirements for the plon,if applicable,was
not increased when measured from March 23,2010.
• The fixed cost-sharing requirements other than repayments did not increase by a total percentage more
than the medical inflation rate plus 15 percent.
® Copayments did not increase by more than the medical inflation rate plus 1S percent or five dollars
(adjusted for Inflation),whichever Is greater.
• The employer's contribution rate for any tier of coverage did not decrease by more than five percent.
® The plan was not amended to impose an annual dollar limit or to adopt an overall annual dollar limit
on benefits that is less than the lifetime limit.
PRODUCIRTI�1FC)V2 mION
Do you have a producer of record? ® Yes ❑ No If no,continue to Section 8.
I have appointed Douglas Evans as my producer of record
with respect to the coverage described in this application,effective 01 01 16
Producer's name: Douglas Evans Title: President
Producer's company name:R.L. Evans Company, Inc.
License number: 12575
Producer/representative's Social Security or tax ID number: 91-0849754
Company address: 3535 Factoria Blvd SE#120, Bellevue, WA 98006
❑ Consultant ❑ Producer ® Commission to be paid to: R_L:_Evans Company
Phone: 425-455-0501 Fax: 425-467-5264
E-mail: douge@rlevansco.com
ACKNOWLEDGMEN I.S AND CERTIFICATION
Applicant acknowledges that if the requested coverage is accepted by the applicable health carrier(Group Health Cooperative
or Group Health Options,Inc.)under the carrier's current rules and practices,a coverage agreement will be issued and effective
on the date determined by the carrier.Applicant further acknowledges and agrees that payment of any prernium due for the
coverage shall constitute applicant's acceptance of the coverage agreement issued.
For Section 2,"Employee Eligibility;'applicant attests it has clearly stated the terms of an eligibility conditions or waiting periods
imposed on employees before they are eligible to become covered under the terms of the plan.Applicant further attests it will
provide Group Health with any changes related to such conditions.
Page S of 7
27
If Section 7 has been completed,applicant has appointed the named producer as the Producer of Record with respect to
the coverage requested in this application.No producer has the authority to guarantee that the health carrier will accept this
application for coverage and no producer has the authority to contract on behalf of the health carrier.
Group Health Cooperative and Group Health Options,Inc.reserve the right to review applicant's State of Washington Employer's
Quarterly Report,Form 5208A,to confirm eligibility and participation requirements.Under Washington law,it is a crime to
knowingly provide false,Incomplete,or misleading Information to a health carrier for the purpose of defrauding the carrier.
Penalties may Include Imprisonment,fines,and denial of benefits.
Signature by applicant's authorized representative shall constitute applicant's 1)request for coverage;
Z)acknowledgement and acceptance of all terms,conditions,and information contained within this application form;
and 3)certification that all information provided by applicant on this form is accurate and complete.
Group representative name: Title:
Signature of representative: Date:
" PRODUCER CF--'RIIFIC:ANON
(complete ON Y i( I)Tod ucel is nrmed in `section 7)
Producer certification:I certify that to the best of my knowledge that the information on this application is accurate.
Producer's name: Title:
Signature of producer: Date:
Page 6 of 7
28
u4
� SALE SI OC:A'I IONS
320 Westlake Ave.N.,Suite 100
Seattle, WA 98109
Seattle Sales 206-448-4140
Toll-flee 1-800-542-6312
Fax: 206-877-0655
950 Pacific Ave., Suite 900
Tacoma,WA 98402
Tacoma Sales 253-383-6226
Toll-free 1-800-854-5322
Fax: 253-383-7825
2211 Rimland Drive, Suite 114
Bellingham,WA 98226
Bellingham Sales 206-448-4140
Toll-free 1-800-542-6312
Fax: 360-647-7249
7601 W. Clearwater Ave., Suite 205
Kennewick,WA 99336
Central Washington Sales 509-783-3484
Toll-free 1-800-458-5450
Fax: 509-736-1910
5615 W.Sunset Highway
Eastern Washington/ Spokane,WA 99224
North Idaho Sales 509-459-9100
Toll-free 1-800-497-2210
Fax: 509-459-1080
400 Warren Ave.
Bremerton, WA 98337
Bremerton Sales 360-478-6786
Toll-free 1-800-552-7114
Fax: 360-698-0982
Page 7 of 7
29
30
���,"9
rW^
Heak@ u D n'fom ii(Aabu a n_)su ire �ju d reii a u� u�.��a': ��M i �����gl')ll� ieA�IIt]
Group Flealth Cooperative("Group Health''),a Washington corporation,_ I _OM eYl,
("Plan Sponsor'),and Plan Sponsor's benefit plan offering health care coverage through Group Health('Benefit Plan"),enter into this Health
Information Disclosure Agreement("Agreement')to facilitate the lawful and necessary disclosure of health Information in the course of
administering Benefit Plan.
`rand Acknowledging Benefit Plan's status as a covered entity under the Health Insurance Portability and Accountability Act of 1996(HIPAA)
u
and its Implementing regulations at 45 C.F.R.§ 160.103,Plan Sponsor and Benefit Plan represent and warrant that any Benefit Plan
Instruction to Group Health for disclosure of Benefit Plan—related health Information shall constitute a lawful Instruction and disclosure
under all applicable federal and state Taws and regulations pertaining to the privocy of health information,Including but not limited to
HIPAA and RCW 70.02, 70.24,71.05,and 7134.
Plan Sponsor and Benefit Plan further represent and warrant that any instruction to Group Health to disclose Benefit Plan—related health
information shall be the minimum necessary for Benefit Plan to conduct payment or permissible health care operations activities pursuant to
45 C.ER,164,501,Plan Sponsor and Benefit Plan agree that all Benefit Plan—related health information disclosed by Group Health to Benefit
Plan or to any Benefit Plan representatives shall be kept confidential and used for the sole purpose of conducting payment or permissible
health care operations activities.Plan Sponsor and Benefit Plan further agree and warrant that all necessary business associate agreements
between Benefit Plan and any third-party representatives of Benefit Plan shall be effective prior to Group Health receiving instruction to
disclose Benefit Plan—related health information to such third parties.Benefit Plan is responsible for notifying Group Health of any change in
the third party representatives to whom Benefit Plan has granted authority to request and receive Benefit Plan—related health information.
In the event of such change,the parties shall either amend this Agreement or execute a new agreement.
Benefit Plan authorizes the below named individuals to request and receive Benefit Plan—related health Information on behalf of Benefit Plan:
Uo�g Evans Cindy Roberts Becky Fowler
Print name Print namo Print name Print name
R.L. Evans R,L. Evans City of Kent
Company Company Company Plan administrator
�i
Plan Sponsor and Benefit Plan agree to indemnify,defend,and hold harmless Group Health and Its employees,directors,officers,
subcontractors,and agents against all claims,damages,ar liabilities arising frorn or In connection with Group Health's per of its
obligations under this Agreement,and the negligent performance or breach of Plan Sponsor's or Benefit Plan's obligations or warranties,
or the Inaccuracies of Plan Sponsor's or Benefit Plan's representations,under this Agr'eemenl.
9im
This Agreement supersedes any and all prior disclosure agreements or agreements of a similar nature between the parties.Any conflict
or ambiguity between the terms of this Agreement,the her of any Group Medical Coverage Agreement,or the terms of any
Administrative Service Agreement between the pestles shall be resolved in favor of this Agreement.
This Agreement shall be effective when fully executed by the below authorized party representatives and Shall terminote only upon subsequent
written agreement by all parties.
Group Health Cooperative Company:
Authorized signature on behalf of
Signature
ante:
_Robert O'Brien Jr. nw eauame
Punted Nnnre
.......................__..........._......_.._......._._.._�._....._.�_
Title: Executive Vice President,Health Plan Division Authorized signature on behalt of Plan Aunt nistrator
Date: _..__.._._.....__.._.__...._..._.............._.........._.__._, rite:
Printer)narne
to 2013 Group Health Cooperative 1 6( )013-0a
31
I
i
32
0n;hh
j.ARGaE GP��G1�G.111� y„cl
Sol U1 IONS
GROUP
Coverage provided by Group Health Cooperot'rve or Group Health options,Inc.
The proposed rates and benefits included on the attached rate pages)are based on guidelines described below.If any of
the following are not met,Group Health reserves the right to withdraw our rate proposal,decline coverage,re-rate this
proposal,or terminate your group Medical Coverage Agreement.
• A large group In 2015 is defined as an employer group with 51 or more ernployees.
• The employer must contribute at least 50 percent of the employee-only monthly premium,and the contributions may
not be made in a discriminatory manner.
• Work-related Illnesses and injuries are not covered unless specified in the contract.
• I he quote does not include coverage for retirees,including early retirees,unless specified.
• The quote does riot include coverage for seasonal employees.
• The rates are guaranteed for 12 months;however,Group Health reserves the right to make any change In the employer
group's benefits and/or rates due to changes in state or federal legislation or regulatory action.
• Art ernployer-employee relationship must exist,with the employee represented on the payroll as receiving a wage or
commission.Documentation substantiating this relationship may be required.
• The rates assume that the employer group entity signing below has at least 51 percent ownership over any entity or
entitles with employees receiving medical coverage through the employer group's Medical Coverage Agreement with
Group Health.
• The proposed rates and benefits assume that 75 percent of all eligible employees are enrolled In a company-sponsored
plan,excluding those who have documented other qualified coverage.
• New employees/dependents must enroll within 31 days of becoming eligible for an effective date matching the
eligibility date,or they must wait until open enrollment.Children must be enrolled within 60 days of berth or adoption if
there is a change In the premium.
• All employees enrolling must complete an enrollment application.Eligible employees who decline to enroll must
complete a Waiver of Coverage for
• The subscriber's legal spouse and dependent children are eligible.Children are covered up to age 26,Domestic partner
coverage is available upon request by the employer.Note:State-registered domestic partners will be treated as spouses
as required by Washington state law.
• Any probationary period must not be discriminatory.
• The employee must enroll In order for dependents to enroll.
• Group Health reserves the right to audit the employer group for adherence to any and all underwriting guidelines.
• A health plan incorrectly designated as grandfathered under the Affordable Care Act must be discontinued and
replaced within 30 days with a non-grandfathered plan that complies with all market requirements.A health plan may
riot retain grandfathered status when there Is a merger,acquisition,or similar business action If one of the principal
purposes of the change Is to cover the newly acquired Individuals under the grandfathered plan.The employer must
notify Group Health of such change.
• If enrollment or demographic Impact at initial sale effective date has changed by 10 percent or more from what was
bid, Group Health reserves the right to re-rate that new business.
• Each offered benefit plan roust have a minimum of 5 enrollees.
Con[invred on next page
33
t4U F1111t t.AltdMHR 1-1L ,-t11€ A :'1`:kklMIIIi0l'^J`ro
All quotes are based on conditions of offering that are no less favorable than other carrier medical plans
offered in regard to employer contribution,access to eligible employees,rate ratios,and health condition
provisions such as:
1. The employer's contribution formula does not put Group Health in a disadvantaged position,and
must he offered on the same basis as all other health care plot s offered.
2. Acceptable formulas include,but are not limited to,fixed employer dollar or percentage contribution.
1 Basic and optional benefits such as durable medical equipment,hariatric surgery,prescription drugs,
and Infertility services are comparable among all health care plans offered.
k Eligibility rules and waiting periods for new hires are the same for all health care plans.Group Health
health care plans must be offered to oll eligible employees.
S. Rate differences between carriers' health care plans must be no more than 10 percent.
6. Rates presented to the employer must be identical in tier structure for all health plans offered.
I'I ! 1pry�°Yf `kP{ f ( II Yt)pVili y0ICIJt F `.tli3€d,APd llUA( I BFIOW.
tr(Mt t C dl+Cl';61
X IviOt Itl)L.l I Ap RHIN
I hereby certify that I understand and agree to the above underwriting guidelines on behalf of the employer group
identified below.
Employer group: City of Kent _.
Print name:
Title:
Signature: Date:
0 2014 Group Health Cooperative and Group I(catch aptians.Inc. 14 LR6-1672-02 2014 08
34
�AKGFGR{](JP
S[)[UTT{lk!S
»� I �������U��
��" ���m �' v°��U�K ��
U X[l ~J�l�\A/��4'��l�l | | ^ �1 ^�l�1��
�.� | |���. | vx / � �;/ |�� �����kJ�~� �| |\. ^r
� ~�
[ovew4epmwdodby6muv Health Luopexx*eo/Group Health op/|mnInc.
-Fire proposed rates and benefits included on the attached rate page(s)are based on guidelines described below.If any of
the following are riot met,Group Meo|U/reserves the nghi|n withdraw our rate proposal,decline covemgc re-rule this
proposal,o/terminate your group Medical Covet age Agreement,
6E[4KALEMP[OYtR6UlDELlNEl,
^ A large group inZO15|s defined nsun employer group with 51o/more employees.
The erniployei loust.contribute at least 50 percent of the employee-only monthly premium,and the conti hurtions rnoy
not be made ino discriminator yManner.
• Work-related illnesses and injuries are not covered unless specified in the contract.
• The quote does not include coverage for retirees,including early retirees,unless specified.
• The quote does not include coverage for seasonal employees.
^ The rates are guaranteed for 12 months;however,Group Health reserves the right to make any change|n the employer
group's beriefits and/or rates due to changes in state or federal legislation or regulatory action,
• An employer-employee relationship i nust exist,with the employee represented on the payroll as receiving a wage or
commission.Documentation substantiating this relationship may herequired,
^ The rates assume that the employer group entity signing below has at least 51 percent ownership over any entity or
entities with employees receiving medical coverage through the employer group's Medical Coverage Agreement with
Group Health,
• The proposed rates and benefits assume that 75 percent of all eligible employees are enrolled/nooumpony+pooso/ed
plan,excluding those who have documented other qualified coverage.
• New employees/dependents must enroll within 31 days of becoming eligible for an effective date matching the �
eligibility date,or they must wait until open enrollment,Children must be enrolled within 60 days of birth or adoption if �
there iso change|n the premium.
° All employees enrolling must complete uo enrollment application.Eligible employees who decline k/enroll mod
complete o Waiver o[Coverage form.
• The subscriber's legal spouse and dependent children are eligible.Children are covered up to age 26.Domestic partner
coverage Is available upon request by the employer.Note:State-registeied domestic partners will be treated(is spouses
vs required by Washington state low.
° Any probationary period must riot bcdiscriminatory.
* The employee must enroll|o order for dependents to enroll,
• Gfoup Health reserves the right to audit the employer group for adherence to any and all underwriting gUidelines.
• A health plan incorrectly designated as grandfathered under the Affordable Care Act Must be discontinued and
replaced within 30 days with a non-grandfarthered plan that complies with all market requirements,A health plan may
not retain grandfathefed status when there Is a merger,acquisition,or similar business action if one of the principal
purposes of the change|s to cover the newly(Acquired individuals under the grondfathered plan.The employer must
notify Group Health o[such change.
° If enrollment or demographic impact at initial sale effective date ties changed by 10 percent or more frorn what was
bid,Group Health reserves the night to re-rate that new business.
^ Each offered benefit plan must[love n minimum uf 5enm||ecs
mowo,.lo/no/,agx
35
VIf(I IPL f f`rWkH R "rl'LUI it Acrr;l1Ml' l l(..if',)S
All quotes are based on conditions of offering that are no less favorable than other carrier medical plans
offered In regard to employer contribution,access to eligible employees,rate ratios,and health condition
provisions such as:
1. The employer's contribution formula does not put Group Health in a disadvantaged position,and
must be offered on the same basis as all other health care plans of feed.
2. Acceptable formulas indUcle,butare not limited to,fixed employer dollar or percentage Contribution.
3. Basic and optional benefits such as durable medical equipment,bariatric surgery,prescription drugs,
and Infertility services are comparable among all health care plans offered.
4. Eligibility rules and waiting periods for new hires are the same for all health care plans.Group Health
health care plans must be offered to all eligible employees.
S. Rate differences between carriers' health care plans must be no more than 10 percent.
6. Rates presented to the employer must be identical in tier structure for all health plans offered.
P1 V NtiF Y I R I VOUR L_L If,ila 8 '>}taC , AND [KID bl ( OW
1:.641iltIFN
I hereby certify that I understand and agree to the above underwriting guidelines on behalf of the employer group
identified below.
Employer group City of Kent
Print name:
Title:
Signature: Date: _
tJ 2014 Group Health Cooperative and Group Health Options,Inc. 14-LRG-1672 02 201408
1, l;
R � m
W m
12
w E
C ; S
E E v
N m c
m
2 o N
m
1° CJ m
m o o co m
•- II O` N
0 02 0
C7 a o
m
a > �
U
U 0.
m y N
N 61 E
C m J
m > E_
0
� � U c
E
N
O N
O X
N N
� O
N N
N
pC O p
C U m
C O
O
O O U
N
W w Uw U ) N N ❑
N E_ iiw ' W
10 �
1 Xltt N a
imam � a i
u'� X L m
rnnrnn o � I
25
15
orn�
m m
I i
N I
of sm-
nn m
c �
m m �
°wHu u a a 1
U I
N N L df9 �
I
U a a (p 0
w C
37
Human Resources
Chris Hills, Acting Director
• Phone: 253-856-5290
.ENT rWl FFax: 253-856-6255
Nxgrvu r.G51u
Address: 220 Fourth Avenue S.
Kent, WA. 98032-5895
DATE: November 17, 2015
TO: Operations Committee
FROM: Becky Fowler, Benefits Manager
SUBJECT: Stop Loss Contract - 2016 Life Wise Assurance Company
MOTION: Recommend Council approve the 2016 LifeWise Assurance
Company amendment for our individual stop loss coverage be placed on the
City Council consent calendar for the December 8, 2015 meeting subject to
approval of final terms and conditions by the City Attorney.
SUMMARY: The City's third party administrator for our individual and aggregate
stop loss coverage is Lifewise Assurance Company. In November Lifewise provided
us with a preliminary renewal increase of 19 percent for 2016. The City went out to
the market for a competitive bid process. After the competitive bid process and
appealing Lifewise's preliminary decision, Lifewise reduced their preliminary renewal
amount to a 15percent increase for 2016.
BUDGET IMPACT: $476,495
BACKGROUND: As you are aware, the City is self-insured for all medical claims
through Premera Blue Cross. All city employees and their dependents that are
enrolled in the City's self-insured medical program are covered under a stop loss
insurance policy. This stop loss policy provides added coverage to the City for
individual medical claims exceeding $200,000 per employee or dependent for each
calendar year. All medical costs exceeding $200,000 per enrollee per year will be
reimbursed to the City under this policy. The cost of the City's stop loss insurance
is funded in the Health & Wellness fund.
R C� C� R M "I P.,
co
In -x w wW CS H In
VI m IN IN'
11 In
CD C� w 19
lb
IN
vi
0
IT CJ 1, w 0
w
In I� 11 ca ;D
M
PJ 11 In W In ID
N V) 'I T4 M
In
I eq
0 W, 0 IDcY
Id. T, 14 m 16 W
'q"I I'm
Iq IN
14 In
V� VF
0 0
41 0 O Q0 0 LA
r
N 0 L" N rli II l I Ii x 9
E N
u
0
O
rn IT
IQ w
CIO w I,)'
cr�
EZ
IN
0 0
IS IS
IT) w M
O
VI
O
C,
4 4
16
In
In
O
k2
-16
IN
x u m
---—------- ..................... .........................
39
ECONOMIC and COMMUNITY DEVELOPMENT
Ben Wolters, Director
K� O T xc�a�s�� PLANNING DIVISION
Charlene Anderson, AICP, Planning Manager
Phone: 253-856-5454
Fax: 253-856-6454
220 Fourth Avenue S.
Kent, WA 98032-5895
Date: November 17, 2015
TO: Kent City Council Operations Committee
FROM: Ben Wolters, Economic and Community Development Director
RE: Lodging Tax Advisory Committee Board Member Expansion Ordinance
MOTION: Recommend City Council adopt an ordinance amending Chapter
2.54 of the Kent City Code, entitled "Lodging Tax Advisory Committee," to
increase the number of committee members from seven to nine.
SUMMARY: The Lodging Tax Fund has seen a steady increase in hotel/motel tax
revenues in the past three years with 17 motel/hotels in Kent.
The Lodging Tax Advisory Committee is pursuing a more aggressive and expansive
strategy to market Kent to visitors and businesses through a new marketing brand
and a targeted social media, radio, and TV campaign.
With the growing work of the Committee, it would be useful to include a wider
range of voices and broader participation on the Committee from those who collect
the hotel/motel tax (hotels) and those community representatives that use lodging
tax funding to promote Kent to help guide the marketing and branding strategy for
Kent.
BACKGROUND: The Lodging Tax Advisory Committee currently consists of seven
members. Three members appointed by the City Council, are representatives of
businesses required to collect tax (hotels) under Chapter 67.28 RCW (Ordinance
3417). Three members, also appointed by the City Council, are persons involved in
activities authorized to be funded by revenue received (i.e., Kent Downtown
Partnership, ShoWare Center) under Chapter 67.25 RCW (ordinance 3417). The
Council President appoints one member of Council's Operations Committee to serve
as a member of and to Chair the Lodging Tax Advisory Committee.
The Lodging Tax Advisory Committee also makes reports and recommendations to
the Mayor and City Council as follows;
• The committee considers proposals for impositions of a City lodging tax
under Chapter 67.28 RCW.
• If such tax is adopted, the Committee reviews any proposed increase in the
rate of tax imposed, repeal of any exemptions from a tax imposed, or a
40
change in the use of revenue received under Chapter 67.28 RCW. The
Committee considers all such proposals, provides for public input, and
submits comments in a timely manner to the Mayor and the City Council. The
comments must include an analysis of the extent to which the proposal will
accommodate activities for tourists or increase tourism, and the extent to
which the proposal will affect the long-term stability of the fund created
under RCW 67.28.1815.
The proposed amendment would increase the membership of the Lodging Tax
Advisory Committee from seven to nine members, adding one representative
position each from the hotel community and from the visitor promotion community
in Kent. Doing so will both broaden and deepen the Committee's representation of
the community as Kent continues to grow and take more proactive steps to market
itself in the region, around the state and beyond.
BUDGET IMPACT: None
41
ORDINANCE NO.
AN ORDINANCE of the City Council of the
City of Kent, Washington, amending Chapter 2.54
of the Kent City Code, entitled "Lodging Tax
Advisory Committee," increasing the number of
committee members from seven to nine.
RECITALS
A. The Lodging Tax Fund has seen a steady increase in
hotel/motel tax revenues in the past three years with 17 motel/hotels in
Kent.
B. The Lodging Tax Advisory Committee is pursuing a more
aggressive and expansive strategy to market Kent to visitors and
businesses through a new marketing brand and a targeted social media,
radio, and TV campaign.
C. With the growing work of the Committee, it would be useful
to include a wider range of voices and broader participation on the
Committee from those who collect the hotel/motel tax (hotels) and those
community representatives that use lodging tax funding to promote Kent
to help guide the marketing and branding strategy for Kent.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
WASHINGTON, DOES HEREBY ORDAIN AS FOLLOWS:
1 Amend KCC 2.54 -
Re. Lodging Tax Advisory Committee
42
ORDINANCE
SECTION 1. - Amendment. Chapter 2.54 of the Kent City Code,
entitled "Lodging Tax Advisory Committee," as follows:
Sec. 2.54.010. Created. There is hereby created the lodging tax
advisory committee. The committee shall serve in an advisory capacity to
the mayor and city council.
Sec. 2.54.020. Membership. The lodging tax advisory committee
shall consist of sevennine {7}members as follows:
A. ThFeeFour {3)—members appointed by the city council who are
representatives of businesses required to collect tax under Chapter 67.28
RCW;
B. ThFeeFour {3)—members appointed by the city council who are
persons involved in activities authorized to be funded by revenue received
under Chapter 67.28 RCW; and
C. The council president shall appoint a member of council's operations
committee to serve as a member of and to chair the lodging tax advisory
committee.
Sec. 2.54.030. Terms. All members appointed pursuant to KCC
2.54.020 above shall serve three={H�--year terms. The initial appointment
shall be staggered with tw-athree Ryappointments serving a one=-(Iyyear
term, twethree {}appointments serving a two-- �year term, and two
{2-)--appointments serving a three=--f3)--year term. Organizations
representing businesses required to collect tax under Chapter 67.28 RCW
and organizations involved in activities authorized to be funded by revenue
2 Amend KCC 2.54 -
Re. Lodging Tax Advisory Committee
43
received under said tax as well as local agencies involved in tourism and
promotion may submit recommendations for membership on the
committee.
Sec. 2.54.040 Responsibilities. The lodging tax advisory
committee shall make reports and recommendations to the mayor and city
council as follows:
A. The committee shall consider proposals for imposition of a city
lodging tax under Chapter 67.28 RCW.
B. If such tax is adopted, the committee shall review any increases in
the rate of tax imposed, repeal of any exemption from a tax imposed, or a
change in the use of revenue received under Chapter 67.28 RCW. The
committee shall consider any such proposal, provide for public input, and
submit comments in a timely manner to the mayor and city council. The
comments shall include an analysis of the extent to which the proposal will
accommodate activities for tourists or increase tourism, and the extent to
which the proposal will affect the long-term stability of the fund created
under RCW 67.28.1815.
SECTION 2. — Severability. If any one or more section, subsection,
or sentence of this ordinance is held to be unconstitutional or invalid, such
decision shall not affect the validity of the remaining portion of this
ordinance and the same shall remain in full force and effect.
SECTION 4. — Corrections by City Clerk or Code Reviser. Upon
approval of the city attorney, the city clerk and the code reviser are
authorized to make necessary corrections to this ordinance, including the
correction of clerical errors; ordinance, section, or subsection numbering;
or references to other local, state, or federal laws, codes, rules, or
regulations.
3 Amend KCC 2.54 -
Re. Lodging Tax Advisory Committee
44
SECTION 5, — Effective Date. This ordinance shall take effect and
be in force 30 days from and after its passage, as provided by law.
SUZETTE COOKE, MAYOR
ATTEST:
RONALD F. MOORE, CITY CLERK
APPROVED AS TO FORM:
TOM BRUBAKER, CITY ATTORNEY
PASSED: day of 2015.
APPROVED: day of 2015.
PUBLISHED: day of 2015.
I hereby certify that this is a true copy of Ordinance No.
passed by the City Council of the City of Kent, Washington, and approved
by the Mayor of the City of Kent as hereon indicated.
(SEAL)
RONALD F. MOORE, CITY CLERK
p:\civil\ordinance\lodging tax advisory committee kcc 2.54.docx
4 Amend KCC 2.54 -
Re. Lodging Tax Advisory Committee