HomeMy WebLinkAboutC11-285 CNIC Adminstration Service Agreement Amendment AMENDMENT
TO
ADMINISTRATION SERVICE AGREEMENT
CNIC HEALTH SOLUTIONS, INC. EAGLE COUNTY GOVERNMENT
a Colorado corporation (herein "CNIC ") (herein "Plan Sponsor ")
Address of CNIC: Address of Plan Sponsor:
6251 Greenwood Plaza Blvd., Suite 300 500 Broadway
Greenwood Village, CO 80111 Eagle, CO 81631
Tax I.D. No.: 84- 6000762
CNIC and Plan Sponsor are parties to an Administration Service Agreement dated September 8,
2008, under which CNIC provides Administration Services to Plan Sponsor. The Administration
Service Agreement and any amendments thereto shall collectively be referred to as the
"Agreement." All definitions and terms of the Agreement are incorporated herein by this
reference.
CNIC and Plan Sponsor desire to amend the Agreement.
CNIC and Plan Sponsor agree to all Terms and Conditions, attached, along with the Exhibits
described below, all of which are incorporated herein by this reference.
This Amendment is dated and shall be effective on the date set forth below by CNIC as the
effective date.
CNIC . - ' H SOLUTIONS, INC., EAGL COUNTY GO RNMENT
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Effective Date: January 1, 2011
ATTACHMENTS:
Exhibit A — Administration Services/Fees
Eagle County Government
TERMS AND CONDITIONS
1. Agreements — (2) Services to be Performed. The section in the Agreement, which is
entitled "Services to be Performed" shall be amended by the addition of (q) provide
eligibility information upon request when required by applicable Federal and/or state
law for the performance of Medicare and/or Medicaid eligibility screening and
similar services
2. Agreements — (7) Term and Termination. The section in the Agreement, which is
entitled "Term and Termination" shall be amended by the deletion of paragraph
7(a)(iii) and the replacement of paragraph 7(a)(iii) with the following provision:
With or without cause by providing thirty (30) days advanced written notice of its
intent to terminate to the other party thirty.
3. Agreements — (12) Indemnification. The section in the Agreement, which is entitled
"Indemnification" shall be amended by the deletion of the entire section and replaced
with the following language:
Indemnification. To the extent permissible by law, the Contract Administrator
agrees to fully and forever indemnify, protect, and hold harmless the Plan Sponsor
and its officers, directors, shareholders, employees, agents, contractors,
representatives, counsel and affiliates, and their respective heirs, successors and
assigns, from and against any and all controversies, claims, demands, rights, causes of
action, liens, remedies, obligations, duties, damages, costs, losses, expenses,
attorney's fees, debts and liabilities (collectively, the "Claims ") which are in any
manner whatsoever associated or connected with or related to or arise out of a willful
or bad faith breach by the Contract Administrator of any of its representations,
warranties, agreements or covenants under this Agreement, whether any or all of such
Claims are, at the present time, liquidated or unliquidated, known or unknown,
foreseen or unforeseen, concealed or hidden, suspected or unsuspected, or statutory,
at law or in equity.
To the extent permissible by law, the Plan Sponsor agrees to fully and forever
indemnify, protect, and hold harmless the Contract Administrator and its officers,
directors, shareholders, employees, agents, contractors, representatives, counsel and
affiliates, and their respective heirs, successors and assigns, from and against any and
all Claims which are in any manner whatsoever associated or connected with or
related to or arise out of a breach by the Plan Sponsor of any of its representations,
warranties, agreements, covenants, obligations, or actions under this Agreement,
whether any or all of such Claims are, at the present time, liquidated or unliquidated,
known or unknown, foreseen or unforeseen, concealed or hidden, suspected or
unsuspected, or statutory, at law or in equity.
4. Agreements — (29) Requirements under Colorado's Tax Payor's Bill of Rights
(TABOR). The Agreement shall be amended to add section 29 titled "Requirements
under Colorado's Tax Payor's Bill of Rights (TABOR) ", which shall include the
following language:
Notwithstanding anything to the contrary contained in this Agreement, no charges
shall be made to the Plan Sponsor nor shall any payment be made to the Contract
Eagle County Government 2 2011 ASA Amendment
Administrator in excess of the amount for any Services done without the written
approval in accordance with a budget adopted by the Board in accordance with
provisions of the Colorado Revised Statutes. Moreover, the parties agree that the
County is a governmental entity and that all obligations beyond the current fiscal year
are subject to funds being budgeted and appropriated.
5. Exhibit A - Administration Service Fees. The Exhibit to the Agreement, which
describes the Administration Services provided and the fees charged by CNIC under
the Agreement, shall be deleted in its entirety and replaced with the attached Exhibit
A, entitled, "Administration Services."
6. Effect. Except as set forth in this Amendment, all terms, covenants and conditions of
the Agreement shall remain in full force and effect.
7. Effective Date. This Amendment is effective for Administration Services provided
on or after the effective date set forth above.
Eagle County Government 3 2011 ASA Amendment
EXHIBIT A
ADMINISTRATION SERVICES/FEES
1. Administration Service Fees
Plan Sponsor shall pay CNIC the monthly fee specified on lines (a) through (c) below for the
Administration Services described in paragraph 1.A.(1) of the Agreement, along with the
printing and document fees described below. Additionally, Plan Sponsor shall pay CNIC the
fees specified below for the Additional Services described on lines (d) through (o) which are
checked.
X (a) Monthly Administration Services fee of $18.38 Medical/$2.57 Dental /$0.51
Vision per Enrolled Employee per month.
(b) Broker /Consultant fee per Enrolled Employee per month.
(c) An initial one -time set up fee.
X (d) Monthly COBRA* administration fee of $1.78 per Enrolled Employee per
month.
(e) COBRA* general /initial notice fee per Enrolled Employee per month.
X (1) HIPAA* certification letter fee is included in the COBRA administration fee for
CNIC to provide HIPAA certification letters of creditable coverage.
X (g) Utilization review fee is included in the Administration Services fee for CNIC to
provide utilization review services.
X (h) CNIC's On -line Access Fee is included in the Administration Services for access
to CNIC's on -line services.
(i) 24 hour Nurseline fee per Enrolled Employee per month to be paid to the Vendor
for access to 24 hour Nurseline.
(j) Premium Billing fee per Enrolled Employee per month.
X (k) CNIC's Disease Management fee $7.00 per Enrolled Employee per month.
X (1) Rx fee of $2.00 per fill to be paid to the Rx Vendor for pharmacy benefit
manager services.
X (m) HRA fee of $6.00 per Enrolled Employee per month.
(n) Run -in Fees are 2 x first month's fees or as negotiated.
X (o) Fee of $450.00 per form for assisting Plan Sponsor with preparation of form
5500 (excluding independent audit).
Rate increase not to exceed 2% in 2" year
*If changes to regulations relating to COBRA or HIPAA result in increased costs to CNIC to
provide these services, CNIC has the right to adjust these fees accordingly upon written
notice to Plan Sponsor.
Plan Sponsor shall reimburse CNIC for any additional expenses incurred by CNIC, including
additional programming, reporting or service costs, resulting from a change in the Plan. If
any fines are levied against CNIC by the United States Department of Labor, CMS or any
regulatory agency due to Plan Sponsor's failure to provide information, including but not
limited to social security numbers, to CNIC, Plan Sponsor shall reimburse CNIC for such
Exhibit A
Eagle County Government Page 1 of 6 2011 ASA Amendment
expenses or fines. Such expenses or fines will be immediately paid by Plan Sponsor upon
receipt of an invoice from CNIC.
2. PPO Network Access Fees
Plan Sponsor shall pay CNIC as set forth below for Network Access that is part of
Administration Services.
$7.50 Per Enrolled Employee Per Month — Cofinity
21% of Savings — Multiplan Complimentary Network
Network access fees are to be paid to CNIC. If Plan Participants access providers out of
Colorado, the Multiplan Complimentary Network will be used and billed at twenty -one
percent (21 %) of savings. Savings are defined as the difference between the provider billed
charge and the contracted allowed amount. These fees may be subject to change if Plan
Sponsor deems a change in network or medical management vendor is necessary.
Additionally, fees may be subject to change if the fees charged to CNIC by provider network
or medical management vendor are changed. CNIC agrees to make best efforts to provide at
least thirty (30) days notice of any fee changes. Plan Sponsor acknowledges and agrees that
CNIC may retain all or a portion of the access fees paid to CNIC, depending on CNIC's
agreement with the network providers.
3. Payment of Fees
CNIC shall provide a monthly statement to Plan Sponsor, on or before the beginning of each
month, of the fees listed above, based upon the number of Enrolled Employees as of the date
the statement is prepared. Statements are prepared on or about the 20 of each month for
fees due for services to be provided in the following month. For the initial month, CNIC will
use the enrollment information provided by Plan Sponsor when the Plan is set up. Plan
Sponsor shall remit payment to CNIC by the 10 of the month. If the Plan Sponsor does not
provide sufficient funds to meet Plan Sponsor's obligations under this Agreement, including
but not limited to the payment of claims, premiums, Administration Service fees, any other
fees, service charges or late fees, CNIC may immediately terminate this Agreement upon
written notice to Plan Sponsor if payment is not received by the 15 of next month that
follows the payment due date and /or a late fee is assessed more than 3 times in a 12 month
period. The rights of CNIC set forth above shall not limit any other rights of CNIC under the
Agreement in the event Plan Sponsor fails to remit payment.
Exhibit A
Eagle County Government Page 2 of 6 2011 ASA Amendment
4. Payments to Vendors
CNIC shall provide a monthly statement to Plan Sponsor, on or before the beginning of each
month, of the premiums, fees and costs due to carriers and other vendors providing services
to the Plan, based upon the number of Enrolled Employees as of the date the statement is
prepared. Statements are prepared on or about the 20 of each month for premiums, fees and
costs due in the following month. For the initial month, CNIC will use the enrollment
information provided by Plan Sponsor when the Plan is set up. The premiums, fees and costs
shall include but not be limited to reinsurance premiums, pharmacy benefit management fees,
network access fees, ancillary insurance premiums and fees and costs associated with vendor
services elected for or selected by Plan Sponsor under any vendor service agreements or
contracts to which CNIC is a party. Plan Sponsor shall remit payment to CNIC of all such
premiums, fees and costs by the 10 of the month. CNIC shall collect from Plan Sponsor or
deduct from the Plan account such premiums, fees and costs on or after these dates. In the
event adequate funding is not timely provided to CNIC to make these payments on more than
one occasion, CNIC, at its option, may require that Plan Sponsor be responsible for making
direct payment to such carriers and vendors. If the Plan's funds are insufficient, or if Plan
Sponsor does not submit to CNIC payment sufficient to cover the amount of premiums, fees
and costs by the last day of the month for that month's coverage, Plan Sponsor understands
and agrees that the group's reinsurance and other policies may be terminated for non-
payment of premium and CNIC shall have no liability to Plan Sponsor for such termination
of coverage. Plan Sponsor understands and agrees that it will maintain the funds necessary to
provide for the timely payment of such premiums, fees, costs and any and all liabilities of the
Plan. CNIC shall have no liability for payment of premiums, fees or costs due on behalf of
the Plan.
5. Printing and Document Fees
All ongoing printing costs not specifically included in the set -up fee, including, but not
limited to, the printing or reprinting of ID cards, summary plan description booklets, custom
checks, custom claim forms, custom enrollment cards or any other custom printing, are the
responsibility of Plan Sponsor. Plan Sponsor shall pay these costs upon receipt of an invoice
for the costs.
The fees for printing or reprinting ID cards are as follows:
Imprinted Plastic ID cards $1.50 per card
Printed/Laminated ID cards
1— 500 cards (minimum $150.00) $1.50 per card
501 -1,000 cards $1.10 per card
1,001 or more cards $.75 per card
Note: The number of ID cards printed or reprinted is at least 2 -1/2 times enrollment.
All charges for preparing or updating ID cards are the responsibility of Plan Sponsor.
Exhibit A
Eagle County Government Page 3 of 6 2011 ASA Amendment
The fees are per Plan Document are as follows:
Health Plan Documents with Standard Corbel Formats*
Initial Health Plan Document —
requiring reconciliation to old document $ 1,250.00
Restated Health Plan Document —
changes to both Schedule of Benefits and other language $ 1,000.00
Restated Health Plan Document —
changes limited to Schedule of Benefits $ 250.00
Initial Dental and /or Vision Plan Document —
Standard Corbel document requiring reconciliation to old document $ 500.00
Restated Dental and /or Vision Plan Document —
Standard Corbel document with changes to
both Schedule of Benefits and other language $ 250.00
Restated Dental and /or Vision Plan Document —
Standard Corbel document with changed limited to
the Schedule of Benefits $ 50.00
Health Plan Documents with Non - Corbel Formats*
Initial Health Plan Document - Non - Corbel document
requiring reconciliation to old document $ 2,000.00
Restated Health Plan Document - Non - Corbel document with
changes to both Schedule of Benefits and other document language $ 1,500.00
Restated Health Plan Document - Non - Corbel document with
changed limited to the Schedule of Benefits $ 250.00
The fees for preparing amendments are as follows:
Single Plan Document Amendment* $ 100.00
Multiple Plan Document Amendments (All prepared at the same time) $ 150.00
The fees for preparing outlines of benefit schedules are as follows:
Initial Outline of benefit schedule —
Prepared at same time as initial plan document No charge
Restate outline of benefit schedule $ 100.00
Provide outline of benefit schedule on disk No charge
Multiple documents for a single customer Contact
Documents
Team
*Not applicable to Eagle County Government
All charges for preparing, restating or updating current or prior plan documentation are the
responsibility of Plan Sponsor.
The fees for printing or reprinting booklets will vary depending on volume, book size
and other factors. Contact your CNIC account manager to obtain a fee estimate. Plan
Sponsor shall pay these costs upon receipt of an invoice for the costs.
Exhibit A
Eagle County Government Page 4 of 6 2011 ASA Amendment
6. Other miscellaneous service fees as performed
Plan Sponsor shall pay CNIC the following miscellaneous service fees upon receipt of an
invoice for such fees:
a) For any aggregate claim filing, a charge of $150.00 per hour up to $1,100.00 will be
made for additional administrative duties necessary to provide records in preparation
and assistance with audit.
b) Subrogation services are charged at ten percent (10 %) of recovery, up to a maximum
fee of $2,000.00 per case, plus reimbursement for out of pocket expenses incurred by
CNIC.
c) Negotiation services for out -of- network claims are charged at twenty -three percent
(23 %) of negotiated savings per case.
d) Any additional expenses incurred by CNIC, including additional programming,
reporting or service costs, resulting from a change in the Plan will be paid by Plan
Sponsor upon receipt of a billing from CNIC.
7. Fees Charged Upon Termination
The fees for CNIC's services for run -out claims administration, after termination of the Term
of this Agreement, shall be based on the average of fees during the last two (2) calendar
months immediately preceding the termination date of this Agreement (the "Average Fees "),
as follows:
% of the Average Fees
Months After the Immediately
Preceding One -Year Term
100% 1 month
80% 2 " month
60% 3` month
40% 4th month
25% 5 th month
25% 6 month and thereafter
Notwithstanding the rate chart above, if twelve (12) months of run out services are elected
and fully funded prior to the last day of the Term of this Agreement, the twelve (12) months
of run -out services will be provided at 350% of the Average Fees.
Run -out services will not be provided if:
a) Plan Sponsor is not current in its funding of all premiums, fees and claims at the time of
termination; and
b) The amount of CNIC's fees for the term of the run -out services are not received in
advance of such services. CNIC shall provide a statement to Plan Sponsor of the amount
of fees due for the run -out period purchased.
Exhibit A
Eagle County Government Page 5 of 6 2011 ASA Amendment
If Plan Sponsor does not request and purchase run -out claims administration services prior to
the last day this Agreement is in effect, and subsequently requests such run -out services,
there will be a charge of $350.00 in addition to the rates set forth in the chart above. If Plan
Sponsor requests an extension to the originally purchased run -out period after such run -out
period has ended, the fee for each additional month will be as set forth in the chart above plus
a charge of $350.00. Claims received after the end of the purchased run -out period will be
submitted to the new administrator for three (3) months.
CNIC will charge a fee of $2.00 per unissued check, to void any checks that are unfunded at
the time the Agreement is terminated. Unfunded checks will not be printed or returned to
Plan Sponsor. CNIC will however, upon request, provide the Client with a listing of unissued
or unfunded checks within 19 days of the Termination notice.
8. Preparation of Reports Upon Termination of This Agreement
Upon request, CNIC will provide the following standard reports upon termination of this
Agreement. Reports will be provided in the standard electronic format used by CNIC at the
time of termination:
• Eligibility Listing — List of active Plan Participants and COBRA participants
• Individual Specific Analysis - List of individuals at/exceeding fifty percent (50 %)
of specific deductible for current contract period and all applicable disclosure data
• Paid Claims Analysis — Claims paid history for current and previous year
• Accumulation Data — Deductible, life time maximum, etc.
• Final Status of Qualified Beneficiaries — if COBRA Administration Services are
elected
Also upon request, CNIC will provide HIPAA Certificates upon termination of this
Agreement if HIPAA Administration Services are elected.
Additional reports may be provided upon request at a mutually agreed upon fee payable in
advance.
Exhibit A
Eagle County Government Page 6 of 6 2011 ASA Amendment
