No preview available
HomeMy WebLinkAboutC20-007 Voya Financial - AdministrationSelf-Administered Page 1 of 2 - Incomplete without all pages. Order #173385 05/17/2018 ADMINISTRATION AGREEMENT ReliaStar Life Insurance Company, Minneapolis, MN ReliaStar Life Insurance Company of New York, Woodbury, NY Members of the Voya® family of companies (the “Company”) Policyholder Name (the “Policyholder”) Eagle County Government Policy Effective Date 01/01/2020 Insurance Contracts. The Company issues insurance policies and certificates based on your application and our state approved products (the “Policies”). Our obligations are determined solely by the terms of the policies we issue. EXCESS RISK COVERAGE Claim Administration. Upon determination of a potential claim under the Policy, you will confirm employees’ eligibility for coverage and provide required eligibility and claim documentation to the Company, either directly or through your health claim administrator. The Company shall be responsible for all claim reviews, determinations and payments under the Policy. Confidentiality. We will keep confidential all information provided to us by you or your health claims administrator in connection with the Policy, in compliance with applicable law. You authorize your health claims administrator, if any, to release to the Company information and data regarding claims paid to be used in connection with the Policy. GROUP ANNUAL TERM LIFE, PERSONAL ACCIDENT INSURANCE, DISABILITY, CRITICAL ILLNESS, ACCIDENT AND/OR HOSPITAL CONFINEMENT INDEMNITY COVERAGE Policy Administration. Your group policy will be “Self-Administered”. This means that you or a third party that you engage will be responsible to maintain all enrollment, beneficiary, and billing records for the Policies (as applicable). The records you keep must provide the ability for you and/or your employees to: • appropriately apply Policy limits and rules • know how much coverage the employee has at all times • provide the employee with the appropriate “Conversion” and/or “Portability” documentation (as applicable) • set up any payroll deductions correctly • pay premium to the insurance company with supporting documentation • file a claim The parties agree that the Policies will be self-administered by Policyholder and that the insurance charges reflect that arrangement. Communications. All forms and other materials we provide to you must be presented to employees without alteration. Any benefit and eligibility descriptions you or your third party service provider communicates to employees must be consistent with the materials and guidelines we provide to you. We will work carefully with you to make corrections in the case of any inadvertent error in communications. However, you are responsible for any costs incurred in correcting errors caused by incorrect data you provide to employees or to Company, including incorrect benefit descriptions and eligibility determinations. Evidence of Insurability. If evidence of insurability is required in connection with an application for coverage under the terms of a Policy, you will apply the evidence of insurability rules appropriately, obtain the necessary forms from any applicant for such coverage and provide those forms to the Company. Claim Administration. Upon receipt of notice of a potential claim under a Policy, you will confirm employees’ eligibility for coverage and provide required claim documentation at the Company‘s request. The Company shall be responsible for all claim reviews, determinations and payments. Certificates of Insurance and Summary Plan Description. If you request that we provide Summary Plan Description(s) (“SPD”) for distribution to ERISA plan participants, we will provide the SPD using our standard language and format unless otherwise directed by you. If we agree to electronically post certificates of insurance and/or SPDs for access by your employees, you are responsible for assuring that each covered employee is informed how the documents can be accessed and that each employee has access or otherwise receives a copy(ies) of these documents. Any legal advice as to the style, format, content or distribution of the SPD or distribution of the certificate of insurance must be provided by your legal counsel. We are unable to provide legal advice to your plan and assume no responsibility for meeting ERISA’s disclosure requirements. Indemnity. Each party shall indemnify and hold the other harmless against any and all losses, claims, damages, costs or expenses (including reasonable attorneys’ fees) which the indemnified party may become obligated to pay resulting from 1) the indemnifying party’s error or omission in performing obligations under this Agreement, except to the extent that the indemnified party has caused or significantly contributed to such error or omission, and 2) any breach by the indemnifying party of any of its obligations under this Agreement regardless of whether such breach is either willful or negligent. RESET FORM DocuSign Envelope ID: 1C04E937-896D-4D97-B058-8D40438C8D6E Self-Administered Page 2 of 2 - Incomplete without all pages. Order #173385 05/17/2018 GENERAL ADMINISTRATION – ALL PRODUCTS: Record Keeping. You agree to maintain accurate books and records documenting the administration of the Policies, including employee demographics, eligibility records, dependent data, coverage amounts, enrollment history, payroll deductions, benefit elections and beneficiary designations (as applicable). Such records must be maintained for a period of seven (7) years following termination of the Policies to which they relate. Upon reasonable notice, we shall have the right to review, inspect and audit, at our expense, the books, records, data files or other information maintained by you or your vendor related to the Policies. Transmission of Data. You are responsible for the accuracy and security of data transmitted to us, including data transmitted by any third party service provider you engage to assist in administration of your benefit plans. Each party will establish and maintain (1) administrative, technical and physical safeguards against the destruction, loss or alteration of data, and (2) appropriate security measures to protect data, which measures are consistent with all state and federal regulations relating to personal information security, including, without limitation, the Gramm-Leach-Bliley Act. Premium payment. If you engage a third party to submit premium to us, we will not consider the premium paid until it is received in our Home Office. General terms. This Agreement will remain in effect during the duration of the Policy and will terminate automatically upon termination of all Policies. This Agreement may be amended only in writing signed by both parties. In the event of any conflict or inconsistency between the terms of this Agreement and the terms of any Policy, the terms of the Policy shall control. Governing law. This Agreement shall be governed in all respects, including validity, interpretation and effect, without regard to principles of conflict of laws, by the law of the state where the Policy is issued. Accepted and Agreed to: Policyholder Name (Please print.) Policyholder Authorized Signature Date Print signer’s name and title RELIASTAR LIFE INSURANCE COMPANY RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK Company Authorized Signature Date 10/22/2019 Print signer’s name and title Mona Zielke, Vice President DocuSign Envelope ID: 1C04E937-896D-4D97-B058-8D40438C8D6E Jeanne McQueeney 1/7/2020 Commissioner