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Backup Documents 09/08/2015 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO i Q THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTINGSLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office WS- 11 •2• I5 4. BCC Office Board of County Commissioners \`�z\ 5. Minutes and Records Clerk of Court's Office T 1 //z-1 c c`;/5 PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Jeff Walker/Alice Toppe 252-8906 Contact/ Department Agenda Date Item was September 8,2015 Agenda Item Number 16E3 Approved by the BCC Type of Document Aetna Disability Service Agreement Number of Original One(1) Attached Documents Attached PO number or account n/a number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signa re STAMP OK j\ -• 2. Does the document need to be sent to another agency for additiona signatures? If yes, JW provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signedIQ,� by the Office of the County Attorney. �'^�" 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JW signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 9/8/15 and all changes made during t 111 meeting have been incorporated in the attached document. The County Attorney ! Office has reviewed the chances,if a' I licable. 9. Initials of attorneyverifying that the attached document is the version approved bythe '-d".1-07," fy� g pp BCC,all changes directed by the BCC have been made, and the document is ready fo'the Chairman's signature. i . [04-COA-01030/1220424/111:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.0 .! Revised 1 ..05,Revised 2.24.05; Revised 11/30/12 I 6 E 3 MEMORANDUM Date: November 2, 2015 To: Jeff Walker, Director Risk Management Department From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Aetna Disability Service Agreement Attached for your records is one (1) copy of the resolution referenced above, (Item #16E3) adopted by the Board of County Commissioners on Tuesday, September 8, 2015. The Minutes and Record's Department has held the original document for the Official Record of the Board. If you have any questions, please contact me 252-8411. Thank you. Attachment 16E3 3 Collier County Government Disability Rate Summary aletnam Proposed Disability Rates Administrative Service Contract Per Employee Coverage Lives Per Month Monthly Fees Short Term Disability ASC 2,011 $2.547 $5,121 We have assumed an annual incidence rate of 3.71%. Monthly Fees $5,121 Annual Fees $61,453 The above fees are subject to verification of lives as appropriate. If the actual amounts differ by more than 10%from our assumed amounts then we reserve the right to reevaluate the fees. March 2015 aria Page 1 G4" 16F Collier County Government Disability Rate Summary Fully Insured Long Term Disability Rate Per$100 Monthly of Monthly Monthly Long Term Disability Lives Covered Payroll Covered Payroll Premium Core Only 953 4,147,062 $0.124 $5,138 Buy-Up 1,062 4,703,669 $0396 $18,650 Monthly Total 2,015 8,850,731 $23,788 Annual Premium $285,457 The above fees are subject to verification of lives as appropriate.If the actual amounts differ by more than 10%from our assumed amounts then we reserve the right to reevaluate the fees. March 2015 Wirral Page 2 16E 7 Collier County Government Short Term Disability Administrative Services Plan Administrative Services Contract Short Term Disability Schedule of Benefits Effective Date 01/01/2016 Contract Period 36 months ASC Short Term Disability Number of Eligible Employees 2,011 Class 1:All Active FT excluding those defined in Class 2 Eligibility Class 2:County Attorney and Board Aide Class 3:County Mgr Eligibility Waiting Period First of the month following Date of Hire Minimum Hours Per Week 30 hours Employee Contribution 100%for Buy-up Employer FICA Match Not Included Participation Requirement None March 2015 " Page 3 �,P Collier County Government Short Term Disability Administrative Services Plan ASC Short Term Disability Schedule We will administer this plan in accordance with current plan specifications. Injury-Day Benefits begin 8th day Illness-Day Benefits begin 8th day Maximum Benefit Period 26 weeks Definition of Covered Earnings Base rate of earnings exclusive of commissions, bonuses, overtime or extra compensation. Class 1:Core:40%of earnings, Buy-up:66 2/3%of earnings; Benefit Percentage Class 2:50%of earnings Class 3:66 2/3%of earnings Percentage Cap N/A Maximum Weekly Benefit Class 1:$2,000 Class 2 &3:$2,250 Minimum Benefit None Coverage Type Non-Occupational Definition of Disability Inability to perform own occupation and have a 20%earnings loss. Partial Disability Benefit Included First Day Hospitalization Not Included Integration Method Not Applicable-LTD will still be affected by Offsets Rehabilitation Provision Voluntary Separate Periods of Disability Less than 15 consecutive days Pre-existing Condition Exclusion Not Included Does not cover any disability that: •Occupational disabilities •Self-inflicted injuries Exclusions • Committing or attempting to commit a criminal act •Act of war,driving while intoxicated • Insurrection • Rebellion •Taking part in a riot or civil commotion March 2015 acting Page 4 C34 16E3 Collier County Government Administrative Services Administrative Services Contract Basic Services Self-Funded(ASC) Short Term Disability Core Services and Programs included in Administrative Fees Eligibility Verification Included Clinical Model: Physician Review,Senior Nurse Review, Behavioral Health Unit, Case Management Included Intake(3 point contact) Included Claim Determination Included Contract Issuance Included W2s(included if Aetna pays benefit) Included Standard Reporting Included Standard Portal Included Standard Correspondence Included Independent Medical Examination Included Vocational Rehabilitation(fee for external services) Included Social Security Assistance(fee for external services per event) Included Physician Peer Review Included Special Investigations Unit(fee for external services) Included Subrogation Not Included Appeals 1 Level Optional Services Reverse File Feed $10,000 per file Eligibility File requiring customization $150 per hour Dedicated 800 number $5,000 per line Customization of Communication Letters $150 per hour Customization of Intake Script $150 per hour Customization of Reports $150 per hour Fee Based is direct billed back to the customer at Aetna's cost. *Aetna will not be fiduciary on non-ERISA plans March 2015 ' ett' Page 5 C�' 1 bE Collier County Government Long Term Disability Long Term Disability Schedule of Benefits Effective Date 01/01/2016 Contract Period 36 months Commission Level 10%Commissions on Buy-up Long Term Disability Number of Eligible Employees 2,015 Total Covered Payroll $8,850,731 Class 1: EEs excluding Exec Mgr to Board,County Mgr&County Eligibility Attorney; Class 2:Exec Mgr to Board&County Attorney; Class 3:County Mgr. Eligibility Waiting Period First of the month following Date of Hire Minimum Hours Per Week 30 hours Employee Contribution 100%Post-Tax for Buy-up Employer FICA Match Included on Employer paid lines Evidence of Insurability included for Late Entrants on Buy-up Participation Requirement None March 2015 MIME Page 6 Collier County Government Long Term Disability Long Term Disability Schedule For additional details,refer to the LTD Plan Provisions and Glossary sections. Class 1:Core 40%of earnings;Buy-up 66 2/3%of earnings; Monthly Benefit Percent Class 2:50%of earnings Class 3:66 2/3%of earnings Monthly Maximum Benefit Class 1&2:$9,000; Class 3:$10,000 Monthly Minimum Benefit $100 Elimination Period 180 days Base rate of earnings exclusive of commissions,bonuses, Definition of Covered Earnings overtime or extra compensation. Own Occupation Period Class 1:24 months; Class 2&3:Own Occupation Work Incentive Benefit Included, 12 months Partial Disability Benefit Proportional Loss Formula(See LTD Plan Provisions) Integration Method Direct Employee Only Zero Day Residual Included Maximum Benefit Period ADEA 1 with SSNRA(See LTD Plan Provisions) Rehabilitation Program Mandatory Rehabilitation Incentive Benefit Included Child Care Benefit Included Separate Periods of Disability During the Elimination Period: less than 30 consecutive days. After the Elimination Period: Less than 6 consecutive months. Mental/Nervous Limitation 24 months of benefit payments per occurrence Alcohol/Drug Limitation 24 months of benefit payments per occurrence Survivor Benefit 3 months of gross benefit payable in a lump sum Pre-existing Condition Exclusion 3/12 Cost of Living Adjustment Not Included Does not cover any disability that result from: •Self-inflicted injuries •Committing or attempting to commit a criminal act, •Act of war, Exclusions • Driving while intoxicated • Insurrection • Rebellion •Taking part in a riot or civil commotion • Pre-existing conditions. Conversion Not Included Benefit Escalator Not Included Extended Disability Benefit Included Accidental Personal Loss indemnity Included Benefit March 2015 MinaPage 7 CA 16E3 Collier County Government Disability Glossary Disability Glossary Contribution Percentage The percentage of premium paid by the employee. The requirement disabled employees must meet to be eligible to Definition of Disability receive benefits. The amount of an employee's earnings used to calculate benefit Definition of Earnings payments. Eligibility Waiting Period The continuous period of time the employee must be working before becoming eligible for disability coverage. Eligible Class The group(s)of employees who are eligible for coverage. Elimination Period The period of time the employee must be disabled prior to receiving benefits. Satisfactory evidence of good health that is submitted in certain Evidence of Insurability situations.Completion of Aetna's Evidence of Insurability statement is required. Exclusions Those conditions for which benefits are not paid. Employer FICA Match Employer FICA match program applies only to taxes paid on the Employer portion of benefits. The United States of America,the Commonwealth of Puerto Rico, Home Area Guam,and the Virgin Islands of the United States. Maximum Benefit The maximum disability benefit payable. Maximum Benefit Period The maximum period of time benefits are payable after satisfaction of the elimination period. Minimum Benefit The minimum disability benefit payable. The minimum number of hours that employees regularly work each Minimum Hours week to be eligible for disability coverage. Partial Disability Benefit The method used to offset employment earnings during a period of disability. Physical,mental or vocational rehabilitation designed to maximize the Rehabilitation disabled employee's work capabilities. Scheduled Benefit The gross disability benefit payable. Separate Periods of The maximum amount of time a disabled employee can return to work Disability and have it considered the same period of disability.The periods of disability must be due to the same or related condition. Types of Disabilities The determination of whether disabilities occurring on or off the job are covered. March 2015 MOW Page 8 CA 16E3 Collier County Government Long Term Disability Plan Provisions LTD Plan Provisions Any day that an individual is unable to perform the material duties of his/her own occupation;or while unable to perform the material duties of his/her own occupation, is performing at least one of the material duties of any occupation on a part-time or full-time basis and has lost at least 20%of his/her indexed pre- Own Occupation Test disability earnings due to a disabling condition. Please note:The loss of a professional or occupational license or certification that is required by your own occupation does not mean you meet the test of disability.You must meet the plan's test of disability to be considered disabled. Any day that an individual is unable to perform the material duties of any occupation for which he/she is or may become fitted,based on training,education or experience;or while Any Occupation Test unable to perform the material duties of any reasonable occupation,is performing at least one of the material duties of any occupation on a part-time or full-time basis and has lost at least 20%of his/her indexed pre-disability earnings due to a disabling condition. During the disabled employee's active participation in an Aetna Approved Rehabilitation Program,Aetna will pay an additional Rehabilitation Incentive Benefit 10%net monthly benefit,but not more than$500 per month. This incentive will be paid up to 6 consecutive months for each period of disability. An additional monthly benefit paid for child care expenses for a Child Care Benefit disabled employee participating in an approved rehabilitation program of$250 per month per dependent child under age 13 with a maximum of$500 payable up to 24 months. Benefit Escalator Not Included A benefit paid to an eligible survivor if the employee dies while benefits are payable.The amount of the benefit is equal to the Survivor Benefit gross monthly benefit multiplied by the number of months shown in the Schedule of Benefits. An eligible survivor is defined as the spouse and/or unmarried dependent children under age 25. March 2015 MUM'. Page 9 �9 16E3 Collier County Government Long Term Disability Plan Provisions Other income sources which are used to reduce the monthly benefit.This includes but is not limited to: • 50%of the Jones Act/Maritime Doctrine. •Statutory disability, retirement,or unemployment benefits. •Automobile no-fault;Social Security, Railroad Retirement, Other Income Benefits Canada Pension Plan,Quebec Pension Plan. • Other Disability benefits arranged for by the employer. • Disability Payments resulting from membership in any association, union,or other organization. • Retirement and Pension benefits. • 3rd Party Liability payments. •Group Mortgage or Group Credit disability benefits. If while monthly benefits are payable,an individual has employment income from any occupation which is greater than 20%of indexed pre-disability earnings,the monthly net benefit Work Incentive Benefit will be adjusted as follows: During the first 12 months the employee has such employment income,the monthly benefit will be reduced only to the extent the amount of that employment income plus the gross monthly benefit exceeds 100%of indexed pre-disability earnings. Proportional Loss Formula After 12 months,the adjusted benefit will be determined as follows: (A divided by B)x C where: A=Indexed pre-disability earnings minus such employment income. B=Indexed pre-disability earnings. C=The monthly net benefit. This is your predisability earnings plus any increase made on Adjusted Predisability Earnings each January 1,starting on the January 1 following 12 months of (Indexing) a period of disability.The increase on each such January 1 will be by the percentage increase in the Consumer Price Index,rounded to the nearest tenth;but not by more than 10%. March 2015 aetnar Page 10 ('1 16E3 Collier County Government Long Term Disability Plan Provisions There is no period of time where you have to be'totally disabled' (including during the elimination period). Residual test of disability:An insured is considered to be disabled if: •from the date that the insured becomes disabled until the end of the own occ period:the insured is unable to perform Zero Day Residual the material duties of their own occupation solely because (Residual Test of Disability) of disease or injury and the insured's work earnings are no more than 80%of their adjusted predisability earnings. • after the end of the own occ period:the insured is unable to work at any reasonable occupation (which includes that the insured's work earnings be no more than 60%of their adjusted predisability earnings)solely because of disease or injury. Integration Method The method used to offset other income benefits.Our quote includes the following: Direct Under direct integration,offsets are subtracted from the Scheduled Monthly Benefit Social Security Type Other income benefit sources include those which are payable to the employee's spouse,children and dependents. A period of disability will end after the number of months listed in the Schedule of Benefits are payable if it is determined that the disability is primarily caused by: •a Mental Health or Psychiatric condition, including physical manifestations of these conditions,but excluding those conditions with demonstrable,structural brain damage;or •Alcohol and/or Drug Abuse. There are two exceptions which apply if you are confined as an Mental/Nervous Limitation inpatient in a hospital or treatment facility for treatment of that Alcohol/Drug Limitation condition at the end of such period: • If the inpatient confinement lasts less than 30 days,the period of disability will cease when you are no longer confined. • If the inpatient confinement lasts 30 days or more,the period of disability may continue until 90 days after the date you have not be so continuously confined. The Separate Periods of Disability section does not apply beyond such period to periods of disability which are subject to the above. March 2015 aetna Page 11 trl r Collier County Government Long Term Disability Plan Provisions These employees are not covered since they are not active Employees on COBRA,lay-off, employees and they also do not meet the minimum hours leave of absence or severance worked requirement. No benefit is payable for any disability that is caused by or contributed to by a "pre-existing condition"and starts before the end of the first 12 months following your effective date of coverage. A disease or injury is a pre-existing condition if, during the 3 Pre-Existing Condition Exclusion months before your effective date coverage: • it was diagnosed or treated;or • services were received for the diagnosis or treatment of the disease or injury;or •you took drugs or medicines prescribed or recommended by a physician for that condition. A reduced disability benefit may be payable for up to 60 months beyond the maximum duration if disabled employee is confined Extended Disability Benefit or receiving home health care and requires substantial assistance to perform 2 or more ADIs or substantial supervision due to cognitive impairment. Benefit is reduced to 85%of the monthly benefit,after offsets applied,up to$5000/month Accidental Personal Loss Subject to the elimination period,a set number of benefit Indemnity Benefit payments wilt be made if an employee suffers a covered accidental personal loss according to the following schedule: Personal Loss Benefit Payments Both hands; Both feet; Entire sight of both eyes; Hearing in both ears;Speech;One hand &one foot;One hand and 46 Months entire sight in one eye;One foot and entire sight in one eye One arm;One leg 35 Months One hand;One foot 23 Months Entire sight in one eye; Entire 15 Months hearing in one ear Employees who enroll for any contributory LTD coverage more Evidence of insurability than 31 days later than the date they are first eligible must provide medical evidence of insurability. Cessation of employment,contract termination,ineligible class, Termination of Coverage failure to make contribution. March 2015 a.*p_a Page 12 . 16E3 3 Collier County Government Long Term Disability Plan Provisions Maximum Benefit Period Benefits are payable while disabled according to the following schedule or until the 1983 amended Social Security Normal Retirement Age,if later. Age when disability occurs Benefits period 61 or younger continue to end of month age 65 62 42 months 63 36 months 64 30 months 65 24 months 66 21 months 67 18 months 68 15 months 69+ 12 months The 1983 Normal Retirement Age(NRA)amendment to the Social Security Act results in the following schedule: Year of Birth Normal Retirement Age(NRA) 1937 or earlier 65 1938 65&2 months 1939 65&4 months 1940 65&6 months 1941 65&8 months 1942 65& 10 months 19434954 66 1955 66&2 months 1956 66&4 months 1957 66&6 months 1958 66&8 months 1959 66&10 months 1960 and later 67 March 2015 as Page 13 IN WITNESS WHEREOF,authorized representatives of the parties have confirmed the agreement of the parties to the foregoing terms by affixing their signatures below: Collier County Board of Commissioners By: Name:TIM NANCE ATTEST: DWIGHT E. BRO9C, Clerk Ti tie: CHAIRMAN B, Date: September 8, 2015 . A4it to Chairman's 1lnitbture only. Attaa By: Name:Eric Bunce Title:Sales Executive Date: C28 ( .. /1 'aiz qty 6-4) to Iif Assistant • Attorney Page 14 V