Backup Documents 09/23/2014 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO E
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU
Routed by Purchasing Department to Office Initials Date
the Following Addressee(s)(In routing order)
1. Risk Management Rik
2. County Attorney Office County Attorney Office Al�
3. BCC Office Board of County ���/ �`
Commissioners \ \
4. Minutes and Records Clerk of Court's Office ?.LP I'
5. Return to Purchasing Department Purchasing
P g
Contact: Diana DeLeon
PRIMARY CONTACT INFORMATION
Name of Primary Diana De Leon for Scott Johnson Phone Number 252-8375
Purchasing Staff September 23,2014
Contact and Date
Agenda Date Item was September 23,2014 IV Agenda Item Number 16.E.3 1 -
Approved by the BCC
Type of Document Amendment Number of Original 2
Attached Documents Attached
PO number or account N/A Solicitation/Contract 11-5729 Allegiance
number if document is Number/Vendor Name Benefit Plan Mgmt
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 signature? DD
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 signed`,,,,�°
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 DD
signature and initials are required.
7. In most cases(some contracts are an exception),an electronic copy of the document and DD
this routing slip should be provided to the County Attorney's Office before the item is
input into SIRE.
8. The document was approved by the BCC on the date above and all changes made DD
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the f
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
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MEMORANDUM
Date: September 26, 2014
To: Diana De Leon, Contracts Technician
Purchasing Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment #2 to Contract #11-5729
"Third Party Administrator for Health Benefits"
Attached is an original copy of the contract referenced above, (Item #16E3)
approved by the Board of County Commissioners on Tuesday, September 23, 2014.
The second original contract will be held in the Minutes and Records Department
for the Board's Official Record.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachment
16E3
EXHIBIT A-2 Contract Amendment#2 to Contract#11-5729
"Third Party Administrator for Health Benefits"
This amendment,dated iklra-23 2014 to the referenced agreement shall be by and between the
parties to the original Agreement,Collier County Government(to be referred to as"the Plan Sponsor")
and Allegiance Benefit Plan Management, Inc., (to be referred to as"the TPA").
Statement of Understanding
RE: Contract# 11-5729"Third Party Administrator for Health Benefits"
In order to continue the services provided for in the original contract document referenced above, the
TPA agrees to amend the Contract by replacing in its entirety Appendix A, I Fee Schedule and II Funding
and Fee Payment Terms with the attached Exhibit A2-A and is hereby made an integral part of this
Amendment. This amendment will be effective on January 1, 2015 and will run concurrently with
Contract#11-5729.
All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF,the parties have each, respectively, by an authorized person or agent, have
executed this Amendment on the date(s)indicated below.
Accepted: j _ r- 23 ,2014
THE PLAN SPONSOR:
BOARD OF CO ,' TY CO ISSIONERS
OF COLLIER !I UNTY ORIDA
Dwi: it E.Brock;C rk
By
ttes 'a$; 0 , 'I'' rk Tom Henning,Chairman
signature only.
T' ' ' t Witness: THE TPA:
Allegiance Benefit Plan Management, Inc.
B .
41. C.) __ By:<-7a141/24- 1415-,4.-e
Prmt
7P. aeNT Q--
Print Name and Title
TPA's Second Witness:
By: Vali/1 - --x:
M10-- tnit no
Print Name
Ap s rov- as to Fo L'gality: Item# (Go C3
Agenda q (.3 1 cL
Sco r R. Teach, Date
Deputy County Attorney Date q (14A4
Rec d
Deputy C er
CD
16E3
EXHIBIT A2-A Amendment#2 to Contract#11-5729
"Third Party Administrator for Health Benefits"
Fee Schedule
The Plan Sponsor and the TPA hereby agree to the compensation schedules set forth below as being the sole compensation to the TPA for
the performance of its obligations under this Agreement. Monthly fees are based upon Plan Participant enrollment as of the beginning of
each month.
A. Administration fees are guaranteed from January 1, 2012 through December 31,2016, as follows:
CCHCC Member 2012 2013 2014 2015 2016
Collier County Government $15.50 $15.50 $15.97 $16.44 $16.94
The above fees shall include services for production and maintenance of Plan Documents/Summary Plan Description, plan
building,amendment production, plan document compliance,and HIPAA compliance,regulatory compliance(if applicable)and
production and mailing via bulk mail to the Plan Sponsor of health plan identification cards,and all of the following services that
are checked:
X Medical Claims
X Vision Claims
X PPO Management and Provider Network Coordination
X Predictive Modeling Disease Management Data Extracts
X Consolidated Billing
X COBRA services and HIPAA Certificates of Creditable Coverage,provided by Allegiance COBRA Services,Inc.pursuant to
the COBRA Administrative Services and Certification of Creditable Coverage Agreement Appendix C,attached hereto. (In
addition to this fee,the TPA will also retain two(2)percent of all COBRA premiums as fees for COBRA services.)
X any administrative fees charged by the Pharmacy Benefit Management(PBM)company that is utilized by the Plan
Distribution of plan materials will be delivered to the Plan Sponsor. An additional postage and handling fee will be paid to
the TPA for mailing materials to individual Plan Participants, except for Welcome Packets and identification cards..
B. Dental claims processing services of$2.75 per Employee per Month.
A pass through fee paid by Plan Sponsor for Medical Identification Card reprint required by adding dental benefits based upon
TPA's cost
MEDICAL ASA MED STD SNGL EMP
ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. Page 1 of 4 REV.2011-2(6-11)
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C. Run Out Fees:
Run Out services shall be based upon a separate run out agreement executed at the time Run Out is requested. However,the
fees therefore shall be calculated as follows:
There shall be a single fee payable in advance, equal to three(3)times the administration fee paid for the month immediately
preceding the date Run Out Services are requested to process claims for a twelve(12)month period beginning January 1,2012
and ending December 31, 2012.
D. Hourly fee of$125.00 for welfare plan consulting. Such services must be agreed to in advance by the Plan Sponsor.
E. Hourly fee of$125.00 for stop-loss reimbursement services,audit assistance services and any other services provided by the TPA
after termination of this Agreement and in the absence of a separate Run-Out Services Agreement.
F. Hourly fee of$125.00 for special programming requests or research including production of any special daims history reports.
Such services must be agreed to in advance by the Plan Sponsor.
G. Special Reports requested by the Plan Sponsor and produced by the TPA upon prior agreement as to report(s)and fee(s),if any.
H. Final fee of$500.00 for forwarding magnet diskette of eligibility/enrollment file in DBC or ASCII format to the Plan Sponsor(if
requested).
I. Final fee of$1,500.00 for forwarding magnetic diskette of Claims history file in DBC or ASCII format to the Plan Sponsor (if
requested).
J. Check customization,customized printed material,special statistical reports other than those enumerated in this contract,special
medical underwriting,new taxes assessed against the Plan,or other services mutually agreed upon will be billed separately at the
rate of$125.00 per hour for such services. Such services must be agreed to in advance by the Plan Sponsor.
K. A fee equal to the actual costs for printing Summary Plan Description Booklets,together with costs of shipping for each booklet.
L. A fee of$125.00 per hour for time expended producing and providing information to agents,consultants or brokers for whom the
Plan Sponsor requests Plan information be provided,together with any postage,shipping and copying costs. Paper copies will be
billed at fifteen($.15)cents per copy and electronic copies shall be billed at$500.00 per disk in DBC or ASCII format only.
MEDICAL ASA MED STD SNGL EMP
ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.2011-2(6-11)
Page 2 of 4
Gyp
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M. PPO access fees for any PPO organization or claim negotiation company that assesses a per Plan Participant fee,a per Claim
fee, or a percentage of claims savings fees not to exceed twenty-five(25%)percent of the actual savings amount between the
charges billed by the Health Care Provider and the discounted amount agreed to between the PPO or Claims Negotiation
Company and the Health Care Provider,except for those entities specifically listed below,for which no service fee applies. The
amount charged under this Agreement shall be equal to the amount charged by the PPO or Claims Negotiation Company. The
TPA, its parents or its affiliates, may be paid a service fee by the PPO for claim repricing or other administrative services
associated with the claims discount or negotiation. The Plan Sponsor will receive a report that outlines the total billed charges,the
total discounts obtained,the net claims cost and the total daim savings to the Plan.Any additional fee in excess of this amount
must be approved in advance by the Plan Sponsor. The TPA may be paid a fee not to exceed twenty-five(25%)percent of net
savings payable to TPA,its parent or its affiliates,realized as a result of any negotiation or reduction in the amount of claims paid
or any recovered funds obtained by TPA through employment of cost containment companies.Specific fees at the inception of this
contract for which a per Participant per month rate is charged are:
$ -0- per Plan Participant per month for Community Health Partners PHO
The network access fee for the Cigna PPA network is$5.50 PPPM.
N. Funds held in accounts by TPA,until paid out for benefits,may accrue interest. The interest accrued will be retained by TPA as
reasonable compensation and fees for fees assessed on the accounts, for paper, printing and postage, record keeping and
account reconciliation, bank service fees,trust tax return preparation; and SAS 70 and related trust activities audit fees.
MEDICAL ASA MED STD SNGL EMP
ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. REV.2011-2(6-11)
Page 3 of 4
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Funding and Fee Payment Terms
Plan Sponsor will establish and maintain a zero balance Claims Payment Account for payment and reimbursement of Covered Services.
TPA will notify Plan Sponsor or its designee on a weekly basis of amount required to be deposited to the Claims Payment Account to pay
claims after they have been processed for payment. Notification of the amount required to be deposited will take place as follows:
On Monday of each week(Tuesday, if Monday coincides with a recognized Federal holiday), an electronic notification will be
provided to Plan Sponsor that the weekly report of claims processed for payment is available on TPA's secured website.
Upon approval from Plan Sponsor,TPA will release the claims checks issued for the batch approved for that week. .
TPA will generate a monthly bill for fees. Payment of monthly billing will be as follows:
On or about the 25th of each month,TPA will provide an electronic notification to Plan Sponsor that the monthly bill is available on
TPA's secured website.
Upon approval from Plan Sponsor,TPA will effect an electronic withdrawal of funds from an account designated by Plan Sponsor
on the Debit Authorization Form.
MEDICAL ASA MED STD SNGL EMP
ALLEGIANCE BENEFIT PLAN MANAGEMENT,INC. Page 4 of 4 REV.2011-2(6-11)
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