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PSA with Corvel Enterprise Comp, Inc. 610/V- 02lefic,26. PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND CORVEL ENTERPRISE COMP, INC. FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS COMPENSATION AND GENERAL LIABILITY, PURSUANT TO RFP#2014-302-SW This Professional Services Agreement ("Agreement") is entered into this 1' day of February, 2014, ("Effective Date"), between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation organized and existing under the laws of the State of Florida, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139 ("City"), and CORVEL ENTERPRISE COMP, INC., a California corporation, whose address is 2010 Main Street Suite 600 Irvine, CA 92614 (Consultant). SECTION 1 DEFINITIONS Agreement: This Agreement between the City and Consultant, including any exhibits and amendments thereto. City Manager: The chief administrative officer of the City. Consultant: For the purposes of this Agreement, Consultant shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services, work and actions by the Consultant performed or undertaken pursuant to the Agreement. Fee: Amount paid to the Consultant as compensation for Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach RFP, No. 2014- 302-SW for Third Party Administration for Workers Compensation and GL claims, together with all amendments thereto, issued by the City in contemplation of this Agreement (the RFP), and the Consultant's proposal in response thereto (Proposal), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFP, and the Proposal. Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139: telephone number(305) 673-7000, Ext. 6435: and fax number(305) 673-7023. SECTION 2 SCOPE OF SERVICES (SERVICES) 2.1 In consideration of the Fee to be paid to Consultant by the City, Consultant shall provide the work and services described in Exhibit"A-1" hereto (the Services). 2.2 Consultant's Services, and any deliverables incident thereto, shall be completed in accordance with the timeline(s) and/or schedule(s) in Exhibit A hereto. 2.3 Consultant shall provide its Online software system the "CareMC Application," pursuant to the "CareMC License Agreement", attached as Exhibit "C" hereto. SECTION 3 TERM The term of this Agreement (Term) shall commence upon execution of this Agreement by all parties hereto, which shall be the Effective Date on page 1 hereof, and shall have an initial term of two (2) years, with three (3) one year renewal options, to be exercised at the City Manager's sole option and discretion, by providing Consultant with written notice of same no less than thirty (30) days prior to the expiration of the initial term (or a renewal option, as the case may be). Notwithstanding the Term provided herein, Consultant shall adhere to any specific timelines, schedules, dates, and/or performance milestones for completion and delivery of the Services, as same is/are set forth in the timeline and/or schedule referenced in Exhibits "A" and "A-1" hereto. SECTION 4 FEE 4.1 In consideration of the Services to be provided, Consultant shall be compensated pursuant to the attached Exhibit B ("Fees"). 4.2 INVOICING Upon receipt of an acceptable and approved invoice, payment(s) shall be made within thirty (30) days for that portion (or those portions) of the Services satisfactorily rendered (and referenced in the particular invoice). Invoices shall include a detailed description of the Services (or portions thereof) provided, and shall be submitted to the City at the following address: City of Miami Beach Human Resources 1700 Convention Center Drive 3rd Floor Miami Beach, Florida 33139 Attention: Sonia Bridges Risk Manager 2 SECTION 5 TERMINATION 5.1 TERMINATION FOR CAUSE If the Consultant shall fail to fulfill in a timely manner, or otherwise violates, any of the covenants, agreements, or stipulations material to this Agreement, the City, through its City Manager, shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the Consultant of its violation of the particular term(s) of this Agreement, and shall grant Consultant ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City may terminate this Agreement without further notice to Consultant. Upon termination, the City shall be fully discharged from any and all liabilities, duties, and terms arising out of, or by virtue of, this Agreement. Notwithstanding the above, the Consultant shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Consultant. The City, at its sole option and discretion, shall be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's right and remedies against Consultant. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. 5.2 TERMINATION FOR CONVENIENCE OF THE CITY THE CITY MAY ALSO, THROUGH ITS CITY MANAGER, AND FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THE AGREEMENT AT ANY TIME DURING THE TERM BY GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH TERMINATION; WHICH SHALL BECOME EFFECTIVE WITHIN THIRTY (30) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF SUCH NOTICE. IF THE AGREEMENT IS TERMINATED FOR CONVENIENCE BY THE CITY, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED UP TO THE DATE OF TERMINATION; FOLLOWING WHICH THE CITY SHALL BE DISCHARGED FROM ANY AND ALL LIABILITIES, DUTIES, AND TERMS ARISING OUT OF, OR BY VIRTUE OF, THIS AGREEMENT. 5.3 TERMINATION FOR INSOLVENCY The City also reserves the right to terminate the Agreement in the event the Consultant is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 5.2. SECTION 6 INDEMNIFICATION AND INSURANCE REQUIREMENTS 6.1 INDEMNIFICATION Consultant agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees, agents, and contractors, from and against any and all actions (whether at law or in equity), claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees and costs, for personal, economic or bodily injury, wrongful death, loss of or damage to property, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other 3 wrongful conduct of the Consultant, its officers, employees, agents, contractors, or any other person or entity acting under Consultant's control or supervision, in connection with, related to, or as a result of the Consultant's performance of the Services pursuant to this Agreement. To that extent, the Consultant shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The parties agree that one percent (1%) of the total compensation to Consultant for performance of the Services under this Agreement is the specific consideration from the City to the Consultant for the Consultant's indemnity agreement. The provisions of this Section 6.1 and of this indemnification shall survive termination or expiration of this Agreement. 6.2 INSURANCE REQUIREMENTS The Consultant shall maintain and carry in full force during the Term, the following insurance: A. Worker's Compensation and Employers Liability Insurance for all employees of the provider as required by Florida Statute 440. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence and $2,000,000 in the aggregate, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. The insurance must be furnished by insurance companies authorized to do business in the State of Florida. All insurance policies must be issued by companies rated no less than "B+" as to management and not less than "Class VI" as to strength by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All of Consultant's certificates shall contain endorsements providing that written notice shall be given to the City at least thirty (30) days prior to termination, cancellation or reduction in coverage in the policy. Original certificates of insurance must be submitted to the City's Risk Manager for approval (prior to any work and/or services commencing) and will be kept on file in the Office of the Risk Manager. The City shall have the right to obtain from the Consultant specimen copies of the insurance policies in the event that submitted certificates of insurance are inadequate to ascertain compliance with required coverage. The Consultant is also solely responsible for obtaining and submitting all insurance certificates for any sub-consultants. Compliance with the foregoing requirements shall not relieve the Consultant of the liabilities and obligations under this Section or under any other portion of this Agreement. The Consultant shall not commence any work and or services pursuant to this Agreement until all insurance required under this Section has been obtained and such insurance has been approved by the City's Risk Manager. 4 SECTION 7 LITIGATION JURISDICTION/VENUE/JURY TRIAL WAIVER This Agreement shall be construed in accordance with the laws of the State of Florida. This Agreement shall be enforceable in Miami-Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for the enforcement of same shall lie in Miami-Dade County, Florida. By entering into this Agreement, Consultant and the City expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of this Agreement. SECTION 8 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action, for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of $10,000. Consultant hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of$10,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Consultant hereby agrees that the City shall not be liable to the Consultant for damages in an amount in excess of $10,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this section or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability, as set forth in Section 768.28, Florida Statutes. SECTION 9 [INTENTIONALLY DELETED] SECTION 10 GENERAL PROVISIONS 10.1 AUDIT AND INSPECTIONS Upon reasonable verbal or written notice to Consultant, and at any time during normal business hours (i.e. 9AM — 5PM, Monday through Fridays, excluding nationally recognized holidays), and as often as the City Manger may, in his/her reasonable discretion and judgment, deem necessary, there shall be made available to the City Manager, and/or such representatives as the City Manager may deem to act on the City's behalf, to audit, examine, and/ or inspect, any and all other documents and/or records relating to all matters covered by this Agreement. Consultant shall maintain any and all such records at its place of business at the address set forth in the "Notices" section of this Agreement. 10.2 [INTENTIONALLY DELETETD] 5 10.3 ASSIGNMENT, TRANSFER OR SUBCONSULTING Consultant shall not subcontract, assign, or transfer all or any portion of any work and/or service under this Agreement without the prior written consent of the City Manager, which consent, if given at all, shall be in the Manager's sole judgment and discretion. Neither this Agreement, nor any term or provision hereof, or right hereunder, shall be assignable unless as approved pursuant to this Section, and any attempt to make such assignment (unless approved) shall be void. 10.4 PUBLIC ENTITY CRIMES Prior to commencement of the Services, the Consultant shall file a State of Florida Form PUR 7068, Sworn Statement under Section 287.133(3)(a) Florida Statute on Public Entity Crimes with the City's Procurement Division. 10.5 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of the Services, the Consultant shall not discriminate against any employee or applicant for employment because of race, color, national origin, religion, sex, gender identity, sexual orientation, disability, marital and familial status, or age. 10.6 CONFLICT OF INTEREST The Consultant herein agrees to adhere to and be governed by all applicable Miami-Dade County Conflict of Interest Ordinances and Ethics provisions, as set forth in the Miami-Dade County Code, and as may be amended from time to time; and by the City of Miami Beach Charter and Code (as some may be amended from time to time); both of which are incorporated by reference herein as if fully set forth herein. The Consultant covenants that it presently has no interest and shall not acquire any interest, direct or indirectly, which could conflict in any manner or degree with the performance of the Services. The Consultant further covenants that in the performance of this Agreement, no person having any such interest shall knowingly be employed by the Consultant. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising there from. SECTION 11 NOTICES All notices and communications in writing required or permitted hereunder, shall be delivered personally to the representatives of the Consultant and the City listed below or may be mailed by U.S. Certified Mail, return receipt requested, postage prepaid, or by a nationally recognized overnight delivery service. Until changed by notice in writing, all such notices and communications shall be addressed as follows: 6 agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Title and paragraph headings are for convenient reference and are not intended to confer any rights or obligations upon the parties to this Agreement. 12.4 CONSULTANT'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW Pursuant to Section 119.0701 of the Florida Statutes, if the Consultant meets the definition of "Contractor" as defined in Section 119.0701(1)(a), the Consultant shall: a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service; b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; and d) Meet all requirements for retaining public records and transfer to the City, at no City cost, all public records created, received, maintained and/or directly related to the performance of this Agreement that are in possession of the Consultant upon termination of this Agreement. Upon termination of this Agreement, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. For purposes of this Article, the term "public records" shall mean all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless. of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. Consultant's failure to comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes shall be a breach of this Agreement. In the event the Consultant does not comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes, the City may, at the City's sole discretion, avail itself of the remedies set forth under this Agreement and available at law. [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] 8 .,........,,•,...,..., , , IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by . their appropriate officials, as of the date first entered above, • , . FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: 0 , • City ft erk ,7 ''''..--• (/:-/ / . FOR CONSULTANT: CORVEL ENTERPRISE COMP, INC. . , i ATTEST: f By: p„a ke. i°roe i t„ VP 12-egiOriCte By:5,2.4.4u4. c5'&74-L44_, SVP „. Secretar f MO President . Dt kti C Po rovfch 1 vp 4 iDiriO Bennie Stoner SVP Print Name (Cititi Print Name . , . „ , . . 1 .t.q.... ..... .;':.: :•.'.• • • ' APPROVED AS TO . . , . . . • . • • • , •...•,. . . • FORM&LANGUAGE • . 6 • •.•.■ &FOR EXECUTION 1 , ..., s'--- City Attorney Date . ' . ; . 9 . , . , , EXHIBIT "A" SCOPE OF SERVICES EXHIBIT A Workers' Compensation Claims Management Services Terms and Conditions DESCRIPTION OF WORKERS' COMPENSATION CLAIMS MANAGEMENT SERVICES (a) Customer shall promptly notify CorVel of all incidents subject to the services described in this Agreement. (b) First report of loss services involve gathering pertinent information related to a work injury and reporting such information to the appropriate state industrial accident board or commission as required by law, and is used to facilitate CorVel's initial review of the claim to determine whether the claim is likely to be medical-only or lost time and to help guide the initial determination of Services that may be required("First Report Services"). (c) CorVel's Workers' Compensation Claims Management services provide Customer with a process to comply with Customer's workers' compensation issues in the applicable jurisdiction. CorVel shall provide workers' compensation claims management services set forth herein to Customer on behalf of employees that sustain work related injuries ("Injured Employees"). CorVel may subcontract with a third party to provide some portion or all of its claims management services obligations hereunder. II. DELIVERY OF FIRST REPORT OF LOSS SERVICES (a) CorVel shall provide First Report Services to Customer upon receipt by CorVel of specific requests from Customer. Prior to the implementation of CorVel First Report Services and as required during the Term of this Agreement, Customer may provide CorVel with instructions regarding the scope and extent of the First Report to be performed by CorVel. Absent such instruction, CorVel First Report Services shall be performed as described below. (b) Customer shall initiate First Report Services by (i) entering such information online through CareMC, (ii) calling CorVel via a toll free number provided by CorVel, or (iii) faxing such information to the CorVel intake specialist. Customer or the Customer representative entering such information on CareMC, making such calls, or faxing such information shall provide CorVel with all information required to complete the First Report of Loss form required by the applicable state ("Required Information"). Required Information generally includes the following: name/address of claimant, date of incident, description of injuries, social security number, date of birth, employer, salary, and other descriptive information reasonably required by CorVel, and may include information required by applicable statute (e.g., employer TIN). CorVel shall (i) provide sufficient staff to handle all incoming calls, and (ii) be prepared to complete First Report of Loss forms for all applicable states. (c) Once the Required Information is validated and confirmed by a CorVel representative, First Report of Loss forms will be made available to Customer through the CareMC Application. CorVel will, upon request of Customer, provide a hard copy of the completed First Report of Loss form to the Customer. An electronic copy shall be available to Customer via CareMC. To the extent permitted by the applicable state industrial accident board or commission, the Required Information shall be transmitted electronically. (d) To the extent required by applicable statute or otherwise agreed in writing by CorVel, CorVel will file additional reports on earlier-filed First Reports of Loss ("Subsequent Reports"). to (e) Unless agreed to otherwise in writing by the parties, any questions or concerns from an industrial accident board or commission concerning First Reports of Loss forms completed by CorVel hereunder will be handled directly by CorVel. All such inquiries will receive an initial response within the next business day following CorVel's receipt of the inquiry. CorVel will keep Customer apprised of any inquiries it receives and the response thereto. CorVel will send a written response to the inquiry within five (5) business days outlining the nature of the inquiry and the resolution of same by CorVel. A copy of such response will also be sent to the attention of the designated Customer representative if requested in writing by Customer. Customer shall have the right, but not the obligation, at any time and at Customer's expense, to interject itself into the inquiry between CorVel and the industrial accident board or commission, and in connection therewith to resolve the inquiry in a manner acceptable to Customer at its sole discretion, in which case Customer shall defend, indemnify and hold harmless CorVel from and against any claim, liability, damages or costs arising from Customer's handling of such inquiry or the resolution thereof. III. DELIVERY OF CLAIMS MANAGEMENT SERVICES (a) Customer shall arrange so that all claims and all related bills of any type, as well as all other correspondence that Customer receives relating to such claims, are sent directly to CorVel. CorVel shall perform all of the following "Claims Services" in connection with each portion of a Claim related to Workers' Compensation benefit payments for lost income (each an "Indemnity Claim") and one or more of such Claims Services with respect to that portion of a Claim related to Workers' Compensation benefits other than payments for lost income (each a "Non-Indemnity Claim"). All Claims Services provided by CorVel under this Agreement shall be performed in accordance with the guidelines set forth in Sections II-IV of this Exhibit A: (i) CorVel shall immediately assign each new Indemnity Claim and Non-Indemnity Claim to CorVel's designated claims professional. (ii) Utilizing CorVel's CareMC Application or other applicable CorVel Online System, CorVel shall maintain a chronological record of all Claims Services performed by CorVel. (iii) CorVel shall make all filings related to Indemnity Claims and Non-Indemnity Claims with the appropriate state Workers' Compensation regulatory authorities. (iv) CorVel shall maintain a complete and accurate claim file for each Indemnity Claim and Non-Indemnity Claim. (v) CorVel shall perform reasonable and necessary administrative and clerical work including, without limitation, the following: (A) Investigate all Indemnity Claims and Non-Indemnity Claims. . (B) Determine and evaluate any coverage and/or compensability issues and provide Customer with appropriate recommendations and advice regarding the same. (C) Adjust, handle, or settle to a conclusion those Indemnity Claims and Non-Indemnity Claims that CorVel believes the Customer is legally obligated to pay under applicable state law and regulations, and in accordance with the authority granted to CorVel by Customer under the Agreement. (D) Prepare checks for payments of Indemnity claims, Non-Indemnity Claims and Allocated Loss Adjustment Expenses. II (E) Prepare documents as necessary to close out Indemnity Claims and Non- Indemnity Claims. (vi) CorVel Shall perform Bill Review Services which will include CorVel's proprietary computerized bill review software program enables an application of the appropriate Fee Schedule,and further value-added applications subscribed to by client which includes PPO,Professional Review,Enhanced Bill Review(CERiS),Onsite,and Check writing Services applied to medical provider bills("Provider Bills"),hospital bills("Hospital Bills")and,both together,"Bills"). (A) Professional Review Services. CorVel may provide professional review services to verify coding by providers are valid. This can include clinical review to validate coding is correct for all applicable Provider bills, Ambulatory Surgical Center bills, and all Hospital Bills (inpatient and outpatient) including: (1) review and analysis of codes, charges and billing structure for incorrect coding, incorrect billing, bundling, and up-coding of procedures which effect Fee Schedule values; (2) review of bills, records, and documentation by a nurse and/or coder; (3) separation of charges not related to the compensable injury; (4) diagnostic related group validation (i.e., verification that the diagnostic related group billed is appropriate for the services rendered); and (5) cost shifting of revenue and CPT codes. (B) Hospital Line Itemization Review Services. CorVel's Enhanced Bill Review Services (CERiS) are performed on Hospital Bills (inpatient and outpatient) in excess of two thousand five-hundred dollars ($2,500) and consist of procurement of actual bill itemization, (i) a line-by-line validation and comparison of the itemization description charges actually billed by a particular hospital to what CMS billing guidelines allow to be separately billed for in order to disallow inappropriate charges, and then will compare the valid itemization descriptions to the average itemization description charges utilized by other hospitals within a pre-designated geographic area, and and (ii) a review of charges that fall outside of any pre-contracted discounts or fee schedules, and generates payment recommendations in accordance with the Customer's "Payors Allowable" language. This service does not itself include negotiation services nor Implant Cost Services. (C) Negotiation Services. CorVel's Enhanced Bill Review Services (CERiS) can provide negotiation services with respect to all Hospital Bills (inpatient and outpatient) in excess of two thousand five-hundred dollars ($2,500). CorVel will contact the provider for agreement of the negotiated rate. A signed agreement regarding such rates will be maintained by CorVel. CorVel will use its commercially reasonable efforts to enter into an agreement regarding negotiated rates in accordance with a mutually agreed upon schedule. (D) Implant Cost Review Service. CorVel's Enhanced Bill Review Services 12 (CERiS) can include Implant Cost Review services with respect to the applicability of the Customer's "Payors Allowable" plan or policy language that specifically addresses implant payments. CorVel will identify and provide the manufacturers implant cost through its proprietary repository of national implant invoice data. CorVel then determines the recommended payment in accordance with the Customer's "Payors Allowable". In the event there is insufficient implant invoice data for the requested implant, CorVel will notify the Customer and CorVel shall not be responsible for any costs, fees, damages or penalties for any such inability of CorVel to produce a cost savings per Customer's request. (E) CorVel's preferred provider organization is a network of hospitals,physicians and other health care providers("Participating Providers") that offer services at pre-negotiated rates("PPO Network"). (b) CorVel shall process claims and process the disbursement of benefit payments to claimants and providers entitled to such payments from Customer. Funding for the payment of all benefits to claimants, providers, vendors and "allocated loss adjustment expenses" (as defined below) is the sole responsibility of Customer and Customer agrees to be liable for and fund all proper claims processed by CorVel. Such payment shall be made through a bank account established by CorVel. There shall be one account established for claims relating to both First Reports of Loss arising on or after Februray 1, 2015, and for claims relating to First Reports of Loss that arose prior to January 31, 2015 that were administered by Wells Fargo (the"bank account"), if applicable (i.e., if CorVel is assuming responsibility for providing Claims Administration services for claims occurring prior to the effective date of the Agreement). CorVel shall provide Customer with a check register in a mutually agreed format for each checkrun drawn on a bank account prior to mailing of the checks. CorVel also will provide Customer information as necessary for Customer to prepare periodic bank account reconciliation reports. Customer agrees to pay into the bank account funds sufficient to pay approved claims and to maintain the advance deposit set forth below and to provide CorVel with such authorizations as shall be necessary to make the required instruments valid claims against Customer. Notwithstanding the other provisions of this Agreement, if payments are not made when due, Customer shall be in default and subject to immediate termination without notice, and CorVel shall have no liability for claims, penalties or other damages arising out of or relating to any such failures on the part of Customer. (i) Customer shall make an initial advance deposit into the bank account in an amount equal to Dollars ($ ). (ii) "Allocated loss adjustment expenses" or "ALAE" shall mean claim adjustment costs and expenses incurred by CorVel or its subcontractor and allocated by CorVel to the investigation, adjustment and settlement or defense of a claim for benefits, including, without limitation, attorneys' fees and disbursements,pre and post judgment interest, court reporter services and transcripts, deposition charges and transcripts, fees for service of process, court costs, courier/express mail, long distance, appeal bonds, printing costs related to trials and appeals, witness and expert fees, medical examination and review, laboratory costs, engineering, independent adjuster fees, surveillance, photography, and similar costs and expenses reasonably incurred and related to the investigation and defense of claims or the protection and collection of subrogation rights of the Customer. (c) CorVel shall provide Customer with payment services through Check Writing services in accordance with specifications mutually agreed by Customer and CorVel. 13 (i) The checks referred to in Section II(d) will be drawn on CorVel's account at Wells Farg o Bank, Portland, Oregon or CorVel's account at such other bank as the parties of this Agreement may mutually accept, as evidenced by a letter or written document signed by both parties (hereafter, the "Bank"), with Customer identified on each check as the insurer or any insurance carrier as such may be required. Check Writing services shall also include IRS form 1099 filing and associated follow-up, bank reconciliation, and bank fees specifically related to such processing if Customer is using CorVel's bank account. Otherwise, such services will be subject to an additional fee. (d) CorVel agrees to provide the following services to Customer relating to the processing and payment of claims: (i) to receive claims and process payment of benefits in accordance with applicable State(s) program guidelines required for the payment of workers' compensation claims; (ii) to correspond with the claimants, providers of services and vendors if additional information is deemed necessary to complete the processing of claims; (iii) to determine the amount of benefits payable; (iv) to provide notice to claimants as to the reason(s) for denial of benefits (when such are denied)and to provide for the review of such denied claims; (v) to receive and process for payment claims for benefits incurred prior to the Effective Date in consideration for the separate fees established in Exhibit B; and (vi) at Customer's request, to provide specified additional services for such fees as the parties mutually agree; (e) Subject to applicable law, all claims files, data, systems and records and associated documents and notices regarding the administration of claims and provision of services pursuant to this Agreement and the payment of claims and allocated loss adjustment expenses, may be audited, examined, and copied by Customer, its representatives, excess carriers, reinsurers or any state insurance department or other regulatory body that so requires, at Customer's expense, at any time or times during CorVel's normal business hours and with not less than thirty (30) days advance notice; and notwithstanding anything to the contrary contained in this Agreement. (f) CorVel is and shall remain an independent contractor with respect to the services being performed hereunder and shall not for any purpose be deemed an employee of Customer, nor shall CorVel and Customer be deemed partners,joint venturers or governed by any legal relationship other than that of independent contractor as set forth herein. CorVel does not assume any responsibility for the adequacy of the funding of benefits or any act or omission or breach of duty by Customer. (g) CorVel is not in any way to be deemed an insurer, underwriter or guarantor with respect to any benefits payable under Customer's workers' compensation program. (h) CorVel may rely on instructions received from such person or persons as Customer may from time to time designate in writing, provided that no such instruction may vary the terms of this Agreement. (i) Unless otherwise directed by Customer or precluded by law, CorVel shall seek subrogation recoveries on behalf of Customer and shall provide Customer with any recoveries obtained, minus the attorneys' fees and costs incurred in obtaining such recoveries. Customer represents and warrants that its workers' compensation program provides for rights of subrogation. Customer delegates and/or assigns these subrogation 14 rights and third party recovery rights to CorVel as its agent for purposes of subrogation only. Customer shall assist CorVel in its subrogation efforts by providing requested information and documentation. CorVel may engage the services of a subrogation management firm to assist with the identification and management of subrogation cases. The fees charged by the subrogation management firm will be deducted from any recovery. In those cases where the subrogation recovery efforts of the claimant's attorney should be compensated, Customer delegates to CorVel full authority to act on behalf of the Customer to negotiate reasonable attorneys' fees. In those instances where Customer's subrogation lien, in the opinion of CorVel, should be compromised or abandoned, Customer delegates to CorVel full authority to act on behalf of Customer to compromise or abandon the lien. Any determination by CorVel with respect to subrogation liens shall be final and conclusive, unless overturned by order of a limited arbitrary and capricious standard of review. (j) CorVel shall consult and cooperate with Customer with respect to any loss or claim resulting in a lawsuit being instituted against Customer. Nothing in this paragraph shall be construed in any way as a waiver by CorVel of any attorney/client, work product or other applicable privilege with respect to any materials or documents prepared by CorVel or its counsel in anticipation of litigation. (k) CorVel shall assist, cooperate and participate with Customer, carriers and reinsurers in connection with claim reviews and audits and catastrophic injury claim analysis and excess claim related reporting. IV. SERVICE CRITERIA, STANDARDS AND GUIDELINES (a) Assignments: Customer will notify CorVel, either via CareMC, telephone or facsimile, that Customer's employee has sustained a work related injury. All new Lost Time claims will be acknowledged and established by CorVel within the next business day following such notice. The acknowledgement will included the name and contact information of the assigned Adjuster. (b) Contacts: As warranted, and always with regard to lost time, or anticipated lost time claim situations, initial contact with the injured employee will be made within the next business day following receipt of a new assignment claim. Contact with the Physician, and employer, if required will be made by the next business day. (c) Investigation: Completed and documented within 30 days from date of assignment. 15 EXHIBIT A— 1 Property and Liability Claims Management Services Terms and Conditions GENERAL SERVICES (a) Subject to the Customer's direction, CorVel shall supervise and administer the Liability Claims Adjustment Program for the Customer and shall act as the Customer's representative in connection with the investigation, adjustment, processing, supervision and resolution of liability claims by third parties against the Customer. (b) CorVel shall undertake periodic program and administrative reviews on at least a quarterly basis to Customer as to any CorVel recommendations for changes or improvements in the administration of the third party claims program. (c) CorVel shall manage the following types of claims: ❑ General Liability ❑ Personal Injury ❑ Professional Liability ❑ Product Liability ❑ Property ❑ Auto Liability ❑ Auto Physical Damage ❑ Other(Specify): • • • II. INVESTIGATIVE SERVICES (a) CorVel shall provide investigative services to include,but not limited to: (i) Receipt and examination of all reports of accidents, incidents, and claims cases which are or may be the subject of such liability claims; (ii) Investigation of such accidents, incidents, claims or cases where examination warrants such investigation to include on-site investigation, photographs, statements of clients, claimants and witnesses, evaluation and determination of losses, and other such investigative services necessary to determine liability and losses, but not to include extraordinary investigative services as set forth in Section b(iii)below; (iii) Timely and periodic reporting to the Customer of the in-progress investigation efforts and the results of the investigations, as well as offering recommendations to the Customer of extraordinary investigative services, if required. (b) To the extent extraordinary investigative services are required: 16 (i) Customer agrees to pay the cost of all reasonable and supportable extraordinary investigative services such as, but not limited to, service performed by other adjusting and/or investigating companies, professional photographs, independent medical examinations, professional engineering services, laboratory services and legal services. CorVel shall order such extraordinary investigative services only with prior written authorization from the Customer. To the extent circumstances do not permit prior written authorization from the Customer, CorVel shall obtain verbal authorization from the Customer to proceed with the recommended extraordinary investigative services and CorVel shall promptly confirm in writing the verbal authorization provided by the Customer. III. CLAIMS ADJUSTMENT SERVICES (a) CorVel shall provide reasonable and customary Property and Liability claims adjustment services. (b) CorVel shall create, maintain and keep current a claim file on each potential or actual claim reported to CorVel. The Customer will be entitled to access and review the claim files of CorVel. (c) If CorVel's investigation results in a determination that the Customer has sustained a property or liability loss, CorVel shall process any such claim or potential claim for settlement in accordance with the instructions and policies established by the Customer for settlement of such claims. CorVel shall document all processing efforts and timely report to the Customer on all such processing and settlement efforts.. (d) Subject to the Customer's direction, CorVel shall serve as a liaison and be responsible for communications between insurance and excess carriers, if any, and the Customer on any matters affecting the adjustment of such claim or potential claim. (e) CorVel shall obtain all necessary written Release Agreements on settlement of any claim or potential claim (other than those in litigation), and shall maintain fully-executed originals or copies in the claim file. (i) Upon the Customer's request, CorVel shall provide the Customer with a copy of the executed Release Agreement(s); (ii) Upon the Customer's request, CorVel shall seek to incorporate in standard Release Agreements such further provisions as the Customer may reasonably request by reason of the nature and specifics of the claim or potential claim being processed and settled. (f) Pursuant to CorVel's Liability Claims Handling Best Practices, each adjuster will be assigned a reasonable and manageable number of claims files. Adjusters assigned to the Customer's account shall also be supervised to assure proper, competent, timely, and complete services for the Customer. (g) CorVel's adjusters shall work, on average, no more than one hundred fifty(150) files for the Customer. IV. CLAIMS ADMINISTRATIVE SERVICES (a) CorVel shall provide reasonable and customary administrative services as required and appropriate for First and Third Party claims administration services on behalf of the Customer. 17 (b) CorVel shall enter all new claims and tail claims into the RIMS system and provide to the Customer a Monthly Status Report for the term of this Agreement. (i) The Monthly Status Report shall be provided within thirty (30) days of the close of each calendar month; (ii) The Monthly Status Report shall indicate the status of each reported claim assigned to CorVel, the details of each claim, the outstanding reserves for each claim, and the details of all claim payments during the month; (iii) CorVel shall, upon written and reasonable request from the Customer, add additional reporting categories to the Monthly Status Report. (c) CorVel shall periodically review and adjust reserves on all open claims. (d) CorVel will set up the appropriate Trust account to process claim payments suggested in the client instructions. 18 EXHIBIT "B" FEES OPTION #1: FLAT ANNUAL FEE OPTION Column 1 Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims including $154,000 new and prior claims (per contract year) 2. Per Claim Fee for Quantity Excess Claim Fee Per Claims in Excess of $475 40 per year Year 345 Per Year (per excess claim) $19,000 (Column 1 x Column 2) TOTAL OPTION 1 (Flat Annual.Fee Option): $173,500 Total Lines 1 -2 *Deposit Amount To Be Maintained By The City: $**2.5x **Industry standard is 2.5 times the average monthly payout. ADDITIONAL SERVICES List of services, as needed, which are in addition to the fee s pro•osed in O•tions 1 - 3. Description of Service Fee Telephonic Medical Case Management Fee On All Claims: $92.00 Per Hour Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $4.50/Per Bill Per Bill/Flat Fee Percentage Of PPO Savings—Network Discount Savings Below State Fee Schedule: 27% Percentage Of Utilization Review And Reasonable&Customary Savings: 20% Subrogation And/Or Liens Fee Percentage: 25%of recoveries Osha 300 Log Reporting: $ Included Electronic Data Interchange Filed With State: $ Included Safety Consulting Services Per case basis review of case at no cost. Notice Of Injury Entry: $Into CareMC at no cost Custom/Ad Hoc Reports: $ Included Data And File Conversion Fee: $No Cost One-Time Setup Flat Fee Medicare Reporting Costs: $2,000 Flat fee life of contract Liability Claims Adjuster(City Of Miami Beach In-House Adjuster) $see below Option 1: Workers Compensation Claims Adjuster(City Of Miami Beach In- House Adjuster $ Included Additional Service Fee Description Of Additional Service: $5,000 Description Of Additional Service: $Waived Description Of Additional Service: $35 Per Intake Description Of Additional Service: $ Option 1: Life of Contract Handling Fee: Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Liability $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster included will handle on a per-case basis according to GL fee schedule. Description: Pricing Data Conversion Included First Notice of Loss Intake If submitted via CareMc Fee Waived ($30.00 per claim) or app If reported by $30.00 per claim Incident Only Reporting If submitted via CareMc Fee Waived ($30.00 per claim) If reported by phone or fax $30.00 per claim 24/7 Nurse Triage Included Option 1:Life of Contract Flat Annual Fee 345 Claims per Year $154,500.00 Per claim Fee after 345 claims: Medical-Only $475.00 Option 2: Life of Contract Claims Handling Fee Medical-Only $150.00 Indemnity $950.00 Indemnity Tail $550.00 Claims Medical- $ 95.00 • Option 3: Life of Contract Blended Rate Medical-Only & $475.00 Indemnity $425.00 Annual Administration Fee Includes all state filing requirements, etc. $ 5,000.00 CareMC User IDs Included Annual Banking Fees(per account) One account included Carrier TPA Oversight Fees Bill from carrier to client Bill Tail Claims from carrier to client Subrogation 25%of Recoveries $10.00 per index Indexing Claims Administration The above pricing per claim is based on handling of all claims that occur and are reported during the agreement period. They will be handled until closed or until the end of the agreement period, whichever comes first. Rates on claims that occur outside of the United States are subject to alternative pricing to be discussed prior to start of the contract. Pricing is valid for first year of the contract. At the end of the first year, all flat rate fees are subject to an annual increase not to exceed the greater of CPI or 3.5%. (1)Fees for Additional Professional Services: If Customer requires any additional professional services from CorVel relating to the Services or the CareMC Application, including but not limited to integration of the CareMC Application with EDI or other Customer systems,Customer shall submit a written request to CorVel for such services. CorVel shall, in good faith,consider providing such services at its then-current professional services fee rate and standard terms and conditions. (2) Fees Adjustments for Regulatory Changes: If,at any time during the Term of this Agreement,regulatory or legislative changes impact CorVel's business operations and add to CorVel's costs of providing the Services, CorVel may(a) increase its fees for one or more Services upon written notice to Customer,or(b)terminate this Agreement upon ninety(90)days written notice to Customer. (3) Billing and Payments for Pharmacy Program: Retail Mail order IAWP-4% +4.50 AWP-8%+$4.50 AWP- 10%-$4 AWP- 18%+$4 (a) Charges for medications processed through the Pharmacy Program will be applied to the claim file. (b) CorVel uses the Medi-Span AWP at pre-settlement levels. To maintain pricing neutrality CorVel applies the established multiplier to impacted prescriptions. (c) Relative to state fee schedules, CorVel will apply the lesser of the Customer's contracted pharmacy rate or the applicable state fee schedule. The following exceptions apply: (i) All Florida pharmacy prescriptions will be priced at the Florida fee schedule. (d) Both parties understand that pricing indices historically used(including under this Agreement)for determining the financial components of pharmacy billing rates are outside the control of CorVel and Customer. The parties also understand there are extra-market industry,legal,governmental and regulatory activities which may lead to changes relating to,or elimination of,these pricing indices that could alter the financial positions and expectations of both parties as intended under this Agreement. Both parties agree that, upon entering into this Agreement and thereafter,their mutual intent has been and is to maintain pricing neutrality as intended and not to benefit one party to the detriment of the other. Accordingly,to preserve this mutual intent,if CorVel undertakes any or all of the following: (i) Changes the AWP source across its book of business(e.g.,from Medi-Span to First Databank);or (ii) Maintains AWP as the pricing index with an appropriate adjustment in the event the AWP methodology and/or its calculation is changed, whether by the existing or alternative sources;or (iii) Transitions the pricing index from AWP to another index or benchmark (e.g., to Wholesale Acquisition Cost). (e) Pharmacy rates will be modified as reasonably and equitably necessary to maintain the pricing intent under this Agreement. CorVel shall provide Customer with at least ninety (90) days prior written notice of the change (or if such notice is not practicable, as much notice as is reasonable under the circumstances), and written illustration of the financial impact of the pricing source or index change (e.g., specific drug examples). If Customer disputes the illustration of the financial impact of the pricing source, both parties agree to cooperate in good faith to resolve such disputes. EXHIBIT "C" CareMC License Agreement EXHIBIT C CareMC License Agreement This CAREMC LICENSE AGREEMENT(the"CareMC License Agreement") is incorporated by reference into the Services Agreement (the "Professional Services Agreement") to which it is attached and shall be between City of Miami Beach and CorVel Enterprise Comp, Inc. (the "Parties") The Parties The parties acknowledge and agree that the terms and conditions under which the Third Party Administration and bundled Managed Care Services are provided by CorVel and received by Customer shall be governed by the Master Agreement (including without limitation all additional Exhibits and applicable Schedules attached thereto), while the terms and conditions under which Customer may access and use the Online Services shall be governed by the terms and conditions of this CareMC License Agreement. Any conflict in terms between the Master Agreement and the CareMC License Agreement shall be superseded by the Master Agreement. All defined terms used herein and not otherwise defined shall have the meaning ascribed to such terms in the Master Agreement. 1. ACCESS TO THE CAREMC APPLICATION A. Registration Information. Prior to accessing the CareMC Application, Customer shall provide CorVel with certain registration information requested therein ("Registration Information"). Customer covenants that the Registration Information Customer provides will be true,accurate, current and complete and will be updated as necessary to it so. B. Passwords and Levels of Access. As soon as practicable after the execution of this Agreement, CorVel shall create a unique username and password for each individual Authorized User identified by Customer as requiring access to the Online Services. Customer shall then designate two groups of Authorized Users. The first group of Authorized Users ("Restricted Users") shall have access to only the data available on the CareMC Site that relates to claims specific to that Authorized User and such other data that Customer specifically requests in writing be accessible to such Authorized User. The second group of Authorized Users("Non-Restricted Users") shall have access to all data available on the CareMC Site that relates to claims specific to Customer. Access by Individual Users and Non-Restricted Users to data available on the CareMC Site shall be subject in all cases to any limitations imposed by applicable law. C. PHI Data. Authorized Users shall have access to all data available through the CareMC Application, including data that constitutes or contains"protected health information"("PHI Data")as such term is defined in 45 CFR Section 164.501 of the regulations promulgated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ("HIPAA"), but shall only have access to PHI Data to the extent necessary for Customer to render payment on a claim, and then only to those portions or amounts of PHI Data that are determined by CorVel, in its sole discretion, to be the minimum necessary for Customer to render payment on such claim. D. Security of Passwords. Customer acknowledges and agrees that it shall be solely responsible for (i) selecting Authorized Users, (ii) assigning the various levels of authority and access each Authorized User may have to the CareMC Application, Online Services and Customer Data, including by determining which Authorized Users shall be Non-Restricted Users, (iii) ensuring that only Authorized Users have access to the passwords provided by CorVel or changed by Authorized Users, (iv) implementing a system to control, track and account for all passwords, (v) strictly maintaining the confidentiality and integrity of all passwords and levels of authority among Authorized Users, and (vi) ensuring that Authorized Users shall at all times comply with the terms and conditions of this Agreement. Customer further agrees that it shall notify CorVel immediately in writing if the security or integrity of a password has been compromised. CorVel will provide reasonable cooperation to Customer in the event of a security breach. Such support will include but not be limited to suspending service for passwords whose security or integrity has been violated. Passwords may be changed at any time by Authorized Users,and must be changed at least once every ninety(90)days. E. Customer Data. Responsibility for ensuring that the content and data provided by or for Customer ("Customer Data") to be entered into the CareMC Application by CorVel is accurate and reflects Customer's requirements lies solely with Customer. All data generated by and through Customer's use of the CareMC Application and Online Services shall reside on CorVel's server. CorVel reserves the right to temporarily 19 suspend access to any Customer Data that it determines, in its sole discretion, violates the terms and conditions of this CareMC License Agreement or any applicable laws. F. Customer Representations. Customer represents that (i) it has the legal authority to provide the Customer Data to CorVel hereunder, and (ii) it is fully aware and knowledgeable of and shall comply with its duties and responsibilities with respect to the privacy and confidentiality of medical records and protected health information under applicable federal and state laws, including but not limited to those imposed by HIPAA. 2. LICENSE AND RESTRICTIONS A. Limited License. Subject to the terms and conditions of this CareMC License Agreement, CorVel grants to Customer during the License Term (as defined in Section 5A below) a limited, non-exclusive, non- transferable, non-sublicensable license to access and use, and allow Authorized Users to access and use, the CareMC Application via the CareMC Site solely for Customer's own internal business use and operations. Customer shall access and use the CareMC Application in accordance with the user's guides and online instruction provided to Customer by CorVel ("Documentation") and all applicable laws, statutes, rules and regulations. B. Restrictions. Customer shall not, and shall not allow Authorized Users or any third party to (i) rent, lease, re-license or otherwise provide access to the CareMC Application or Online Services to any third party, (ii) alter, modify or create derivative works of the CareMC Application, (iii) use any reverse compilation, decompilation or disassembly techniques or similar methods to determine any design structure, concepts and construction method of the CareMC Application or replicate the functionality of the CareMC Application for any purpose, or(iv) copy the CareMC Application or any content, materials, information and other data provided by CorVel on the CareMC Site or used in providing the Online Services("CorVel Content") and/or Documentation without CorVel's prior written consent. C. Third Parties. Customer shall not allow any third party to have access to the CareMC Application or Online Services without prior written consent of CorVel and ensuring that (i) such third party enters into a legally enforceable written agreement with CorVel, or (ii) such third party enters into a legally enforceable written agreement with Customer consistent with the terms of this CareMC License Agreement and which shall include terms at least as protective of CorVel as the following Sections of this CareMC License Agreement: Sections 1A-1F,2B,2D,3B,and 4A-4E. D. Ownership and Changes. CorVel owns and shall retain all right, title and interest in and to the CareMC Application,Documentation, CareMC Site,Online Services, CorVel Content and any intellectual property rights inherent therein or arising therefrom. In addition to CorVel's rights in the individual elements of the CorVel Content, CorVel owns a copyright in the selection, coordination, arrangement and enhancement of the CorVel Content. Neither Customer nor any Authorized User shall obtain any ownership rights, express or implied, or any other rights other than those expressly set forth herein in the CareMC Application,Documentation or CorVel Content. CorVel reserves the right, at any time in its sole discretion and without liability to Customer, to delete or change features of the CareMC Application, CareMC Site or Online Services provided such changes do not materially alter the functionality of the CareMC Application. E. Compliance Monitoring and Audits. CorVel may monitor and perform remote audits of Customer's use of the CareMC Application and CareMC Site for the purpose of verifying that Customer and Authorized Users are using the CareMC Application in compliance with the terms of this CareMC License Agreement. CorVel reserves the right to temporarily suspend Customer's or any Authorized User's access to the CareMC Application in the event Customer or such Authorized User engages in, or CorVel in good faith suspects is engaged in, any unauthorized conduct. To the extent CorVel requires access to Customer's facilities to conduct an audit hereunder, Customer agrees to provide such access upon reasonable advanced notice and during Customer's regular business hours. 3. INFRASTRUCTURE,MAINTENANCE AND SUPPORT A. CorVel Infrastructure Obligations. Subject to Customer's compliance with the terms and conditions of this CareMC License Agreement, CorVel shall be responsible for providing and maintaining the hardware, software and other equipment required to host the CareMC Application for Customer("CareMC Infrastructure"). The CareMC Infrastructure is subject to modification by CorVel from time to time for purposes such as adding new functionality, maximizing operating efficiency and upgrading hardware, provided such modifications shall not in the aggregate degrade the performance of the Online Services utilized by Customer. Customer acknowledges and agrees that such modifications may require changes to Customer's Internet access and/or 20 telecommunications infrastructure to maintain Customer's desired level of performance. CorVel shall give Customer reasonable prior written notice of any required modifications. B. Customer Infrastructure Obligations. Except for the CareMC Infrastructure, which will be provided by CorVel, Customer shall be responsible for obtaining and maintaining all hardware, software,equipment, Internet access and/or telecommunications services and other items or services furnished by third party venders or providers("Third Party Providers") required to enable Customer to access and use the CareMC Application and CareMC Site as contemplated hereunder. C. Support. CorVel will provide general support regarding questions on the CareMC Application via email and by telephone from Monday through Friday between the hours of 5:00 a.m. and 6:00 p.m. Pacific Standard Time,excluding holidays. D. Scheduled Maintenance. CorVel will use reasonable efforts to (i) perform any scheduled downtime outside of Customer's normal business hours, (ii) notify Customer of all scheduled downtimes at least seventy- two (72) hours in advance, and (iii) perform software updates to the CareMC Application with minimal disruption to Customer's use of the Online Services. E. System Monitoring. CorVel will use reasonable efforts to continuously monitor its web servers and database servers to ensure that they are functioning properly. F. Security. CorVel will implement and use reasonable efforts to maintain secure systems through the use of firewalls, virtual private networks (VPN) and other security technologies. Any security violations that affect the data of Customer will be promptly reported to Customer. G. Disaster Recovery and Backup. CorVel will use reasonable efforts to perform nightly backups of essential data on its web servers and database servers. CorVel has implemented third party backup and restoration technology to enable high speed recovery of data. CorVel utilizes redundant load balanced Win 2000 servers for 24x7, 365 day access, except for regularly scheduled system maintenance and upgrade processes. SQL Server databases are hosted on clustered servers offering fall-over capability, redundant communication links, and load balanced application servers. Backup tapes are restored into a test environment not less than quarterly to confirm validity of backups. The CareMC Site has redundant inbound Internet and Intranet connectivity. 4. APPLICATION SPECIFIC DISCLAIMERS A. Disclaimers. TO THE EXTENT ALLOWED BY APPLICABLE LAW,EXCEPT FOR THE LIMITED WARRANTIES DESCRIBED IN THE MASTER AGREEMENT, CORVEL MAKES NO OTHER WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AND EXPRESSLY DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, GOOD TITLE, SATISFACTORY QUALITY AND NONINFRINGEMENT. B. Internet Usage. Customer acknowledges that the Internet is essentially an unregulated, insecure and unreliable environment,and that the ability of Customer to access and use the CareMC Application is dependent on the Internet and hardware, software and services provided by various Third Party Providers. CORVEL SHALL NOT BE RESPONSIBLE FOR CUSTOMER'S INABILITY TO ACCESS OR USE THE CAREMC APPLICATION TO THE EXTENT CAUSED BY FAILURES OR INTERRUPTIONS OF ANY HARDWARE, SOFTWARE OR SERVICES PROVIDED BY CUSTOMER OR THIRD PARTY PROVIDERS. C. CareMC Application. CUSTOMER ACKNOWLEDGES AND AGREES THAT CORVEL DOES NOT WARRANT THAT THE CAREMC APPLICATION OR ONLINE SERVICES ARE ERROR FREE, THAT CUSTOMER WILL BE ABLE TO ACCESS OR USE THE CAREMC APPLICATION OR ONLINE SERVICES WITHOUT PROBLEMS OR INTERRUPTIONS, OR THAT THE CAREMC SITE AND CAREMC APPLICATION ARE NOT SUSCEPTIBLE TO INTRUSION, ATTACK OR COMPUTER VIRUS INFECTION. D. Network Intrusions. CUSTOMER AGREES THAT CORVEL WILL NOT BE LIABLE FOR DAMAGES ARISING FROM ANY BREACH, UNAUTHORIZED ACCESS TO, MISUSE OF, OR INTRUSION INTO, CUSTOMER DATA RESIDING ON CORVEL'S SERVER(S) OR ANY NETWORK USED BY CUSTOMER TO THE EXTENT SUCH DAMAGES WERE BEYOND CORVEL'S REASONABLE CONTROL. 21 5. LICENSE TERM AND TERMINATION A. License Term. This CareMC License Agreement shall be effective as of the Effective Date and, unless terminated earlier as provided below, shall automatically terminate upon expiration or termination of the Master Agreement(the term of this CareMC License Agreement,the"License Term"). B. Termination for Convenience. Either party shall have the right to terminate this CareMC License Agreement for any reason or for no reason,upon ninety(90)days written notice to the other party. C. Termination for Cause. This CareMC License Agreement may be terminated by either party for cause as follows: (i) upon thirty (30) days written notice if the other party breaches or defaults under any material provision of this Agreement and does not cures such breach prior to the end of such thirty(30) day period, (ii) effective immediately and without notice if the other party ceases to do business, or otherwise terminates its business operations, except as a result of an assignment, as permitted under the terms and conditions of this CareMC License Agreement, or (iii) effective immediately and without notice if the other party becomes insolvent or seeks protection under any bankruptcy, receivership, trust deed, creditors arrangement, composition or comparable proceeding, or if any such proceeding is instituted against the other (and not dismissed within ninety(90)days). D. Effect of Termination. Expiration or termination of this CareMC License Agreement shall have the following effects: (i) CorVel shall provide Customer with any proprietary data belonging to Customer, in the current format in which it is stored at CorVel at the termination of this CareMC License Agreement, (ii) all licenses granted under this CareMC License Agreement shall terminate immediately, (iii) all rights to use the CareMC Application and Online Services shall cease immediately, and (iv) each party shall promptly return all information, documents, manuals and other materials belonging to the other party related to this CareMC License Agreement, whether in printed or electronic form, including without limitation all confidential information of the other party then currently in its possession, provided each party may retain one (1) copy of such materials for archival purposes. E. Survival. Except to the extent expressly provided to the contrary herein or in the Master Agreement, any right of action for breach of the CareMC License Agreement prior to termination, and the following provisions shall survive the termination of this CareMC License Agreement: Sections 1B-F,2B,2D,4 and 5E. 22 RFP 2014-302-SW AND ADDENDUMS MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO. 4 REQUEST FOR PROPOSAL 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) September 10, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: Effective Wednesday, September 10, 2014, the Mayor and City Commission have approved an ordinance repealing Section 2-372 of Division 3, Article VI, of Chapter 2 of the Miami Beach City Code titled "Procedure to provide preference to Miami Beach based vendors in contracts for goods and contractual services". Due to this change, the Miami Beach-based vendor preference specified in the solicitation has been deleted in its entirety and is no longer applicable. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado(a�miamibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez , 305-673-7000 ext. 6652 lourdesrodriguez @miamibeachfl.gov Bidders are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential bidders that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s)for not submitting a proposal. S' cerely, D4. tProcur-ment Director _ AA I AM I BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE RFP No. 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITYADDENDUM NO. 3 September 4, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: a) The deadline for receipt of proposals is extended until 3:00p.m., Friday, September 12, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. b) Section 0300, Proposal Submittal Instructions and Format has been amended. 1. SEALED RESPONSES. One original Proposal (preferably in 3-ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, tcn (10) seven (7) bound copies and one (1) electronic format (CD or USB format) are to be submitted. c) Appendix E, Cost Proposal Form has been amended. Proposers are required to submit the amended Appendix E — Cost Proposal Form in order to be deemed responsive. 2. RESPONSES TO QUESTIONS RECEIVED: Q #1: What company currently provides the medical case management services on behalf of the City of Miami Beach? If it is Johns Eastern Company, how much are they paid for these services? A#1: Johns Eastern Company is the current provider of medical case management services for the City of Miami Beach. Johns Eastern Company is compensated at $195 per lost time and medical only exposure. Please refer to Attachment C, Service Contract for further information. Q #2: If another company is used for case management, how much are they paid? Are their services paid as allocated expenses off each file? A#2: Johns Eastern Company is the only provider. Q #3: The RFP requested loss control and surveillance services? Who currently provides these services for the City of Miami Beach? Is there an estimate of the amount of these services the City will utilize? A#3: Proven Investigations, LLC, (formerly Horizon Investigators) of FL Lauderdale, Florida currently provides the surveillance services. In the past two (2) fiscal years, the City of Miami Beach has not utilized any loss control services. There is no estimate of loss control or surveillance services as they are requested on an as needed basis. • • RFP No. 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q #4: For medical bill payments and bill review services, the proposer would like to know the following information for the fiscal year 2013—2014. Q #4.1: Number of medical bills processed (excluding duplicates. A#4.1: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.2: Total Medical Charges A#4.2: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.3: Total Fee Schedule Reductions A#4.3: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.4: Total Audit Reductions A #4.4: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.5: Total PPO Reductions A #4.5: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.6: Total Bill Review Fees A#4.6: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.7: Total Audit Fees A#4.7: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.8: Total PPO Fees A#4.8: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #5: Is there any way to receive the Loss History in an excel format? A#5: Please refer to Attachment A, Open Claims and Attachment B, Closed Claims. Q #6: Will the City of Miami Beach utilize the Third Party Administrator's Bank? A#6: The City reserves the right to approve the bank utilized by the Third Party Administrator, or select its own. Q #7: Based on the required maximum claim counts of 100 lost time claims, the City of Miami Beach program will need two (2) dedicated Worker's Compensation lost time adjusters. Does the City of Miami Beach want a third dedicated adjuster as the on-site Workers' Compensation adjuster or will the on-site dedicated adjuster handle a case load? A#7: The City is looking for one (1) Worker's Compensation lost time on-site adjuster, who will not handle a case load, but be the intermediary between the Third Party Administrator, the City of Miami Beach and its employees. RFP No. 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO. 2 September 4, 2014 Q #8: Does the City of Miami Beach want the designated liability adjuster to handle field investigations only or will the adjuster handle assigned liability claims to conclusion? A#8: Yes, the designated liability adjuster will be required to handle field investigations only. Q #9: Please provide a copy of your current contract with Johns Eastern Company. A#9: Please refer to Attachment C, Service Contract. Q#10: Please provide the total amount of fees paid to Johns Eastern Company for the past three (3) full years of contract periods, by year. A#10: Please refer to Attachment E, Copy of Johns Eastern FY 11-12-13-14 Fees Paid. Q#11: Are the fees paid to Johns Eastern Company all-inclusive or are they also paid for any services as an allocated expense from the claims? A#11: Please refer to Attachment C, Service Contract. Q#12: Does the City of Miami Beach currently have a dedicated onsite worker's compensation adjuster from Johns Eastern Company or is this a new requirement? A#12: The City does not currently have a dedicated onsite worker's compensation adjuster. This is a new requirement. Q#13: For any onsite adjuster(s), will the City of Miami Beach provide office space, phones and internet access? Is there any charge to the Third Party Administrator for these services? A#13: Yes, the City will provide office space, phone, internet access for any onsite adjuster services requested by the City of Miami Beach. There is no additional charge for these services to the Third Party Administrator. Q#14: Please clarify the City of Miami Beach's need for an onsite liability adjuster? Section C.3,indicates this adjuster is to be used on an as needed basis. 3, of the A#14: For clarification, the City is looking for a liability claims adjuster to handle investigative work on an as needed basis to handle 15-30 Claims per fiscal year. This service will not require a dedicated on-site adjuster for liability adjusting services. Q#15: What is the annual volume of liability claim services the city expects to utilize? A#15: Approximately 15-30 liability claims per fiscal year. Q#16: How much was the Johns Eastern Company paid for liability services for the last three (3) full years? A#16: This service was not a part of Johns Eastern Company's contract. Q#17: The RFP indicates there are currently 421 open claims. It shows the open claim breakdown as 292 indemnity/ lost time claims, and 129 medical only claims. Please confirm this is accurate in both total and the indemnity/MO breakdown. A#17: Yes, the total number of open claims is 421; with 292 indemnity/lost time claims and 129 medical only claims. Q#18: The RFP indicated a required caseload cap of 100 open claims maximum per adjuster. Does the current Third Party Administrator comply with that caseload cap and have approximately three (3) indemnity adjusters assigned to handle this volume on your account? A#18: Yes • • RFP No. 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q#19: Is the caseload cap of 100 open claims maximum per adjuster a requirement or will a model with higher caseloads be considered? A#19: The City requires the caseload cap of 100 open claims per adjuster. Q#20: Regarding the Cost Proposal Form, Option #2, Fixed per Claim Fee Option. Does it have a liability fixed per claim fee? A#20: Option #2, Fixed per Claim Fee Option on the Cost Proposal Form is only referring to Worker's Compensation. For liability fixed per claim fee, please utilize the Liability Claims Adjuster option in the "Additional Services" section of the Cost Proposal Form. Q#21: Does the Liability Claims adjuster work fulltime in-house at the City of Miami Beach? A#21: No. Please note also on the revised Cost Proposal Form that the Liability Claims Adjuster will handle approximately 15-30 Claims, per fiscal year. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Contact: Telephone: Email: Lourdes Rodriguez 1 305.673.7000 x6652 lourdesrodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your ITN submission. Potential proposers that have elected not to submit a response to the ITN are requested to complete and return the "Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Si cerely, • ex Denis 'rocurement Director APPENDIX E ,''�i ' �1�.,�11 y� Cost Proposal Form "REVISED" September 4, 3014 RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY • PROCUREMENT DEPARTMENT 700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014.3025W 'PH Claims Adninisrcoiior, for Workers Comp and Gen Liability . APPENDIX E "REVISED" COST PROPOSAL FORM Failure to submit Section 5, Proposal Tender Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in proposal being non-responsive and being rejected. g Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance, The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be initialed. IN ORDER TO BE DEEMED RESPONSIVE, PROPOSERS MUST SUBMIT COST FOR EACH OPTION 1-3. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered for evaluation. OPTION #1: FLAT ANNUAL FEE OPTION Column 1 Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims including $ new and prior claims (per contract year) 2. Per Claim Fee for Quantity Excess Claim Fee Per Claims in Excess of $ 40 per year Year 345 Per Year (per excess claim) $ (Column 1 x Column 2) TOTAL OPTION 1 (Flat Annual Fee Option): $ (Total Lines 1 -2 *Deposit Amount To Be Maintained By The City: $ *Proposer shall include amount,which the City may negotiate at its discretion. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 2 i OPTION #2: FIXED PER CLAIM FEE OPTION Column 1 Column 2 Column 3 - NEW CLAIMS • • Claims with dates of accident after'contract inception-February'1,2015 1. Indemnity Per Claim Quantity (Litigated Or Non- $ 100 per year $ Litigated .er claim (Column 1 x Column 2) 2. Medical Only Claim Quantity (Litigated Or Non- $ 175 per year $ Litigated per claim (Column 1 x Column 2) 3. Medical Only Claim Quantity Transferred To $ 25 per year $ Indemnity Claim (per claim) (Column 1 x Column 2) (Litigated Or Non- Litigated) • - ,PRIOR,CLAIMS - - , • - • = Claims;with dates of accident-. nor to contract inception--Februa 1,,2015 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 292 per year $ Litigated •er claim (Column 1 x Column 2) 5. Medical Only Claim Quantity (Litigated Or Non- $ 129 per year $ Litigated) (per claim • (Column 1 x Column 2) 4 -. E 8 } TOTAL OPTION 2(FixeitPer Claim Fee..Option) - $ ,._ r n . Total Lines 1 -5 OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION Column 1 Column 2 Column 3 Y r ;`NEW CLAIMS � ..;4 -i }-;-"'�s.V;,r yX' .3: p =-4.-"5• $_t,f T +�f-._Y 6 ` c•'° 1.;37_;,,,,.-:9-i+ 'i✓ ° Y a - _1., : 4 r,g-; Claim s;with dates of acciident after contact ince tion- :t:..,„•-`,1,!-:,,,',a 15 .`1 µ 1 . _.- .3. .� ,.p. .. . Pte: r Februa� 1,20,15 " ,. Indemnity Or Medical ry Quantity Only Per Claim $ 300 per year $ (Litigated Or Non- (per claim) (Column 1 x Column 2) Litigated) 3- my '`� - -- , ,jam t a 4 "- r r [' X--. <r��, ; s r� F :: PRIOR CLAIMS ,f "w{� 44: , ' '�`�3 F�Clai a.Y. Y s ad r ^s:G S 1; :� a i J y , `,,, i y ,Y G ti 7 r,__� Y 5,;: (aims with dates of�accident priorto`contract inception "aFeb"ua 1''201'5 y �:•si{>E^ ,',...1,,-, t-.1--: rr.,y?d�r.:s ry-r l'ss.: k .•I�`_z ",,q..� 2. Indemnity Or Medical Quantity Only Per Claim $ 421 per year $ (Litigated Or Non- (per claim) (Column 1 x Column 2) Litigated) R b s , r SN+ A '� ,'5 7TOTAL OPTION 3$(Fxed Per Claim Blended Fee Option) $, `i !Y ' 4r F' - u i v ✓ . : 7 z . �. , R , (Total Lines 1 -2) �'�bh��:-:itlA.�„'w'S�4&'�iL'..Z�eb..,sY,'.aC`..,i9.>":3l'=�y.:sq`$'.•a'ne??�tt 34xY;c'L�^F,:E$�=Fy.t�%xiS a:i)�3itfK.:x3'�'u"'ii:>i°i.°bi4.r`.:.:Ri>i1Sa3,�&'d�gal b7slFC:wL�Z.'3i+'�'ss^1,3'�'i.^.TZ'.£5:4'•t;.K,r�Ya'�s`%,q:isf�.XYkc'tiza'�9s''i';2dG Y.ki+A`Y.'tS?F3snG:wA>.�$+`i3s�b'?':Y2«r`"T`>xLR,:bxAai;N'w; RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 3 • ADDITIONAL SERVICES List of services, as needed, which are in addition to the fees proposed in Options 1 - p 3. Description of Service Fee - , Telephonic Medical Case Management Fee On All Claims: $ Bill Review Fee To Include State Fee Schedule Reduction: Per Bill/Flat Fee Percentage Of PPO Savings—Network Discount Savings Below State Per Bill/Flat Fee Fee Schedule: Percentage Of Utilization Review And Reasonable&Customary Savings: % Subrogation and/or Liens Fee Percentage: Osha 300 Log Reporting: Electronic Data Interchange Filed With State: Safety Consulting Services Notice Of Injury Entry: Custom/Ad Hoc Reports: Data And File Conversion Fee: $ Medicare Reporting Costs: One-Time Setup Flat Fee Liability Claims Adjuster(15-30 Claims per fiscal year) Workers Compensation Claims Adjuster(City Of Miami Beach In- House Ad uster) $ �.. 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L. (� lf) In In Ln Lf) Lf) In Ln lO Ln Lf) In Ln Ln Ln Ln lf) In lf) Lf) Lf) Ln In U 0 O 4J ;c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 c0 CO c0 c0 c0 c0 c0 c0 CO (A1 M1 c- ..- c- c- c- c- c- .- c- c- c- c- c- c- c- c- c- r- c- c- c- c- = &A;76442e/1? JOHNS EASTERN COMPANY, INC. givj Claim AdJusrer and Third Party Administrators SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAIMS HANDLING THIS SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAIMS HANDLING-is made and entered into this 11th day of January 2010, but is effective for all purposes as of the 1st day of February 2010, by and between the CITY OF MIAMI BEACH (referred to as the "Client"), and JOHNS EASTERN COMPANY, INC. (referred to as the "Service Agent"). WITNESSETH: WHEREAS, the Client has undertaken to self-insure its Workers' Compensation liability in accordance with the Workers' Compensation Law and other applicable statutes and regulations; and WHEREAS, the Service Agent is engaged in the supervision and administration of programs for self-insured employers; WHEREAS, the Client desires to engage the Service Agent for, and the Service A ent desires to assist the Client in workers' compensation claims handling; g NOW, THEREFORE, for and in consideration of the premises and of the mutual obligations, performance of services, and payment of compensation set forth herein, the parties agree as follows: 1. Engagement. The Client hereby engages the Service Agent to supervise and administer the Self-Insured Workers' Compensation Program of the Client in accordance with the Workers' Compensation Law as adopted and amended by the State of Florida (the "Law") and the applicable rules and regulations as promulgated by the applicable agencies of the State of Florida relating to the Law (the "Rules"), all in accordance with the Service Agent's proposal dated September 3, 2009 a copy of which is attached hereto and incorporated herein by this reference (the"Proposal"). 2. Amp Subject to termination pursuant to Paragraph 9, the term of this Agreement shall begin as of Febi ary-1, :;20:10 Arid .':shall terminate=on•°January 31, 2015;' provided. 3. Fund for Payment of CIaims. The Client has the sole obligation and responsibility for funding the payment of claims made by its employees under the Law and Rules, The Service Agent assumes no duty to fund any such claims at any time and shall have no obligation to advance funds for any such payment. The Client agrees to maintain all necessary funds for payment of claims in accordance with the Law and Rules and to inform the Service Agent of all relevant details with respect to any such accounts in order for the Service Agent to perform its duties under this Agreement. The Client shall add to or increase the amount in any such accounts as needed, and, in any event, within five (5) business days from the Service Agent's notice to the Client to such effect. 4. Allocated Claims Expenses. Charges for services below are billed at negotiated rates for vendors selected by CLIENT/SERVICE AGENT unless otherwise outlined below. "Allocated Claims Expenses" shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the CLIENT specified in Paragraph 3, including, but not limited to: a. Attorneys' and legal assistants' fees for claim and any lawsuits, before and at trial, on appeal, or otherwise; b. Court and other litigation and settlement expenses, including, without limitation: • - _ • . _ (i) MedicaI examinations to determine extent of liability; - (ii) Expert medical and other testimony; (iii) Laboratory, X-ray and other diagnostic tests; (iv) Autopsy, surgical reviews, and other pathology services; . (v) Physician and related fees and expenses in reading,interpreting, or performing any of the foregoing tests or services; (vi) Stenographer,process server, and other related trial preparation, trial, settlement, and court costs; (vii) Witnesses fees and expenses before and at trial, deposition, settlement discussions, or otherwise; and • c. Fees and expenses for surveillance,private investigators, or otherwise, d. Fees for the indexing of injured employees, e. Fees for any work done outside the office,including, but not limited to, field investigations necessary to determine compensability,liability, Special Disability Trust Fund or subrogation recoverability, claimant control, attendance at mediations, hearings and depositions, attendance at management meetings, attendance at medical consultations or hearings, appraisals, case management, recorded statements, . f. Telephonic medical management will be$195.00 per lost time and medical only exposure whose dates of loss fall between February 1, 2010 and • January 31, 2013. This fee applies only to cases handled by the Service Agent. g. Fees for over-night or special mail service for various documents, h. Fees for examining and reducing hospital and medical bills as appropriate are$5.95 per bill and 30% of savings over and above Fee Schedule savings. i. Photocopying and/or CD-ROM copies,review of relevant documentation. j. Pre-Certification of Hospital Admissions, On-Site Case Management, Peer Review, Medical Care Audits, and Hospital Bill Audits. k. Medicare Set-Aside (MSA) services to include; recommendation for MSA submission, MSA cost projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, conditional lien dispute, projection update. _ _ _ 5. Compensation for the Service Agent. For performing its services under this Agreement, the Service Agent shall be entitled to the following compensation: a. Fees for claims handling for the Client's exposures whose dates of loss fall • between February 1, 2010 and January 31, 2011 will be a minimum and deposit of$200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450,the Service Agent will increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. b. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2011 and January 31,.2012 will be a minimum and deposit of$200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450,the Service Agent will increase the fees proportionately. This fee covers all claims management/a.dministration and data processing services outlined in the original proposal. All years are subject to audit. • c. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2012 and January 31, 2013 will be a minimum and deposit of$200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers' compensation exposures. If the number of exposures exceeds 450, the Service Agent will increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. d' _ ees= o'years,2013/14;acid 2014/15 will not=exceed 7:5%over the`:previous 'year's fees, e. Allocated expenses are costs associated with investigation and/or adjustment of a claim. The Service Agent will charge the allocated expense to the claim file. Fees for any field investigation will be$95.00 per hour, $0.55 a mile, and 1.00 per color photograph, and administrative expenses. The Service Agent will bill _ _ _ at these rates all activities involving handling, controlling or settling an employer's liability on a claim. f. Loss control services are available through the Service Agent's consultant at a rate of$95.00 per hour. The Service Agent can customize Safety/Loss Control services to meet the CIient's program and risk needs. This service is offered on an as needed basis. 6. Excess Reporting Obligation - Unless otherwise specified in this addendum, Service Agent agrees that reporting claims to excess insurance carrier is the Service Agent's responsibility. It is the responsibility of the Client to provide accurate coverage information regarding any insurance policies insuring claims covered by this contract. The information for all claim years that the Service Agent is handling will be made available to the Service Agent within 90 days of contract inception. New insurance information on renewal years will be made within 90 days of renewal date. Excess information will include name and claims reporting address and phone number of all carriers, policy number, effective dates, limits of liability, deductibles, specific retentions and loss funds. Actual policies will be provided. • This information is required for each claim year that the Service Agent is handling for the Client. If this information is not made available as outlined in this Paragraph, Service Agent will not be responsible for any penalties, interest, or reductions in excess recoveries because of late reporting. 7. Continuing Handling of Claims After Termination of Contract or Legally Imposed Mandates. Upon termination of this Agreement as set forth in paragraph 8, the Service Agent agrees to continue handling all claims that have been made and reported to it prior to such date of termination for thirty(3 0) days unless the parties have agreed otherwise in writing. Upon repeal of any service mandated by the workers' compensation law and/or other applicable statutes and/or regulations, the Service Agent agrees to continue handling all claims under the repealed service that have been reported to it prior to the date of such repeal for thirty(30) days unless the parties have agreed otherwise in writing. Upon exiting, client data will be provided to the new TPA either by a series of attachments to one or more email messages containing zip files which can be password-protected or via CD ROMS. The claim files may exist as paper files and will be shipped as such. If the claim files are stored as images in a document retrieval system, they will be provided via CD ROM or the most current means of providing data. The cost for this will be no greater than$3,500.00. The Client will be billed for any additional programming to help in data transfer. 8. Disputes Subject to Arbitration. Any dispute or claim arising out of or relating to this Agreement or any breach thereof shall be resolved by submission of such dispute or claim to an arbitration panel composed as follows: The Client and the Service Agent shall each select one member of the panel and the two selected _. members shall select.a third member. The parties agree to follow the rules of the American Arbitration Association. 9. Termination. This Agreement may be terminated by either the Client or the Service Agent by giving prior written notice of ninety (90) days. In the event of such termination, compensation paid or payable to Service Agent under Paragraph 5 shall be prorated as appropriate. Notwithstanding anything in this Paragraph 8 to the contrary, the insolvency or filing for relief from creditors of any party pursuant to the United States Bankruptcy Code or the material breach of a material provision of this Agreement by any party shall permit the party + p Y p other art to cancel this p 5 Agreement immediately upon written notice. 10. Covenants of the Service Agent and the Client. Each of the Service Agent and the Client agrees to use its noinial and ordinary professional care and diligence in the performance of its duties under this Agreement and will use its best efforts to comply at all times with the Law and the Rules. 11. Indemnification. Service Agent agrees to indemnify and hold harmless the Client and its officers, employees, and agents, from and against any and all actions, claims, liabilities, losses and expenses, including but not limited to, attorneys' fees, for personal, economic or bodily injury, wrongful death, loss of or damage to property, at law or in equity, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Service Agent,its employees, agents, sub-contractors, or any other person or entity acting under Service Agent's control, including without limitation any and all temporary personnel assigned to the Client pursuant to this Agreement, in connection with the Service Agent's performance of the Services pursuant to this Agreement; and to that extent, the Service agent shall pay all such claims and losses and shall pay all • such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the CIient in the defense of such claims and losses, including appeals. The parties agree that one percent(1%) of the total compensation to the Service Agent for performance of the Services under this Agreement is the specific consideration from the Client to the Service Agent for the Service Agent's Indemnity Agreement. The Service Agent's obligation under this Subsection shall not include the obligation to indemnify the Client and its officers, employees and agents, from and against any actions or claims which arise or are alleged to have arisen from the sole negligent acts or omissions or other wrongful conduct of the Client and its officers, employees and agents. The parties each agree to give the other party prompt notice of any claim coming to its knowledge that in any way directly or indirectly affects the other party. 12. Miscellaneous. a. Each party represents and warrants that it has full power and authority to -- _ enter into this Agreement. b. All notices, requests, demands and other communications which are required or may be given under this Agreement shall be in writing and shall be deemed to have been duly given when received if personally delivered; when transmitted if transmitted by telecopy, electronic telephone line facsimile transmission, or other similar electronic or digital transmission method; the day after it is sent, if sent by recognized expedited delivery service; and five (5) days after it is sent, if mailed, certified or registered mail, return receipt requested,postage prepaid. In each case, notice shall be sent to: If to the Client: City of Miami Beach 1700 Convention Center Dr. City Hall Miami Beach, FL 33139 If to the Service Agent: Johns Eastern Company,Inc, Post Office Box 110259 Lakewood Ranch, FL 34211-0004 or to such other address as either party may have specified in writing to the other using the procedures specified above in this Paragraph. c. (i) This Agreement shall be construed pursuant to and governed by the substantive laws of the State of Florida(and any provision of Florida.law shall not apply if the law of a state or jurisdiction other than Florida would otherwise apply). (ii) The headings of the various Paragraphs in this Agreement are inserted for the convenience of the parties and shall not affect the meaning, construction, or interpretation of this Agreement. (iii) Any provision of this Agreement which is determined by a court of competent jurisdiction to be prohibited,unenforceable or not authorized in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition, unenforceability or non- authorization without invalidating the remaining provisions hereof or affecting the validity, enforceability or legality of such provision in any other jurisdiction. In any such case, such determination shall not affect any other provision of this Agreement, and the remaining provisions of this Agreement shall remain in full force and effect. If any provision or term of this Agreement is susceptible to two or more constructions or interpretations, one or more of which would render the provision or term void or unenforceable, the parties agree _._... ._ . _ that a _construction or interpretation which renders the term or provision valid shall be favored. d. This Agreement constitutes the entire Agreement, and supersedes all prior agreements and understandings, oral and written among the parties to this Agreement with respect to the subject matter hereof e. (i) If, within ten (10) days after demand to comply with the obligations of one of the parties to this Agreement served in writing on the other, compliance or reasonable assurance of compliance is not forthcoming, and the other party takes steps to enforce rights under this Agreement pursuant to Paragraph 8 or otherwise, the prevailing party in any action shall be entitled to recover all reasonable costs and expenses (including reasonable attorneys' and legal assistants' fees before and at trial, on appeal, or otherwise.) (ii) If any monies shall be due either of the parties to this Agreement hereunder and shall not be paid within forty-five (45) days from the due date of such payment, interest shall accrue on such unpaid amount at the rate of 1% per month in accordance with the Florida Prompt Payment Act- F.S.218.70-79. f. This Agreement shall be binding upon and inure to the benefit of the successors in interest and assigns of the parties. g. The parties to this Agreement will execute and deliver, or cause to b executed and delivered, such additional or further documents, agreements, 1 or instruments and shall cooperate with one another in all respects for the purpose of carrying out the transactions contemplated by this Agreement. h. This Agreement may be executed in any number of counterparts, each of which shall be considered an original, but all of which together shall constitute one and the same instrument and shall become effective when each of the parties has executed at least one of the counterparts even if all the parties have not executed the same counterpart. IN WITNESS WHEREOF, the parties have executed this Agreement effective for all purposes as of February 1, 2010. CITY OF MIAMI BEACH . L� .�/ � k u - s Matti Herrera Bower la C ( Mayor •- City Clerk WI ►.TESSES: JOHNS EASTERN COMPANY,INC. �••� Bever y Adkin AIM,AIC Executive Vice President ea66( s axe etccvaacr APPROVED AS TO FORM&LANGUAGE &FOR EXECUTION / L -t (-(6 • -it-9 Atte . y y,, Date . EASTERN COMPANY; INC. f,,10frn A.rliu:.texs and TI1'r+ r K .,Mar il.ltrt tor5 ADDENDUM NUMBER I TO SERVICE CONTRACT FOR WORKERS' COMPENSATION CLAIMS HANDLING This is the First Addendum to the Agreement entered into between Johns Eastern Company,Inc., hereinafter called the SERVICE AGENT,and City of Miami Beach,hereinafter called the CLIENT,dated the ft day of February 2010. This Addendum affects the remuneration to be paid by the CLIENTto the SERVICE AGENT for the handling of claims with a date of loss of February 1,2013 through January 31,2014. All other terms of the original Contract remain unchanged. The remuneration to be paid to the SERVICE AGENT under this Agreement by the CLIENT for workers'compensation claims handling and safety services during the term of this Agreement shall be as follows: 4. Allocated Claims Expenses. Charges for services below are billed at negotiated rates for vendors selected by CLIENT/SERVICE AGENT unless otherwise outlined below. "Allocated Claims Expenses" shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the CLIENT specified in Paragraph 3, including, but not limited to: a. Attorneys'and legal assistants'fees for claim and any lawsuits, before and at trial, on appeal, or otherwise; b. Court and other litigation and settlement expenses, including,without limitation: (1) Medical examinations to determine extent of liability; (ii) Expert medical and other testimony; (iii) Laboratory,X-ray and other diagnostic tests; (iv) Autopsy,surgical reviews, and other pathology services; (v) Physician and related fees and expenses in reading, interpreting,or performing any of the foregoing tests or services; (vi) Stenographer, process server, and other related trial preparation,trial, settlement, and court costs; (vii) Witnesses fees and expenses before and at trial,deposition,settlement discussions, or otherwise;and c. Fees and expenses for surveillance, private investigators, or otherwise, d. Fees for the indexing of injured claimants, e. Fees for any work done outside the office, hcluding, but not limited to,field • i • investigations necessary to determine compensability, liability,Special Disability Trust Fund or subrogation recoverability,claimant control, attendance at mediations, hearings and depositions, attendance at management meetings, attendance at medical consultations or hearings, appraisals, case management, recorded statements, f• Telephonic medical management will be$195.00 per lost time and medical only exposure. This fee only applies to cases handled by the Service Agent g. Fees for over-night or special mail service for various documents, h. Fees for examining and reducing hospital and medical bills as appropriate will be $5.95/bill and 30%of savings over and above Fee Schedule savings, Photocopying and/or CD-ROM copies, review of relevant documentation. • j. Pre-Certification of Hospital Admissions,On-Site Case Management,Peer Review, Medical Care Audits, and Hospital Bill Audits. • • -k. Medicare Set-Aside (MSA) services to include; recommendation for MSA submission, MSA cost projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, conditional lien dispute, projection update. 5. Compensation for the Service Agent: For performing its services under this Agreement,the Service Agent shall be entitled to the following compensation: a. Fees for claims handling for the Client's exposures whose dates of loss fall between February 1, 2013 and January 31, 2014 will be a minimum and deposit of $200,000.00. The Service Agent will bill this minimum and deposit quarterly, with the first payment due upon program inception. The annual minimum and deposit covers handling 450 workers'compensation exposures. If the number of exposures exceeds 450,the Service Agent wil increase the fees proportionately. This fee covers all claims management/administration and data processing services outlined in the original proposal. All years are subject to audit. b. Fees for years 2014/15 will not exceed 7.5%over the p-evious year's fees. c. Allocated expenses are costs associated with investigation and/or adjustment of a claim. The Service Agent will charge the allocated.expense to the claim file. Fees for any field investigation will be $95.00 per hour, $055 a mile, and 1.00 per color photograph, and administrative expenses. The Service Agent will bill at these rates all activities involving handling,controlling or settling an employer's liability on a claim. d: Loss control services are available through the Service Agent's consultant at a rate of $95.00 per hour. The Service Agent can customize Safety/Loss Control services to meet the Client's program and risk needs. This service is offered on an as needed basis, 6. Excess Reporting Obligation - Unless otherwise specified in this addendum,Service Agent agrees that reporting claims to excess insurance carrier is the Service Agent's responsibility. It is the responsibility of the Client to provide accurate coverage information regarding any insurance policies insuring claims covered by this contract. The information for all claim years thatthe Service Agent is handling will be made available to the Service Agent within 90 days of contract inception. New insurance information on renewal years will be made within 90 days of renewal date. Excess information will include name and claims reporting address and phone number of all carriers,policy number, effective dates, limits of liability, deductibles,specific retentions and loss funds. Actual policies will be provided. This information is required for each claim year that the Service Agent is handling for the Client. If this information is not made available as outlined in this paragraph, Service Agent will not be responsible for any penalties,interest,or reductions in excess recoveries because of late reporting. The Service Agent shall not be responsible for costs, judgments', settlements, damages, etc. resulting from the excess carrier's denial of a claim due to untimely reporting at the fault of the prior administrator(s)for claims assumed under the current contract, The Service Agent shall not be responsible for reporting to excess or collecting recoverable(s) for closed claims at time of contract inception, unless so directed by Client. 7. Continuing Handling of Claims After Termination of Contract or Legally Imposed Mandates. Upon termination of this Agreement as set forth in paragraph 8, the Service Agent agrees to continue handling all claims that have been made and reported to it prior to such date of termination for thirty(30)days unless the parties have agreed otherwise in writing. Upon repeal of any service mandated by the workers'compensation law and/or other applicable statutes and/or regulations, the Service Agent agrees to continue handling all claims under the repealed service that have been reported to it prior to the date of such repeal for thirty(30)days unless the parties have agreed otherwise in writing. Upon exiting,client data will be provided to the new TPA either by a series of attachments to one or more email messages containing zip files which can be password-protected or via CD ROMS. The claim files may exist as paper files and will be shipped as such. If the claim files are stored as images in a document retrieval system, they will be provided via CD ROM or the most current means of providing data. The cost for this will be no greater than$3,500.00. The Client will be billed for any additional programming to help in data transfer, 12. Miscellaneous. b. All notices, requests, demands and other communications which are required.or may be given under this Agreement shall be in writing and shall be deemed to have been duly given when received if persondly delivered; when transmitted If transmitted by telecopy,electronic telephoneline facsimile transmission, or other similar electronic or digital transmission method; the day after it is sent, if sent by recognized expedited delivery service; aid five (5) days after it is sent, if mailed,certified or registered mail, return receipt requested, postage prepaid. In each case, notice shall be sent to: If to Client: City of Miami Beach 1700 Convention Center Drive—City Hall , Miami Beach, FL 33139 If to the Service Agent: Johns Eastern Company, Inc. Post Office Box 110259 Lakewood Ranch, FL 34211-0004 or to such other address as either party may have specified in writing to the other using the procedures specified above In this Paragraph. All other terms of the contract remain unchanged. IN WITNESS WHEREOF,the SERVICE AGENT and the CLIENT have each caused this Addendum to be executed by its duly authorized representative to be effective the 1St day of February 2013. WITNESSES: CITY OF MIAMI EA ,7/7- WITNESSES: JOHNS EASTERN COMPANY, INC. A r r / B v ly Ad ns, AIC, AIM t2- `',, a 210-2444- Executive Vice President Special Account Services - APPROVED AS TO FORM & LANGUAGE &FOR EXECUTION r-- '�-__ = •rage ... Dat: '"' f ' I i 1\4 r / ii e e INVOICEDT Type DCN Claim# Provider Transfer Dt 10/31/12 I 632547 542662 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 I 632561 288001 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 I 632577 542707 ORTHOPAEDIC ASSOCIATES USA 10/02/12 10/31/12 I 632580 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 I 632584 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 I 632596 542846 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 I 632606 264529 JOSEPH I FERNANDEZ MD 10/02/12 10/31/12 I 632616 434063 WORKERS HEALTH SOLUTIONS INC 10/02/12 10/31/12 I 632641 544082 MOUNT SINAI MEDICAL CTR 10/02/12 10/31/12 I 632655 544318 MOUNT SINAI MEDICAL CTR 10/02/12 10/31/12 I 632706 542764 STERLING EM SVC OF MIAMI BEACH 10/02/12 10/31/12 I 632710 542226 SUNRISE MEDICAL GROUP I LLC 10/02/12 10/31/12 I 632713 540597 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 I 632774 540511 PHYSICIANS HEALTH CENTERANC 5 10/02/12 10/31/12 I 632776 540511 PHYSICIANS HEALTH CENTERANC S 10/02/12 10/31/12 I 632802 543542 ANNE BATES LEACH EYE HOSP. 10/02/12 10/31/12 I 632843 535607 GULFSTREAM EMERG PHYS 10/02/12 10/31/12 I 632886 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 I 632953 277541 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 I , 632962 541243 JACKSON HEALTH SYSTEM 10/02/12 10/31/12 I 633065 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 I 633069 540597 JON D DONSHIK MD PA 10/02/12 10/31/12 I 633087 542707 PRESCRIPTION PARTNERS LLC 10/02/12 10/31/12 I 633118 539855 FLORIDA BRACING CENTERS, INC. 10/02/12 10/31/12 I 633146 525377 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633155 537610 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633156 513267 STEPHEN B MEISEL, M.D. 10/02/12 10/31/12 I 633157 543545 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633161 542662 MARK SCHOENFELD 10/02/12 10/31/12 I 633163 532327 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633164 288001 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633184 542819 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633208 543276 STEPHEN B MEISEL M.D. 10/02/12 10/31/12 I 633260 513267 HOME CARE CONNECT LLC 10/02/12 10/31/12 I 633273 460888 JON D DONSHIK MD PA 10/02/12 10/31/12 I 633311 470122 JON D DONSHIK MD PA 10/02/12 10/31/12 I 633331 543276 RX DEVELOPMENT ASSOCIATES INC 10/02/12 10/31/12 I 633352 541282 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I 633355 541282 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I 633357 540084 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I 633360 540084 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I 633362 543276 DOCTORS MEDICAL 10/02/12 10/31/12 I 633369 544800 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I. 633376 538826 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 10/31/12 I 633378 538826 HEALTH CARE CENTER OF MIAMI BEACH 10/02/12 i ! 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I m Ll1 I W O 1 N• N N i u'I I j I 1 ! I GJ IN hr N W 1 m (JD O M I s 1 0 N, m O 1 Co'1 O U U10 m H m 1m m 0 m m m101 ,-1 mI 5 ol�1r-I cr co if) r-1 co1mi N � o1 NI W10,, c O, r Ln Ln CO 0 I r-III m 1 I � LU I N I oo 1 01 I O'N I N N N N IN N N 1 IN I N 1 I I IN. N I N j N, N IU LI -I: c-I t--I a-I 1 ' N r1 a-N N N,--1 1 CO m m m ,t 1 �.�1 O.0 0 0 I O I O O I O ii 1 '1 m I m O 010 O O O I I I I N N N N I N 1 N€N N N N I N 1 N,N N LL 1 fy :/ J\/ J City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO. 2 REQUEST FOR PROPOSAL 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) August 25, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: The deadline for receipt of proposals is extended until 3:00p.m., Tuesday, September 9, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfl.gov/newcity/depts/purchase/bidintro.asp Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado(a�miamibeachfl.gov Contact: Telephone: 1 Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers" questionnaire with the reason(s) for not submitting a proposal. Sink -.y --- Alehx Deni Pr cit curement Director MIA.tv . IBE!i.... .CH BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 1 REQUEST FOR PROPOSAL 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) August 20, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: The due date for receipt of proposals has been extended until 3:00p.m., Tuesday, September 2, 2014. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfl.gov/newcity/depts/purchase/bidintro.asp Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado anmiamibeachfl.gov Contact: Telephone: Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers" questionnaire with the reason(s) for not submitting a proposal. Si Icerel f :x Den's Procurement Director RFP No. 2014-302-SW Addendum#1 8/20/2014 REQUEST FOR P ( REP FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY RFP 2014-302-SW RFP ISSUANCE DATE: JULY 24, 2014 PROPOSALS DUE: AUGUST 26, 2014 @ 3:00 PM ISSUED BY: Steven Williams MIAMI BEACH Steven Williams, Procurement Coordinator PROCUREMENT DEPARTMENT 1700 Convention Center Drive, Miami Beach, FL 33139 305.673.7000 x6650 ( Fax: 786.373. 4330 I www.miamibeachfl.gov i∎I V\IBEACH TABLE OF CONTENTS SOLICITATION SECTIONS: PAGE 0100 NOT UTILIZED N/A 0200 INSTRUCTIONS TO PROPOSERS & GENERAL CONDITIONS 3 0300 PROPOSAL SUBMITTAL INSTRUCTIONS & FORMAT 10 0400 PROPOSAL EVALUATION 12 APPENDICES: PAGE APPENDIX A PROPOSAL CERTIFICATON, QUESTIONNAIRE AND AFFIDAVITS 14 APPENDIX B "NO PROPOSAL" FORM 21 APPENDIX C MINIMUM REQUIREMENTS & SPECIFICATIONS 23 APPENDIX D SPECIAL CONDITIONS 34 APPENDIX E COST PROPOSAL FORM 36 APPENDIX F INSURANCE REQUIREMENTS 40 APPENDIX G CLAIMS EXPERIENCE 42 RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 2 � nlA^ ' 1 BEACH SECTION 0200 INSTRUCTIONS TO RESPONDENTS & GENERAL CONDITIONS 1. GENERAL. This Request for Proposals (RFP) is issued by the City of Miami Beach, Florida (the "City"), as the means for prospective Proposers to submit their qualifications, proposed scopes of work and cost proposals (the "proposal") to the City for the City's consideration as an option in achieving the required scope of services and requirements as noted herein. All documents released in connection with this solicitation, including all appendixes and addenda, whether included herein or released under separate cover, comprise the solicitation, and are complementary to one another and together establish the complete terms, conditions and obligations of the Proposers and, subsequently, the successful Proposer(s) (the"contractor[s]") if this RFP results in an award. The City utilizes PublicPurchase (www.publicpurchase.com) for automatic notification of competitive solicitation opportunities and document fulfillment, including the issuance of any addendum to this RFP. Any prospective Proposer who has received this RFP by any means other than through PublicPurchase must register immediately with PublicPurchase to assure it receives any addendum issued to this RFP. Failure to receive an addendum may result in disqualification of proposal submitted. 2. PURPOSE. The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self-insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore the City is seeking the professional services of an experienced and qualified firm to provide services as a third party administrator for Workers Compensation and General Liability. 3. SOLICITATION TIMETABLE. The tentative schedule for this solicitation is as follows: RFP Issued July 24, 2014 Pre-Proposal Meeting August 12, 2014 @ 10:30 a.m. Deadline for Receipt of Questions August 19, 2014 Responses Due August 26, 2014 @ 3:00p.m. Evaluation Committee Review TBD Proposer Presentations TBD Tentative Commission Approval Authorizing TBD Negotiations Contract Negotiations Following Commission Approval 4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact named herein, in writing, with a copy to the City Clerk's Office, Rafael E. Granado via e-mail: RafaelGranado(a miamibeachfl.gov ; or facsimile: 786-394-4188. The Bid title/number shall be referenced on all correspondence. All questions or requests for clarification must be received no later than seven (7) calendar days prior to the date proposals are due as scheduled in Section 0200-3. All responses to questions/clarifications will be sent to all prospective Proposers in the form of an addendum. Procurement Contact: Telephone: Email: Steven Williams (305)673-7497 StevenWilliams @miamibeachfl.gov RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability ht � 3 1V\AI A 1 BEACH 5. PRE-PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre-proposal meeting or site visit(s) may be scheduled. A Pre-PROPOSAL conference will be held as scheduled in Solicitation Timeline above at the following address: City of Miami Beach City Hall -4th Floor City Manager's Large Conference Room 1700 Convention Center Drive Miami Beach, Florida 33139 Attendance (in person or via telephone) is encouraged and recommended as a source of information, but is not mandatory. Proposers interested in participating in the Pre-Proposal Submission Meeting via telephone must follow these steps: (1) Dial the TELEPHONE NUMBER: 1- 888-270-9936 (Toll-free North America) (2) Enter the MEETING NUMBER: 1142644 Proposers who are interested in participating via telephone should send an e-mail to the contact person listed in this RFP expressing their intent to participate via telephone. 6. PRE-PROPOSAL INTERPRETATIONS. Oral information or responses to questions received by prospective Proposers are not binding on the City and will be without legal effect, including any information received at pre- submittal meeting or site visit(s). Only questions answered by written addenda will be binding and may supersede terms noted in this solicitation. Addendum will be released through PublicPurchase, 7. CONE OF SILENCE. Pursuant to Section 2-486 of the City Code, all procurement solicitations once advertised and until an award recommendation has been forwarded to the City Commission by the City Manager are under the "Cone of Silence." The Cone of Silence ordinance is available at http://library.municode.com/index.aspx?clientlD=13097&statelD=9&statename=Florida. Any communication or inquiry in reference to this solicitation with any City employee or City official is strictly prohibited with the of exception communications with the Procurement Director, or his/her administrative staff responsible for administering the procurement process for this solicitation providing said communication is limited to matters of process or procedure regarding the solicitation. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranado @miamibeachfl.gov. Balance of Page Intentionally Left Blank REP 2014-302-SW TPA Claims Administration for Workers Comp p and Gen Liability ,. . .. 4 _ AC AA ,A,/\i\I BEH 8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject to the following ordinances/resolutions, which may be found on the City Of Miami Beach website: http://web.miamibeachfl.qov/procurement/scroll.aspx?id=23510 • CONE OF SILENCE CITY CODE SECTION 2-486 • PROTEST PROCEDURES . . CITY CODE SECTION 2-371 • DEBARMENT PROCEEDINGS...... . CITY CODE SECTIONS 2-397 THROUGH 2-485.3 • LOBBYIST REGISTRATION AND DISCLOSURE OF FEES CITY CODE SECTIONS 2-481 THROUGH 2-406 • CAMPAIGN CONTRIBUTIONS BY VENDORS........................... CITY CODE SECTION 2-487 • CAMPAIGN CONTRIBUTIONS BY LOBBYISTS ON PROCUREMENT ISSUES CITY CODE SECTION 2-488 • REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL BENEFITS FOR DOMESTIC PARTNERS...,..... CITY CODE SECTION 2-373 • LIVING WAGE REQUIREMENT CITY CODE SECTIONS 2-407 THROUGH 2-410 • LOCAL PREFERENCE FOR MIAMI BEACH-BASED VENDORS CITY CODE SECTION 2-372 • PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND CONTROLLED BY VETERANS AND TO STATE-CERTIFIED SERVICE- DISABLED VETERAN BUSINESS ENTERPRISES............................. CITY CODE SECTION 2-374 • FALSE CLAIMS ORDINANCE...,..... CITY CODE SECTION 70-300 • ACCEPTANCE OF GIFTS,FAVORS&SERVICES............................ CITY CODE SECTION 2-449 9. POSTPONEMENT OF DUE DATE FOR RECEIPT OF PROPOSALS. The City reserves the right to postpone the deadline for submittal of proposals and will make a reasonable effort to give at least three (3) calendar days written notice of any such postponement to all prospective Proposers through PublicPurchase. 10. PROTESTS. Protests concerning the specifications, requirements, and/or terms; or protests after the proposal due date in accordance with City Code Section 2-371, which establishes procedures for protested proposals and proposed awards. Protests not submitted in a timely manner pursuant to the requirements of City Code Section 2- 371 shall be barred. 11. MIAMI BEACH-BASED VENDORS PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011-3747, a five (5) point preference will be given to a responsive and responsible Miami Beach-based Proposer. 12. VETERAN BUSINESS ENTERPRISES PREFERENCE. Pursuant to City of Miami Beach Ordinance No. 2011- 3748, the City shall give a five (5) point preference to a responsive and responsible Proposer which is a small business concern owned and controlled by a veteran(s) or which is a service-disabled veteran business enterprise. 13. DETERMINATION OF AWARD. The final ranking results of Step 1 & 2 outlined in Section 0400, Evaluation of Proposals, will be considered by the City Manager who may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Manager's recommendation need not be consistent with the scoring results identified herein and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1) The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation,judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. J. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 5 /v\I AAA I BEACH f: The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. Upon approval of selection by the City Commission, negotiations between the City and the selected Proposer(s) will take place to arrive at a mutually acceptable Agreement. 14. ACCEPTANCE OR REJECTION OF PROPOSALS. The City reserves the right to reject any or all proposals prior to award. Reasonable efforts will be made to either award the Contract or reject all proposals within one- hundred twenty (120) calendar days after proposals opening date. A Proposer may not withdraw its proposals unilaterally before the expiration of one hundred and twenty (120) calendar days from the date of proposals opening. 15. PROPOSER'S RESPONSIBILITY. Before submitting a Proposal, each Proposer shall be solely responsible for making any and all investigations, evaluations, and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. Ignorance of such conditions and requirements, and/or failure to make such evaluations, investigations, and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. 16. COSTS INCURRED BY PROPOSERS. All expenses involved with the preparation and submission of Proposals, or any work performed in connection therewith, shall be the sole responsibility (and shall be at the sole cost and expense) of the Proposer, and shall not be reimbursed by the City. 17. RELATIONSHIP TO THE CITY. It is the intent of the City, and Proposers hereby acknowledge and agree, that the successful Proposer is considered to be an independent contractor, and that neither the Proposer, nor the Proposer's employees, agents, and/or contractors, shall, under any circumstances, be considered employees or agents of the City. 18. TAXES. The City of Miami Beach is exempt from all Federal Excise and State taxes. 19. MISTAKES. Proposers are expected to examine the terms, conditions, specifications, delivery schedules, proposed pricing, and all instructions pertaining to the goods and services relative to this RFP. Failure to do so will be at the Proposer's risk and may result in the Proposal being non-responsive. 20. PAYMENT. Payment will be made by the City after the goods or services have been received, inspected, and found to comply with contract, specifications, free of damage or defect, and are properly invoiced. Invoices must be consistent with Purchase Order format. 21. PATENTS & ROYALTIES. Proposer shall indemnify and save harmless the City of Miami Beach, Florida, and its officers, employees, contractors, and/or agents, from liability of any nature or kind, including cost and expenses for, or on account of, any copyrighted, patented, or unpatented invention, process, or article manufactured or used in the performance of the contract, including its use by the City of Miami Beach, Florida. If the Proposer uses any design, device or materials covered by letters, patent, or copyright, it is mutually understood and agreed, without exception, that the proposal prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. REP 2014-302-SW TPA Claims Administration for Workers Comp and Gen liability 6 A 4 M.1 B EA C H ,. 22. MANNER OF PERFORMANCE. Proposer agrees to perform its duties and obligations in a professional manner and in accordance with all applicable Local, State, County, and Federal laws, rules, regulations and codes. Lack of knowledge or ignorance by the Proposer with/of applicable laws will in no way be a cause for relief from responsibility. Proposer agrees that the services provided shall be provided by employees that are educated, trained, experienced, certified, and licensed in all areas encompassed within their designated duties. Proposer agrees to furnish to the City any and all documentation, certification, authorization, license, permit, or registration currently required by applicable laws, rules, and regulations. Proposer further certifies that it and its employees will keep all licenses, permits, registrations, authorizations, or certifications required by applicable laws or regulations in full force and effect during the term of this contract. Failure of Proposer to comply with this paragraph shall constitute a material breach of this contract. Where contractor is required to enter or go on to City of Miami Beach property to deliver materials or perform work or services as a result of any contract resulting from this solicitation, the contractor will assume the full duty, obligation and expense of obtaining all necessary licenses, permits, and insurance, and assure all work complies with all applicable laws. The contractor shall be liable for any damages or loss to the City occasioned by negligence of the Proposer, or its officers, employees, contractors, and/or agents, for failure to comply with applicable laws. 23. SPECIAL CONDITIONS. Any and all Special Conditions that may vary from these General Terms and Conditions shall have precedence. 24. ANTI-DISCRIMINATION. The Proposer certifies that he/she is in compliance with the non-discrimination clause contained in Section 202, Executive Order 11246, as amended by Executive Order 11375, relative to equal employment opportunity for all persons without regard to race, color, religion, sex or national origin. 25. DEMONSTRATION OF COMPETENCY. A. Pre-award inspection of the Proposer's facility may be made prior to the award of contract. B. Proposals will only be considered from firms which are regularly engaged in the business of providing the goods and/or services as described in this solicitation. C. Proposers must be able to demonstrate a good record of performance for a reasonable period of time, and have sufficient financial capacity, equipment, and organization to ensure that they can satisfactorily perform the services if awarded a contract under the terms and conditions of this solicitation. D. The terms "equipment and organization", as used herein shall, be construed to mean a fully equipped and well established company in line with the best business practices in the industry, and as determined by the City of Miami Beach. E. The City may consider any evidence available regarding the financial, technical, and other qualifications and abilities of a Proposer, including past performance (experience), in making an award that is in the best interest of the City. F. The City may require Proposer s to show proof that they have been designated as authorized representatives of a manufacturer or supplier, which is the actual source of supply. In these instances, the City may also require material information from the source of supply regarding the quality, packaging, and characteristics of the products to be supply to the City. 26. ASSIGNMENT. The successful Proposer shall not assign, transfer, convey, sublet or otherwise dispose of the contract, including any or all of its right, title or interest therein, or his/her or its power to execute such contract, to any person, company or corporation, without the prior written consent of the City. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 7 / I LARAI BEACH 27. LAWS, PERMITS AND REGULATIONS. The Proposer shall obtain and pay for all licenses, permits, and inspection fees required to complete the work and shall comply with all applicable laws. 28. OPTIONAL CONTRACT USAGE. When the successful Proposer (s) is in agreement, other units of government or non-profit agencies may participate in purchases pursuant to the award of this contract at the option of the unit of government or non-profit agency. 29. VOLUME OF WORK TO BE RECEIVED BY CONTRACTOR. It is the intent of the City to purchase the goods and services specifically listed in this solicitation from the contractor. However, the City reserves the right to purchase any goods or services awarded from state or other governmental contract, or on an as-needed basis through the City's spot market purchase provisions. 30. DISPUTES. In the event of a conflict between the documents, the order of priority of the documents shall be as follows: A. Any contract or agreement resulting from the award of this solicitation; then B. Addendum issued for this solicitation, with the latest Addendum taking precedence; then C. The solicitation; then D. The Proposer's proposal in response to the solicitation. 31. INDEMNIFICATION. The contractor shall indemnify and hold harmless the City and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all claims and losses in connection therewith, and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorney's fees which may be incurred thereon. The contractor expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The above indemnification provisions shall survive the expiration or termination of this Agreement. 32. CONTRACT EXTENSION. The City reserves the right to require the Contractor to extend contract past the stated termination date for a period of up to 120 days in the event that a subsequent contract has not yet been awarded. Additional extensions past the 120 days may occur as needed by the City and as mutually agreed upon by the City and the contractor. Balance of Page Intentionally Left Blank RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 8 /v\!Ai\AI BEACH 33. FLORIDA PUBLIC RECORDS LAW. Proposers are hereby notified that all Bid including, without limitation, any and all information and documentation submitted therewith, are exempt from public records requirements under Section 119.07(1), Florida Statutes, and s. 24(a), Art. 1 of the State Constitution until such time as the City provides notice of an intended decision or until thirty (30) days after opening of the proposals, whichever is earlier. Additionally, Contractor agrees to be in full compliance with Florida Statute 119.0701 including, but not limited to, agreement to (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the services; (b) provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. 34. MODIFICATION/WITHDRAWALS OF PROPOSALS. A Proposer may submit a modified Proposal to replace all or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received after the Proposal due date and time will not be considered. Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the Proposal due date, or after expiration of 120 calendar days from the opening of Proposals without a contract award. Letters of withdrawal received after the Proposal due date and before said expiration date, and letters of withdrawal received after contract award will not be considered. 35. EXCEPTIONS TO RFP. Proposers must clearly indicate any exceptions they wish to take to any of the terms in this RFP, and outline what, if any, alternative is being offered. All exceptions and alternatives shall be included and clearly delineated, in writing, in the Proposal. The City, at its sole and absolute discretion, may accept or reject any or all exceptions and alternatives. In cases in which exceptions and alternatives are rejected, the City shall require the Proposer to comply with the particular term and/or condition of the RFP to which Proposer took exception to (as said term and/or condition was originally set forth on the RFP). 36. ACCEPTANCE OF GIFTS, FAVORS, SERVICES. Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the City, for the purpose of influencing consideration of this Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or service that might reasonably tend improperly to influence him in the discharge of his official duties. Balance of Page Intentionally Left Blank w :c.x.rn.r-.-.s,. -.1.:x tx3r:u+-.t4 sn.�s» � -r.H :< .:2 c. v r.r..y-...�e..:esoz�-,r�..rnn...- ■ a..l.r�...•u�.w:r-a.4-. T s. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 9 T,"\J � t BEACH vi. , /', SECTION 0300 PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMAT 1. SEALED RESPONSES. One original Proposal (preferably in 3-ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (10) bound copies and one (1) electronic format (CD or USB format) are to be submitted. The following information should be clearly marked on the face of the envelope or container in which the proposal is submitted: solicitation number, solicitation title, Proposer name, Proposer return address. Proposals received electronically, either through email or facsimile, are not acceptable and will be rejected. 2. LATE BIDS. Bid Proposals are to be received on or before the due date established herein for the receipt of Bids. Any Bid received after the deadline established for receipt of proposals will be considered late and not be accepted or will be returned to Proposer unopened. The City does not accept responsibility for any delays, natural or otherwise. • 3. PROPOSAL FORMAT. In order to maintain comparability, facilitate the review process and assist the Evaluation Committee in review of proposals, it is strongly recommended that proposals be organized and tabbed in accordance with the sections and manner specified below. Hard copy submittal should be tabbed as enumerated below and contain a table of contents with page references. Electronic copies should also be tabbed and contain a table of contents with page references. Proposals that do not include the required information will be deemed non- responsive and will not be considered. Cover Letter& Minimum Qualifications Requirements 1.1 Cover Letter and Table of Contents. The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A). Attach Appendix A fully completed and executed. 1.3 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualifications requirements established in Appendix C, Minimum Requirements and Specifications. Experience& Qualifications 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the Proposer submits as evidence of similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s)and term of engagement. 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. 2.3 Financial Capacity. Each Proposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer. The Proposer shall request the SQR report from D&B at: https:l/supplierportal.dnb.com/webapp/wcs/stores/servlet/SupplierPortal?storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each Proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 10 `1AIAi'A BEACH ;'TAB 3 -. Scope of Services Proposed Submit detailed information addressing how Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. TAB 4...: Approach and Methodology Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline, phasing options, testing and risk mitigation options for assuring project is implemented on time and within budget. TAB 5 Cost Proposal Submit a completed Cost Proposal Form (Appendix E). Proposers must submit pricing for all three options. The City will review each option and reserves the right to select the option that is most advantageous to the City. If pricing is included or at no additional charge, proposer must indicate"Included"or`NbAdditional Charge,"as applicable, within the Cost Proposal. Failure to submit pricing for all three options request in the Cost Proposal Form will result in the proposals being considered non-responsive and not further considered. Note: After proposal submittal, the City reserves the right to require additional information from Proposers (or Proposer team members or sub-consultants) to determine: qualifications (including, but not limited to, litigation history, regulatory action, or additional references); and financial capability (including, but not limited to, annual reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years). RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 11 I i 1MA1BEACH SECTION 0400 PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the proposals only. The Evaluation Committee does not make an award recommendation to the City Manager. The results of Step 1 & Step 2 Evaluations will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. 2. Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Procurement Department. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all proposals received, with or without conducting interview sessions; or • review all proposals received and short-list one or more Proposers to be further considered during subsequent interview session(s) (using the same criteria). Step 1-.Qualitative Criteria Maximum Points Proposer Experience and Qualifications, including Financial Capability 25 Scope of Services Proposed 25 Approach and Methodology 35 TOTAL AVAILABLE STEP 1 POINTS s-85 • 3. Step 2 Evaluation. Following the results of Step 1 Evaluation of qualitative criteria, the Proposers may receive additional quantitative criteria points to be added by the Procurement Department to those points earned in Step 1, as follows. ,.-Step 2 r Quentitative Criteria : z ,T :�'r Cost Proposal(Based on Average Total Points) 15 Miami Beach-Based Vendor Preference 5 Veterans Preference 5 • ` TOTAL AVAILABLE STEP 2POINTS t:,: 4. Cost Proposal Evaluation. The cost proposal points shall be developed in accordance with the following formula: Sample Objective Formula for Cost Vendor Vendor Example Maximum Formula for Calculating Points Total Cost Allowable Points (lowest cost/cost of proposal Points Proposal (Points noted are for being evaluated X maximum Awarded illustrative purposes only. allowable points=awarded Actual points are noted above.) points) Round to Vendor A $100.00 20 $1001$100 X 20=20 20 Vendor B $150.00 20 $1001$150 X 20=13 13 Vendor C $200.00 20 $1001$200 X 20=10 10 RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 1 2 i /AOI AIA i BEACH Note: In evaluating cost proposals, the City will evaluate each option from all proposals in accordance with the methodology established above (lowest price/proposers price x maximum number of points = assigned points) and then calculate the Average Total Points for each proposer as indicated below. Averaged Cost Proposal Points: A B C Vendor Total Option 1 Total Option 2 Total Option 3 Average Total Points (A+B+C/3)* Proposer X 15 12 14 14 Proposer Y 10 15 12 12 * Points will be rounded to the nearest whole number. The Average Total Points will be utilized in the Step 2 Qualitative Criteria portion of the evaluation noted above. 5. Determination of Final Ranking. At the conclusion of the Evaluation Committee Step 1 scoring, Step 2 Points will be added to each evaluation committee member's scores by the Procurement Department Management. Step 1 and 2 scores will be converted to rankings in accordance with the example below: . I. -Proposer A: - 4 Proposer B, Proposer C`' Step 1 Points 82 76 80 Step 2 Points 22 15 12 • Committee Total 104 91 92 Member 1 Rank 1 3 2 Step 1 Points 79 85 72 Step 2 Points 22 15 12 101 100 Total 84 Committee Member 2 Rank 1 2 3 Step 1 Points 80 74 66 Step 2 Points 22 15 12 Total Committee 102 89 78 Member 2 Rank 1 2 3 Low Aggregate :_Score * , , . I . . i t �: 2.-1:-:-Final.Ranking .. •. �•., , ,',: .,. • . * Final Ranking is presented to the City Manager for further due dilig'e'nce and recommendation to the City Commission. Final Ranking does not constitute an award recommendation until such time as the City Manager has made his recommendation to the City Commission, which may be different than final ranking results. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen LiabilityPµ 13 APPENDIX A MIAMI _ SCI- Proposal Certification , Questionnaire & Requirements Affidavit RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 20la?:25'✓" TPA I ims Administration for Workers Comp and Gen Liability` Solicitation No: Solicitation Title: 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY Procurement Contact: Tel: Email: Steven Williams 305-673-7000, x. 6650 Stevenwilliams @miamibeachfl.gov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. 1. General Proposer Information. FIRM NAME: No of Years in Business: No of Years in Business Locally: No.of Employees: OTHER NAME(S)PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: FIRM PRIMARY ADDRESS(HEADQUARTERS): CITY: STATE: ZIP CODE: TELEPHONE NO.: TOLL FREE NO.: FAX NO.: FIRM LOCAL ADDRESS: CITY: STATE: ZIP CODE: PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: ACCOUNT REP TELEPHONE NO.: ACCOUNT REP TOLL FREE NO.: ACCOUNT REP EMAIL: FEDERAL TAX IDENTIFICATION NO.: The City reserves the right to seek additional information from Proposer or other source(s), including but not limited to: any firm or principal information, applicable licensure, resumes of relevant individuals, client information, financial information, or any information the City deems necessary to evaluate the capacity of the Proposer to perform in accordance with contract requirements. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 15 1. Miami Beach Based(Local)Vendor.Is Proposer claiming Miami Beach based firm status? YES NO SUBMITTAL REQUIREMENT: Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt issued by the City of Miami Beach and the proof of residency requirement, as required pursuant to ordinance 2011-3747, as amended,to demonstrate that the Proposer is a Miami Beach Based Vendor. 2. Veteran Owned Business. Is Proposer claiming a veteran owned business status? YES NO SUBMITTAL REQUIREMENT:Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States federal government,as required pursuant to ordinance 2011-3748,as amended.. 3. Conflict Of Interest.All Proposers must disclose, in their Proposal, the name(s)of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%)percent or more in the Proposer entity or any of its affiliates 4. References&Past Performance. Proposer shall submit at least three(3)references for whom the Proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1)Firm Name, 2)Contact Individual Name&Title, 3)Address,4)Telephone,5) Contact's Email and 6)Narrative on Scope of Services Provided. 5. Suspension, Debarment or Contract Cancellation. Has Proposer ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance b any public sector agency? YES NO SUBMITTAL REQUIREMENT: If answer to above is"YES,"Proposer shall submit a statement detailing the reasons that led to action(s). 6. Litigation History. Proposer shall submit a statement of any litigation or regulatory action that has been filed against your firm(s) in the last five years. If an action has been filed, state and describe the litigation or regulatory action filed, and identify the court or agency before which the action was instituted, the applicable case or file number, and the status or disposition for such reported action. If no litigation or regulatory action has been filed against your firm(s), provide a statement to that effect. If"No"litigation or regulatory action has been filed against your firm(s), please provide a statement to that effect. Truthful and complete answers to this question may not necessarily disqualify a firm from consideration but will be a factor in the selection process. Untruthful, misleading or false answers to this question shall result in the disqualification of the firm for this project. SUBMITTAL REQUIREMENT: Proposer shall submit history of litigation or regulatory action filed against proposer, or any proposer team member firm, in the past 5 years. If Proposer has no litigation history or regulatory action in the past 5 years, submit a statement accordingly. 7. Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including disqualification of their Proposals, in the event of such non- compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities (including your sub-consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability ,..z.,.AaY v,..16 whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. 8. Code of Business Ethics. Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Department with its proposal/response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics, Proposer may submit a statement indicating that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at www.miamibeachfl.gov/procurement/. 9. Living Wage. Pursuant to Section 2-408 of the Miami Beach City Code, as same may be amended from time to time, Proposers shall be required to pay all employees who provide services pursuant to this Agreement, the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13(October 1, 2012), the hourly living rate will be$11.28/hr with health benefits,and$12.92/hr without benefits. The living wage rate and health care benefits rate may, by Resolution of the City Commission be indexed annually for inflation using the Consumer Price Index for all Urban Consumers (CPI-U) Miami/Ft. Lauderdale, issued by the U.S. Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percent(3%). The City may also, by resolution,elect not to index the living wage rate in any particular year, if it determines it would not be fiscally sound to implement same(in a particular year). Proposers' failure to comply with this provision shall be deemed a material breach under this proposal, under which the City may, at its sole option, immediately deem said Proposer as non-responsive, and may further subject Proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfl.gov/procurement/. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees to the living wage requirement. 10. Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide "Equal Benefits" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? YES NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners*or to domestic partners of employees? YES NO C. Please check all benefits that apply to your answers above and list in the "other"section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave;other benefits are provided directly to the spouse or domestic partner, such as medical insurance. BENEFIT Firm Provides for Firm Provides for Firm does not Employees with Employees with Provide Benefit Spouses Domestic Partners Health Sick Leave Family Medical Leave RFP 2014-302-SW TPA Cairns Administration for Workers Comp and Gen Liability 17 I Bereavement Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage)you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfl.gov/procurement/. 11. Public Entity Crimes. Section 287.133(2)(a), Florida Statutes, as currently enacted or as amended from time to time, states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on convicted vendor list. 12. Acknowledgement of Addendum. After issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional information to Proposers or alter solicitation requirements. The City will strive to reach every Proposer having received solicitation through the City's e-procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to Confirm Initial to Confirm Initial to Confirm Receipt Receipt Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required,submit under separate cover. RFP 2014-302-SW TPA Cairns Administration for Workers Comp and Gen Liability 18 { DISCLOSURE AND DISCLAIMER SECTION- •-- The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach (the "City") for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this solicitation, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancelling awards, or in withdrawing or cancelling this solicitation,either before or after issuance of an award, shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the solicitation, as it deems appropriate and in its best interest. In its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicant's affiliates, officers, directors, shareholders, partners and employees,as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete. The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents, or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations, interpretations, and analyses. The solicitation is being provided by the City without any warranty or representation, express or implied, as to its content,its accuracy,or its completeness. No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation, or approval. The City shall have no obligation or liability with respect to this solicitation, the selection and the award process, or whether any award will be made. Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer, and agrees to be bound by the terms hereof. Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information is for guidance only, and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal(or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason, or for no reason, without any resultant liability to the City. The City is governed by the Government-in-the-Sunshine Law, and all Proposals and supporting documents shall be subject to disclosure as required by such law.All Proposals shall be submitted in sealed proposal form and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses. At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal, and authorizes the release to the City of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge, information, and belief. Notwithstanding the foregoing or anything contained in the solicitation, all Proposers agree that in the event of a final unappeasable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to $10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation, it is understood that the provisions of this Disclosure and Disclaimer shall always govern. The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the State of Florida. RFP 2014-302-SW TPA Cairns Administration for Workers Comp and iGen Liability 19 -. PROPOSER CERTIFICATION; I hereby certify that: I, as an authorized agent of the Proposer, am submitting the following information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments, exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement; Proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of proposal submitted; Proposer has not divulged, discussed, or compared the proposal with other Proposers and has not colluded with any other Proposer or party to any other proposal; Proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this proposal, inclusive of the Proposal Certification, Questionnaire and Requirements Affidavit are true and accurate. Name of Proposer's Authorized Representative: Title of Proposers Authorized Representative: Signature of Proposers Authorized Representative: Date: • State of ) On this day of , 20_, personally appeared before me who County of ) stated that (s)he is the of , a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Before me: Notary Public for the State of Florida My Commission Expires: RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 20 APPENDIX B f_,.. AA I Am op " No Bid " Form RFP 2 CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY AD FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 Gr��' q 5s_s ,K. �� -. f n k51 t, t J � os f c m+R r/+ tef.t. .c.. ONO- ;.. c �0:; fi P*g t f rat vU L Y g.dee V t Sf©ft 1,5 Q a v,a ) 021:k W i 0451.1*..` i� _�`'� .i.#t � .�°��j�� t �:y�i'�;�;. j`r�'1 ,.�,.� r ? `� �� C": , �4,. . �,rf, ('"' ,,( lS✓��Pa L` _�''.::�r�`,_.�-.-,�;� ,r- < j-�� ...,�1:�x1 �"1'�� (:J:,�°�!��3.f,.L�rL�''Je: j"�i-"�%!;?1'�i�ti.�� ,� .� ,�I". i3L.,� �� fl�: CJ'U �.''t+ "4 ��`� �.'1;1 �� H`�- " "-'1w �1�3��r � 7t�� ,� � �.�-�,f©�_i'F��.3�l�£ r n", V -.. � ./� . � /� -_� ''��`` -'E hi :CV, ficy l VAtf ' CW._ 7A.._. F. - .L'xCi1tiC!fWC:c_e'Ait .'t±r- �..:��-.SY•�'SS]4fw3+�.�<iitiY�J:%�4//d�,V i� RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 21 Statement of No Bid WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR REASON(S) CHECKED AND/OR INDICATED BELOW: Workload does not allow us to proposal Insufficient time to respond Specifications unclear or too restrictive Unable to meet specifications Unable to meet service requirements Unable to meet insurance requirements Do not offer this product/service OTHER. (Please specify) We do _ do not_want to be retained on your mailing list for future proposals of this type product and/or service. Signature: Title: Legal Company Name: Note: Failure to respond, either by submitting a proposal or this completed form, may result in your company being removed from our vendors list. PLEASE RETURN TO: CITY OF MIAMI BEACH DEPT. OF PROCUREMENT MANAGEMENT ATTN: Steven Williams PROPOSAL #2014-302-SW 1700 Convention Center Drive MIAMI BEACH, FL 33139 "�313:-�ka-_Y4'3H;.'TUKfifla r*=3fY-a-f'f..-,+:.ati�.K'.t-_'ti#s-nrcY,sr ie`;-A'�}r.:..isz n�.`eahr. t;,,:SO+iy.bus :a +A:_.TrL.s37;tia;;xst:e?•.2:i.za!a-.R etta..,.• s_-•a .¢+f,:3v-h2.'":•r�,rE..K•L-'W.iJ.'.iYn7W NE!ss-E1".k4 S+-41::Y 9=--.•ee1F J:tli.i4. Ati 34J:..3'.TiM P 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 22 APPENDIX C tv\ IAtv\ i Ekl1: H Minimum Requirements & Specifications RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 20 3G25W iPC. Claims A inistration for Workers Comp and Gen Liability 23 C1. Minimum Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit detailed verifiable information affirmatively documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements will be deemed non-responsive and will not be considered. 1. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5-229 Florida Administrative Code) 2. The proposer must have experience as a Third Party Administrator ("TPA") for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five (5) consecutive years. For each experience proposer must submit as evidence: agency name, agency contact, contact telephone, email and years(s) of experience for verification purposes. 3. The proposer must have a staffed office in the state of Florida, with a qualified staff member of the firm to serve as the primary contact for the City of Miami Beach, and a secondary contact to serve in the absence of the primary contact. The proposer must submit as evidence: a primary and secondary name, a primary and secondary contact telephone, a primary and secondary email address, and a copy of primary and secondary's resumes for verification purposes. C2. Statement of Work Required. The City of Miami Beach (the "City") is approved by the Florida Department of Labor and Employment Security/Division of Workers' Compensation to self-insure for Workers' Compensation. The Division of Workers' Compensation requires that the claims administration be provided by a State Certified Workers' Compensation Claims Administrator. Therefore, the City is seeking proposals for third party claims administration services for its self- insurance Worker's Compensation program. Proposers must submit cost proposal for the entire scope of services requested. Proposals to handle only selected parts of the scope will not be considered. It is understood by the successful proposer that all services are to be provided by the proposer's employees and cannot be contracted out to another party without the prior approval of the City. The commencement date of the contract will be February 1, 2015. C3. Specifications. The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking/loss fund reconciliation. The specific required services are outlined in greater detail within this request for proposals. The City has approximately 1,900 employees, and averages 345 claims annually. The breakdown is estimated at 239 medical only and 106 lost time. Currently there are approximately 421 open claims. Prior to October 1996, the City purchased excess workers' compensation insurance. The City does not currently purchase excess workers' compensation insurance. • A- • m "�•m 7ns3 o'�n.F. ore7 r"o_ an• en ia•i i i 24 In agreement with Ordinance No. 1335, the City pays Supplemental Injury Pay for a maximum of 32 weeks, for employees who have a work-related injury but remain absent due to restrictions resulting from their injury. The Supplemental Injury Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of p the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the claims administrator unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. In addition, certain medical conditions and work related activities are covered under workers' compensation for police and fire personnel pursuant to union contract. All proposers are to assume the complete handling of all future and past claims now being handled by our present Claims Administrator (see Appendix G for open/closed claims for all years), along with all new claims. The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. It is also required that the claim data associated with all claims occurring prior to February 1, 2015, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The claim administrator is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination date. The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation and General Liability: • TPA shall provide workers' compensation third-party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. This includes the necessary medical benefits, expenses and other services ,-1 �;aCC�sca�R,i. -r.aims '•ministration orvVor ers omp an. en is i ity 25 ' r usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. • TPA shall provide, on behalf of the City, all self-insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self insurer for workers' compensation must provide. • TPA shall accept all current claims and/or re-opened claims as run-in claims to the TPA if selected as the new TPA for the City. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically, by facsimile or by phone based on the severity, circumstances or nature of injury at no additional cost. • TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, assigned adjuster name, email and telephone number, claimant's name, and date of loss. • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. • TPA shall have the ability to provide prescription drug authorization on the same day as injury to all injured employees. • TPA shall triage every notice of injury with an initial review by a claims supervisor, a registered nurse review of medicals, and assigned adjuster's review of entire claim file. • TPA shall utilize any recommended medical primary care physicians or specialists as directed by City, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non occupational or non-network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. • The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. • City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre-litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the 6'1'- a7m 1."mr=a1o `3oL iv o> e rs'��C-__o mp a nGe- ia.i it' 26 City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. • TPA shall provide the City with an on-site experienced, dedicated adjuster to provide professional workers' compensation adjusting services and employee claim assistance on- site at the City's Risk Management Division Office of the Human Resources Department, or as otherwise designated by the City, with duties and responsibilities to be mutually agreed upon by the TPA and the City. TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary worker's compensation claim adjustment services and assistance as done by the City's Risk Management staff in accordance with the third-party claims administrator agreement between the City and TPA. The scope of assignment includes, but is not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions, filing wage statements, updating diary notes, assisting attorneys with litigated files, and working with the City's regularly assigned workers'compensation claims adjusters. • TPA shall provide, on an as needed basis, an on-site dedicated licensed liability claims adjuster at the City's Risk Management Division, Office of the Human Resources Department, or as otherwise designated by the City, to assist the City's Risk Manager with claims administration services for the City of Miami Beach's self-insured liability program. The City is self-insured and self-administered for liability claims management. The adjuster shall perform claims administration services for automobile and general liability claims. The scope of assignment includes, but not limited to, investigations, creating file diaries, record keeping, and other services necessary or proper for, or incidental to, performing claims adjusting. • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. • TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. • TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are �. � '• YRts�c R • 0 -- � - ;��: ��. � � � porkers o p an � l A- 0 - vv aims `dministration or ► m . en ia.i i �.. 27 more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. • TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third-party tortfeasors. TPA shall not proceed with any legal action against a third-party tortfeasor without the City's Risk Manager's approval. • TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. • TPA shall attend in person or via telephonically all mediations. The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings. • TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non-litigated complex cases. • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. • TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. aims •ministration or or ers omp an• en ia.i ity 28 • The City of Miami Beach has not purchased excess coverage since 1997. However, TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re-opened) claims such as, but not limited to reporting. • TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carrier(s) due to TPA's failure to properly report new or existing claims as required by each carriers' coverage agreement reporting requirements. • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. • TPA shall agree to maintain a 9 SSAE 16 audit on controls placed in operations and tests for operating effectiveness, and agrees to provide copies to the City as requested. • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation and liability claim payments and settlements. TPA agrees to comply with the City's Positive Pay (fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. • TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e-mail to City of Miami Beach, unless otherwise instructed. • TPA shall mail the City monthly financial institution reconciliations. • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. • TPA shall be audited by the City at the City's sole discretion and cost. • TPA shall invoice the City quarterly for its administrative claim fee. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and aims '.ministration or or<ers amp and en ia•i ity 29 its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. • TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjuster's claim activity on a file. • TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7) working days of month-end. • TPA shall provide periodic information to the City's actuarial service provider when required. • TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. • TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CD. • Other claims adjusting services for Workers' Compensation and General Liability, as needed. am s .mna f o fo ers m p. 30 .i STAFFING AND PERSONNEL: It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the administrator hires and retains the appropriately qualified professionals to handle our claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. The required maximum open case loads per adjusters (may have more than one adjuster assigned to the account) are to be as follows (claims manager should not handle files): workers' compensation (lost time) - 100 workers' compensation (medical only) - 500 The administrator agrees to add staff as necessary to maintain these maximum pending caseload levels. Explain how the office or unit will be staffed and explain the level of supervision that will be provided. Claims personnel must be employees of the administrator. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. LOSS FUND MANAGEMENT: 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts. The City will pay all service fees that are normal and customary in this account. All interest earned or service credits generated will accrue to the benefit of the City. 2. The claims administrator is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. 3. All claims, expense and legal payments will be made by the claims administrator on checks drawn on an account set up by the administrator and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. 4.. The administrator is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. aims A.ministration or TVor ers omp and Gen Liabi ity 3 5. The monthly reconciliation statement submitted by the administrator to the City will include the following: - balance at inception of statement period - total disbursements which cleared, by date and claimant/payee - balance at close of statement period - amount of deposit required 6. A list of all checks is to be submitted monthly. SUPPLEMENTAL QUESTIONS In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? 2. Number of professional claim, clerical and/or support staff at that location. 3. Name, experience, resume and professional designations of claim manager. 4. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. 5. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. 6. Advise the current pending case load for each designated adjuster. 7. What is the current number of monthly new assignments to each adjuster? 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2015? 9. Name the 4 law firms (2 workers' compensation, 2 liability) that you currently handle the most cases with. Provide a contact person and phone number. 10. Estimate the percentage of time your adjusters are out of the office doing field work. If all are telephone adjusters, please indicate. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? 12. Name, address, phone and contact person for independents you utilize. 13. Can you provide all the required services with your own personnel? ' ' Ol A- • - aims `•ministration or or ers Comp an. Gen ia.i ity 32 14. Do your adjusters receive any continuing education and training? Explain. 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. 16. Do you have the capability to provide all the loss data.reports required? Explain. 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 2015? 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. 19. Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. Balance of Page Intentionally Left Blank 'FfJ • e3• - a ms `•ministration or r rs m en ia.1 li 33 APPENDIX D MIAMI 5LACF=1 Special Conditions RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 t; �r;kFakR4#n'P 23asR?�Kr.-ei txxS'N.`- + M: _ 1? Na3 Xs:R' Safer tr±af! fi� � PSt.:.a,� 4 .2" RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 34 1. TERM OF CONTRACT. The contract shall commence upon the date of notice of award and shall be effective for a period of two (2) years. 2. OPTIONS TO RENEW. The City, through its City Manager, will have the option to extend for three (3) additional one (1) years periods. 3. REQUIRED CERTIFICATIONS. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5- 229 Florida Administrative Code). 4. ADDITIONAL SERVICES. If during the contractual period additional services are needed, the selected Contractor may, at the option of the City of Miami Beach, be engaged to perform these services. The selected contractor shall upon receipt of the written request from the City's Risk Manager, provide a proposal for such services and the City reserves the option to issue a purchase order for the specified work as approved by both parties. Balance of Page Intentionally Left Blank 'Sa2Y1•i1Ci.'iEbEf+.A3+�d;A`-' ,a-.�._,r ;d�=JdR"d):.Y+,.i76...,.$'„a'i = ,_.4`/.Y?A'J,"Ja'tk'.5l"^'-., 4YP `='kiJSiF._'L•i:_t`- 'SeyiF:`�16T•. Q•rs me ?-'...Y'+2Ltnva.•,h`.LYviL+J.• -- '�:1-.rhYJT 'Y�1?:w`y."Ci.Y?'9'fiA3i..1C"ii^E'+$ -i'1/.�tT�sv+SG'Mr!v: RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 35 APPENDIX E A/\iAt\VAd tHACH Cost Proposal Form RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014-302-SW TPA I s Adminis u 'c IoWorkers Comp ni Gen 1a61N.• . �•. .• .... ' � APPENDIX E COST PROPOSAL FORM Failure to submit Section 5, Proposal Tender Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive.All corrections on the Proposal Tender Form shall be initialed. • IN ORDER TO BE DEEMED RESPONSIVE, PROPOSERS MUST SUBMIT COST-FOR EACH OPTION 1-3. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered for evaluation. OPTION #1: FLAT ANNUAL FEE OPTION Column 1 Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims including $ new and prior claims) = (per contract year) 2. Per Claim Fee for Quantity Excess Claim Fee Per Claims in Excess of $ 40 per year Year 345 Per Year (per excess claim) $ (Column 1 x Column 2) • TOTAL OPTION 1 (Flat Annual Fee Option): $ (Total Lines 1 -2) • *Deposit Amount To Be Maintained By T he City: $ *Proposer shall include amount,which the City may negotiate at its discretion. REP 2014-302-SW TPA C aims A•ministration or Wor ersAComp an• Gen [ia•i ity 37 OPTION #2: FIXED PER CLAIM FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS Claims with dates of accident after contract inception- February 1, 2015 1. Indemnity Per Claim Quantity (Litigated Or Non- $ 100 per year $ Liti•ated •er claim (Column 1 x Column 2) 2. Medical Only Claim Quantity (Litigated Or Non- $ 175 per year $ Litigated per claim (Column 1 x Column 2) 3. Medical Only Claim Quantity Transferred To $ 25 per year $ Indemnity Claim (per claim) (Column 1 x Column 2) (Litigated Or Non- Litigated) - PRIOR CLAIMS : _ _ Claims with dates of accident prior to contract inception-.February 1, 2015. 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 292 per year $ Litigated) (per claim) (Column 1 x Column 2) 5. Medical Only Claim Quantity (Litigated Or Non- $ 129 per year $ Litigated) (per claim) (Column 1 x Column 2) TOTAL OPTION 2(Fixed Per Claim Fee Option): $•- (Total Lines 1 -5 OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION' Column 1 Column 2 Column 3 NEW CLAIMS Claims with dates of accident after contract inception-February:'t, 2015 1. Indemnity Or Medical Quantity Only Per Claim $ 300 per year (Litigated Or Non- (per claim) (Column 1 x Column 2) Litigated) • • PRIOR CLAIMS Claims with dates of accident prior to contract inception-February 1 2015. 2. Indemnity Or Medical Quantity Only Per Claim $ 421 per year $ (Litigated Or Non- (per claim) (Column 1 x Column 2) Litigated) TOTAL OPTION 3(Fixed Per Claim Blended Fee Option): ' $ Total Lines 1 -2) . er7.:"�,_,- .C:!�-.Y.`.$. -,.."-:lax.f"5v�.•t::; -ti rF'- !'yti:i:iFt,:r-a ="air.t. RFP 2014-302-SW TPA C aims A•ministration or Wor ers Comp an. Gen Lia•i ity 38 ADDITIONAL SERVICES List of services, as needed, which are in addition to the fees proposed in Options 1 - 3. • =..Description of.Service Fee _ Telephonic Medical Case Management Fee On All Claims: $ Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ Per Bill/Flat Fee Percentage Of PP0 Savings—Network Discount Savings Below State Fee Schedule: Percentage Of Utilization Review And Reasonable&Customary Savings: Subrogation And/Or Liens Fee Percentage: Osha 300 Log Reporting: Electronic Data Interchange Filed With State: Safety Consulting Services $ Notice Of Injury Entry: Custom/Ad Hoc Reports: Data And File Conversion Fee: $ One-Time Setup Flat Fee Medicare Reporting Costs: Liability Claims Adjuster(City Of Miami Beach In-House Adjuster) Workers Compensation Claims Adjuster(City Of Miami Beach In- House Adjuster $ _ f t� ,Addition IS' rvice� x� ., . -.,; � .'�� ,-=a-• ,,. �.4:�� a .��:- :,-f�� Description Of Additional Service: $ Description Of Additional Service: $ Description Of Additional Service: $ Description Of Additional Service: $ F , .--Bidder's°Affirmation { Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: '.r�,`evert=!i.- 'rlia '!sti^;:�H.�.atis;�s,. ...=rfx 'w4Y,.:i�a-zy#:n.zu._-,:.-::s`:,.�t:.'. �1s;C#'*Yaa�LLF3_ _ dt3?sazUF1•sC�* �Sf WS�.� ..,'i?xSK'' 2°. 'fr`.3: REP 2014-302-SW TPA C aims A•ministration or Wor<ers Comp an Gen Lia•i i1- 39 APPENDIX F MIAMI 2 Insurance Requirements RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 :�:..:s.�Sii:*"G:tn`i':lic�J a cis:�fh. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 40 x M1A,t\/ 1IEA1\CH PROFESSIONAL SERVICES INSURANCE REQUIREMENTS The provider shall furnish to the Human Resources Department, Risk Management Division, City of Miami Beach, 1700 Convention Center Drive, 3rd Floor, Miami Beach, Florida 33139, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: A. Worker's Compensation and Employer's Liability Insurance for all employees of the provider as required by Florida Statute 440. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence and $2,000,000 in the aggregate, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Professional Liability Insurance in an amount not less than $1,000,000 with the deductible per claim, if any, not to exceed 10% of the limit of liability. The insurance coverage above must include a waiver of subrogation in favor of the City. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals, which most nearly reflect the operations of the provider. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The company must be rated no less than "B" as to management, and no less than "Class V" as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the City Risk Management Division. or The company must hold a valid Florida Certificate of Authority as shown in the latest "List of All Insurance Companies Authorized or Approved to Do Business in Florida" issued by the State of Florida Department of Insurance and are members of the Florida Guaranty Fund. Certificates will indicate no modification or change in insurance shall be made without thirty (30) days advance notice to the certificate holder. CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH 1700 CONVENTION CENTER DRIVE 3rd FLOOR MIAMI BEACH, FL 33139 Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. REP 2014-302-SW TPA Cairns Administration for Workers Comp and Gen Liability 41 APPENDIX G MIAMI I$ EA\CH : Claims Experience RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 REP'2 1:416-2- r'a Claims Administration for Workers Comp and Gen Liability 42 RESPONSE TO RFP 2014-302-SW CORVEL ENTERPRISE CORP., INC. CorVel's Response to -- 4...-- Request for Proposal for s- 1''1,4 The City of Miami Beach e ri Claims Administration Services by a INCOPP;.CRATED Third Party Administrator for Workers' �' `' Compensation and General Liability i, ,t - RFP 2014-302-SW/ September 12, 2014 Original ., _ AO* * • 4 idipii- 16 VIII lif of' -.4*,.4,10 4 a 04116 eMw - A A 1 .. . A 14\ AI 1 , y� t „Imo 1 L U „� C � i� f i i ::m:)11 C0RVE L -♦`iKC4-‘-iii a�,lit 1,.„„ ,,,,,..4 ��, TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS TAB 1 : Cover Letter & Minimum Qualifications Requirements September 12, 2014 C O R V E L Page 2 CORVE L September 12, 2014 The City of Miami Beach 1700 Convention Center Drive Miami Beach, FL 33139 Attn: Procurement Thank you for considering CorVel Corporation as a strategic partner to help the City reach its risk management goals. We offer extensive experience in the government industry, and our top priority is to return your employees back to work. We appreciate the opportunity to present this proposal, and we believe it will confirm why CorVel is the right choice. Our approach to claims management is distinguished by these key differentiators: • A single platform for all elements of the claim handling data • One source for all services • No pass through or bridge to third party vendors In business, it is the personal connections that are often the biggest contributors of success. At CorVel you will find that every associate is personally committed to making the claims experience a more positive one. We look forward to creating win-win strategies that can help you achieve your most important claims management goals. It is the strength that comes from more than three decades of experience, a passion for a better solution, together with the personal attention of our entire team that delivers meaningful results. I will serve as the primary contact for this proposal and look forward to answering any questions you may have. I can be reached via telephone at (954) 233-5906. Thank you again for your consideration. We look forward to working with you. Sincer Debbie Popovich Vice President—Regional Sales 1560 Sawgrass Corporate Parkway,Suite 100,Sunrise,FL 33323 1(800)929-0107 4:i'c , *`INCORP CRATED "• '��.t -�,��y' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS TABLE OF CONTENTS Tab 1: Cover Letter & Minimum Qualifications Requirements 2 1.1 Cover Letter and Table of Contents 3 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A) 7 1.3 Minimum Qualifications Requirements 15 Tab 2: Experience & Qualifications 53 2.1 Qualifications of Proposing Frim 54 2.2 Qualifications of Proposer Team 56 2.3 Financial Capacity 56 Tab 3: Scope of Services Proposed 57 Tab 4: Approach and Methodology 59 Tab 5: Cost Proposal 61 Attachments 63 September 12, 2014 C ® R v EL Page 4 1 �P 1 f9C 1*(INCOTIP ORATED *' EXECUTIVE SUMMARY '9'QC' c), "As with general health, the workers comp line continues to migrate to being a medical management business,with policy makers, employers, and carriers struggling to manage and control the costs of medical care" (NCCI). Risk Managers are focusing more on the health and well-being of the employee, making this a primary goal versus focusing solely on the cost. Similarly, while the liability industry is fueled by the fear associated with keeping lawsuits at bay, Risk Managers are choosing to confidently contract with experienced Adjusters to facilitate litigation management and protect their brand. CorVel is uniquely positioned in this space.With extensive experience in managing the medical care and functional restoration of the injured worker, in addition to an extensive understanding in the liability sector, we work closely with employers to reverse the stigmas of an adversarial n g and costly program. Our unique workers'compensation and liability claims management service model applies technology, intelligence and the human touch throughout the healthcare and disability continuum. Our company's reputation is grounded in financial stability, extensive workers' compensation and liability expertise, renowned customer service and strong relationships within the industry. Furthermore, we are experts in proactive decision-making, patient advocacy and instant access to real-time information. The bottom line: We provide tailored solutions that deliver real results. Our proactive healthcare approach puts patients first. When an employee is hurt, proper medical care is priority one. With CorVel's early intake process and precise protocols, we connect claimants to appropriate medical services from the very onset of injury— ultimately driving timely access to treatment and saving both time and money. Our solution starts with access to a 24/7 nurse hotline for first aid advice or referral to preferred providers, capturing first fill prescriptions and simplifying complex processes. We are passionate about patient advocacy and process improvement. We are with you at every step. CorVel serves as your experienced partner, managing claims through every milestone – from claims receipt, file documentation and investigation to litigation management. Our Liability Adjusters average over 20 years of experience and our Workers' Compensation Adjusters average 10 years of experience. Combined with the utilization of our proven best practices, we achieve better results. CorVel protects your brand as if it were our own. By embodying your company's values as an extension of our service offering, we facilitate collaborative, strategic processes for superior program results. We help you move at the speed of information. In the world of claims management, time is often the enemy. We use our industry-unique Carew platform, call center and responsive workflows to speed decision-making and reduce costly lag-time. Both workers' compensation and liability incidents are immediately processed by our proprietary rules engine and a Claims Adjuster is assigned within one business day. For added convenience, we offer direct access via smart phone and tablet devices. Everything is connected in a single database—and the minute an update is made, it is online and available. Leveraging our own technology is a stand-out advantage. You get immediate access to information—when and how you want it. Empowered account management team. Powerful results start with performance-driven partnerships. Account Managers enabled with the right resources can make a real difference in taking your claims management process to the next level of efficiency and cost-effectiveness. We offer the best of both worlds – national resources backed by the stability of a public company and local service our clients have come to know and trust. Regardless of the challenges that may arise, we are committed to finding solutions. Taking a collaborative approach. Our claims and medical management teams work together in one system to deliver a single, streamlined solution. The disjointed service models that are typical to the industry are susceptible to costly delays and information getting lost in translation. By maintaining all services in-house and having all parties collaborate within a single platform, CorVel aligns with your patient-centered goals, maximizes efficiency and returns your employees to work sooner. September 12, 2014 C O R V E L Page 5 Iii INCA RATm ,12, .0' EXECUTIVE SUMMARY A better bottom line. Using intelligently designed technology and leading medical expertise from the moment an incident is reported can truly transform your workers' compensation and liability programs. You cannot always control a claim, but making significant decreases—even for small claims—adds up over time. It is all about getting more value from every dollar spent—and partnering with an expert that can help you reach results. It is the CorVel difference at work. September 12, 2014 C ® R V E L Page 6 *EIlk ios"*\,3 u ��" TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS /126 1.2 Proposal Certification, Questionnaire& Requirements Affidavit(Appendix A) SabTralion Ab: snicraC n Tice 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY PioQourers Ca ttacc Tel. teat Steven Williams 305-673-7000,a.6650 Stetrenwfffliattrsai,riamibeachtl.gee PROPOSAL CERTIFICATION,QUESTIONNAIRE&REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements A.ffidav+it Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness,responsibility and or detennintrig factors and compliance with requirements may be evaluated.This Proposal Certification,Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. t_ General Proposer Information. CorVel Enterprise Comp,Inc No dtYen in ASS Over 30 years No 0d YYeats in&Isms floet*f NO of Emblem years 3 f HAS LAZIER CYDER s�owned subsidiary af Gas vd Ccupasaeam a -Czdd aralblrme..a.maresaa at cmxaamuy. FIRM PR4NARY A0 55(HEA 0 UART>RS) 2010 Main Street.Suite 600 wine STATE -at,CODE CA , 93614 9 851-1473 TU,1.FREE NO.: MO 726-7335 FAX No: 949)851-1469 FEW 11S60Sagrass Corporate Parkway.Suite 100 Sunrise STATE ZIP=De FL 33323 PRIP/ARY ACCOUNT REPir 5ENTATNE FOR 11*ENC NT: Debbie Papovich.Vice President,Regional Sales ACCOUNT REP TELEPHOP E NO: 1954)233-5906 ACCOUNT REP TOIL FREE NO.: (888)726-7835 ACCOUNT REP EMIL: debbie popovidicaconreLcom MEM TAX InerfcATICN NO: 42-1704550 The City rest the right to seek additional information from Proposer or other stuce(s),indisfing but not fended iac any firm or pine intimation,apptlicable licensee,restsnes of relevard individuals,client internalise,financial irfoma mud to any to City tuns necessary to evaluate the capacity of the der to perform in accordance ioth contract teseei. Rf r 20 14-.1o2-5'V`v1 IPA Claims Administratic,n It-i Workers romp and Ggin ..i3bIIIi.w 15 September 12, 2014 C O R V E L Page 7 Solicitation No: Solicitation Title: 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY Procurement Contact: Tel: Email: Steven Williams _ 305-673-7000,x.6650 Stevenwilliams @miamibeachfl.gov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. 1. General Proposer Information. FIRM NAME: CorVel Enterprise Comp,Inc. No of Years in Business: Over 30 years No of Years in Business Locally: No.of Employees: Y 6 years 3,300 OTHER NAME(S)PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: CorVel Enterprise Comp,Inc.is a wholly-owned operating subsidiary of CorVel Corporation,a publicly-traded healthcare managemelt company. FIRM PRIMARY ADDRESS(HEADQUARTERS): 2010 Main Street,Suite 600 CITY: Irvine STATE: ZIP CODE: CA 92614 TELEPHONE NO.: (949)851-1473 TOLL FREE NO.: (888)726-7835 FAX NO.: 949)851-1469 FIRM LOCAL ADDRESS: 1560 Sawgrass Corporate Parkway,Suite 100 CITY: Sunrise STATE: ZIP CODE: FL 33323 PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: Debbie Popovich,Vice President,Regional Sales ACCOUNT REP TELEPHONE NO.: (954)233-5906 ACCOUNT REP TOLL FREE NO.: (888)726-7835 ACCOUNT REP EMAIL: debbie_popovich @corvel.com FEDERAL TAX IDENTIFICATION NO.: 42-1704550 The City reserves the right to seek additional information from Proposer or other source(s), including but not limited to: any firm or principal information, applicable licensure, resumes of relevant individuals, client information,financial information,or any information the City deems necessary to evaluate the capacity of the Proposer to perform in accordance with contract requirements. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 15 *�INCORP ORAiID)� %,3 ,h; TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 1. Miami Beach Based (Local)Vendor. Is Proposer claiming Miami Beach based firm status? ❑ YES o NO SUBMITTAL REQUIREMENT: Proposers claiming Miami Beach vendor status shall submit a Business Tax Receipt issued by the City of Miami Beach and the proof of residency requirement, as required pursuant to ordinance 2011-3747, as amended, to demonstrate that the Proposer is a Miami Beach Based Vendor. Not applicable. CorVel is not claiming Miami Beach based firm status. 2. Veteran Owned Business. Is Proposer claiming a veteran owned business status? ❑ YES o NO SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States federal government, as required pursuant to ordinance 2011-3748, as amended. Not applicable. CorVel is not claiming a veteran owned business status. 3. Conflict Of Interest. All Proposers must disclose, in their Proposal, the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. CorVel does not have any officer, director, agent, or immediate family member (spouse, parent, sibling, and child)who is also an employee of the City of Miami Beach. CorVel Enterprise Comp, Inc. is a wholly-owned operating subsidiary of CorVel Corporation,a publicly traded healthcare management company(NASDAQ GS: CRVL)held to the standards of NASDAQ and the SEC. CorVel Corporation is incorporated in the state of Delaware. September 12, 2014 C O R V E L Page 8 1 *`INCORP RATE.* TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS ,4,P�H 267 4. References & Past Performance. Proposer shall submit at least three (3) references for whom the Proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1)Firm Name, 2)Contact Individual Name&Title, 3)Address,4)Telephone, 5)Contact's Email and 6) Narrative on Scope of Services Provided. Client Name& Contact Address Phone Email Scope of Service City of Pompano Ed Beecher, Risk P.O. Box Drawer 1300 *client requests Eddie.beecher Beach Manager Pompano Beach, FL email contact @copbfl.com 33061 only Scope:Third Party Claims Administration and Managed Care services. City of West Palm Kathy 401 Clematis St. 561-494-1135 kstakermann @wpb.org Beach Stakermann, West Palm Beach, FL Risk Manager 33401 Scope:Third Party Claims Administration and Managed Care services. Florida League of Jay Goldrick, P.O. Box 538135 407-367-1746 jgoldrick @flcities.com Cities Workers' Orlando, FL 32853 Compensation Scope:Third Party Claims Manager Claims Administration and Managed Care services. 5. Suspension, Debarment or Contract Cancellation. Has Proposer ever been debarred, suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency? ❑ YES El NO SUBMITTAL REQUIREMENT: If answer to above is "YES," Proposer shall submit a statement detailing the reasons that led to action(s). Not applicable. CorVel has never been debarred,suspended or other legal violation, or had a contract cancelled due to non-performance by any public sector agency. September 12, 2014 C o R V E L Page 9 �� * S#i'MCORP RQCD 1 9 �h= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS C ��1_ 6. Litigation History. Proposer shall submit a statement of any litigation or regulatory action that has been filed against your firm(s) in the last five years. If an action has been filed, state and describe the litigation or regulatory action filed, and identify the court or agency before which the action was instituted, the applicable case or file number, and the status or disposition for such reported action. If no litigation or regulatory action has been filed against your firm(s), provide a statement to that effect. If "No" litigation or regulatory action has been filed against your firm(s), please provide a statement to that effect. Truthful and complete answers to this question may not necessarily disqualify a firm from consideration but will be a factor in the selection process. Untruthful, misleading or false answers to this question shall result in the disqualification of the firm for this project. SUBMITTAL REQUIREMENT: Proposer shall submit history of litigation or regulatory action filed against proposer, or any proposer team member firm, in the past 5 years. If Proposer has no litigation history or regulatory action in the past 5 years, submit a statement accordingly. In the last five years, there has not been any investigatory or regulatory action undertaken against CorVel that would affect our performance of any duties or responsibilities. contemplated by five other than as disclosed in our publicly-filed financial statements. 7. Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including disqualification of their Proposals, in the event of such non- compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities(including your sub- consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. Not applicable. CorVel does not have any controlling financial interest as defined in this solicitation. 8. Code of Business Ethics. Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Department with its proposal/response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics, Proposer may submit a statement indicating that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at www.miamibeachfl.gov/procurement/. Please see Attachment A: CorVel's Code of Ethics. September 12, 2014 C O R V E L Page 10 _ � s rm� �j *I R * s 9 h= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 9. Living Wage.Pursuant to Section 2-408 of the Miami Beach City Code,as same may be amended from time to time, Proposers shall be required to pay all employees who provide services pursuant to this Agreement, the hourly living wage rates listed below: • Commencing with City fiscal year 2012-13 (October 1, 2012), the hourly living rate will be $11.28/hr with health benefits, and $12.92/hr without benefits. The living wage rate and health care benefits rate may, by Resolution of the City Commission be indexed annually for inflation using the Consumer Price Index for all Urban Consumers (CPI-U) Miami/Ft. Lauderdale, issued by the U.S. Department of Labor's Bureau of Labor Statistics. Notwithstanding the preceding, no annual index shall exceed three percent (3%). The City may also, by resolution, elect not to index the living wage rate in any particular year, if it determines it would not be fiscally sound to implement same (in a particular year). Proposers' failure to comply with this provision shall be deemed a material breach under this proposal, under which the City may, at its sole option, immediately deem said Proposer as non- responsive, and may further subject Proposer to additional penalties and fines, as provided in the City's Living Wage Ordinance, as amended. Further information on the Living Wage requirement is available at www.miamibeachfl.gov/procurement/. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees to the living wage requirement. CorVel agrees and will comply with the living wage requirement. Please see the attached affidavit document. 10. Equal Benefits for Employees with Spouses and Employees with Domestic Partners.When awarding competitively solicited contracts valued at over$100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide"Equal Benefits"to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? o YES❑ NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners*or to domestic partners of employees? © YES❑ NO CorVel shall offer benefits to its employees with (same or opposite sex) "registered" domestic partners or to"registered" domestic partners of employees upon award of an RFP to CorVel for the CorVel office location(s)where services shall be provided. September 12, 2014 Co R V E L Page 11 �Mti9 't!INCORP NATO * 0.101 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. BENEFIT Firm Provides for Firm Provides for Firm does not Employees with Employees with Provide Benefit Spouses Domestic Partners Health X X Sick Leave X X Family Medical X X Leave Bereavement Leave X X CorVel shall offer benefits to its employees with (same or opposite sex) "registered" domestic partners or to "registered" domestic partners of employees upon award of an RFP to CorVel for the CorVel office location(s) where services shall be provided. If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage)you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfl.gov/procurement/. 11. Public Entity Crimes. Section 287.133(2)(a), Florida Statutes, as currently enacted or as amended from time to time, states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on convicted vendor list. CorVel agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on a convicted vendor list. September 12, 2014 C ® R V E L Page 12 iHC man 3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 9.c ,y 2r_ 12. Acknowledgement of Addendum. After issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional information to Proposers or alter solicitation requirements. The City will strive to reach every Proposer having received solicitation through the City's e-procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation. This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in proposal disqualification. Initial to Initial to Initial to Confirm Confirm Confirm Receipt Receipt Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 l Addendum 3 Addendum 8 Addendum 13 stD)y—/- Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required, submit under separate cover. September 12, 2014 C O R V E L Page 13 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 1 REQUEST FOR PROPOSAL 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) August 20, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: The due date for receipt of proposals has been extended until 3:00p.m., Tuesday,, September 2i 2014. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfi.gov/newcity/depts/purchase/bidintro.asp Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado( miamibeachfl.gov Contact: Telephone: Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers" questionnaire with the reason(s) for not submitting a proposal. Si ;c-rl , • r =x Den" Procurement Director RFP No.2014-302-SW Addendum#1 8/20/2014 MI B . City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO. 2 REQUEST FOR PROPOSAL 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) August 25, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, • or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: deadline for receipt of proposals is extended until 3:00 .m. Tuesday, September 9, 2014. The deadli p p p p , Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. YOU ARE HEREBY ADVISED THAT THIS INVITATION TO NEGOTIATE IS UNDER THE CONE OF SILENCE—ORDINANCE NO. 2002-3378 WHICH MAY BE FOUND ON THE CITY OF MIAMI BEACH WEBSITE: http://www.miamibeachfl.gov/newcity/depts/purchase/bidintro.asp Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranadoa_miamibeachfl.gov Contact: Telephone: Email: Steven Williams 305-673-7000 ext. 6650 Stevenwilliams @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential proposers that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Proposers"questionnaire with the reason(s)for not submitting a proposal. Sid- s,, --tort J f A Deni ' Procurement Director • M City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE RFP No. 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITYADDENDUM NO. 3 September 4, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. 1. REVISION: a) The deadline for receipt of proposals is extended until 3:00p.m., Friday, September 12, 2014. Late submittals will not be accepted. Proposers are cautioned to plan sufficient time to allow for traffic or other delays for which the Proposer is solely responsible. b) Section 0300, Proposal Submittal Instructions and Format has been amended. 1. SEALED RESPONSES. One original Proposal (preferably in 3-ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (10) seven (7) bound copies and one (1) electronic format (CD or USB format) are to be submitted. c) Appendix E, Cost Proposal Form has been amended. Proposers are required to submit the amended Appendix E— Cost Proposal Form in order to be deemed responsive. 2. RESPONSES TO QUESTIONS RECEIVED: Q#1: What company currently provides the medical case management services on behalf of the City of Miami Beach? If it is Johns Eastern Company, how much are they paid for these services? A#1: Johns Eastern Company is the current provider of medical case management services for the City of Miami Beach. Johns Eastern Company is compensated at $195 per lost time and medical only exposure. Please refer to Attachment C, Service Contract for further information. Q #2: If another company is used for case management, how much are they paid? Are their services paid as allocated expenses off each file? A#2: Johns Eastern Company is the only provider. Q #3: The RFP requested loss control and surveillance services?Who currently provides these services for the City of Miami Beach? Is there an estimate of the amount of these services the City will utilize? A#3: Proven Investigations, LLC, (formerly Horizon Investigators) of Ft. Lauderdale, Florida currently provides the surveillance services. In the past two (2) fiscal years, the City of Miami Beach has not utilized any loss control services. There is no estimate of loss control or surveillance services as they are requested on an as needed basis. RFP No.2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q #4: For medical bill payments and bill review services, the proposer would like to know the following information for the fiscal year 2013—2014. Q#4.1: Number of medical bills processed (excluding duplicates. A#4.1: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.2: Total Medical Charges A#4.2: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.3: Total Fee Schedule Reductions A#4.3: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.4: Total Audit Reductions A#4.4: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.5: Total PPO Reductions A#4.5: Please refer to Attachment 0, Copy of COMB Medical Costs for further information. Q #4.6: Total Bill Review Fees A#4.6: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q#4.7: Total Audit Fees A#4.7: Please refer to Attachment D, Copy of COMB Medical Costs for further information. Q #4.8: Total PPO Fees A#4.8: Please refer to Attachment D, Copy of COMB Medical Costs for further Information. Q #5: Is there any way to receive the Loss History in an excel format? A#5: Please refer to Attachment A, Open Claims and Attachment B, Closed Claims. Q #6: Will the City of Miami Beach utilize the Third Party Administrator's Bank? A#6: The City reserves the right to approve the bank utilized by the Third Party Administrator, or select its own. Q #7: Based on the required maximum claim counts of 100 lost time claims, the City of Miami Beach program will need two (2) dedicated Worker's Compensation lost time adjusters. Does the City of Miami Beach want a third dedicated adjuster as the on-site Workers' Compensation adjuster or will the on-site dedicated adjuster handle a case load? A#7: The City is looking for one (1) Worker's Compensation lost time on-site adjuster,who will not handle a case load, but be the intermediary between the Third Party Administrator, the City of Miami Beach and its employees. RFP No.2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4, 2014 Q#8: Does the City of Miami Beach want the designated liability adjuster to handle field investigations only or will the adjuster handle assigned liability claims to conclusion? A#8: Yes, the designated liability adjuster will be required to handle field investigations only. Q#9: Please provide a copy of your current contract with Johns Eastern Company. A#9: Please refer to Attachment C, Service Contract. Q#10: Please provide the total amount of fees paid to Johns Eastern Company for the past three (3) full years of contract periods, by year. A#10: Please refer to Attachment E, Copy of Johns Eastern FY 11-12-13-14 Fees Paid. Q#11: Are the fees paid to Johns Eastern Company all-inclusive or are they also paid for any services as an allocated expense from the claims? A#11: Please refer to Attachment C, Service Contract. Q#12: Does the City of Miami Beach currently have a dedicated onsite worker's compensation adjuster from Johns Eastern Company or is this a new requirement? A#12: The City does not currently have a dedicated onsite worker's compensation adjuster. This is a new requirement. Q#13: For any onsite adjuster(s), will the City of Miami Beach provide office space, phones and Internet access? Is there any charge to the Third Party Administrator for these services? A#13: Yes, the City will provide office space, phone, internet access for any onsite adjuster services requested by the City of Miami Beach. There is no additional charge for these services to the Third Party Administrator. Q#14: Please clarify the City of Miami Beach's need for an onsite liability adjuster? Section C.3, of the RFP indicates this adjuster is to be used on an as needed basis. A#14: For clarification, the City is looking for a liability claims adjuster to handle investigative work on an as needed basis to handle 15-30 Claims per fiscal year. This service will not require a dedicated on-site adjuster for liability adjusting services. Q#15: What is the annual volume of liability claim services the city expects to utilize? A#15: Approximately 15-30 liability claims per fiscal year. Q#16: How much was the Johns Eastern Company paid for liability services for the last three (3) full years? A#16: This service was not a part of Johns Eastern Company's contract. Q#17: The RFP indicates there are currently 421 open claims. It shows the open claim breakdown as 292 indemnity/ lost time claims, and 129 medical only claims. Please confirm this is accurate in both total and the indemnity/MO breakdown. A#17: Yes, the total number of open claims is 421; with 292 indemnity/lost time claims and 129 medical only claims. Q#18: The RFP indicated a required caseload cap of 100 open claims maximum per adjuster. Does the current Third Party Administrator comply with that caseload cap and have approximately three (3) indemnity adjusters assigned to handle this volume on your account? A#18: Yes RFP No.2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS' COMPENSATION AND GENERAL LIABILITY ADDENDUM NO.2 September 4,2014 Q#19: Is the caseload cap of 100 open claims maximum per adjuster a requirement or will a model with higher caseloads be considered? A#19: The City requires the caseload cap of 100 open claims per adjuster. Q#20: Regarding the Cost Proposal Form, Option #2, Fixed per Claim Fee Option. Does it have a liability fixed per claim fee? A#20: Option #2, Fixed per Claim Fee Option on the Cost Proposal Form is only referring to Worker's Compensation. For liability fixed per claim fee, please utilize the Liability Claims Adjuster option in the "Additional Services" section of the Cost Proposal Form. Q#21: Does the Liability Claims adjuster work fulltime in-house at the City of Miami Beach? A#21: No. Please note also on the revised Cost Proposal Form that the Liability Claims Adjuster will handle approximately 15-30 Claims, per fiscal year. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Contact: Telephone: Email: Lourdes Rodriguez 305.673.7000 x6652 lourdesrodriguez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your ITN submission. Potential proposers that have elected not to submit a response to the ITN are requested to complete and return the "Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Sicerely, • ow ' ex Denis 4 -rocurement Director APPENDIX E MIAMI Cost Proposal Form "REVISED"September 4,2014 RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 1700 Convention Center Drive Miami Beach, Florida 33139 RFP 2014302 SW TPA C airns Administration or Workers Comp and men Lo...y - APPENDIX E "REVISED" COST PROPOSAL FORM Failure to submit Section 5; Proposal Tender Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items in full accordance with the requirements of this RFP, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed in pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be initialed. IN ORDER TO BE DEEMED RESPONSIVE, PROPOSERS MUST SUBMIT COST FOR EACH OPTION 1-3. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered for evaluation. OPTION #1: FLAT ANNUAL FEE OPTION Column 1 Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims including $ new and •rior claims (per contract year) 2. Per Claim Fee for Quantity Excess Claim Fee Per Claims in Excess of $ 40 per year Year 345 Per Year (per excess claim) $ (Column 1 x Column 2) TOTAL OPTION 1 (Flat Annual Fee Option):. $ Total Lines 1 -2 *Deposit Amount To Be Maintained By The City: $ *Proposer shall include amount,which the City may negotiate at its discretion. RFP 2014-302-SW TPA Claims Administration or Workers Comp and Gen Lia•i ity 2 OPTION #2: FIXED PER CLAIM FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS Claims With dates of accident after contract:incep'tion;- February 1,, 2015 1. Indemnity Per Claim Quantity (Litigated Or Non- $ 100 per year $ • Liti•ated •er claim (Column 1 x Column 2) 2. Medical Only Claim Quantity (Litigated Or Non- $ 175 per year $ Liti•ated •er claim (Column 1 x Column 2) 3. Medical Only Claim Quantity Transferred To $ 25 per year $ Indemnity Claim (per claim) (Column 1 x Column 2) (Litigated Or Non- Liti•ated PRIOR CLAIMS Claims with dates of accident prior to contract inception- February 1, 2015. 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 292 per year $ Liti•ated •er claim (Column 1 x Column 2) 5. Medical Only Claim Quantity (Litigated Or Non- $ 129 per year $ Lit•ated •er claim (Column 1 x Column 2) TOTAL OPTION 2(Fixed Per Claim Fee'Option): $ Total Lines 1 -5 OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS Claims with dates of accident after contract inception- February 1, 2015 1. Indemnity Or Medical Quantity Only Per Claim $ 300 per year $ (Litigated Or Non- (per claim) (Column 1 x Column 2) Liti•ated PRIOR CLAIMS Claims with dates of accident prior to,contract inception - February'1, 2015. 2. Indemnity Or Medical Quantity Only Per Claim $ 421 per year $ (Litigated Or Non- (per claim) (Column 1 x Column 2) Liti•ated TOTAL OPTION 3(Fixed Per Claim Blended Fee Option): $ Total Lines 1-2 RFP 2014-302-SW TPA Claims Administration or Workers Comp and Gen Lia•i ily 3 ADDITIONAL SERVICES List of services, as needed, which are in addition to the fees •ro•osed in 0•tions 1 3. Description of Service Fee Telephonic Medical Case Management Fee On All Claims: $ Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ Per Bill/Flat Fee Percentage Of PPO Savings—Network Discount Savings Below State Fee Schedule: ok Percentage Of Utilization Review And Reasonable&Customary Savings: ok Subrogation and/or Liens Fee Percentage: ok Osha 300 Log Reporting: Electronic Data Interchange Filed With State: $ Safety Consulting Services Notice Of Injury Entry: Custom/Ad Hoc Reports: Data And File Conversion Fee: $ One-Time Setup Flat Fee Medicare Reporting Costs: $ Liability Claims Adjuster(15-30 Claims per fiscal year) $ Workers Compensation Claims Adjuster(City Of Miami Beach In-. House Adjuster $ ,Additional Service Fee Description Of Additional Service: $ Description Of Additional Service: _ $ Description Of Additional Service: $ Description Of Additional Service: $ Bidder's Affirmation Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: RFP 2014-302-SW TPA Claims Administration for Workers Comp anc Gen Lia i ity 4 MIAMI BEACH :ity of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov PROCUREMENT DEPARTMENT Tel: 305-673-7497, Fax: 786-394-4330 PUBLIC NOTICE ADDENDUM NO. 4 REQUEST FOR PROPOSAL 2014-302-SW FOR CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKER'S COMPENSATION AND GENERAL LIABILITY(the RFP) September 10, 2014 This Addendum to the above-referenced RFP is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The RFP is amended in the following particulars only. I. REVISIONS: Effective Wednesday, September 10, 2014, the Mayor and City Commission have approved an ordinance repealing Section 2-372 of Division 3, Article VI, of Chapter 2 of the Miami Beach City Code titled "Procedure to provide preference to Miami Beach based vendors in contracts for goods and contractual services". Due to this change, the Miami Beach-based vendor preference specified in the solicitation has been deleted in its entirety and is no longer applicable. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado(a.rniamibeachfl.gov Contact: Telephone: Email: Lourdes Rodriguez 305-673-7000 ext. 6652 Iourdesrodriguez @miamibeachfl.gov Bidders are reminded to acknowledge receipt of this addendum as part of your RFP submission. Potential bidders that have elected not to submit a response to the RFP are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s)for not submitting a proposal. S' cerely, i; Procur-ment Director ----Al 1 if? .',, 8Q, 'Cf• TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Appendix A Continued nay twaAnm referplta0 tenth is An tones,to to=Ow by An Co of Nam stmt oho s.Any man taken by ten Gay d Ne .a Propes&nave Posit t Otte adze a'Cory'► r M rabe,In t�q...WV m=be are said pmwaa m An RlgeaW a e etlm9�/seed,a m mltitrtbrr,caw before a ear am=a a erwrL Wall be et bed a n rMpn►eeee2 v caroling On '- .; +nvtwttl a oaA®m m ten pad d the C01r a wow way that L in an am drew amt d h Prawn,an streatm0 the�q ratoautOn w my beds In Oa We dlareaat the ON cal Mew he McCraw alter taabe a dtr heated Ram.VIM a mrefem and aaaaadr7md acmoanrs d the term ate cad low a Irb*amok end may aim Prara>ai Medr Wrath ban to e.Bdalmr.a a deem and in in 6 ore ad a�hwartae ma Wyc4mu Orb.mfibb and wave to e bound Ne to we er any Aabrrea ran.W-An C�IIMmama=em rptPrglmssad awpta M dory PIMa to n ada�t0 Rrwmab en mwarw m Oro sobref n caame dawned b to eddrae6nn�t Rapoan Add m m m we and all anwha we re tmnn ed Formby wanheon d sad a Roma the a reason Amtaea and aa�e>a1d that the mmwtp re repaieomb Wawa an/dtat arlw dam femme m Om Rapetd era�C wawa 4a0sr die.nrbmaC®era anaarem.:rdrdrq d orb sa0ddtlar en/taw m often em cosA in d}¢a�thr d Minnie aabntjd:Roemer Cm not aru�s L dhatm mbhae.pareaea oral 'a0.abide atRaioq de h a oLVma, db�er4 te armored the Papma rcl loam Res aria bet we co/Wed.are any caw Fracas a ar-0b1m.e0 rearatad by as Walton afar ply Pmweer aiarwmdpe tam al becaratmn cantered been iw pat d the Ode a by The brmnvetlm waned a ado b p Wltad way for em aanrtnrenm apmfpldte P bpme a,orb tar lanbe b Rade Smdam as Rank Reorda Law el mopaew.dea end Woman waned o meal I/saw rmA An kmmearn maeled herein b madam ed�ploa Than Cty dots nor peril d Oie racl�m .. -aq,, . ...Alltlaw ore oar mr0 totem. amrncydwyedbmtemIthe era ■7'asaasetae a m W - - - - -- nowee eScn ream et/ m` 'Usti atomsaasrera...tee Anlrfee m 9ws OeaaLY,a m env OmaOM mmttd�ap Nth Cay Alto sloe be a An=aeon am r$ abet)/rely atmahgy m Per ten maa0aban.bCrptamtars.and aa[lem.ere err pe b bag mead by the fly What I Richard Schweppe I Chid Bambini CMlrrr err�rarerta eweim�ran,cares or me ad.as m es want.lb maw.a b mmpfsemm No eeway amen b i.wave i An Cy a An Vats Ora any PRIMO malmNrp m pew rspmaema eV be eaaebd le mat)/wrema rtepatwm,a Alf o° L �Gl�/ � A August 12,2014 lhedyaae/haw no t a Way rah rasped m this water.am aaalm am am wet doom,err Weer --'7 �.--.------ -----� aA be nods My manes deb sddbem elm=waft An h0y wmafodpa el Om OreName of ea Mebane An mom.b tol /ata m as Omabwm An Beddow An rapm s m be Wad oy to Any beet M4 Ropmtaa emnaSod Qlyyitamam Pds coisaidon anmbdteda Om stet net acid rrretaebty dAe Pole aroma./AnParma Rib sdaeed;m o made Wiled m morsel of afraid.oadmmw a chief Dom em octet mama notice Mamba b far awe a California ) Co Pe e d AAn tad tenant tams®Gay.eM does not ohneam eta'hypena w apeeread ) re'pt fie nn.re mo a.d.,�wre iMGbvadaRapowmambdort0 ) Mew that eNeIstengbadB.ala t QQa3e mfyw,a end der a Propose(a Ptepbew),at eaten may 6e rearebd,and ee eppCamb 0hrd `by mondial.and that to hmtnerat ma*pad as blletl d °�wa orB p tenth ore e�>oarmo m e d Ow 0e1 Wrama m the teen of am met corporator by adhere,of do bit d Oman are a knob tea datMa aaaarw�mum anal em palm. may be m co refaced by the Ca,a sly iabulrrart m be rb wArdary Oct add fwd.Behrs rim: ./ raesen.0eAb w maw rdead ay m a9st Maya be CAN. _•sr It. b gnawer by ore Oatamaemer tee•wmw;m taw tam ra ._er otacIKS{ dwdoaas w rattled by era tae.Ad b well m ettrn dd n soda ad B doaawnb eta 4 maid m my Rena>a ti sea a Rehm Phoned by Forme SUMS.a e the dam and Ow ta4e�d mr PODmd tam ant tiro rem mil*ns m to by Ow Yy CoaaaYdm Ban Cey peel brow Pork records. w ewpams Al era ttrm,el wane*lemhea by to • Paws=we mom b ratio all Odom,eras dwaretbro as m wwW1 b Cis a By wln cty n d a Pmpeal the '• Rocasatmw4yaam saves mare aV tee m w bate b nabs ra age,amaai radeemCann amtaw a a00bwea mmmaaw maae d n PO thwart ard atm=Pe mesw le the My or eat ad ail berme r meta in ash Sri a leeeigrdart Bch Abase mass Pd Oa mmrmatat aanelmd m the ROpmm le Pa.mama and aaltbls to the bffi d re mbeledw,Idamobon.and held. NatAatrnmrp to hreacmp or aryaahe BBGafled a An refobb n.re Wooten apnw An b to area d e del mrtitCOSapy MM. by a mat d mepma Ii n An awes an the Cal my Why Mane ad of Ida mbabae,an any meow w 1 CMc. ail area a neaten by An City ear wawa trade.An Way stab m Goad m 510,000.09 an ateedown An Wham Re Mow warm Wagwa An not be mend/to distant ay By the 00w ameba By Pb D acbeam era MeloSne WW1 hams no nary m Pe Qty. a to even of ray dffertecos in Waage Mew tab Maw.ael thadwnet rd to beta dam adda)m,It o amadtod Oda the onAnno of Ps Ceermw a rad Db<demnr thee obeys Wean.The meobow end say Mane Mang ton to wawa.. Wm to premed by tad bewared In bemdaaaarat dm raw a em Sew d Roble RIP 2C 14-302•SW PA Cams A:bant am.,For Ov7:an camp ofd ion;oh Iry ■ RFP 2014302•SN IPA Cbms Admlmn+olun is Wakens Cam and Car.iiab,6ry :q CALIFORNIA ARUM WITH ARRANT STATEMENT avaaaeslerr awe lame • CI See Attached Document(Notary to arose Out Rues 1-6 Wow) °See Statement Below(Lbws I-B to be complated troy by document signals/.not Notary) s' • 3 earwrne.r taw.r\r ge..ro..ryy.a.facia State d Ge0lamta Subpaibea and beam to fax afOnned)bet eg rno caddy of CTQCY(I ee this 12 day d AiA t, 14 by . (1) I•ITUt21 SCNtePPG • �' t>tasMw s oaf Pwrred m ms an the taco d aafr.f�ay evidence i • tlslrRr•owr to be tee person woo eppsarad both a rem C)(.) \:_! �aw! end ga Moo a aloe proved to lam Q1 019 beet.d aadbl> ry eval01 ore , to be ten Parson who,ypmred below me.) . MNa war.s•a ate OPTIONAL him OPTIONAL -nrf^i �•r eV eibrat nto..a roe mpahrlbyrs 8nor,pow KU. !roc u trope rra rid vevo rte . to eeead rgnp m COO ddlel.ea Ore call doom tnillrf mane i . andrwatsarrwr a mw arm a/stew mcmwrt Fier.Owanptmtt of Any Attached Daeudeet • my a tweet llomr.a - I . e.®rt O.R t4mdP. - 1 9grarw 01.Tam Weed eras • r �.aWe e eeW nr Air.ai.Au�w•1seaAataandowe September 12, 2014 C O R V E Page 14 DISCLOSURE AND DISCLAIMER SECTION The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach (the "City") for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this solicitation, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancellin g awards, or in withdrawing or cancelling this solicitation,either before or after issuance of an award,shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the solicitation, as it deems appropriate and in its best interest. In its sole discretion,the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal,the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation,the applicant's affiliates, officers, directors,shareholders,partners and employees,as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers.It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete. The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents,or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations,interpretations, and analyses.The solicitation is being provided by the City without any warranty or representation,express or implied,as to its content,its accuracy,or its completeness.No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation, or approval. The City shall have no obligation or liability with respect to this solicitation,the selection and the award process,or whether any award will be made. Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer,and agrees to be bound by the terms hereof.Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information is for guidance only,and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as,if and when a Proposal(or Proposals),as same may be modified,and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this solicitation may be accepted or rejected by the City for any reason,or for no reason,without any resultant liability to the City. The City is governed by the Government-in-the-Sunshine Law, and all Proposals and supporting documents shall be subject to disclosure as required by such law.All Proposals shall be submitted in sealed proposal form and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses.At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal, and authorizes the release to the City of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge,information,and belief. Notwithstanding the foregoing or anything contained in the solicitation, all Proposers agree that in the event of a final unappeasable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to $10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation,it is understood that the provisions of this Disclosure and Disclaimer shall always govern.The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the State of Florida. RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 19 PROPOSER CERTIFICATION I hereby certify that: I, as an authorized agent of the Proposer, am submitting the following information as my firm's proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments,exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement;*Proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of proposal submitted; Proposer has not divulged, discussed, or compared the proposal with other Proposers and has not colluded with any other Proposer or party to any other proposal; Proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this proposal, inclusive of the Pro.osal Certification,Questionnaire and Requirements Affidavit are true and accurate. Name of Proposer's Authorized Representative: Title of Proposer's Authorized Representative: Richard Schweppe Chief Financial Officer Signature of P pos is Authorized Re resentative: Date: 4- Q� August 12,2014 If CorVel is awarded this littP and Agreement,City agrees to negotiate terms and conditions of the Agreement with CorVel. State of California ) On this 12 day f y August ,2014,personally appeared before me Richard Schweppe who County of Orange ) stated that (s)he is the Chief Financial Officer oforVel Enterprise Comp,Inc.'a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Before me: q Notary Public for the St to of Florida My Commission Exp' s: See �ite1C31 eV RFP 2014-302-SW TPA Claims Administration for Workers Comp and Gen Liability 20 CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 ..v.•_ :v.._%..... - _ _w•vi.`v�•_o,.-.iii.•_7 -7-" f`c:c—Z:`.C<' Cf:C=w-.+,.,:v..v-A>:v,'.- •..iii•.w•.c.•c,-v: q ❑ See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) 1 r. r) f: L.................._....,........__ .,..._,......._..... ........,...,.._...._..__....__.... ..__.._......._..__....,._..._............___....-.......__ _...,..,._........,._.._...,.._.._._....__.._...._...._......_.,._._....___....___.........___._ P l ic 3 i I' (' K7, ri tl (@ 6 ,@ Signature of Document Signer No.1 Signature of Document Signer No.2(if any) d r@ State of California Subscribed and sworn to (or affirmed) before me ie 1 f `L County of Qc{ nG'� on this 1 i" day of NV-G'1U+- fi , 20 1'T , ', �.• by Date MQdth Year , (1) GCZ = J Name of Signer er ' STEFAN PETERSON err,■ 6 proved to me on the basis of satisfactory evidence , f;` ', • to be the person who appeared before me (.) (,) le .1 „'J � :: , (and Y . 1 2017, a Name of Signer 1 p proved to me on the basis of satisfactory evidence < ra to be the person who ra•peared before me.) (e r' / . i Signature '. _■.._ __ f . — 3 Place Notary Seal Above j Sig-.ture of Notary Public :@ 1 0 OPTIONAL ,RIGHT THUMBPRINT RIGHT THUMBPRINT OF.SIGNER'#1:` ' OF'SIGNER:#2- ' e Though the information below is not required by law,it may prove valuable Top of thumb here Top of thumb here to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. 1. Further Description of Any Attached Document , '@ Title or Type of Document: QDocument Date: Number of Pages: 4. Signer(s)Other Than Named Above: ©2010 National Notary Association•NationalNotary.org•1-800-US NOTARY(1-800-876-6827) Item#5910 iA%f9c t*aINCORP'-0RATLD �9y (41.-1 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS RC.,26 C1. Minimum Requirements. The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit detailed verifiable information affirmatively documenting compliance with each minimum requirement. Proposers that fail to comply with minimum requirements will be deemed non-responsive and will not be considered. 1. The proposer must be a Qualified Servicing Entity with the State of Florida, Department of Financial Services, Division of Workers' Compensation (per 69L-5-229 Florida Administrative Code) CorVel is a Qualified Servicing Entity with the State of Florida. Please see Attachment B: Florida Certification. 2. The proposer must have experience as a Third Party Administrator ("TPA") for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five (5) consecutive years. For each experience proposer must submit as evidence: agency name, agency contact, contact telephone, email and years(s) of experience for verification purposes. CorVel has experience as a Third Party Administrator for Workers' Compensation and General Liability for Florida local government(s) for a minimum of five consecutive years. The following references are a testament to our experience. Client Name& Scope Contact Address Phone Email of Service City of Pompano Beach Ed Beecher, P.O. Box Drawer 1300 *client requests Eddie.beecher Risk Manager Pompano Beach, FL email contact @copbfl.com Scope:Third Party Claims 33061 only Administration and Managed Care services. Contract Years: 2008-Present Miami Dade County Dan Cullen, 111 N.W. 1St Street 305-375-3216 Dcullen Director Suite 2340 @miamidade.gov Scope:CorVel serves as the Miami, FL 33128 medical management arm with network solutions for the self- — administered WC and GL government client for over five years plus a contract for EDI medical bill review with the network. Contract Years: 2009-Present September 12, 2014 C ® R V E L Page 15 September 12-2014 C o R V E L rage ito '('*I INCORP ORATED *% S3 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Proposers must submit cost proposal for the entire scope of services requested. Proposals to handle only selected parts of the scope will not be considered. It is understood by the successful proposer that all services are to be provided by the proposer's employees and cannot be contracted out to another party without the prior approval of the City. The commencement date of the contract will be February 1, 2015. Please see Attachment D: CorVel's Cost Proposal. C3. Specifications.The administrator will provide all specified adjusting services for all claims as well as all other required services, such as administrative, managed care/medical case management, computerized claims/loss statistical information (RMIS) and banking/loss fund reconciliation. The specific required services are outlined in greater detail within this request for proposals. The City has approximately 1,900 employees, and averages 345 claims annually. The breakdown is estimated at 239 medical only and 106 lost time. Currently there are approximately 421 open claims. Prior to October 1996, the City purchased excess workers' compensation insurance. The City does not currently purchase excess workers' compensation insurance. In agreement with Ordinance No. 1335, the City pays Supplemental Injury Pay for a maximum of 32 weeks, for employees who have a work-related injury but remain absent due to restrictions resulting from their injury. The Supplemental Injury Pay is the amount equal to the difference between their normal City pay and the amount of compensation payable under the provisions of the Workers' Compensation law of the State of Florida. This benefit allows employees to receive their full pay while absent due to an approved work-related injury. In view of this, temporary total indemnity benefits will not need to be paid by the claims administrator unless the injured employee is eligible for temporary total benefits in excess of 32 weeks. In addition, certain medical conditions and work related activities are covered under workers' compensation for police and fire personnel pursuant to union contract. All proposers are to assume the complete handling of all future and past claims now being handled by our present Claims Administrator(see Appendix G for open/closed claims for all years), along with all new claims.The information provided regarding the volume and type of pending claims to be assumed is based on the latest information provided to the City and cannot be guaranteed as to its accuracy. If the amount of prior claim files to be taken over is 25% greater than represented in this RFP, the City will consider a proportionate adjustment to the proposer's flat annual fee. It is the responsibility of the proposer to review prior claim files to determine the additional proposed cost, if any, to take over these files. It is also required that the claim data associated with all claims occurring prior to February 1, 2015, be transferred into the proposer's computer information system, so that future loss runs will contain a complete history of all claim years. The transfer of all claims data must be completed by June 1, 2015. The proposer is responsible for specifically indicating in their proposal the fees, if any, for assumption of prior claims and the data conversion. The program is run on an "occurrence" basis, therefore, all claims occurring in the contract year, regardless of when reported, are to be handled per the requirements of this agreement. The claim administrator is required to handle all claims to their conclusion or to the conclusion of the contract, whichever occurs first, at no additional charge to the City other than the annual fee. The contract may be terminated by either party with ninety (90) days written notice to the other. However, any cancellation does not alter the administrator's obligation to handle all claims prior to the termination date. September 12, 2014 C O R V E L Page 17 *INCRRP RATED *' -,3� ��, TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS The City requires that the selected TPA provide, at a minimum, the following professional services related to the administration of the City's self-insured Workers' Compensation and General Liability: • TPA shall provide workers' compensation third-party claims administration services to the City of Miami Beach's self-insured workers' compensation program in accordance with Florida Statute, Section 440, applicable Florida Administrative Code(s), and applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s). City shall provide TPA with copies of applicable City Code(s), Resolution(s) or Collective Bargaining Agreement(s) as necessary. This includes the necessary medical benefits, expenses and other services usual and customary to the administration and management of workers' compensation claims, if not otherwise noted herein. CorVel agrees and will comply. CorVel is active in the regulatory environment of our industry. Our involvement starts at the state level with the primary office in Florida. Information for Florida is gathered nationally and collated. We track both state and federal legislative and regulatory changes that affect any of the services we provide. CorVel hosts training and informational meetings to keep our claims personnel current on recent updates to workers' compensation laws, claims handling techniques, and rules and regulations. Meetings also including up to date information about investigations, fraud identification, subrogation and litigation management. • TPA shall provide, on behalf of the City, all self-insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida, all annual reports, unit statistical, modification factor, assessment indemnity, medical and any and all forms required by the State of Florida which a self insurer for workers' compensation must provide. CorVel agrees and will provide all reports and forms as required by the State of Florida, including but not limited to all self-insurer reporting to the Self Insurance Bureau, Division of Workers' Compensation, State of Florida and all annual reports. CorVel will report to all states in which state reporting is required on behalf of the City and according to the state's guidelines. If required by the state, we will submit the reporting data via EDI. We run state reports on a weekly basis. Our system reports to states based on the submitter information provided by the state. • TPA shall accept all current claims and/or re-opened claims as run-in claims to the TPA if selected as the new TPA for the City. CorVel will accept all current claims and/or re-opened claims as run-in claims if selected as the new TPA for the City. The City's current open claims data will be mapped and integrated into Confel's claims system and will require an Adjuster to review the claim file before any payments can be made on the file. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing September 12, 2014 C O R V E L Page 18 *;►NCO toRATm; TAB 1: COVER LETTER& MINIMUM QUALIFICATIONS the bill image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts,code translations,etc.Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level.We can accept and map your data to appropriate fields within our system which includes: • transactional data • exhibits in PDF,Word • file notes and Excel formats • reserve history • assigned departments • subrogation and litigation • employee occupation information • accident locations • scanned documents • injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system integration provides the Adjuster with the appropriate data integrity to perform their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. • TPA shall provide the City with the ability to report first reports of injury and loss notices electronically, by facsimile or by phone based on the severity, circumstances or nature of injury at no additional cost. Claims can be reported online via CorVel's website, 24/7 Nurse Advocacy service, toll free call center, faxed, or input via mobile apps available for smart phones and tablet devices. CorVel's early intake process promotes immediate and convenient access to report an injury or incident to improve return to work results. For immediate care,we recommend reporting incidents to our 24/7 Nurse Triage call center. All other non-urgent or retrospective injuries can be reported via CorVel's website, toll free call center, faxed, or entered via mobile apps available for smart phones and tablet devices. Claims are immediately processed by our proprietary rules engine where medical management begins immediately as needed, and the claim is assigned to a Claims Adjuster within one business day or less of initial receipt. • TPA shall provide automated acknowledgement upon the receipt of each claim. The acknowledgement shall include, but not be limited, to the following: claim number, assigned adjuster name, email and telephone number, claimant's name, and date of loss. CorVel will provide automated acknowledgements upon the receipt of each claim. The acknowledgement will include the information specified by the City. September 12, 2014 C O R V E L Page 19 __--w--,y, ,--e -1,4,,,, f.6c.-.� 1y' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS o ti, s, '•,.: f 26,.1- • TPA shall set up all new claims within twenty-four (24) hours after notification. Assigned adjuster, supervisor or nurse case manager shall make all contacts and initiate investigation within forty-eight (48) hours of receipt of new claims. CorVel agrees and will comply. Investigation begins within 24 hours of claim receipt and involves timely and thorough fact gathering. The assigned Adjuster will make all initial contacts.All claims identified as complex will have a comprehensive initial investigation performed with detailed file documentation that addresses compensability, evaluates possible exposure and outlines the future plan of action. Three point contact with the injured worker, the City, and physician will be initiated within 24 hours and completed within 48 hours. Situations preventing completion within 48 hours will be documented and additional efforts will be made to contact each party, including the use of email and regular mail (certified letter to the injured worker). Once the investigation phase is complete, a determination of compensability is made. The initial plan of action is initiated within two business days of claim receipt. On all open active claims,where compensation benefits are being paid,the file will be updated at a minimum of every 30 days. For all other indemnity claims, the file will be updated every 90 days. Upon completion of the initial contacts and investigation,an accurate reserve reflecting the expected cost of the claim is entered into the CorVel system no later than five days after the initial receipt of the claim. Reserve levels are based on the information known about the claim at that time.The reserve review performed at 30 days includes a reserve worksheet detailing the reserve amount and any additional information received. Reserves will be reviewed every 90 days thereafter. • TPA shall have the ability to provide prescription drug authorization on the same day as injury to all injured employees. CorVel will provide prescription drug authorization on the same day as the injury to all injured employees. We offer mobile technology that allows us to connect more quickly, effectively and efficiently through the use of smart phones and/or tablet devices. We have the capabilities to text pharmacy ID card information to injured workers so they can quickly obtain their first fill prescription. CorVel's new Claimant App provides injured workers with access to essential claim information conveniently on their smart phone or tablet device. Injured workers have access to their initial treatment guide, permanent pharmacy card and their CorVel contacts' information including their Adjuster and Case Manager, if applicable. The newest release from our suite of mobile technology capabilities requires a secure log- in and is maintained upon a secure authentication path. Additionally, CorVel's pharmacy program has a toll free number where our staff is available 24 hours a day, 7 days a week to provide medication authorization that an injured worker may need. Additionally, CorVel's pharmacy benefits software has drug September 12, 2014 C O R V E L Page 20 INC J' \: TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS utilization review (DUR) edits as an integral part of the program. These edits include information on standard dosages and utilization. The pharmacy program clinical department develops prior authorization criteria based upon guidelines established by various Workers' Compensation entities, i.e. NCCI; or may be tailored to meet the City's current protocols. The pharmacy will receive a message stating that the prescription requires a prior authorization and the telephone number to call to obtain this authorization. The authorization process can be handled by the pharmacy program clinical department or the pharmacy staff will notify the appropriate the City personnel for final determination on the prior authorization request. The pharmacy will be notified of the final outcome of their request. • TPA shall triage every notice of injury with an initial review by a claims supervisor, a registered nurse review of medicals, and assigned adjuster's review of entire claim file. CorVel agrees and will comply. Triage Process Advocacy 24/7 As a part of CorVel's early intake process, incidents can be reported to our 24/7 Nurse Triage call center in order to facilitate medical management at the onset of an injury and to improve return to work results. At the time of the incident,employees can call and speak with a 24/7 Advocacy Nurse— a live, registered nurse who will evaluate the nature of the incident or injury and determine the employee's immediate medical needs. The nurse creates a report including her recommendations within our system, which starts the claim reporting process. Important healthcare information including comorbidities is also collected at this time to most accurately assess the injured worker's needs and assist with the set- up of the claim file. By addressing the medical treatment needs when the injury first occurs, we are able to provide quick and accurate care intervention, often helping to prevent a minor injury from becoming an expensive claim. This initial phase of triage also creates the possibility to make a shift in the claims mix. Because a nurse initiates the management of the claim by providing medical advice, it allows us to identify cases that cannot be managed by self-care. These potentially complex cases have immediate access to healthcare resources and are directed into our network for additional savings. The employer is notified of an incident report and direct as a claim if time loss from work has occurred. CorVel's staff of registered nurses are licensed in all 50 states and advocate timely return to work with quality care for the City's employees. Our nurses' use nationally recognized triage protocols with industry standards to facilitate appropriate treatment options. Our advocacy services include: immediate intervention and evaluation, channeling to preferred network of providers, channel to CorVel's pharmacy program by providing a First Fill number,employer access to online case information and 24/7 access to nurses that specialize in occupational injuries. September 12, 2014 Co R V E L Page 21 a*i ,„,:s. 40,7 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Claim Intake Should an incident become a claim, the Triage Nurse's report is sent to the FNOL department to determine additional information that may be needed for the claim file. Employers are immediately notified when an incident occurs, after which they can report the claim via the call center, mobile apps or our online web portal, www.caremc.com. Triage Processes—Smart Triage After being entered into the system, smart triage begins. All incidents and claims are immediately processed by our proprietary rules engine where medical management begins immediately as needed. The claim is also assigned to a Claims Adjuster within one business day or less of initial receipt. CorVel's industry-leading technology is used to identify and prioritize claims. We process the FNOL and separate non-complex claims, such as medical only, from potentially complex claims, such as potentially ongoing indemnity and medical only claims that need management beyond the typical medical only model. During this level of triage, the claim is also assigned to a specific office and Case Manager— if necessary—all within one business day. Additional Triage If a claim is identified as potentially complex in nature,an additional level of nurse triage is performed. The Triage Nurse examines the claim and based on numerous factors including the type of injury, patient's comorbidities and age, will determine if the claim is non-complex or complex. Non-complex claims are directed to the claims team,while complex claims will be routed to a nurse and claims team. Three Point Contact Upon assignment, preliminary investigation begins by the Adjuster. In complex cases, a nurse assigned to the file works with the patient and physician while the Adjuster conducts three point contact. CorVel's best practices require three point contact with the City, the injured worker and physician within one business day of receipt of an indemnity claim or medical only claim with lost time potential. However,our claims staff regularly exceed this expectation and perform three point contact within four business hours of receipt of the claim. Written and/or recorded statements will be obtained where appropriate, claims will be indexed and onsite investigations will occur as needed. Continuous Rules Engine Processing Throughout the life of the claim, the rules engine continuously fires, alerting the Adjuster of any events or information that may impact the claim or affect its return to work status. This processing calls immediate attention to claims, avoiding costly delays. Our integrated model houses all claims and managed care information on one platform, allowing insight into every aspect of our clients' programs and continuous predictive modeling throughout the life of a claim. With our system's predictive modeling functionality, CorVel can identify cases requiring other efforts (including medication September 12, 2014 C O R V E L Page 22 __ 8,,., i*{1NCARP ORATED *,' \ TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS ,9.Cyr , review and ongoing return to work initiatives) and redirect a claim to the most appropriate, quality care at any time. 24/7 Advocacy—Nurse Review CorVel offers a nurse triage call center for the City's employees, 24 hours a day, 7 days a week.At the time of the incident,employees can call and speak with a registered nurse who will evaluate the nature of the incident or injury and determine the employee's immediate medical needs. By addressing the case when it first occurs, we are able to provide quick and accurate care intervention, often helping to prevent a minor injury from becoming an expensive claim. CorVel's staff of registered nurses are licensed in all 50 states and advocate timely return to work with quality care for the City's employees. Our nurses use nationally recognized triage protocols with industry standards to facilitate appropriate treatment options. Our advocacy services include: immediate intervention and evaluation, channeling to preferred network of providers, employer access to online case information and 24/7 access to nurses that specialize in occupational injuries. Claims Supervisor and Adjuster Review The Claims Supervisor conducts an initial review prior to assigning the claim to an Adjuster. Upon assignment, the Adjuster will review the entire claim file and begin a preliminary investigation prior to completing three point contact. • TPA shall utilize any recommended medical primary care physicians or specialists as directed by City, even if not in the TPA's network, if it is in the best interest of the injured employee or the City. This would include authorizing treatment by non-occupational or non-network physicians or providers who have treated an injured employee under emergency or exigent circumstances in an emergency room or other facility, if such treatment would be considered prudent and reasonable for continuity of care purposes. CorVel agrees and will comply. CorVel offers a proprietary national PPO network comprised of more than 750,000 provider locations and specialties, including over 53,200 in Florida, to offer our clients local insight with national coverage. Providers are selected from a demanding criteria based on quality, range of services and location. Each provider is thoroughly evaluated and credentialed, then re-credentialed every three years. Through this extensive evaluation process, we are able to provide significant hospital, physician and ancillary medical savings while maintaining high quality care. Additionally, the City can request that providers be added to the network in a variety of formats including an internet nomination form (found on the CorVel website or system website), a faxed or emailed provider nomination form, or by telephonic request. Once a provider is nominated,CorVel's local PPO Developer will begin immediate recruitment of the provider.This process can take 4-8 weeks due to the credentialing requirements; however, CorVel will work diligently to make sure the credentialing and application processes of the existing the City preferred providers is expedited to ensure enrollment by the program start date. As CorVel owns and maintains its own provider network, addition of providers is an easy process for us to complete. September 12, 2014 CORN/ EL Page 23 s�,P�189c, *i1NGORP ORATED `.,� - TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 1t? • The City reserves the right, but not the obligation, to approve all vendor partners and ancillary services used by the TPA that are part of the workers' compensation allocated claim expense or reserve. CorVel agrees and will comply. CorVel's software, systems and staff are direct resources of our company. We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside investigation and appraisals. The City will be able to approve all vendor partners and ancillary services used. • City reserves the right to select its own workers' compensation defense counsel to manage any and all litigation for the City's workers' compensation and employer's liability program, and/or to seek pre-litigation legal advice and claim strategy. The City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. TPA shall agree to work with the City's chosen workers' compensation defense counsel. In the event the TPA is unable to work with the City's workers' compensation defense counsel or has a conflict of interest, then City reserves the right to deem the TPA's proposal non-responsive, or terminate the TPA's Contract. CorVel agrees and will comply. Legal referrals are closely monitored for need and effectiveness. Specific attorneys, rather than firms, generally provide the most effective representation. CorVel will work closely with counsel in evaluating and making recommendations for claims management. We are accustomed to working in partnership with various reputable law firms. CorVel will work closely with the City in evaluating legal counsel and make recommendations regarding suitable panel attorneys. We can use existing the City attorneys if preferred. We understand that the City's Risk Manager has the authority to approve the workers' compensation defense counsel's fee, cost schedule and/or any allocated legal claim adjustment expenses. • TPA shall provide the City with an on-site experienced, dedicated adjuster to provide professional workers' compensation adjusting services and employee claim assistance on-site at the City's Risk Management Division Office of the Human Resources Department, or as otherwise designated by the City, with duties and responsibilities to be mutually agreed upon by the TPA and the City. TPA must provide access to Spanish and Creole speaking adjusters for situations when injured workers are more comfortable conversing in Spanish or Creole. TPA should clearly outline the staffing which will be provided. The adjuster shall perform all the usual and customary worker's compensation claim adjustment services and assistance as done by the City's Risk Management staff in accordance with the third-party claims administrator agreement between the City and TPA. The scope of assignment includes, but is not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions,filing wage statements, updating diary notes, assisting attorneys with litigated files, and working with the City's regularly assigned workers' compensation claims adjusters. September 12, 2014 C ® R V E L Page 24 's*fIN;OWED *i '•;�� PJ TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS CorVel will provide the City with an on-site experienced, dedicated Adjuster to provide professional workers' compensation adjusting services and employee claim assistance on-site. CorVel recognizes the importance of ongoing contact with injured workers and will maintain regular contact with employees. We will work with the City during the implementation process to select Adjusters that are bilingual or multilingual in languages that include Spanish, Creole, Vietnamese, Korean, Chinese, French and Russian. The following staffing will be provided to the City: • Carrie Rath, Workers' Compensation Claims Manager • Felipe Benitez, Liability Claims Manager • Jennifer Johns, Claims Supervisor • Anita Alvarez, Senior Claims Adjuster • On-site Claims Adjuster,to be hired The Adjuster assigned to the City's program will perform all the usual and customary workers'compensation claim adjustment services and assistance as done by the City's Risk Management staff. CorVel's Adjuster will perform the scope of assignment including, but not limited to, filing new losses, coordinating light duty assignments, assisting employees with claim questions, filing wage statements, updating diary notes, assisting attorneys and working with the City's regularly assigned workers' compensation Claims Adjusters. • TPA shall provide, on an as needed basis, an on-site dedicated licensed liability claims adjuster at the City's Risk Management Division, Office of the Human Resources Department, or as otherwise designated by the City, to assist the City's Risk Manager with claims administration services for the City of Miami Beach's self-insured liability program. The City is self-insured and self-administered for liability claims management. The adjuster shall perform claims administration services for automobile and general liability claims. The scope of assignment includes, but not limited to, investigations, creating file diaries, record keeping, and other services necessary or proper for, or incidental to, performing claims adjusting. The City will have a designated liability claims unit based on claim volume. We are willing to discuss an on-site designated licensed liability claims Adjuster on an as needed basis. If an Adjuster on the City's team does not carry a full caseload of the City's claim files, that Adjuster may be utilized on another account. Adjusters that will be designated to the City's account, and the percentage of time each individual will be designated to the account, will be determined once the proposed organizational chart is finalized. All permanent, designated team members will be located in the Sunrise, Florida office. CorVel's Adjuster will perform claims administration services for automobile and general liability claims according to the scope of assignment, including investigations, creating file diaries, record keeping and other services necessary for performing claims adjusting. September 12, 2014 C O R V E L Page 25 \pNl1 9cs; { *INCORP ORM ' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall provide the City with telephonic case management services on all workers' compensation claims as an allocated loss adjustment expense, unless otherwise directed by City. CorVel agrees and will comply. Telephonic case management is a cost efficient evaluation and coordination of medical care delivery, conducted over the phone by a nurse. It is geared toward less medically and vocationally complex cases, and is usually targeted to a time limited intervention of 30 to 60 days, focusing on early return to work, maximum medical improvement, and aggressive negotiation with medical providers. • TPA shall provide a list of PPO networks affiliated with the TPA, as requested by City. CorVel agrees and will comply. CorVel offers a proprietary national PPO network comprised of more than 750,000 provider locations and specialties, including over 53,200 in Florida, to offer our clients local insight with national coverage. Providers are selected from a demanding criteria based on quality, range of services and location. Each provider is thoroughly evaluated and credentialed, then re-credentialed every three years. Through this extensive evaluation process,we are able to provide significant hospital, physician and ancillary medical savings while maintaining high quality care. CorVel works closely with its customers to ensure maximum usage of the PPO network. Network channeling occurs along all points of the managed care continuum, beginning having adequate provider panels posted at the City's locations.We work with all treating physicians to make sure all specialty referrals are directed to an in-network provider. Each time provider channeling occurs during the course of treatment, it is noted within the system. CorVel also has directed care networks in specific states to direct care to the most appropriate provider, along with achieving maximum savings. We offer many channeling tools to the City including online provider look up, demographic file downloads, online directories, toll free scheduling number, provider inquiry email, toll free provider inquiry line and an online referral process. Also, our network providers are contractually obligated to refer to other network providers whenever possible and according to state laws. CorVel's online provider lookup functionality also includes enhanced features for the specialized needs of the City. Features include printable directories and customized provider panels. Specific directories, based on physician specialty or geographic location can be generated directly by the City and printed instantly for a readily available reference.The City can also hand select a panel of preferred providers for any given location, print the preformatted one page panel and post as any easy access resource guide for employees. The panel and directories are customized with your company's name and location(s). These enhanced services proactively assist you in directing employees to preferred care providers. We can provide the City with a link to our network directory to facilitate easy access for employees, Occupational Benefit Specialist and the City's treating providers. September 12, 2014 C O R V E L Page 26 *ZINC ORATED* <4 = TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall evaluate and qualify various service providers recommended by the City to service its account, provided such service providers do not present a perceived or potential conflict of interest. CorVel agrees and will comply. The City can request that providers be added to the network in a variety of formats including an internet nomination form (found on the CorVel website or system website), a faxed or emailed provider nomination form, or by telephonic request. Once a provider is nominated, CorVel's local PPO Developer will begin immediate recruitment of the provider. This process can take 4-8 weeks due to the credentialing requirements; however, CorVel will work diligently to make sure the credentialing and application processes of the existing the City preferred providers is expedited to ensure enrollment by the program start date. As CorVel owns and maintains its own provider network, addition of providers is an easy process for us to complete. • TPA shall provide the City with field case management services, catastrophic case management services, medical cost projections, life care planning, Medicare set-aside assessments, development of reports, surveillance, peer review, utilization review and reasonable and customary savings review, bill review, percentage of PPO savings and any other usual and customary workers' compensation claims administration claims practice, strategy or activity as all allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or TPA's judgment. CorVel will provide the City with the services mentioned above as well as any other usual and customary workers' compensation claims administration claims activity as allocated loss adjustment expenses, unless such expenses are more appropriately allocated as a medical expense under the claim per Florida Statutes or our judgment. Our managed care services include the following: Field Case Management Field case management is a method of evaluating and coordinating medical care for claims characterized by high severity or related difficulty and complexity. It is the preferred method when intervention should be intensive in nature and involves Field Case Managers with expert knowledge of the local medical communities and labor markets who engage in face to face meetings with key parties to ensure medical care is appropriate, high quality and cost effective. Catastrophic Case Management CorVel's catastrophic case management service provides access to an on-call nurse, 24 hours per day, 7 days per week,to facilitate an immediate response to a catastrophic injury. Upon notification, the claim will be immediately referred to a Catastrophic Case Manager experienced in critical care and acute injuries. Instant communication is established as the Case Manager coordinates treatment while guiding the patient through the critical episode of care and recovery. The Catastrophic Case Manager will contact the hospital where the injured worker has been admitted and arrange an onsite visit with the injured worker, the injured worker's family and the medical providers involved with their treatment. The Catastrophic Case September 12, 2014 C O R V E L Page 27 *tnecin o;; *s TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Manager will continue to communicate with the providers and injured worker on a daily basis until the acute phase has passed. Early intervention in catastrophic cases can result in significant medical, indemnity, legal and overall claims savings. Medical Cost Projections CorVel realizes that reserving can have a significant impact on the financial well being of our customers. They must be established timely and accurately to reflect our best judgment considering the injury,estimated period of disability,ability to return to a form of wage earning capacity, along with environmental considerations. As CorVel offers a fully integrated claims management and managed care program, our Claims Adjusters work closely with Case Managers via our online, real time claims management portal to manage reserves, RTW objectives, and case closure. Our Adjusters consider the particular circumstances of each claim and maintain contact with the injured worker, Case Manager, physicians and the City to develop a reserve that is current, realistic and based on the probable cost of each claim. Reserves are based on the medical information received from Case Managers and treating physicians. Reserves may be adjusted as: • New medical information is received • Prognosis is updated • Injured worker obtains legal representation • Settlement is anticipated • Additional pertinent information is received It is CorVel's practice to avoid the stair step methodology or have reserves continually increase or decrease. However, reserves will be adjusted as the claim develops and additional information is received throughout the life of the claim. Reserve changes, payments and file closings are input into the system within 24 hours. Reserves on all open claims are reviewed every 90 days or more frequently based on our event driven diary system. All reserve activity is documented in the claim file. Life Care Planning CorVel offers certified Life Care Planners to aid in cost containment for catastrophic injuries, while advocating quality care for patients. Life Care Planning is a tool used to project long-term future needs,services and related costs associated with a catastrophic injury. CorVel's Life Care Plans summarize extensive amounts of medical data and compiles it into a comprehensive report for future care requirements.The report assists claims payors with future cost projections while identifying the continuing medical care needs of the injured individual. Medicare Set-Aside Assessments The Centers for Medicare/Medicaid Services(CMS) requires their interests be protected prior to any settlement of the medical portion of a claim for qualified individuals.CorVel offers our clients CMS compliance by utilizing qualified and specially trained Medicare Set Aside specialists experienced with CMS requirements. Our services are comprehensive and seamless,from development and submission of the MSA allocation report through the completion of settlement documents. September 12, 2014 C O R V E L Page 28 i*I ixca�e oavm *s �. �:= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS `26 Program Services: • Development of comprehensive allocation report • Free initial consultation to determine need for Medicare Set Asides • Obtain any necessary rated age information • Assistance with outstanding conditional payment status • Assistance with Social Security/Medicare status • Assist and prepare all necessary forms Program Benefits: • CorVel offers a strong working relationship with CMS • Comprehensive solution to meet all of your needs • Fast turnaround time • Continuous communication and follow up with necessary parties • Free onsite claim file copying • Expedited settlement agreement services CorVel will continue to query the SSN,name,gender and date of birth of injured workers on all open claims on a monthly basis to determine if Medicare eligibility has begun. This is not explicitly required in the CMS regulations, but it is the only way an RRE/Agent can be sure of an injured worker's eligibility on ORM or other types of long- term claims. Development of Reports CorVel's reporting capabilities are extensive. The City will have access to a variety of reports via the claims system, allowing you to create reports to meet your specific needs. Every report allows the user to group, total or sort by various data fields with an assortment of filters. All reporting can be grouped and totaled by multiple location tiering. CorVel's reports are user friendly, well organized, intuitive and simple to use. Surveillance It is CorVel's practice to discuss any outside investigation activities with the City prior to assignment. Before a referral, the Claims Adjuster conducts a cost/benefit analysis to determine if the investigation has the potential to derive the savings necessary to employ the expense. We do not recommend investigation assignments on files with very limited potential exposure. Any request by the City for outside investigation will be honored. Criteria for initiating investigation include: • Injured worker may be working while collecting temporary disability or salary continuation • Injured worker may be engaging in activities outside of their restrictions • Injured worker's permanent disability is grossly inconsistent with reported activities or objective findings September 12, 2014 C O R V E L Page 29 i,Z-‘-;i._:..(4\ f *tINC44P RATED*' TAB 1: COVER LETTER& MINIMUM QUALIFICATIONS CorVel has a provider list for investigators and will honor any vendor selection by the City for case referrals. Outside investigation assignments will be completed and submitted within 30 days. Peer Review CorVel has a large consultant panel of physician advisors that perform peer reviews. These physician advisors are board certified in their specialty and in an active medical practice. Peer reviews are performed between like specialties, i.e. Neurosurgeon to Neurosurgeon, Orthopedic to Orthopedic. CorVel recruits providers as needed in each state to accommodate the volume of peer reviews. The peer reviewer professionals must go through the same certification process as the providers that are in the PPO network. CorVel has peer review capabilities for the following specialties: • Occupational Medicine • Acupuncture • Orthopedic Surgery • Anesthesiology • Pain Management • Cardiovascular • Physical Medicine and • Dentistry Rehabilitation • General Surgery • Neurology • Hand Surgery • Podiatry • Hematology • Internal Medicine • Neurosurgery • Toxicology • Plastic Surgery • Oncology • Rheumatology • Psychiatry • Thoracic Surgery and Urology The specialty of the treating provider will determine which peer specialty will be utilized. CorVel only utilizes peer review physicians who support their findings with medically based evidence and are URAC IRO accredited. Utilization Review CorVel's utilization review program provides prospective,concurrent and retrospective review of specific treatments. Our experienced staff of Utilization Review Case Managers, board certified Medical Directors and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting. The goal of our utilization review program is to avoid unnecessary treatments and their associated costs and to ensure high quality,timely, cost effective medical care for injured workers. Key utilization review features include: • Medical treatment plan review • Patient referral to select CorVel PPO providers • Pre-certification of an admission and approval of a specific length of stay • Coordination of discharge planning, DME and other services • Timeliness of service: compliance with Florida legislation September 12, 2014 C O R V E L Page 30 _______-i--,,,‘‘, /-1- „----- 4,,,,, *=1NCORP ORATED*1 `.,39 cP1 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS ,„ ?6°� • Confirmation letter to the provider, injured worker and Adjuster of any certification or denial Reasonable and Customary Savings Review CorVel's rules engine has more than 10 million rules that apply fee schedule and appropriate reasonable and customary rules as well as pricing as defined by each state. This reduces medical costs from 10% -40% depending on state regulations. Bill Review CorVel offers an innovative medical bill review program with up to 75%average savings per bill in the state of Florida. We offer a complete medical savings solution for all in- network and out-of-network medical bills, including PPO management, medical bill repricing, line-item review, expert fee negotiations, professional review, automated adjudication and electronic reimbursement. Each feature focuses on increasing processing efficiencies and maximizing savings opportunities. Our company specializes in reducing the cost of all medical bills through a combination of rules-based technology, clinical expertise, expert review and a proprietary PPO network. We offer a winning formula by combining these elements into a single, powerful savings solution. CorVel offers up to 28% higher savings than leading competitors. Rules Engine Our proprietary rules engine is highly flexible and can be configured by line of business, company location, state and customer. Populated with more than 10 million rules, the system ensures accurate and consistent bill review to maximize savings for our clients. Through the electronic intake of medical bills and expert review of all charges, CorVel is able to identify unbundled services, re-bundling opportunities, reasonable and customary review,fee schedule analysis, and pharmacy and PPO review. Enhanced Bill Review CorVel's enhanced bill review program adjusts individual line item charges on specific bills to reasonable and customary levels while removing all error and billing discrepancies with professional review. The service is designed to maximize savings opportunities and increase efficiencies for customers. Reporting and Analytics CorVel's reporting and analytic capabilities,via our online portal,offer extensive access to important claims data including scanned medical bills and Explanations of Review (EOR) in addition to all other associated bill review information. With online access to comprehensive data,the City can track medical costs throughout the life of a claim and review bills being processed instantly and at your convenience. In the next year, CorVel will save our customers over $4 billion. We offer the City the most comprehensive solution in the marketplace. From smart processing to payment resolution, we focus on increasing efficiencies and maximizing savings opportunities. Percentage of PPO Savings We deliver discounts below workers' compensation fee schedule and reasonable and customary rates through our national, proprietary network. Our network consists of more than 750,000 provider locations and specialties, with more than 53,200 providers in the state of Florida.Providers are selected using demanding criteria based on quality, September 12, 2014 CORN/ EL Page 31 _____,"„,,.„. : i: "tINt OIUTm*' '•,� ��„ TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS ,RE.. _ range of services and location. Our solutions extend beyond traditional PPO programs via our directed care networks which offer significant discounts with ancillary providers combined with utilization management and increased penetration. Pharmacy CorVel's clinical expertise, investments in technology and customer service can provide the City with significant reductions in your pharmacy costs. Our comprehensive pharmacy solution includes formulary management,maximum network penetration and aggressive utilization management.We provide access to a network of more than 4,400 retail pharmacies in Florida, with over 65,000 retail pharmacies nationwide. Clinical Modeling CorVel is able to proactively identify significant cost-drivers in pharmacy utilization before they become high dollar claims through clinical modeling analysis of all bill review data.We have developed a proprietary set of rules in our system to flag specific indicators such as high narcotics usage, multiple prescribers, and certain drug combinations that can contribute to rising costs or lead to harmful conditions such as addiction and prescription abuse. Integration with CorVel's bill review program provides us with full visibility into a patient's entire drug history including drugs obtained from retail, mail order and out-of-network pharmacies, third party billers and physician dispensed medications so we can manage the City's entire pharmacy exposure. Once a potential costly or harmful claim is identified, it will be forwarded for intervention by our medication review program, with prior approval from the City. Medication Review CorVel's medication review program reduces costs by working with treating physicians to ensure injured workers get the most appropriate care in the most cost effective manner. Our locally based physicians consult with treating physicians to review prescriptions, determine medical necessity, consider alternative medications and obtain the physician's sign off for the new drug plan. This can result in significant reductions in overall medication costs and ensure the injured worker's safety during their episode of care. Directed Care Network CorVel's directed care services are based on four elements in cost containment - utilization, rate reduction, timeliness and reporting. We have contracted with the nation's most respected medical imaging, physical therapy and ancillary service networks to offer convenient access, timely appointments and preferred rates. We manage the entire coordination of care from appointment scheduling through reimbursement, working to achieve timely recovery and increased savings. • TPA shall process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. CorVel will process and handle all electronic data interchange requirements on behalf of the City as required by the State of Florida at no additional charge. CorVel has an extensive and documented process in place for electronic data interface (EDI) projects. We will work with the appropriate personnel at the City to review file formats and specific system requirements for data fields in both systems.We approach each desired piece of the EDI process with test file exchanges, reviews of September 12, 2014 C O R V E L Page 32 *iNcoR a * 3 h= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS results, and acceptance before moving on to the next piece. Data is exchanged via secure file transfer protocol (SFTP) with or without encrypting files, or via file transfer protocol (FTP) with encrypted files. CorVel also supports Web Services and ANSI X12. Encryption is based on PGP's public-key cryptography and an exchange of public keys between CorVel and the City. CorVel's electronic data interface has the ability to deliver EDI files by FTP or virtual private network (VPN). We currently transmit data to approximately 5,000 users and conduct hundreds of data file transfers to our customers on a daily basis.We can tailor data transfer files according to the City's specifications. • TPA shall be responsible for all Medicare reporting obligations under the Medicare Secondary Payor Act, and/or under similar or new legislation at no additional cost to the City. CorVel agrees and will comply. CorVel offers solutions to help the City manage the requirements mandated by the Centers for Medicare and Medicaid Services (CMS). As an assigned agent, we will provide agent services for the City as the Responsible Reporting Entity (RRE). As an experienced information processing provider, we will electronically submit files to the CMS in compliance with timelines and reporting requirements. CMS periodically releases updates to their policies and procedures as they pertain to the reporting process. CorVel is in regular contact with CMS as part of our effort to provide an efficient and cost effective solution for timely compliance. We will provide the City with pertinent updates from CMS when appropriate. Summary of CorVel's agent services: • CorVel's Medicare Secondary Payer (MSP) reporting solution has the capacity to receive data through electronic file transfer and manual entry, integrating the data seamlessly into a web based form. • If the City claims have not been confirmed by CMS as Medicare eligible, CorVel will queue the claims for the monthly query, automatically informing the Adjuster when a claim is tagged as reportable. • Alerts, notifications and work queues are all managed from the web interface, letting the user know what data is missing or not compliant for any record. This ensures that all information flows smoothly based on the City's quarterly report date. • Once the data has been finalized and the report sent, CorVel will integrate the response file back into the work queue, automatically notifying the Adjuster of any compliance issues or missing data. If required by CMS, the claim will be queued again for reporting once the problem elements have been corrected. • CorVel handles all Non-Group Health Plans (NGHP) to include both ongoing responsibility for medicals(ORM)and Total Payment Obligations to the Claimant (TPOC). • CorVel offers reporting technology to provide statistics on report submissions, missing data and compliance issues, as well as varying elements of the claim data. We also offer the capacity to provide a copy of the actual report and its response directly back to the City. September 12, 2014 C O R V E L Page 33 \p c;.: o *IMCORP ORATED '-,1 ""h.= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall provide the City with OSHA 300 log reporting capabilities at no additional cost, as requested by City. CorVel agrees and will comply. CorVel's claims system tracks lost time, and maintains absence information so that OSHA 300 reports are accurate using the Federal reporting standards. Our system pre- populates the OSHA form. We are able to accommodate employers who continue to provide full salary to employees disabled by a compensable work injury while still recording the time as "lost" for insurance and actuary purposes. • TPA shall handle subrogation claims and file lien notices on behalf of the City to protect the City's interests in rights of recovery from third-party tortfeasors. TPA shall not proceed with any legal action against a third-party tortfeasor without the City's Risk Manager's approval. CorVel agrees and will comply. Upon receipt of the claim, CorVel's rules engine evaluates the claim for potential subrogation.If the potential exists the claim is routed to our subrogation specialist team who will complete a thorough investigation that includes collecting, evaluating, and preserving the evidence. Evidence may include statements, photographs, and documents such as receipts, logs, maintenance, and tangible evidence (stored when feasible). Claim types that may include potential subrogation: • Accident involving machinery • Motor vehicle accident • Slip and fall hazard • Explosion or fire • Animal bite • Construction site accident • Accident involving tools or equipment • Product liability • Aircraft,train or boat accident • Claim involving a third party Reserves will be addressed at each claim review and rationale document in the Adjuster's plan of action review. Applicable statute of limitations will also be outlined in the plan of action with aggressive efforts being undertaken to secure recovery of costs as soon as possible. Once identified, the appropriate parties will be placed on notice of lien. We will provide information to the injured worker,the City or the court of the current lien amount.CorVel will receive prior approval from the City for any waiver or reduction of any lien or other settlement. September 12, 2014 C O R V E L Page 34 *31NC0 ORATED)*), � TAB 1: COVER LETTER& MINIMUM QUALIFICATIONS ;..16,= The City designee is kept up to date of the subrogation efforts and status at a minimum of every 90 days.The designee may also view subrogation efforts as noted in the claims system and subrogation report. go TPA shall review and seek approval from the City for any loss reserve adjustment increases greater than twenty-five thousand dollars ($25,000). CorVel will review and seek approval from the City for any loss reserve adjustment increases greater than $25,000. • TPA agrees all negotiated settlement agreements shall require City approval. Such settlements would include but may not be limited to, agreements to wash-out an entire claim, settle a negotiated lien, settle a negotiated attorney fee, or any other type of settlement that is not otherwise considered an administration of a medical, indemnity or allocated expense that would otherwise be due and owed in accordance with Florida law. CorVel agrees and will comply. Upon receipt of appropriate medical documentation, CorVel will rate all reports and calculate the remaining exposures on the file. Our Adjusters are trained to take various other factors into consideration when analyzing reports. Often times, this may involve input from the employer. If the injured worker continues to work for the City, we will recommend a stipulation. However, if the injured worker no longer works for the City,we will provide the City with a recommendation for a future medical buy out through a Compromise and Release, in addition to the stipulation recommendation. CorVel will conduct settlement negotiations on behalf of the City with the opposing attorney. We are confident in our Adjusters' skills in resolving cases prior to trial. We attempt to establish and maintain a good working relationship with applicant counsel in order to reach final settlements quickly, fairly and at the lowest possible price. We do feel there are times it is necessary to take a file to trial and times it would be more cost efficient to settle a claim. CorVel will discuss the claim with the City to guarantee we are all in agreement before we move forward. Prior to recommending a settlement, we will provide the City with an in-depth analysis of our options including a cost benefit evaluation and a suggested plan of action.CorVel will contact the City to obtain authorization before entering any settlement agreements or taking a claim to trial. CorVel Adjusters prepare Compromise and Release Agreements and Stipulations with Request for Awards in specific cases on our claims systems. The Claims Supervisor will maintain first tier approval before our Adjuster makes settlement recommendations to the City. CorVel understands that the City may prefer taking a claim to trial instead of settling the claim. Our Adjusters are well trained to obtain the most qualified attorney for each individual claim and are able to direct an attorney to timely' move a file towards settlement or to file the appropriate paperwork to move the claim towards trial. September 12, 2014 C O R V E L Page 35 f RAT ED TAB 1: COVER LETTER& MINIMUM QUALIFICATIONS .2 - Settlement authority is granted to an Adjuster based on the claims handling agreement established with the City. Written contact is also made for authority, prior to settling a file. We can tailor any program to meet the City's objectives. As the case develops and information is received, settlement always remains a consideration. Alternative methods of resolution are reviewed such as mediation, structured settlements, etc. When a settlement is pursued,a strategy is put together with defense counsel including an initial offer, target settlement amount and maximum settlement amount. Documentation in support of these figures will be placed in the file. In most instances, our Adjuster will do the negotiating. Our Adjusters are experienced at properly evaluating claims and negotiating settlements. • TPA shall attend in person or via telephonically all mediations.The City shall endeavor to have a Risk Management staff member, or designee, at all mediations as well as hearings. CorVel will attend all mediations in person or telephonically. • TPA shall agree to quarterly claim reviews, whether in person or telephonically at the City's discretion, to review all litigated cases, legacy cases, catastrophic cases, or non-litigated complex cases. CorVel agrees and will comply. CorVel will participate in quarterly claim review meetings at the frequency requested by the City. We will work with the City to establish the parameters of the claim file review process. Meetings may be held telephonically or in-person and will be attended by the Account Manager, Claims Supervisor and the City. Claim review meetings serve as an opportunity to discuss specific claims, review all litigated cases, legacy cases, catastrophic cases,or non-litigated complex cases,and ensure they are being managed appropriately, timely and have a clear plan for closure. • TPA shall agree all claim files, reports, and other data prepared or provided in connection with a claim are and shall remain the property of the City. CorVel agrees and will comply. We understand all claim records, as well as claim files, reports and other data, are the City's property and we will therefore provide unlimited access. • TPA shall keep complete and accurate records and accounts in connection with each claim. Such records shall be available at all reasonable times for examination by the City, or its' designee, and shall be kept for a period of no less than three (3) years after the completion of all work to be performed. Incomplete or incorrect entries in such records may be grounds for disallowance by City of any fees or expenses based upon such entries. TPA shall send City all closed claim files that are mutually agreed upon to be inactive. CorVel agrees and will comply. In accordance with established best practices and the City's specific claim handling instructions, claim files will contain electronic or scanned copies of all correspondence September 12, 2014 C O R V. E L Page 36 zo-,-,,,,..,„ t - r *I�NCORP ORATED*, TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS including letters, faxes, reports and emails. Adjuster and Case Manager notes will summarize documents received and sent. Electronic file documentation will include the following as appropriate: monetary transactions, recorded statements and summaries, index reports, expert reports, legal opinions, medical authorizations, medical bills, medical reports, independent Adjuster reports, excess carrier reports, official reports, scene diagrams, photos and damage verifications. Guidelines require that all loss reports identify the time and date the loss was received. Phone calls will be documented in online file notes to reflect Adjuster activity. Claim files are updated in real-time and can be viewed at any time via our online claims system. CorVel maintains electronic copies of all claim files indefinitely. Hard copies are maintained for a period of seven years or in accordance with corresponding jurisdictional requirements, whichever is longer. We will send the City all closed claim files that are mutually agreed upon to be inactive. • The City of Miami Beach has not purchased excess coverage since 1997. However,TPA shall comply with all excess workers' compensation coverage agreements in place; including reporting requirements affording potential or existing coverage on all and any open (or re- opened) claims such as, but not limited to reporting. CorVel agrees and will comply. o Any case that has reached 50/o of the City's self-insured retention level, or has the y ty potential to exceed it,shall be reported to the City and the excess insurer in accordance with the reporting criteria established by the excess insurer. All cases that meet the established reporting criteria are to be reported to the City within 30 days of when the known criterion is met. In addition to claims which have an incurred value equal to or greater than 50% of retention, CorVel customarily reports the following claims immediately without regard to the reserves: • Fatalities • Spinal cord injuries • Brain damage • Third degree burns covering 10% of the body • Second degree burns covering 30% of the body • Amputations • Impairment of vision or hearing by 50% or more • Nerve damage-causing paralysis or loss of sensation in arm, hand or leg • Massive internal injuries affecting a body organ or organs • Multiple fractures-involving more than one limb • Fracture of both heel bones • Occupational disease-such as asbestosis, black lung disease or long-term chemical exposure September 12, 2014 C O R V E L Page 37 S*INCORP ORATED *` -,,� TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • Back injury-requiring surgery or disability of one year or more • Disability of more than one year(some contracts have nine months) • Permanent total disability workers' compensation claims • Cardiac failure workers' compensation claims • Paralytic stroke workers' compensation claims • Environmental claims • Sexual assault and molestation • TPA shall be responsible for any penalties, declined coverage, reservation of rights issued, diminished coverage benefits imposed by City's excess workers' compensation carrier(s) due to TPA's failure to properly report new or existing claims as required by each carriers'coverage agreement reporting requirements. CorVel agrees and will comply. CorVel shall defend and hold the City harmless for any workers' compensation claim whereby we were negligent or caused errors or omissions in the performance of its duties and obligations under the Agreement. Penalties are coded in the claims system by payment type.Separate codes are assigned for penalties related to medical payments, temporary disability payments and permanent disability payments. Each penalty is also coded in reference to the source of the penalty.Separate codes are given for employer caused penalties and TPA caused penalties. Management reports can be generated capturing all penalty payments and sorted by any of the coding options. • TPA agrees to notify the City of proposed or enacted changes in workers' compensation regulatory requirements or legislative acts that may affect the City's claims. CorVel agrees and will comply. CorVel is active in the regulatory environment of our industry. Our involvement starts at the state level with the primary office in Florida. Information for Florida is gathered nationally and collated. We track both state and federal legislative and regulatory changes that affect any of the services we provide. CorVel hosts training and informational meetings to keep our claims personnel current on recent updates to workers'compensation laws, claims handling techniques, and rules and regulations. Meetings also including up to date information about investigations, fraud identification, subrogation and litigation management. • TPA shall agree to maintain a SSAE 16 audit on controls placed in operations and tests for operating effectiveness, and agrees to provide copies to the City as requested. CorVel agrees and will comply. September 12, 2014 C ® R v EL Page 38 r f ,.% t*(INCORP ORATED)*! '.,49 �,= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS . cii 26"V As a publicly traded company (NASDAQ GS: CRVL), CorVel is audited annually and required to comply with all Federal and State regulations, including the Sarbanes-Oxley Act of 2002. CorVel's claims management services and bill review systems have received Service Organization Control (SOC1) reviews in accordance with SSAE16 for the most recent service period July 1, 2013 to June 30, 2014. • TPA shall utilize the City's solely selected and approved financial institution for the funding of workers' compensation and liability claim payments and settlements. TPA agrees to comply with the City's Positive Pay(fraud detection) banking standards and must do a daily data feed to the City's financial institution for fraud detection. CorVel agrees and will comply. Customers wanting to use their own bank will be responsible for submitting the positive pay file on their own. • TPA shall send weekly invoices for wire fund transfer requests to replenish the City's account. Exceptions are made for special requests for unexpected large losses or claim settlements for which specific dedicated invoice for wire fund transfer requests shall be made. CorVel agrees and will comply. We will send the proper funding based on the City's account instructions. • The City shall fund at least fifty percent (50%) times the City's average weekly spend on workers' compensation claims. Presently the City's fund maintains an average weekly balance of two hundred and fifty thousand dollars ($250,000). CorVel agrees and will comply. • TPA shall send original invoices to the attention of the City's Risk Manager, or designee, by e- mail to City of Miami Beach, unless otherwise instructed. CorVel will send original invoices to the attention of the City's Risk Manager, or designee, by email to City of Miami Beach, unless otherwise instructed. • TPA shall mail the City monthly financial institution reconciliations. CorVel will mail the City monthly financial institution reconciliations. • TPA shall issue 1099's to all vendor issued allocated claims payments pursuant to the applicable tax laws in effect. CorVel agrees and will comply. CorVel gathers form 1099 information from all our accounting systems and merges them into one database. Tax ID numbers that meet the 1099 criteria are generated and mailed out on or before January 31. 1099 data is sent to the IRS electronically prior to the reporting deadline. We can supply the City with a report that shows the tax ID and amount they contributed to the 1099 if necessary. September 12, 2014 C O R V E L Page 39 ___,:_,,_.,,,„ i*imcaRP RATED* �h= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • TPA shall be audited by the City at the City's sole discretion and cost. CorVel agrees to make the City's claim files and records available for review in our offices with appropriate lead time notification so as not to disrupt the day-to-day claims handling activities of the claims staff. CorVel Supervisors are available for questions and consultation to assist the City or any outside party in their review. • TPA shall invoice the City quarterly for its administrative claim fee. CorVel will invoice the City quarterly. • TPA shall take extraordinary measures, if is selected as the new TPA for the City, to ensure data and file conversion and transfer is done with as little disruption to the City and its injured employees to ensure continuity in care and continued best workers' compensation claims management practices. CorVel agrees and will comply. The City's current open claims data will be mapped and integrated into CorVel's claims system and will require an Adjuster to review the claim file before any payments can be made on the file. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing the bill image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts,code translations,etc.Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level.We can accept and map your data to appropriate fields within our system which includes: • transactional data • exhibits in PDF, Word • file notes and Excel formats • reserve history • assigned departments • subrogation and litigation • employee occupation information • accident locations • scanned documents • injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system integration provides the Adjuster with the appropriate data integrity to perform September 12, 2014 Co R V E L Page 40 � BE� v r�` ,, f*firi RATED # �c ��h TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS ; their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. • TPA will be required to manage the claims with a comprehensive data base system which allows computer access to notes, correspondence and other pertinent information needed by the City to generate analytical data reports upon demand; which will allow secure web based communication between the City and the TPA adjusters. This program should also allow the City to add information to the adjuster notes section of the TPA computer system. TPA shall provide the City's Risk Manager and it's designees, with access and training to utilize the TPA's Risk Management Information System to monitor the adjuster's claim activity on a file. CorVel's proprietary claims management system has been developed and supported by our in-house, full time information systems division. We have invested millions of dollars into the development of our integrated system that offers tremendous cost and timesaving benefits. Unlike most industry platforms, we do not rely on data feeds from third parties that can delay critical information. Our system supports our claims and medical management teams by supplying extensive, real-time information to better assist injured workers and improve outcomes. We offer a secure system that provides the City with complete program visibility, streamlined processes, and allows you to stay connected throughout the entire claims process. The City will be provided with 24/7 access to real time data including claim activities, diaries, claim notes, reserves, medical bill documentation and financial information.Detailed reports can also be generated in various time periods and formats, and can be sorted in a variety of grouping and filtering options. Features of CorVel's claim system include: • Tailored User Setup—User ability to set up custom alerts and preferences • Dashboards — User friendly dashboards intelligently organize data and provide useful tools for effective claims management • Transparency—24/7 online access to all claims and financial data • Data Security—Password protected via a secure internet connection and HIPAA compliant Please see Attachment E: Screenshots of Claims System. Access to Notes Claims Adjuster and Case Manager activity notes are categorized by activity type, in order of date. This allows the City to filter the claim notes so only pertinent notes are viewed. For example, if a client is interested in the basis for a compensability decision, the investigation note category can be selected and only activities related to the claim investigation will be displayed. All Field Case Managers have iPads and use our proprietary apps to track the status of milestones and events for their cases. This mobile technology enables real-time updates to CorVel's system and allows Case Managers to immediately add notes about appointments and completed tasks for their assigned caseload. An additional feature of the iPad is the ability to electronically approve and email signed case management forms and documentation— providing a virtual sign and send approval process. September 12, 2014 C O R V E L Page 41 V Q . *1 *% •3 1y' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS Correspondence All of CorVel's claims staff has personalized email and voicemail making us accessible through many avenues of communication. Our claim system also offers the ability to gain remote access to review claim data and read Adjuster notes. The claims system allows associates to copy and paste client communication via email, as well as other documents, into the notes. This feature, in effect, enables our clients to type notes in the claim file by simply emailing their comments to the Adjuster. Report Capabilities Many of our reports can be created on demand through CorVel's online system. Rather than inputting a request for specific reports and waiting for the report to be created,the City will have the flexibility to access the online system and create reports instantly. Reports can be printed, emailed and shared which allows for all stakeholders to instantly view and analyze data related to your program. Client Notes Clients are able to enter claim notes. They are denoted in our system as "client added notes" and are a permanent part of the claim file. Training CorVel will coordinate with the City to develop a tailored training program. These planned sessions will incorporate the needs expressed by the City, as well as the expected teamwork needed between the CorVel team and the City's staff. We offer a variety of training options including online meeting conferencing and onsite training at pre-established hubs. Besides hands on training by CorVel's designated Account Manager, we offer online training that consists of updates, bulletins and newsletters. All training materials are included in the primary pricing structure. • TPA shall provide the City with electronic loss runs, claim reports or ad hoc reports as required by City within seven (7)working days of month-end. CorVel will provide the City with comprehensive reports detailing every aspect of your program, enabling the City to make a proper analysis of its exposure. Loss reporting information is available on a monthly basis and in various time formats, history periods, including "as of," and actual time. The City will also have access to create reports through the online reporting center where more than 1,000 data fields can be sorted to organize reports by any lapsed time period, hierarchical sub group,dollar range,time of day/week, coverage or sub classification, or any one of thousands of other combinations. CorVel can consolidate information based on the number of incidents or injuries,costs, etc., per department or division and provide various comparative ratios and averages. Safety/risk management reports will include the same detailed accident listings and accountability.We summarize incidents or injuries by coverage line, injured worker name, type, and age, cause, injury type, occupation, location, supervisor, and incident or injury date/time of day. Loss experience, payments comparisons and localized benchmarking reports are also available. The following are examples of CorVel's standard claims reports: • Program Summary • General Claims Listing for Scorecard Report Open/Closed/All Claims September 12, 2014 C O R V E L Page 42 *;(NCO ORATCO* -4-' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 26 • New Claims Received • Financial Analysis Report Report Safety Analysis Report •• Status Change Activity • Loss Development Report Report • • Claim Payment Register Demographics• • Claim Payment Summary Mechanism of Injury• • Overall Payment Summary Lag Time Report by Type of Payment • Escrow Activity Report • Overall Payment Register • Lost Day Reporter for Period Location Loss Summary •• Detailed Loss Report Denied Claim Report •• Loss Summary by Policy Litigated Claim Report •Period Please see Attachment F: Sample Claims Reports. CorVel's standard reporting capabilities are extensive; however we have the ability to provide ad hoc reports at the City's request for any special reporting needs. Ad hoc report inquiries can be made with data elements that we capture in the claims system. We will provide all reports within seven working days of month-end. • TPA shall provide periodic information to the City's actuarial service provider when required. CorVel agrees and will provide periodic information to the City's actuarial service provider when required. • TPA shall provide safety engineering services as requested by City, and fees shall be negotiated and approved by the City as an allocated loss adjustment expense per applicable claim file. CorVel delivers a variety of safety analysis reports that identify loss trends, analyze derivatives and detail financial impacts. We offer an interactive safety report that will allow the City to tailor reports with specific parameters in an intuitive and user-friendly format. Our Account Managers regularly review loss data and will inform the City of areas that may need further inquiry or analysis. CorVel has developed a recommended panel of safety experts throughout the country. We find that most of our clients have different needs for safety and loss consulting (i.e. ergonomic, OSHA compliance, safety engineering, risk management, industrial hygiene, environmental control, etc.) As a result, we will match the City's needs to safety consultants with that specific expertise for your review and determination. • TPA, as a custodian of records for City, shall comply and cooperate with all applicable City and State record retention and exemptions laws such as, but not limited to, Florida Statutes, Sections, 119, 440, 760 and 112 as they pertain to protected medical, personal and/or work product information. September 12, 2014 C O R V E L Page 43 *+INCORP ORATED sh,= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS .26 CorVel agrees and will comply with all applicable City and State record retention and exemptions laws. CorVel understands the sensitivity of health information and we continue to make company-wide initiatives to protect informational privacy and security. Our systems, software and services are continually enhanced to safeguard Protected Healthcare Information (PHI)and assure our clients and trading partners that exchanging data with CorVel will take place within the bounds of HIPAA compliance. Access to our network and web-based services entails user-specific authentication and role based security. In addition to our technical safeguards,administrative and physical safeguards have been put into place throughout CorVel. Our staff is fully trained in HIPAA compliance and we continue to keep our staff updated through a corporate driven initiative which encompasses all aspects of training, documentation and execution pertaining to HIPAA. • TPA agrees to transfer or ship the electronic file data or hard copy file data at the request and as directed by the City at no cost other than actual incurred reasonable shipping fees. TPA agrees there shall be no charges to transfer electronic data on a per data file basis or other transfer related fees or charges unless agreed upon in writing by City. All electronic data transferred or hard copy data shipped shall be done within sixty (60) days of receipt of written notice from City. Paper data shall be shipped overnight by FED EX, UPS or equivalent common carrier agreed to by City. Electronic data shall be transferred by disk/tape or over internet as requested by City, provided the data files are adequately protected and secured. Electronic file data means all claims information and related claim file information maintained in an electronic computer file format, whether stored on a hard drive, tape backup or CD. CorVel agrees and will comply. • Other claims adjusting services for Workers' Compensation and General Liability, as needed. CorVel will provide claims adjusting services for Workers' Compensation and General Liability as needed. STAFFING AND PERSONNEL: It is the City's claims management philosophy that the proper and most cost-effective method to handle claims and thereby reduce and control the City's self-insured loss payments is to ensure the administrator hires and retains the appropriately qualified professionals to handle our claims. Additionally, the adequate number of adjusters and a manageable caseload enables qualified adjusters to perform the required services. The City therefore requires that the proposer agree to staffing, qualifications and caseload criteria established by the City. CorVel agrees to the City's staffing, qualifications and caseload criteria. CorVel knows that superior service for the City depends on the experience and training of all our associates. The Adjusters assigned to the City's account will have substantial experience reading medical reports, performing investigations,taking recorded statements,estimating the value of bodily injury/medical disability, returning injured workers to work and closing claims. Our Adjusters possess appropriate state licensure and are experienced at proper documentation as well as subrogation/recovery techniques. They know how to determine which claims are compensable and how to establish reserves. Our Adjusters work effectively September 12, 2014 c ® R V E L Page 44 *iu+co RATE)*'s ' TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 26' with all constituents including clients, injured workers, injured worker representatives, excess insurers, government regulators, physicians and defense attorneys. CorVel recruits associates that have established an exceptional reputation in the industry combined with significant work experience.We are able to attract and retain talent by providing competitive compensation and by maintaining caseloads at or below industry averages. We regularly solicit client input regarding personnel in an effort to build effective teams for our clients. The City reserves the right to the final prior approval of the hiring and/or assignment of the claims manager, supervisors and adjusters that are to handle the City's claims. CorVel will include the City during hiring and/or assignment of the Claims Manager, Supervisors and Adjusters that are to handle the City's claims. The required maximum open caseloads per adjusters(may have more than one adjuster assigned to the account) are to be as follows (claims manager should not handle files): Workers' compensation (lost time) - 100 Workers' compensation (medical only) - 500 CorVel will comply with the City's maximum caseloads. The administrator agrees to add staff as necessary to maintain these maximum pending caseload levels. Explain how the office or unit will be staffed and explain the level of supervision that will be provided. Claims personnel must be employees of the administrator. The use of independent adjusters, subcontractors or temporary adjusters is not acceptable without prior approval of the City. Adjuster trainees are not acceptable for handling of the City's claims. Additionally, resumes of all claims professionals specifically assigned to this account are to be submitted with this proposal. All claims professionals must possess a current Florida Workers, Compensation adjuster's license. CorVel agrees and will comply. When possible areas for staffing change or improvement are recognized, the CorVel Account Manager will make recommendations regarding the possible changes to the City.We will work with the City to implement any staffing modifications that the City and CorVel determine would be of benefit or improve outcomes for the program. LOSS FUND MANAGEMENT: 1. The Claim Payment Account will be maintained at the City's commercial banking institution. The account will be classified as part of the analysis group of City accounts.The City will pay all service fees that are normal and customary in this account.All interest e ar ned or service cred its_generated will accrue to the benefit of the City. CorVel agrees and will comply. September 12, 2014 C O R V E L Page 45 *=ikcoae arum ..,,,,��...."�. TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS 2. The claims administrator is required to follow Florida law concerning public deposits. Failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. CorVel will follow all Florida law concerning public deposits.We understand that failure to comply with Florida law is sufficient cause for the City to terminate the contractual agreement with the claims administrator. 3. All claims, expense and legal payments will be made by the claims administrator on checks drawn on an account set up by the administrator and funded monthly by the City. It is understood that all funds in this account are City funds and are to be returned to the City upon request or at termination of this contract. CorVel agrees and will comply. 4. The administrator is responsible for the monthly reconciliation of this account and will provide bank statements to the City monthly, along with a request for a deposit from the City to maintain the monthly balance in the loss fund, as determined by the City. CorVel agrees and will comply. 5. The monthly reconciliation statement submitted by the administrator to the City will include the following: - balance at inception of statement period - total disbursements which cleared, by date and claimant/payee - balance at close of statement period - amount of deposit required CorVel will provide a monthly reconciliation statement to the City that will include the information listed above. 6. A list of all checks is to be submitted monthly. CorVel will submit a list of all checks monthly. September 12, 2014 CORN/ EL Page 46 f ; h:^ TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS SUPPLEMENTAL QUESTIONS In addition to information that may be provided in your proposal and required elsewhere in the RFP, please answer the following (restate question in each answer): 1. Where is your office located? Our Tampa, Florida office will manage the City's workers' compensation claims and our Sunrise, Florida office will manage your liability claims. They are located at: 5401 W Kennedy Blvd. 1560 Sawgrass Corporate Pkwy Suite 535 Suite 100 Tampa, FL 33609 Sunrise, FL 33323 2. Number of professional claim, clerical and/or support staff at that location. , Our Tampa, Florida office houses 24 professional claims staff members. 3. Name, experience, resume and professional designations of claim manager. The following staff will serve as Claims Managers for the City's program: • Carrie Rath, Workers' Compensation Claims Manager — Carrie has more than 11 years of workers' compensation claims experience, with 9 years' experience in supervision and management. She has been with CorVel for two years. Carrie has extensive knowledge of Florida workers' compensation administrative code, state law and regulations, and case law. Her professional designations include her State of Florida All Lines Adjuster License and that she holds an accredited claims Adjuster designation in Florida. • Felipe Benitez, General Liability Claims Supervisor—Felipe has more than 34 years of experience in operations, logistics,financial and human capital management. He has been with CorVel for two years. Felipe's professional designations include serving as a Florida All Lines Adjuster and as a member of the Workers' Compensation Claim Professional Association. Please see Attachment C: Staff Resumes. 4. Name, experience, license type, resume and professional designations of any supervisory level employees that will have responsibility for this account. The following supervisory level employees will have responsibility for this account: • Tom Cassette, Area Vice President. Tom has been with CorVel for 6 years. He has extensive experience with workers' compensation insurance as well as niche market experience including professional employer organizations, self-insured retention and high deductible programs. • Debbie Popovich, Vice President, Regional Sales. Debbie has been with CorVel for 8 years and has more than 17 years of experience in the Florida workers' compensation market. Currently she participates in acquisition sales in the Florida region and serves as an expert for claims and medical management services. September 12, 2014 C O R V E L Page 47 *ttrica>1e nom ,,�9� ,��= TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • Chris Oliphant, Case Management Manager. Chris has been with CorVel for 9 years. She is knowledgeable in Florida 440 Workers' Compensation Law and manages telephonic and field case managers to ensure the delivery of optimal, cost-effective medical care. Her professional designations include serving as the State Legislative Chair for International Association of Rehabilitation Professionals and as a member of the Broward Association of Registered Nurses. Please see Attachment C: Staff Resumes. 5. Name, experience, license type, resume and professional designations of the designated adjusters that will have responsibility for this account. The following designated claims staff will have responsibility for this account: • Jennifer Johns, Claims Supervisor. Jennifer has over 17 years of workers' compensation experience with 10 years' experience with multi jurisdiction claims management supervision. She holds a State of Florida Workers' Compensation Adjuster License. • Anita Alvarez, Senior Claims Adjuster. Anita has over 19 years of workers' compensation claims experience, including extensive knowledge of Florida Workers' Compensation Administrative Code, State Law and Regulations and case law.She is a Licensed Adjuster and fluent in Spanish.Her professional designations include her membership with the Workers' Compensation Claims Professionals Association. Please see Attachment C: Staff Resumes. 6. Advise the current pending case load for each designated adjuster. CorVel's Best Practices dictate the following caseloads: Indemnity Adjuster Up to 100 files Medical Only Adjuster Up to 500 files Liability Adjuster 125— 150 files 7. What is the current number of monthly new assignments to each adjuster? Claim volume and the experience level of the Adjuster dictate new claim assignments. The Supervisor reviews the claim, assigns it to the appropriate Adjuster and provides direction on the future handling of the claim. The Claims Supervisor does not carry a caseload and will review Adjuster caseloads monthly. Management reports are utilized to provide caseloads by claim type at the Adjuster,office and client level.If an Adjuster is nearing a saturation point,either temporary support is provided from a Supervisor or case files are transferred to another Adjuster to decrease caseload. September 12, 2014 Co R V E L Page 48 1*tINCORPrORATCD*1 ,h � TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS X26__ 8. Will the award of this contract necessitate an increase in your staff size to meet the City's staffing and caseload requirements and will that be in place by February 1, 2015? No, the award of this contract will not necessitate an increase in our staff size to meet the City's staffing and caseload requirements. Staffing will be in place by February 1, 2015. 9. Name the 4 law firms (2 workers' compensation, 2 liability) that you currently handle the most cases with. Provide a contact person and phone number. Client Name Contact Phone Email Hurley, Rogner, Miller, Cox Gregory White, 407-571-7400 gwhite @hrmcw.com Waranch &Wescott, PA Esq. Sponsler, Bennett,Jacobs Gwen Jacobs, 813-272-1400 gjacobs @sponslerbennet.com &Adams, PA Esq. Hinshaw&Culbertson, LLP Cheryl Wilke, 941-467-7900 cwilke @hinshawlaw.com Esq. Eraclides, Gelman, Hall, Morgan A. Indek 407-660-0333 mindek @eraclides.com Indek& Goodman, LLP 10. Estimate the percentage of time your adjusters are out of the office doing field work. If all are telephone adjusters, please indicate. Our Adjusters are all telephone Adjusters. CorVel is currently in partnership with G45 Compliance and Investigation, a nationwide surveillance company that provides onsite investigations and appraisals. The CorVel Adjuster will always maintain responsibility for the claim during the investigation. 11. Do you utilize independent contracted adjusters? If so, under what circumstances? -No, we do not utilize independent contracted Adjusters. 12. Name, address, phone and contact person for independents you utilize. Not applicable. 13. Can you provide all the required services with your own personnel? CorVel's software, systems and staff are direct resources of our company.We currently do not outsource or utilize any significant subcontractors with the exception of defense counsel, outside investigation and appraisals. 14. Do your adjusters receive any continuing education and training? Explain. Yes, we conduct initial and ongoing training and development programs for all our claims personnel. We ensure claims personnel stay current on new developments in workers' September 12, 2014 C ® � v E L Page 49 �4' ti B qci,I *(INCORP ORATED * ��,3� �>43 TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS c�, A�- compensation laws and regulations to further enhance their skills, ensuring they continue to meet CorVel's customer service standards. Our training program addresses the needs of the highly specialized lines of insurance coverage in today's environment including entry level claims management to advanced claims techniques, telephone etiquette to address difficult callers, and policies and procedures regarding the latest benchmark management reporting. In addition to our own internal and industry sponsored staff training programs, CorVel also conducts bi-annual seminars for our claims personnel.These workshop style conferences allow us to share our experiences as well as those of our clients, and provide clear, step- by-step advice about claims management, industry trending and reporting procedures. CorVel also promotes professional development of our staff through our educational reimbursement program. This program encourages Claims Assistants, Adjusters and Supervisors to pursue educational opportunities.Claims Assistants are encouraged to take Insurance Education Association courses. All relevant education opportunities are fully reimbursed by CorVel. We will also pay the costs to take a self-insured certification test. CorVel also provides ongoing training sessions as they relate to changes to legislation. In addition, we invite various consultants and experts to provide training sessions in their particular areas of specialty. 15. Do you currently file state and excess insurance forms on behalf of your clients? Explain. Yes, we currently file state and excess insurance forms on behalf of our clients. CorVel will report to all states in which state reporting is required on behalf of the City and according to the state's guidelines. If required by the state, we will submit the reporting data via EDI. We run state reports on a weekly basis. Our system reports to states based on the submitter information provided by the state. Any case that has reached 50%of the City's self-insured retention level,or has the potential to exceed it, shall be reported to the City and the excess insurer in accordance with the reporting criteria established by the excess insurer. All cases that meet the established reporting criteria are to be reported to the City within 30 days of when the known criterion is met. 16. Do you have the capability to provide all the loss data reports required? Explain. Yes, CorVel's reporting capabilities are extensive. The City will have access to a variety of reports via the claims system, allowing you to create reports to meet your specific needs. Every report allows the user to group, total or sort by various data fields with an assortment of filters. All reporting can be grouped and totaled by multiple location tiering. CorVel's reports are user friendly, well organized, intuitive and simple to use. The following are examples of CorVel's standard claims reports: • Program Summary Scorecard • New Claims Received Report Report Status Change Activity Report •• General Claims Listing for • Claim Payment Register Open/Closed/All Claims September 12, 2014 C O R V E L Page 50 y's i TAB 1: COVER LETTER & MINIMUM QUALIFICATIONS • Claim Payment Summary • Loss Development Report • Overall Payment Summary by • Demographics Type of Payment Mechanism of Injury •• Overall Payment Register for • Lag Time Report Period Detailed Loss Report • Escrow Activity Report•• Loss Summary by Policy Period ▪ Lost Day Reporter• • Financial Analysis Report Location Loss Summary • Safety Analysis Report • Denied Claim Report • Litigated Claim Report Please see Attachment F: Sample Claims Reports. 17. Do you have the ability to transfer the City's prior claims data to your information system by June 1, 2015? Yes, CorVel will transfer the City's prior claims data to our information system by June 1, 2015. The City's current open claims data will be mapped and integrated into CorVel's claims system and will require an Adjuster to review the claim file before any payments can be made on the file. If the City's current system does not use a paperless environment, all necessary documents will be scanned into our system in accordance with our claims handling best practice process. Medical bills and supporting documentation will be scanned into our system or an EDI will be established from the current vendor allowing the bill image to be uploaded into our system so the Claims Adjuster can process the bills. We will request a data transfer of all claim activity from the City's previous vendor with corresponding control totals, record layouts, code translations, etc. Optimum time from contract signing to complete the transition of data is 90 days. This timeframe can be shortened depending on the complexity of converting and loading historical data into our system. If there is no historical data to convert to the system we can be ready to accept new claims within 30 days of contract signing. CorVel is able to create up to a 6 tier organizational structure from which reporting can be generated at any level. We can accept and map your data to appropriate fields within our system which includes: • transactional data • exhibits in PDF,Word and Excel • file notes formats • reserve history • assigned departments • subrogation and litigation • employee occupation information • accident locations • scanned documents • injury, body part and cause We have experience capturing data from most of the country's largest insurers and TPAs and seamlessly integrating it into our claims management system. Successful system integration provides the Adjuster with the appropriate data integrity to perform their work while being assisted by operations support to ensure all necessary physical file data is scanned into our system to maintain a paperless file environment. September 12, 2014 C O R V E L Page 51 P�l BF�c�I;/ *?INCORP(ORATED* •.3 W. .,,= TAB 1: COVER LETTER& MINIMUM QUALIFICATIONS ,;,,�� 26(e ti'�_ Please see Attachment G: Sample Implementation Plan. 18. Explain any fees proposed for managed care, medical case management, bill review, utilization review and rehabilitation services. These are not to be included in the annual fee proposed. Please see Attachment D: CorVel's Cost Proposal for explanation of fees. 19. Explain, in detail, any deviation from the services or fee structure type required, specifically indicating any services you cannot perform. Specifically indicate what you consider as allocated expenses and therefore not included in your annual fee proposal amount. Please see Attachment D: CorVel's Cost Proposal and Attachment H: CorVel's Exceptions. September 12, 2014 C O R V E L Page 52 *i1NL•�' .ORATID*' �h' TAB 2: EXPERIENCE &QUALIFICATIONS TAB 2: Experience & Qualifications September 12, 2014 C O R V E L Page 53 *LINCO IOiU1m*' . TAB 2: EXPERIENCE & QUALIFICATIONS 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the Proposer submits as evidence of similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. Company History CorVel has over 30 years of experience as a national provider of healthcare management solutions to employers, insurance companies and government agencies. We are publicly traded (NASDAQ:CRVL) and annual revenues exceeded $480 million in fiscal year 2014. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allow us to continue to deliver industry-leading solutions to the marketplace. We are an industry leader in claims administration solutions. Throughout the years, we have enjoyed long-term relationships with many of the largest and most innovative payors in the nation. Using the expertise gained in those relationships, our entire client base is able to take advantage of the pooled insights of many of the leaders in the casualty insurance industry. CorVel's claims management program is a unique approach to claims administration, healthcare and disability management.We offer a comprehensive claims management solution directed toward the self-insured and municipal markets that proactively manages the entire episode of a claim. By incorporating a strong medical management component in claims management, CorVel is able to control the cost of claims more effectively than the traditional claims management model, saving customers time and money. Municipality Experience CorVel offers a unique approach to claims administration and cost containment for municipalities. Our experience with municipalities across the country provides an innovative, integrated service model that controls claims by advocating medical management at the onset of the injury. Nurse advocacy services are available by telephone before and after working hours to ensure immediate access to care for your unique mix of occupations that can include government administrators, maintenance workers, engineers and planners, parks and recreation, utility services, law enforcement and fire, construction, and human services. Our services decrease administrative costs and improve return to work outcomes. CorVel offers a personalized treatment program that uses precise treatment protocols — advocating timely, quality care for municipal employees. CorVel currently provides third party administration services for more than 470 municipalities and public entities across the United States. They range from small cities and municipalities to some of the largest counties in the country. September 12, 2014 Page 54 CORVE L r ____,:,„---:‘,..„ ,_-., -,,,,,, -,3 �,h TAB 2: EXPERIENCE &QUALIFICATIONS c#2e'°- Client Name& Contact Address Phone Email Scope of Service City of Pompano Ed Beecher, P.O. Box *client requests Eddie.beecher Beach Risk Manager Drawer 1300 email contact @copbfl.com Pompano only Scope:Third Party Beach, FL Claims Administration 33061 and Managed Care services. Contract Years: 2008-Present City of West Palm Kathy 401 Clematis 561-494-1135 kstakermann@ Beach Stakermann, St. wpb.org Risk Manager West Palm Scope:Third Party Beach, FL Claims Administration 33401 and Managed Care services. Contract Years: 2011-Present Prince George's Rick Schnabele, 14741 301-952-3742 fwschnabele@ County Risk Manager Governor Oden co.pg.md.us Bowie Dr. Scope:Third Party Suite 3200 Claims Administration, Upper Managed Care, and Auto Marlboro, MD and General Liability services. 20772 Contract Years: 2005-Present Please see Attachment I: Case Studies for further evidence of our experience. September 12, 2014 C O R V E L Page 55 fe,„_____,.,,, ! ioCOav Oj ATtO)�;; ''% ' 01Y TAB 2: EXPERIENCE & QUALIFICATIONS ."� ,. ,_ 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded,the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. Bennie Stoner Senior Vice President Tom Cassette Florida Area Vice President Carrie Rath Debbie Popovich Jennifer Bierly Felipe Benitez Chris Oliphant Workers' Jenna Cargill Vice President, Vice President, General Liability Case Management Regional Sales Regional.Accounts Compensation Claims Supervisor Manager Account Manager Claims Supervisor Dedicated Claims Designated General Adjuster Liability Adjuster Claims Staff Claims Staff Please see Attachment C: Staff Resumes. 2.3 Financial Capacity. Each Proposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer. The Proposer shall request the SQR report from D&B at: https://supplierportal.dnb.com/webapp/wcs/stores/servlet/SupplierPortal?storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each Proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800-424-2495. CorVel has arranged for Dun &Bradstreet to submit a Supplier Qualification Report directly to the Procurement Department. The report was submitted August 7, 2014. Please see Attachment J: Copy of Dun &Bradstreet Report submitted. September 12, 2014 C O R V E L Page 56 *IINC DRAT®*' '',,3' �� TAB 3: SCOPE OF SERVICES PROPOSED TAB 3: Scope of Services Proposed September 12, 2014 C O R V E L Page 57 l*tr CCRP CRATED *% '�•,3 4,= TAB 3: SCOPE OF SERVICES PROPOSED Submit detailed information addressing how Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable,which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. Please see CorVel's response to item 1.3 Minimum Qualifications and Requirements, pages 15 through 52. September 12, 2014 C O R V E L Page 58 ( f *liT #" ��,' TAB 4: APPROACH AND METHODOLOGY TAB 4: Approach and Methodology • September 12, 2014 C O R V E L - . Page 59 *IINCOR ORATED*I TAB 4: APPROACH AND METHODOLOGY Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline, phasing options, testing and risk mitigation options for assuring project is implemented on time and within budget. Implementation Plan CorVel will utilize the core principals of quality assurance and project management for the City's program, beginning with implementation through continued account management. Utilizing project management methodologies,CorVel and the City will work together to develop strategies, structure, processes and resources for implementation. The plan will consist of major implementation categories including staffing, data transfer and conversion, claims management, banking, communications, personnel, training and information technology. The plan is separated into a pre and post implementation timeline, which includes the task owner and tracks ongoing program deliverables such as task status and date for completion. Based on the implementation plan, we will develop an account management plan which contains the City's specifications, including a special handling section to ensure CorVel's solution is tailored to the exact needs and specifications of the City. The document will be reviewed and signed by the City and CorVel to ensure there is a complete understanding of the service and program deliverables. Next, the City's account management plan and special handling instructions are uploaded and maintained in our claims system to ensure all stakeholders are aware of the program deliverables to ensure compliance and quality. The City's designated Account Manager will ensure that all components of implementation and service delivery are being delivered and all expectations are being met. Upon notification of any issues, the Account Manager will work with the appropriate parties to resolve the issue. The Account Manager will also keep the City fully informed of the status and plan for resolution. All quality assurance measures and best practices will be reviewed during formal claim review meetings. At CorVel, we are committed to providing quality services that exceed customer expectations and add value to the partnership. Project Timeline Please see Attachment G: Sample Implementation Plan. Phasing Options CorVel will work with the City to transition the start-up and review the files at no cost prior to taking over the claims. We have a transition team in place ready to assess the tail and review trending for early intervention measures we may recommend. Phasing coincides with our Implementation Manager and the sample implementation plan referenced above under Attachment G. Testing and Risk Mitigation Options CorVel offers all of our customers tailored programs; therefore, we will work with the City to establish performance measures based upon your specific needs and preferences. If CorVel's performance begins to approach non-compliance, we will act proactively and diligently to resolve any issues before they become complex. Based on the combination of these factors, CorVel has every reason to believe we will meet all of the City's performance standards. Please see Attachment K: Sample Performance Guarantee. September 12, 2014 C O R V E L Page 60 ''' I° °1 TAB 5: COST PROPOSAL TAB 5: Cost Proposal September 12, 2014 C o R V E L Page 61 APPENDIX E MIAMI H Cost Proposal Form "REVISED"September 4,2014 R CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT 700 Convention Center Drive Miami Beach, Florida 33139 kFP 2014302 RAC A nemiml rs Comp on. Gen Lia. ly 1 • APPENDIX E "REVISED" COST PROPOSAL FORM Failure to submit Section 5,'Proposal Tender'Form, in its entirety and fully executed by the deadline established for,the receipt of proposals will result in proposal being deemed nonresponsive and being rejected. Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items In full accordance with the requirements of this RFP, Inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision Is allowed herein and has been exercised by the City Manager in advance, The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed In pencil shall be deemed non-responsive. All corrections on the Proposal Tender Form shall be initialed. IN ORDER TO BE DEEMED RESPONSIVE, PROPOSERS MUST SUBMIT.COST.FOR EACH OPTION 1-3: Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered for evaluation. OPTION#1: FLAT ANNUAL FEE OPTION Column 7 Column 2 Column 3 1. Flat Annual Fee - Flat Annual Fee (for 345 claims including $ 154,500 new and orlor claims (per contract year) 2. Per Claim Fee for , Quantity Excess Claim Fee Per Claims in Excess of $ 475 40 per year Year 345 Per Year (per excess claim) $ 19,000 (Columr I x Column 2) TOTAL OPTION 1_(Fiat Annual Fee Option)' $ 173,500 otal Lines 1-2 'D F osit Amount To Be Niaintained By The City: "2.5x "Proposer shall include amount,which the City may negotiate at Its diecre an, " Industry standard is 2.5 times the average monthly payout. RFP 201 A:302-S TPA Claims Administration or or ers Comp an. Gen lia.l;ity 2 OPTION #2: FIXED PER CLAIM FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS - , Claims with,dates of accident after contract inception-February 1, 2015 - 1. Indemnity Per Claim Quantity, (Litigated Or Non- $ 950 r 100 per year $ 95,000 Litigated) (per claim) (Column 1 x Column 2) 2. Medical Only Claim Quantity Or Non- $ 150 175 per year $ 26,250 Litigated) (per claim) (Column I x Column 2) 3. Medical Only Claim Quantity Transferred To $ 800 25 per year $ 20,000 . Indemnity Claim (per claim) (Column I x Column 2) (Litigated Or Non- :; Liti•ated PRIOR CLAIMS Claims with dates of accident prior to contract inception-February 1,, 2015. 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 550 292 per year $ 160,600 Liti•ated •er claim) (Column 1 x Column 2) 5. Medical Only Claim Quantity (Litigated Or Non- $ 95 129 per year $ 12,255 Liti•ated •er claim (Column 1 x Column 2) TOTAL OPTION 2(Fixed Per Claim Fee Option): $ 314,105 • otal Lines 1-5 **Prior claim fees(tail files)lines 4 and 5 may be staggered on a monthly basis over life of contract. OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION l Column 1 Column 2 Column 3 N_EINCLAiMS . Clainns with dates of accident after contract inception-February 1; 2015 i 1. Indemnity Or Medical Quantity Only Per Claim $ 475 300 per year $ 142,500 (Litigated Or Non- (per claim) (Column 1 x Column 2) Lit!.ated PRIOR CLAIMS • Claims with dates of accident prior to contract inception- February 1,2015. 2. Indemnity Or Medical Quantity Only Per Claim $ 425 421 per year $ 178.925 (Litigated Or Non- (per claim) 1 (Column I x Column 2) Liti•ated TOTAL OPTION 3(Fixed Per Claim Blended Fee Option): $ 321,425 (Total Lines 1-2) RFP 2014-302-SW TPA Ccims As ministration or Wor ers Co tnp an Gen lla•i Hy r. 3 9 ADDITIONAL SERVICES List of services as needed which are in addition to the fees •ro'osed in 0•tions 1 -3. Description of.Service Fee Telephonic Medical Case Management Fee On All Claims: $ 92 i er"our Free Triage Per BillFlat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ 4.50/Per Bili Per Bill/Flat Fee Percentage Of PPO Savings—Network Discount Savings Below State Fee Schedule: 27 % Percentage Of Utilization Review And Reasonable&Customary 20 Savings: Subrogation and/or Liens Fee Percentage: 25%of recoveries% Osha 300 Log Reporting: $ Included Electronic Data Interchange Flied With State: • $ Included • Safety Consulting Services Per case basis review of case at no cost Notice Of Injury Entry: $ Into CareMC at no cost Custom/Ad Hoc Reports: Included Data And File Conversion Fee: $ No cost One-Time Setup Flat Fee Medicare Reporting Costs: $2,000 Flat fee life of contract Liability Claims Adjuster(15-30 Claims per fiscal year) • $_See attached • • Workers Compensation Claims Adjuster(City Of Miami Beach In-, • House Ad us ter $ Included MO* Additional Service Fee • Desalptlon Of Additional Sentce; Annual Administration Fee $ 5,000 Description Ofpddit;onal Seviae: CMS monthly fees waved with 50 allocation reports per year $ Waved Description Of Additional Service: 1-800 toll free FNOI $ 35 Per intake Description Of Additional Service: . Bidder's Affirmation • Company: CorVel Enterprise Comp,Inc. . Authorized Representative: Richard Schweppe • Address: 2010 Main Street,Suite 600,Irvine,CA 92614 Telephone: 949-851-1473 Email: richard_schweppe @corvel.com Authorized Representative's Signature: 4 r' //f/ /.' • • I RFP 20 i 4-302-SW TPA C aims A•ministration or Wor ers Comp an. Gen _la•1 ily 4 *The in-house MO adjuster is at no cost to the City.The MO adjuster will handle the cases on a per-claim basis and charge accordingly to the pricing option the City has selected. • APPENDIX E COST PROPOSAL FORM Attachment Option 1: Life of Contract Handling Fee Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Injury $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster included will handle on a per-case basis according to the GL fee schedule. CONFIDENTIAL ____,,---„, = j S�,*s%1 ,:" TAB 5: COST PROPOSAL 26,+ _- Submit a completed Cost Proposal Form (Appendix E). Proposers must submit pricing for all three options. The City will review each option and reserves the right to select the option that is most advantageous to the City. If pricing is included or at no additional charge, proposer must indicate "Included" or "No Additional Charge," as applicable, within the Cost Proposal. Failure to submit pricing for all three options request in the Cost Proposal Form will result in the proposals being considered non-responsive and not further considered. CorVel has submitted pricing for all three options. Please see Attachment D: CorVel's Cost Proposal. September 12, 2014 C O R V E L Page 62 s 4,„ __.... ,,,,, : ., *`" . = ATTACHMENTS Attachments Attachment A: CorVel's Code of Ethics Attachment B: Florida Certification Attachment C: Staff Resumes Attachment D: CorVel's Cost Proposal Attachment E: Screenshots of Claims System Attachment F: Sample Claims Reports Attachment G: Sample Implementation Plan Attachment H: CorVel's Exceptions Attachment I: Case Studies Attachment J: Copy of Dun & Bradstreet Report Attachment K: Sample Performance Guarantee September 12, 2014 C O R V E L Page 63 A ■ CORVEL CORPORATION CODE OF ETHICS I. INTRODUCTION AND GENERAL POLICY CorVel Corporation is committed to the highest standards of legal and ethical business conduct, and seeks to foster an environment of awareness where the prompt reporting of any unethical or illegal behavior, or any violations of our corporate policies, is protected, encouraged and dealt with fairly. Ethical conduct is an inherent obligation of our directors, officers and employees and, in furtherance of our commitment, we have adopted a Code of Ethics and Conduct to promote the high standards of ethical conduct we value. This Code does not cover every issue that may arise, but is intended to provide a basic summary of the legal, ethical and regulatory principles that should guide the conduct of all our directors, officers and employees. We encourage our directors, officers and employees to read all of our other policies in conjunction with this Code to gain a full understanding of their responsibilities. We expect all of our directors, officers and employees at every level to conduct themselves in strict compliance with all legal and ethical obligations, and to avoid even the appearance of improper behavior. Our philosophy can be implemented only if our directors, officers and employees recognize their responsibility to treat everyone in an honest and fair manner. Compliance with this Code and high standards of ethical business conduct is mandatory for every director, officer and employee. Accordingly, a director's, officer's or employee's failure to fulfill his or her responsibilities under this Code may result in disciplinary action, up to and possibly including immediate termination. This Code requires at a minimum: 1. Honest, prudent and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships; 2. Full, fair, accurate, timely and understandable disclosures in reports and documents that we file with, or submit to, the Securities and Exchange Commission and in any other of our public communications; 3. Compliance with our other corporate policies and with applicable governmental laws, rules and regulations; 4. The prompt internal reporting of violations of this Code, including any illegal activity, to the appropriate person or persons identified in this Code; and This document is considered Confidential and Proprietary to CorVel Corporation 5. Accountability for adherence to this Code. II. CONFLICTS OF INTEREST AND CORPORATE OPPORTUNITIES Our directors, officers and employees should not be involved in any activity that creates or gives the appearance of a conflict of interest. A "conflict of interest" exists when a person's private interest interferes in any way with the interests of the Company. A conflict situation can arise when a director, officer or employee takes actions or has interests that may make it difficult to perform his or her work for the Company objectively and effectively. Accordingly, directors, officers and employees are prohibited from taking for their own personal gain opportunities that are discovered through the use of the Company's property, information or position, without the consent of our Board of Directors. A conflict situation may even arise when a director, officer or employee has a financial interest, including significant stock ownership, in any entity with which we do business, or provides service to or otherwise operates an outside business whose demands interfere with such person's responsibilities to us. Conflicts of interest also may arise when a director, officer or employee, or members of his or her family, receives improper personal benefits as a result of his or her position in the Company. Loans to, or guarantees of obligations of, directors, officers or employees, or their family members, by the Company or any entity with which we do business, may create conflicts of interest. It is almost always a conflict of interest for a director, officer or employee to have other duties, responsibilities or obligations that run counter to his or her duty to the Company, such as working or providing service simultaneously for a competitor, customer, supplier or other business. The best policy is to avoid any direct or indirect business connection with the Company's customers, suppliers or competitors, or with any other outside business, except on behalf of the Company. Directors, officers and employees should notify in writing the appropriate person or persons identified in Section VII of this Code of the existence of any actual or potential conflict of interest. III. FAIR DEALING We require our directors, officers and employees to deal honestly and fairly with, and respect the rights of, our customers, suppliers, competitors, employees and other third parties. Stealing proprietary information, possessing trade secret information that was obtained without the owner's consent or inducing such disclosures by past or present employees of other companies is prohibited. Each director, officer and employee should endeavor to make our contracts, advertising, literature and other public statements clear and precise and to eliminate any misstatement of fact or misleading impressions. No director, officer or employee should take unfair advantage of anyone through This document is considered Confidential and Proprietary to CorVel Corporation manipulation, concealment, abuse of privileged information, misrepresentation of material facts or any other unfair-dealing practice. No bribes, kickbacks or any other form of improper payment, direct or indirect, should ever be offered, given, provided or accepted by any director, officer or employee, their family members or agents. In addition, no gifts, favors or business entertainment should ever be offered, given, provided or accepted by any director, officer or employee, their family members or agents, unless it: (1) is not a cash gift; (2) is consistent with customary business practices; (3) is of nominal value; (4) cannot be construed as a bribe or payoff; and (5) does not otherwise violate our corporate policies or any laws or regulations. IV. RECORD-KEEPING AND PUBLIC DISCLOSURES We require honest and accurate recording and reporting of information. All of our books, records, accounts and financial statements must be maintained in reasonable detail, accurately and fairly reflect our transactions, not contain false or misleading entries, comply with generally accepted accounting principles at all times and conform both to applicable legal requirements and to our system of internal accounting controls. Unrecorded or "off the books" funds or assets should not be maintained unless permitted by applicable law or regulation. We maintain a system of internal accounting controls that will provide reasonable assurances to our management that all transactions are properly recorded and that material information about the Company is made known to management, particularly during the periods in which our periodic reports are being prepared. We expect our directors, officers and employees to notify in writing our Chief Financial Officer of any: (1) material information or unreported transactions that affect the disclosures made in our public filings; (2) information concerning significant deficiencies and material weaknesses in the design or operation of our internal control over financial reporting which are reasonably likely to adversely affect our ability to record, process, summarize and report financial information; and (3)fraud, whether or not material, that involves management or other employees who have a significant role in our internal control over financial reporting. Directors, officers and employees should avoid exaggeration, derogatory remarks, guesswork, and inappropriate characterizations of people and companies in their e-mail, correspondence, internal memos, reports and other records and communications, as these things often become public and can be easily misunderstood. Records always should be retained or destroyed according to our record retention policies. No director, officer or employee should communicate to the public any nonpublic information except through our Chief Executive Officer or Chief Financial Officer. V. COMPLIANCE WITH LAWS AND CORPORATE POLICIES This document is considered Confidential and Proprietary to CorVel Corporation Our corporate policies have been created to ensure that our directors, officers and employees comply with applicable laws and governmental regulations. We expect our directors, officers and employees to respect and obey the law, both in letter and spirit. Reading and understanding our general corporate policies is a good start to learning some of the laws, rules and regulations that govern our lives. By following these policies, our directors, officers and employees can fulfill our commitments to, among other things: (1) maintaining a safe and healthy work environment; (2) promoting a workplace that is free from discrimination or harassment based on race, color, religion, sex, age, national origin, disability or other factors that are unrelated to our business interests; (3) supporting fair competition and laws prohibiting restraints of trade and other unfair trade practices; (4) conducting our activities in full compliance with all applicable environmental laws; (5) keeping the political activities of our directors, officers and employees separate from our business; (6) prohibiting any direct or indirect illegal payments, gifts, favors or gratuities to any government officials, candidates or political parties; (7) prohibiting the unauthorized use, reproduction, or distribution of any third party's trade secrets, copyrighted information or confidential information; (8) prohibiting the sale or export, either directly or through our representatives, of our products to countries where technology related goods such as ours may not be sold; and (9) complying with all applicable state and federal securities laws. Our directors, officers and employees are prohibited from trading our securities while in possession of material, nonpublic ("inside") information about the Company. Our Insider Trading Policy (see Policy 801) describes the nature of inside information and the related restrictions on trading. We encourage our directors, officers and employees to seek advice regarding the details of the policies, laws, rules and regulations with which they must comply, by submitting a written request to our Director of Legal Services. VI. CONFIDENTIALITY AND CORPORATE ASSETS Our directors, officers and employees are entrusted with our confidential information and with the confidential information of our suppliers, customers or other business partners. This information may include without limitation: (1) trade secrets, patents, trademarks, copyrights and other proprietary information and ideas; (2) technical or scientific information about current and future products, services or research; (3) business, marketing or service plans or projections; (4) earnings and other internal financial data; (5) personnel information; (6) supply and customer lists; and (7) other non-public information that, if disclosed, might be of use to our competitors, or harmful to our suppliers, customers or other business partners. This information is our property, or the property of our suppliers, customers or business partners, and in many cases was developed at great expense. Our directors, officers and employees must not discuss or disclose confidential information with, in the presence of or to any unauthorized persons, including family members and friends, and must not use This document is considered Confidential and Proprietary to CorVel Corporation confidential information or other Company property or resources for personal gain, for the personal benefit of anyone else or for anything other than our legitimate business purposes. These obligations are fully described in our Confidentiality/Non-Solicitation Agreement that we require every director, officer and employee to execute upon commencement of service to the Company. VII. REPORTING AND CONSEQUENCES OF VIOLATIONS Reporting Violations and Asking Questions We hold all directors, officers and employees individually responsible for carrying out and monitoring compliance with this Code. Directors and officers immediately should report in writing any known or suspected illegal or unethical behavior to the Chair of our Audit Committee. Employees who are not directors or officers immediately should report in writing any known or suspected illegal or unethical behavior to their Regional Vice President, our Director of Legal Services or the Chair of our Audit Committee. When in doubt, we encourage directors, officers and employees to seek counseling about the best course of action to take in any particular situation. Directors, officers and employees may contact our Director of Legal Services in writing with any questions or concerns about this Code or a business practice. If your complaint or question concerns accounting, internal accounting controls or auditing matters, or financial fraud, securities fraud or other securities law violations, and you wish to submit these complaints, concerns or questions anonymously, you may do so by following the procedures set forth in our Policy Regarding Accounting and Auditing Matters (see Policy 113). If anyone feels uncomfortable reporting potential or actual violations to the person or persons identified in this Code, he or she may instead report those matters in writing to any member of our Audit Committee. Such member will identify and forward the violation report to the appropriate person or persons, not involved in the matter giving rise to the violation, who have sufficient status and authority within the Company to adequately deal with the violator of the Code. The names, addresses and telephone numbers of these individuals are listed at the end of our Policy regarding Accounting and Auditing Matters (see Policy 113). Any questions or reported violations will be addressed immediately and seriously. Investigations and Non-Retaliation The person or persons to whom a potential or actual violation is reported or forwarded will promptly investigate any such violation and will oversee an appropriate response, including corrective action and preventative measures, involving the Chair of our Audit Committee or Chief Executive Officer when required. All reports will be treated confidentially to every extent possible. This document is considered Confidential and Proprietary to CorVel Corporation It is our policy to not allow reprisal or retaliation of any kind against a director, officer or employee who acts in good faith in reporting any known or suspected illegal or unethical behavior, or who asks any questions regarding this Code or appropriate actions in light of the Code. We do, however, expect all directors, officers and employees to fully cooperate in internal investigations of misconduct. Consequences of a Violation Directors, officers and employees who violate any laws, governmental regulations, or any provisions of this Code will face appropriate, case-specific disciplinary action, which may include demotion or immediate discharge. Any director, officer or employee who engages in illegal activity will be reported to the appropriate governmental authorities. Administration Our Board of Directors and Audit Committee have established the standards of business conduct contained in this Code and generally oversee compliance with this Code. Our Board of Directors and Audit Committee also are responsible for updating these standards as they deem appropriate to reflect changes in the legal and regulatory framework applicable to the Company, the business practices within our industry, our own business practices and the prevailing ethical standards of the communities in which we operate. Our Corporate Governance Committee will oversee the procedures designed to implement this Code to ensure that they are operating effectively. Training on this Code will be included in the orientation of new employees and provided to existing directors, officers and employees on an on-going basis. To ensure familiarity with the Code, directors, officers and employees will be asked to read the Code and sign the Compliance Certificate annually. VIII. CHANGES IN OR WAIVERS OF THE CODE Any approval by the Company of a material departure from any provision of this Code, or any failure by the Company to take action within a reasonable period of time regarding a material departure from any provision of this Code that has been made known to an executive officer, is considered to be a waiver of this Code. Any change in or waiver of this Code for directors or officers (including our president, principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions, any vice-president in charge of a principal business unit, division or function, or any other officer who performs a policy-making function) may be made only by the Company's Board of Directors, and the fact of and reasons for such change or waiver must be publicly disclosed in a Form 8-K filed by the Company with the Securities and Exchange Commission within four business days of such change or waiver. No waiver shall be granted except where necessary and warranted, and where such waiver is limited and qualified so as to protect the Company to the greatest extent possible. This document is considered Confidential and Proprietary to CorVel Corporation B CHIEF FINANCIAL OFFICER JEFF ATWATER STATE OF FLORIDA February 28,2014 Ms. Abigail Keenan Corporate Paralegal CorVel Enterprise Comp,Inc. 2010 Main Street, Suite 600 Irvine, CA 92614 RE: Annual Report Dear Ms.Keenan: The Qualified Servicing Entity Annual Report Form for your company has been received. I have reviewed this report and found that your company is in compliance with Rule Chapter 69L- 5.230(11) F.A.C. (Retaining Authorization as a Service Company). This letter will confirm that your company has been recertified for the period March 1,2014 through February 28,2015. Attached is a copy of Form DFS-F2-SI-23 (Qualified Servicing Entity Annual Report Form),to be used for future filing as we no longer mail the form prior to the due date. Also attached is a copy of Form DFS-F2-SI-19 (Certification of Servicing for Self-Insurers), this form is to be completed thirty(30)days of entering into a contract for servicing. Your next annual report is due in our office no later than March 1,2015. Should you have any questions or need further assistance,please contact me at(850)413-1784. S erely, ,Jwa • oil!11 •,�ce Administrator Attachments FLORIDA DEPARTMENT OF FINANCIAL SERVICES Dwayne Manning•Insurance Administrator Division of Workers'Compensation•Bureau of Monitoring and Audit 200 East Gaines Street• Tallahassee,Florida 32399-4224• Tel.850-413-1784•Fax 850-414-2244 Email•Dwayne.Manning@Myiloridacfo.com AFFIRMATIVE ACTION o EQUAL OPPORTUNITY EMPLOYER C C C CORVEL ANITA ALVAREZ CLAIMS ADJUSTER SUMMARY OF QUALIFICATIONS • Over 19 years of Workers' Compensation claims experience • Extensive knowledge of Florida Workers' Compensation Administrative Code, State Law and Regulations,and case law • Experienced in all aspects of claims management including handling catastrophic and complex claims • Experienced in claim auditing • Multi-jurisdictional experience for workers' compensation claims PROFESSIONAL HISTORY • February 2011—Present: CorVel Corporation, Claims Adjuster/Senior Claims Adjuster. Anita is a Senior Claims Specialist for the Tampa, Florida claims office. Prior to joining CorVel, Anita gained experience in the workers' compensation and Professional Employee Leasing industries. Anita has also worked as a claims auditor working to accelerate claim closures. In the 19 years that Anita has spent in the workers' compensation claims industry, she has managed claims in a number of jurisdictions and handled large loss and catastrophic claims. EDUCATION • Hillsborough Community College • Erwin Technical and Vocational Center • Tampa Catholic High School • Workers' Compensation Claims Professionals Association,Licensed Adjuster CREDENTIALS AND AFFILIATIONS • Fluent in Spanish CORVEL CARRIE RATH CLAIMS MANAGER SUMMARY OF QUALIFICATIONS • More than 11 years of workers' compensation claims experience, with 9 years in supervision and management • Extensive knowledge of Florida workers' compensation administrative code, state law and regulations,and case law • Experienced in all aspects of claims management including reporting to and communicating with clients, carriers, and excess carriers, reserving, investigations, compensability decisions, medical management,and litigation • Proficient in claims auditing and due diligence • Professional experience in education and corporate training PROFESSIONAL HISTORY • June 2012—Present: CorVel Corporation,Claims Manager • February 2012—June 2012: CorVel Corporation,Claims Supervisor • Prior to working at CorVel, began in the workers' compensation industry as a claim's adjuster and was promoted into a claims supervisory position and lead the department as it continued to grow and manage claims in multi-state jurisdictions. Additional professional experience in the education and corporate training fields. EDUCATION • Educational Specialist Degree/Doctorate Degree, Leadership & Policy Studies — University of South Florida,Tampa(Currently Enrolled) • Master of Arts,Reading Education-University of South Florida, St.Petersburg(2010) • Bachelors of Science, Elementary Education - University of South Florida, Sarasota/Manatee (2008) CREDENTIALS AND AFFILIATIONS • State of Florida All Lines Adjuster License—520 • Accredited Claims Adjuster Designation,Florida CORVEL CHRIS OLIPHANT CASE MANAGEMENT MANAGER SUMMARY OF QUALIFICATIONS • Workers' Compensation Case Manager knowledgeable in Florida 440 Workers' Compensation Law PROFESSIONAL HISTORY • 2008—present: CorVel Corporation, Case Management Manager. Manage Telephonic and Field Case Managers, ensure the delivery of optimal, cost-effective medical care and facilitate return to gainful employment, ensure quality and timely medical care, reporting and communication from case management team, oversee triage and ensure injured parties are receiving medical treatment immediately after an injury, assist in determining whether an injured patient should receive case management. Responsible for researching medical, length of disability and return to work criteria of diagnoses assigned to injured parties by physicians and questioning physicians about any diagnosis, treatment or functional limitations they assign to the patient; if medically necessary and causally related to the injury of focus. • 2006-2008: Blue Cross Blue Shield, Florida, Workers' Compensation Telephonic Nurse Case Manager. • 2003-2006: CorVel Corporation, Workers' Compensation Field and Telephonic Nurse Case Manager. • 1996-2003: Cross Country/Med Staff Inc. (Nursing Traveling Agencies), Critical Care/Cardiovascular Intensive Care Nurse. • 1997-1999: Hamilton Medical Center,Critical Care Nurse. • 1993-1996: Florida Medical Center, Intern Nurse, Unit Secretary, Floor Nurse, Charge Nurse of the Cardio/Pulmonary Unit, Critical Care Nurse. EDUCATION • Bachelors Degree in Nursing-University of Phoenix • Associates in Nursing-Broward Community College; Ft. Lauderdale,Florida CREDENTIALS AND AFFILIATIONS • State Legislative Chair for International Association of Rehabilitation Professionals-Florida • Member of Broward Association of Registered Nurses r C0RVEL DEBBIE POPOVICH ACCOUNT EXECUTIVE SUMMARY OF QUALIFICATIONS • Acquisition sales and management of accounts to ensure service quality and governmental regulations. • Provide leadership and coaching to other sales associates. • Negotiate contracts with hospitals,physicians and private accounts. • Workers Compensation managed medical consulting expertise; 17 plus years in the Florida market. • Department of Financial Services Florida Educator for the administration of CEU's. PROFESSIONAL HISTORY • 2006 to present: CorVel Corporation. Account Executive. Acquisition sales in Florida Region for Enterprise Comp Services. Consultative account executive for claims and medical management. • 1997 to 2005: CorVel Corporation. Vice President Sales. Developed Florida area through the direct handling of Managed Care Programs. Identified key accounts, developed market plans and supervised/serviced multiple national clients and government programs. • 1990 to 1997: CorVel Corporation. Account Manager. Managed the southern Florida client territory,functioning as a Marketing Account Manager for CorVel Corporation. EDUCATION • Associate Science(2004) Broward Community College Ft.Lauderdale,Fl • Broward Community College Nursing 2001-Davie,Fl CREDENTIALS AND AFFILIATIONS • Department of Financial Services Educator Provider No.: 366326 • Member-PRIMA,FLORIDA-1998-Present • Member-RIMS-1998-Present CORVEL FELIPE BENITEZ LIABILITY CLAIMS MANAGER SUMMARY OF QUALIFICATIONS • Results-oriented leader with 35 years of extensive knowledge and experience in operations, logistics,financial and human capital management • Possesses outstanding record of achievement in operational profitability, expense control, continuous quality improvement and personnel management • Advanced skills in all aspects of operations and human resources leadership including Customer Relationship Management, Change Management, Budgeting, Business Process Reengineering, Human Capital Development, Quality Assurance, Business Development, General liability, Workers' Compensation, Claims Management, Litigation, and Customer Service. PROFESSIONAL HISTORY • 2012—present: CorVel Corporation, Liability Claims Manager. Responsible for the management of the General Liability Unit. • 2010-2012: Ascendant Commercial Insurance,Vice President of Claims. • 2005-2010: AON Risk Services,Senior Claims Consultant. • 2004:AON Risk Consultants,Consultant. • 2002: Hicks,Anderson and Kneale,Consultant. • 1995-2001: Travelers Insurance Company,Associate Service Center Manager,Florida EDUCATION • Bachelor of Science—University of Connecticut Casualty • Claim Law Associate(Liability I&II,Legal Principles) CREDENTIALS AND AFF=ILIATIONS • Florida All Lines Adjuster(2010) • Member of Workers' Compensation Claim Professionals CORVEL JENNA M.CARGILL JENNA CARGILL @CORVEL.COM SUNRISE, FLORIDA SUMMARY OF QUALIFICATIONS Result and detail oriented,hands-on professional with the ability to manage multiple tasks in challenging environments. PROFESSIONAL HISTORY Account Manager. Jenna Cargill started her professional career six years ago in the healthcare industry. She began at CorVel as a Customer Service Representative and quickly moved into an account manager role where she displayed a passion for teamwork and working closely with her colleagues to achieve results. Prior to CorVel, Jenna was the Supervisor of the Durable Medical Equipment Dept.for Medcare Infusion Services,Inc. Currently manages many municipal accounts and is familiar with the budget consciousness that cities and governments must adhere to. Jenna administers the analytic process and stewardship results to the client with meetings to discuss trending and impact. Recently Jenna has been instrumental in managing a national payer with EDI state processes and is efficient and has timely follow up. EDUCATION Bachelor of Science,Business Healthcare Administration. Florida Atlantic University,2008 CORVEL JENNIFER JOHNS CLAIMS SUPERVISOR SUMMARY OF QUALIFICATIONS • 17 years Workers' Compensation Experience with 10 years multi-jurisdiction claims management supervision • Extensive knowledge of Florida's workers' compensation state law, regulations and industry standards. • Extensive experience in workers' compensation claims auditing PROFESSIONAL HISTORY • November 2013—Present: CorVel Corporation,Claims Supervisor. • 2004—2113: PEO,Worker's Compensation Claims Manger. EDUCATION • Vale National Insurance School—Dallas,TX CREDENTIALS AND AFFILIATIONS • State of Florida Worker's Compensation Adjuster License CORVEL TOM CASSETTE AREA VICE PRESIDENT SUMMARY OF QUALIFICATIONS Documented history of building winning teams and business growth in both the corporate work environment as well as several entrepreneurial ventures. Tom is a licensed 2-20 All Lines agent specializing in workers' compensation. PROFESSIONAL HISTORY • 2009 — Current: CorVel Corporation, Area Vice President. Tom joined CorVel in 2009 bringing experience in managing business growth and an expertise in workers' compensation insurance. His prior experience was with a large, regional PEO where he was the agent in charge of the on-site insurance agency as well as the corporate trainer where he trained the outside sales team on the basics of workers' compensation and salesmenship. Prior to this, Tom had several entrepreneurial ventures ranging from commercial printing to medical weight loss business. EDUCATION • Bachelor of Science,Business Administration,Slippery Rock University, 1991 CREDENTIALS AND AFFILIATIONS • Florida All Lines Producer(FL 2-20)—2006 • Florida Life& Health Agent(FL 2-15)—2007 D b D APPENDIX E MIAMI BEACH Cost ProposalForm "REVISED"September 4, 2014 RFP 2014-302-SW CLAIMS ADMINISTRATION SERVICES BY A THIRD PARTY ADMINISTRATOR FOR WORKERS ' COMPENSATION AND GENERAL LIABILITY PROCUREMENT DEPARTMENT ]OO Convention Center Drive '. Miami Beach, Florida 33139 RFP 2014- 02 SW IvA C airs mi�isha�ion or or ens Comp an Gen Ik i0y • APPENDIX E "REVISED" COST PROPOSAL FORM Failure-to-submit-Section 5,Proposal Tender Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the proposal price form below represents the entire cost of the items In full accordance with the requirements of this RFP, Inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, travel, delivery delays, taxes, insurance, cost Indexes or any other unless a cost escalation provision Is allowed herein and has been exercised by the City Manager in advance, The Proposal Tender Form shall be completed mechanically or, if manually, in ink. Cost Proposal Forms completed In pencil shall be deemed non•responslve. All corrections on the Proposal Tender Form shall be initialed. IN ORDER TO BE DEEMED RESPONSIVE, PROPOSERS MUST SUBMIT COST FOR EACH OPTION 1-3. Failure to follow the price proposal format as identified may result in the RFP response being considered non-responsive and the RFP submittal will not be considered for evaluation. OPTION #1: FLAT ANNUAL FEE OPTION Column 1 _ Column 2 Column 3 1. Flat Annual Fee Flat Annual Fee (for 345 claims Including $ 154,500 new and prior claims) (per contract year) 2. Per Claim Fee for Quantity Excess Claim Fee Per Claims in Excess of $ 475 40 per year Year 345 Per Year (per excess claim) $ 19,000 (Column I x Column 2) TOTAL OPTION 1(Flat Annual Fee Option):. $ 173,500 (Total Lines 1-2) 'Deposit Amount To Be Maintained By The City s. "2.5x "Proposer shall include amount,which the City may negotiate at its discretion, ** Industry standard is 2.5 times the average monthly payout. RFP 2014-302-SW TPA Claims Administration or Wor ers Comp an. Gen Lia.iliry 2 OPTION #2: FIXED PER CLAIM FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS - , Claims with dates of accident after-contract inception -Febivary 1,2913 , 1. Indemnity Per Claim Quantity (Litigated Or Non- $ 950 100 per year $ 95,000 Litl•ated •er claim (Column 1 x Column 2) 2. Medical Only Claim Quantity (Litigated Or Non- $ 150 175 per year $ 26,250 Lid'ated •er claim (Column 1 x Column 2) 3. Medical Only Claim Quantity Transferred To $ 800 25 per yer $ 20,000 Indemnity Claim (per claim) (Column 1 x Column 2) (Litigated Or Non- • Liti•ated PRIOR CLAIMS • Claims with dates Of accident prior to contract inception-February�1,,, 2015. 4. Indemnity Per Claim Quantity (Litigated Or Non- $ 550 292 per year $ 160,600 Litlgated •er claim (Column 1 x Column 2) 5. Medical Only Claim Quantity (Litigated Or Non- $ 95 129 per year $ 12,255 Litl•ated •er claim (Column 1 x Column 2) TOTAL OPTION 2(Fiixed Per Claim Fee Option): $ 314,105 - . - . - otal Lines 1-5 "Prior claim fees(tail files)lines 4 and 5 may be staggered on a monthly basis over life of contract. , OPTION #3: FIXED PER CLAIM BLENDED FEE OPTION Column 1 Column 2 Column 3 NEW CLAIMS Claims with dates-of accident after contract inception Februar y 1,2015, 1. Indemnity Or Medical Quantity Only Per Claim $ 475 300 per year $ 142,500 (Litigated Or Non- (per claim) (Column 1 x Column 2) Liti•ated PRIOR CLAIMS • Claims with dates of accident prior to cortract'inceptioi -February.1,2015. 2. Indemnity Or Medical Quantity Only Per Claim $ 425 421 per year $ 178,925 (Litigated Or Non- (per claim) (Column 1 x Column 2) Liti•ated . TOTAL OPTION'3(Fixed Per Claim Blended Fee Option)` $ 321,425 (Total lines 1-2) RFP 2014-302-SW TPA Claims A.ministration or Workers Comp am. Gen Lb.'Hy 3 ) ADDITIONAL SERVICES List of services as needed,which are in addition to the fees proposed in 0•tions 1 -3. - - Description of Service .. - - Fee Telephonic Medical Case Management Fee On All Claims: $ 92 Per our Free Triage Per Bill/Flat Fee Bill Review Fee To Include State Fee Schedule Reduction: $ 4.50/Per Bill Per Bill/Flat Fee Percentage Of PPO Savings—Network Discount Savings Below State Fee Schedule: 27 % Percentage Of Utilization Review And Reasonable&Customary Savings: 20 ova Subrogation and/or Liens Fee Percentage: 25%of recoveries% Osha 300 Log Reporting: $ Included . Electronic Data.Interchange Filed With State: $ Included Safety Consulting Services Per case basis review of case at no cost $ Notice Of Injury Entry: • $ Into CareMC at no cost Custom/Ad Hoc Reports: $ Included Data And File Conversion Fee: $ mo cost One-Time Setup Flat Fee Medicare Reporting Costs: $2,000 Flat fee life of contract Liability Claims Adjuster(15-30 Claims per fiscal year) $See attached Workers Compensation Claims Adjuster(City Of Miami Beach In- House Ad uster $ Included MO* Additional Service Fee ' Description Of Additional Service: Annual Administration Fee $ 5,000 Description Of Additional Service: CMS monthly fees waved with 50 allocation reports per year $ Waved Description Of Additional Service: 1-800 toll free FNOI 35 Per intake Description Of Additional Service: �� $ Bidder's Affirm_ ation• Company: CorVel Enterprise Comp,Inc. Authorize!Representative: Richard Schweppe Address: 2010 Main Street,Suite 600,Irvine,CA 92614 ' Telephone: 949-851-1473 Email: richard_schweppe @corvel.com Authorized Representative's Signature: f 6 ((• _4, . . . . , . RFP 2014-302-SW TPA Claims Administration for Wor<ers Comp an Gen Liael ily 4 *The in-house MO adjuster is at no cost to the City.The MO adjuster will handle the cases on a per-claim basis and charge accordingly to the pricing option the City has selected. APPENDIX E COST PROPOSAL FORM Attachment Option 1: Life of Contract Handling Fee Auto Liability: Bodily Injury $795 Property Damage $495 General Liability: Bodily Injury $550 Property Damage $350 All Other $695 Product Liability $695 Designated GL Adjuster included will handle on a per-case basis according to the GL fee schedule. CONFIDENTIAL E E E CO R V E L Sample Screenshots Claims Management -._ • w • A h h M s A • r r _ Monday,February 4,2C:- _ • PPO Lookup Cdrel Request for Service Report An Incident/Injury Home Claims Management Mandged Care Provider Relation', Log In Usemame Password Foroot Usemame or Pasoward? r ar CorVel offers tools to better manage Learn more about Care"'and how healthcare and claims activities. to access services and resources. More about Car?MC Request Access .o+ngnt,g 2013 CorVel Corocrabcn.AU riyr+b reser•:•_d. orivact Statement ''r/ebmaster Site.e3ource3 Chance=353•hord Care"" Home Page Quick access for login, PPO lookup and service requests ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the CareMC system. C O R V E L Sample Screenshots Claims Management Care Welcome, Risk Manager INTAKE CLAIMS REPORTS TOOLS O. • I Q Dashboard Reports Search Claims C y My Tools PPO Lookup Incident Intake le IN IN • • we IN FNOL Lists Claims Scorecard Alert Preferences Carew Home Screen Select tiles for tailored screen display. @ 2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the Care"'system. CORN/ EL Sample Screenshots Claims Management ---areThi .-- Welcome, 8 Risk Manager :..:. : Notification Center * Open Inventory Detail View(BETA) 0 Claims Safety Codes Dashboard 0 Claims Scorecard ,--,,s ist car :c,-ca;r-a•a•---,-e -,_,,roer of records.Therefore exporting to and viewing the information in Excel is recommended. Select the department level shown in the grid below: L evel 1-Department CI ' Export to Excel Ili :-- i Claim* Customer Department Incjilsni Coveraoe Claim nju_re_ Level RBIs Line in State Claimant Incurred Paid i----• ACME AS-14-010058 West-Sales L0/28/2013 ',‘,(.2 1i... DC Reid,Lcri Ma - SAM Brands .,t ACME 'West- IAD-14-010059 ' 10125/2013 ',Ad C INC DC Smith.Bob 10.00 SUR Brands Manufacturing I — .Acme Akli:11=61 i Wag.-Sales , 10/25/2013 WC I PIP DC Jcres,Mary 50.00 sc.cc Brands i I . . 1 . ACME AB-14-010053 West-Sales 10/21/2013' WC DID DC .',cres,Tom $0.00 10..al Brands . 1 _ ACME T stliELnafird 3 West-Sales 1 10#21/2013 WC MO DC Smith,Bob S0.00 H14010060 ACME Brards West- CperatiorNS , 10/15/2013 WC -i MC DC Jones,Adam S0.00, S_QM l ACME West- 'eitlialgard B ons 10/14/2013 WC MO DC Jackson,Sara gsg PISS, rards Operati ACME AB-14-010050 West-Sales 10/09/2013' WC , MO OR Case,Test $0.00 10.0C Brands Notification Center Drop down notification center streamlines claim information and displays real-time key information specific to each claim ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Caremc Agreement)must be signed before access to the CareMC system. I CO R V E L Sample Screenshots Claims Management O Customer:ACME Brands Alerts u ■ Top 10 Body Parts by Incurred-All Locations u _ _Count Alert �'� A saw.MS- 3 Catastrophic Claims 0 pla ems Exceed tng Thresh old sl*JN • 2 Medical Sills Exceeding Threshold f/a0.0N• . Action Items Y mum— •111C1A,r Count Action yt eie V 0 NE Completed > tie .. of , te 0 IME Requested a / ',e e 41 0 Peer Review Completed 1 it 41 0 Peer Review Requested ta _,.,_.,,4 411. • Links r :'Top 10 Claim Types By Incurred Amount u r Oastibieards dl � Claims Scorecard 4 MUNN s Medical Bill Review Outcomes MUMPS claims Safety Code Dashboard MAO MAN S1A.N SWAMI MaAN N fd V -r..- ________ Claims Dashboard Displays summary of top ten injuries by body part and links to additional dashboards and reporting. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement) must be signed before access to the CareMC system. C Q R \II E L Sample Screenshots Claims Management Customer:Acme Brands 2laims Safety Codes Dashboard • Filters 0— Start Oeta il l faiiiiiike ;t#af)t Pert i CUi'fl e 1 Way Cause: i*Ay MaAte: Oesepellew i!Order By: I '2/1/•200.•/11,1(11AOt2010 • I All Al i;An y AS glj I 1 Ail i' Al II ?1 mooned ii II ill! . Claims Breakdown By Claim Type ID 0 x— .Claims Breakdown By Body Part •4i j— •.Claims Breakdown By Injury Cause ■er s— 52.000.000 1500.000 r:71,-j 32211461 1 S1 533.382 117., ;400000 5175.661 $1.500.000 ;300.000 E_-,F� 9'.000.000 ' - •'l S93' 1 1200.000 F • ] -1 a 3 i 7 =5500.000 i100.00G r::KiY/ 1 57 271 St; SO Indemnity Medical Only Law fiber MAWR lei "WM Willib e Isaias Taber" aim Marl %Ilex Paine Obasel Cm Sack MelOr Umar tSI Trent me Cole Teel W eeko.Hsiang Flyer NI Ana aural Boone. Me Pewxee Linnet Vertebra es =ales e < ! ) < uu > . Claims Breakdown By Occupation Iiei=— , Claims Breakdown By Injury Nature ®.X— Occuoatioe Cleima lad locurced of Quality Checker 1 $145,953.02$223 145 58 Police Officer 3 090,793.47$206.980.00 MMKI •Intnf oau rtficient 1 $185,391 77 $196,752.00 $600.000 dr be me%en Tleetneicniean e t 589,899.85 $173,105 58 5400.000 j;areorver 1 528.116.85$159,179.78 aj Fremen incl. ''42^• Drive 2 593.734 13 5117.559 59 $200000L� it Utility 1 038,306.69 $99,304.96 at pirefiahtera 2 $52.180 45 394,910 97 111■11111111111 el Jr Truck Driver 1 $75,520.85 083.529 95 ?o ar 9ee r Fxem r4r. Ose Caaeao Sterner DY'se s a �e Healthcare 2 522,214 68 360.657 81 aced. Or C1 yyvrker 1j} Claims Safety Dashboard Displays breakdown of claims by injury, body part, occupation and nature of injury. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the Care"'system. C 0 R \f E L Sample Screenshots Claims Management • Medical t#R Review Outcomes !Melt re•ta I■fed Made Raptee state 'Lino sestlnea I Sep 2012 [] j i Sep 2013 ;1 M Stales 0 I 1 y Low 0,1 O Apay � t l : Report s =0r ACME Brands Bills from Sep 2012 to Sep 2013 fsr All States and All LOBs . Network Solutions Savings S• . To 10 Piocedure and Revenue Codes 5) 143 a.� •zsti • • ' am rl" •it it76-o r,,,W3•4 :••.,Sccrhk sSde s1•t �ss ► 2.=.L.- • 1110 -.._ e.am biliktm: •tea "1/140, , _ _, • C� MJ. •3rn•s6C fl•••a•souse.souse. •54/131• e •370 •26370 •29•p/ • 7!O '2 ser. 2,a" . Top 10 ICD9 Codes ISIte . Top 10 Drug and Supply Codes NU 10% ..a>% •.47ti 4 is. 6.764 ♦Y... itic • 620 a • 5.67•.1,14•., • rn.'t ••20617-033•40 �'� • rs7 e• s 27..taitiall a'6i'`• •u4oaa ou7a1 •60•! •ssoas.2a•n•0•.3 a •30+43.41064 • 726.12 6 T6..tip eon 7 974 I'SIN Medical Bill Review Outcomes Displays claims savings including top ICD9 codes, top procedures and drugs. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the Care"'system. C0 R V E L Sample Screenshots Claims Management • Claims Scorecard • Summary of Claim Expenditures•Recovery Period Yidemniy Permanency Medical Expense Total Recovery Nev.2010 111.371 $460 $36.665 $1,571 $50,267 $0 Oct.2010 310,629 3920 $25,337 11,664 $36,550 $0 Sep.2010 113.573 $5,146 $26.605 $1,176 846,030 $0 Total $35.57$ $6.625 $116157 $4911 $114,155 SO • Payment Comparison Month Over Meath Yew Over Year Oct.2010 Nev 2010 Charge FY 2010 to Nov.30.2009 FY 2011 to Nov.30.2010 Change $30.530 $50,257 t 811,737 842.955 3231,336 t 3156,391 • Claim Expenditures•Recovery Mmas— rr4ar— -TOTAL MED -PER -EXP Dec.20011 Jam 2010 Feb.2010 Mar 2010 Apr 2010 May 2010 Jun.2010 Jul 2010 Aug.2010 Sep.2010 Oct 2010 Nor.2010 • • Change In Claim Volume Period Begin New Reopen Closed Ending Change Nev.2010 26 5 0 2 20 t 3 Oct.2010 19 7 0 0 26 t 7 Sep.2010 20 2 0 3 19 ♦ •1 Tetra 14 0 5 t s Claims Scorecard Track and compare payments for claims in the CorVel system. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care""Agreement)must be signed before access to the Care""system. CO R V E L Sample Screenshots Claims Management • New Incident/Injury • West-Sales ••ndicates required nformabon Irt�tifeld Workar' r (fine MJ-lase) Injured wdrlter's 5611• poi at wiry• 4/26/2013 Ill(1M/MhriY) OR--Oregon • .tease choose the'a1pdon •No•radical treatment,aside from first aid.is expected. •Medical treatment is expected. best describes Your situation• • X Caned O Continue Injured warners silt- 777-00•7777 010130113lIry• 4/21/2013 Neese choose the Willeaselle f•w wr•dical treatrn•wt.wade front first awl.n . best describes yoaraili• lib a Orrisn d11ate w Wait•Sales asst Phone!lumber to Corded IN.wws leldar• AWNS/Mein Nisabir Injured rParksrs SittsiAddless.r Injury/Accident Detail Cate a Time of Injury a g24/2013 at 13 00 e •AM PN Sew*` --Select Sarerlty wins - • • Treating Phys, l I O lleldlPPOPMelel alitil milme1 it O Mwsdelh 'ft.do •.Safest TWO Care•• • maws of 111FIfr ••Select Nature of blurt'•• • Body Pact Injured ••!Mast par!of Seely•• •• 0 MI Body Part Siva •'Sulud sect lids ai a.dy.. _ • Added'arts'S.de Of Body Injured X er No r_-.-_- ------ rs: es It Came ANN! t Top Report an Incident/Injury A simplified way to report incident and injuries to CorVel. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the CareMC system. Co R E L Sample Screenshots Claims Management Claim Details-Jones.Jeffrey:AB-10-500004[ECI 0 Ser:ices 0 Documents/Notes 0Injury/Diagnosis 0 Financial Medical D Legal D Reference t All Claim Type Indemnity(IND) Date of Birth 11/06/1964 Flags SSN 333-00-7273 Multiple Claims No Employer Name South-Manufacturing Date of Hire 01/02/1997 Date of Incident 06109/2010 Adjuster Adjusterl.DEMO Policy Effective Date Policy Term Date Policy Number 3ercr 'Hale Marital Status Jurisdiction State KY Jurisdiction Claim No SAL s Closed Claim Services . , Export to Excel"J _.u_ _-r Service Create Referral Opened Closed Case Case Diary Document Seq Status Date Date Date Reason Workers Notes Notes Cover Invoices Vlew Num Page ' ClO�llra ADJ-I CLS 10/30/2011 10/30/2011 5 0 PM cf homer " Q i EDI. 10/30/2011 FRI-1 CIS 10/30/2011 10/30/2011 10:12:00 $1 Q j Q PM 7C�-1 ACT 12L 12/5/2011 $t 2 7 Q e TRP-i ACT 12/07/201i 12//2011 Sl 0 1i 2 Displaying records 1 to 4 of 4 l page 1 all Page:<<Prey 1 Next» RTW Profile Date Entered 1/6/2012 9:36:06 AM Esbmated RTW Date 9/15/2010 RTW Date Physician Release Date Return to Modified Duty-Light Physical Demand RTW Type Level jury Wage RTW Wage 0 Pay period DOT Description DOT_Class no use of right arm off work 6/23-24 for surgery RTW Notes with return to modified duty expected post surgery Name Claim Summary View View detailed claim information from a single spot in Carew. The information is organized under a series of tabs for quick access to critical information such the Return to Work Profile. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the CareTM°system. C0 R EL Sample le Screenshots Claims Management ■ Claim Reports Q Reports 0 My Reports 0 My Schedules 0 Generated Reports(Complete: 6/Generating: 0) Expand all Collapse all ▪ Claim Reports J Finan coal • Liability —+J Liability Accident Reports • Loss Experience * Payment Reports Specialty Reports • State Reports i Subrogation Recov ■ Claim Reports Workers' Comp env 0 Reports 0 My Reports 0 My Schedules 0 Generated Reports(Complete: 6/Generating: 0) Expand all Collapse al _t Claim Reports Claim Detail Claim Log Claim Repeaters Claims Received Count Combined Claim Detail Finance Amount Summary Safety Reporter Salary Continuation .3 Financial Claims Reserve Change Claim Reports Create and view reports with filtering and grouping options. Detailed reserve history, subrogation and recovery are also availble. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care""Agreement)must be signed before access to the Care"'system. p C 0 R V E L Sample Screenshots Claims Management Treatment Calendar Filters Treatment Type ..Choose Treatment Type to filter-- • Select Start Date FrstDalsofTreatrnant r4 Refresh February 2011 March 2011 April 2011 May 2011 0 Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu 'ale Th Fr Sa Su Me Tu We Th Fr Sa 1 2 3 4 5 1 2 1 2 3 4 5 6 7 6 7 1111 9 10 11 12 3 4 I 6 7 3 9 8 9 10 11 12 13 14 . 17 18 19 13 14 15 16 17 18 19 10 11 12 13 14 15 16 15 16 17 18 19 20 21 20 21 22 23 24 25 26 20 21 22 23 24 25 26 17 18 19. 21 22 23 22 23 24 25 26 27 28 27 28 27 28 29 30 31 24 25 26 27 28 29 30 29 30 31 June 2011 July 2011 August 2011 September 2011 Su Mo Tu We Th Fr Sa Su Mo Tu We Th or Sa Su Mo Tu We Th Fr Sa S., Mc T., 'Ne Th F- Sa 1 2 3 4 1 2 I 2 3 4 5 6 1 2 3 5 6 7 8 9 10 11 3 4. 6 7 8 9 7 8 9 10 11 12 13 4 5 6 7 8 9 10 12 13 14 15 16 17 18 10 11 12 13 14 15 16 14 15■ 17 18 19 20 11 12 13 14 15 16 17 19 20 21 22 23 24 25 17 18 19 20 21 22 23 21 22 23 24 25 26 27 18 19 20 21 22 23 24 26 27 28 29 30 24 25 26 27 28 29 30 28 29 30 31 25 26 27 28 29 30 31 October 2011 November 2011 December 2011 January 2012 Su Mo Tu We Th Fr Sa Su Mo Tu We Th Fr Sa Su Mo Tu We Th F- Sa Su Mo Tu Ne Th Fr Sa 1 1 2 3 4 S 1 2 3 1 2 3. 5 6 7 2 3 4 5 6 7 8 6 7 8 9 10 11 12 4 5 6 7 8 9 10 8 9 1.0.■ 13 14 9 10 11 12 13 14 15 13 14 111 16 17 18 19 11 12 13 14 15 16 17 15■ 17.■ 20 21 16 17 18 19 20 21 22 20 21 22 23 24 25 26 18 19 20 21 22 23 24 22■ 24.111 27 28 23 24 25 26 27 28 29 27 28 29 30 25 26 27 28 29 30 31 29 111 31 30 31 Treatment Calendar View color-coded treatment calendar. Sort by treatment type and date to view various procedures. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care""Agreement)must be signed before access to the Care""system. C 0 R V E L Sample le Screenshots Claims Management Case Notes Claim:AB-10-500007 patient Name Perry,Sharon Service 0 Ipte Type All v mote Category • Cate Range 19/28/2011 13/28/2012 1 f Claim Level r Case Level Close t{ Search 11,111Watill$MMIMPOMPORPIllr... „ . , Time User eaory Note Edit Code 12/29/2011 05:351314 • Cam PT Other Doctor appointrner t scheduled for Manager 12/30/2012 9:30am. Worker is still unable to work. Next Case 12/29/2011 05:34PM Mr PT Comments doctor appointment should be scheduled by Fnday. Compensability/Injuries accepted: left leg Work status: release to full duty Diagnosis: left femoral neck fracture Salary Continuance or TTD: No ordered by NCIC to discontinue TTD benefits When Does Salary Continuance Expire; N/A Medical/Current treatment: Client has reached MMI, and rec'd a 40% rating DEMO given to left leg. Case management: Pl 10/12/2011 05:46AM Adjuster AD) an of none Subro Status: no 3 party Action potential legal Status: none Reserves: Med Reserves Ik to pay Claim Notes View notes from adjusters and case managers. Search options include by note type and date ranges. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(CareTM°Agreement)must be signed before access to the CareMc system. CQ R \/ E L Sample Screenshots Claims Management Tat Action Certified Last Date guidelines Est Actual RTW Tvoe Dates Duff Days Moat Worked RTW Date RTW Date Reason Return to Modified Duty- no use right arm FD release expected next yiew/Edit 08/17/2010 09/15/2010 Light Physical Demand 706 appt Level Return to Modified Duty- View/Edit 07/20/2010 09/15/2010 Light Physical Demand 726 no use right arm next appt 38/19/10 Level Return to Modified Duty- View/Edit 07/06/2010 09/15/2010 Light Physical Demand 736 no use of right arm Level Return to Modified Duty- no use of right arm off work 6/23-24 for View/Edit 06/09/2010 09/15/2010 Light Physical Demand 755 surgery with return to modified duty Level expected post surgery View/Edit 09/14/2010 09/15/2010 Released to Full Duty and 686 Released from Care ■ Restrictions:Robinson.Andrew:AB-11-500019 Activity Tvoe Descriotion Comment Restriction Physician Effective Date Carrying above shoulders IW should not lift anything above shoulders Brown John 01/12/2012 Return to Work Information View return to work plan,work restrictions,date last worked, estimated return to work date,actual return to work date,total days off and claim specific notes ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(CareMc Agreement)must be signed before access to the Care"'system. C O R V E L Sample Screenshots Claims Management •Claim Details Jones,Jeffrey:AB-10-500004[EC] 0 S.rviaa O 8eeaaa.et./Not.a 0 lejery/Dlgwosla 0 Fleariclal 0 Modica! O L.a1 0 Referees. D All Claim Type indemnity[R101 Data of OlrtO 11/110/19114 Ftaga SSN 333-00-7273 Multiple Claims N. Employer Name South-Manafactarin0 Der.of Hire 01102/1097 0.1.of bcid.at 06/w2010 Adjuster Adjuster,.DEMO Policy Effective Date Policy Term Dab Policy Number Geode, Maio Marital Statue Jurisdiction State KY Jurisdiction Claim No States Closed Drug History • Adjuster:Adjustert,DEMO Export to Excel El hod= , alma aril mac Ikusibmcdollos gorlIbt sZ,Mama U j3lot j 66180- Stoneriwr Third Party 06/09/2010 Cephalopod's Generic 0122- CEP/ALEXIA CAP 50@0G 40 Pharmacy EiNaru Paid $54.04 $54.04 $.00 02 Solutions 00406- 9tdnenver 06/09/2010 Ahab Generic 00512- TABOXyC�000 ./A�fAMD10PMEN 70 6, Paid $.26.74 $26.74 1.00 Solutions 00406- rYO R00000lElACEfAMM00P1EN StOnudw Y 06/10/2010 Generic 0356- TAE 7�0 0 e Paid $15.37 $1537 $.00 Pharmacy OS Solutions 49684- Stonarivar 09/22/2010 Generic 05 0946- TABTRAMAOa H1 DROCMLORIDElAC 50 S ro Party Paid $53.36 $53.36 $.00 49004- Stoneriver OPiate 12/1/2010 awes. Gamut 0946- TTAB37.0LHYDIbOCKARIDE/AC 0 Pharmacy w y Paid $53.36 $53.36 $.00 05 Solutions 64720- Stoneriver Third Pam, 12/20/2010 Generic 0321- METAXALCNE TAB 800e1G SO Pharmacy Bi6ars Paid $191.70 $191.70 VA 10 Solutions 64720- Stonemvar Third Party 02/22/2011 Generic 0321- METAXALONE TAE 80014G 50 Pharr.y Noe, Rejected $200.50 $.00 $206.50 10 Solutions 49684- Stoneriver 02/22/2011 Generic 05 0946- TTAO 37.5_3 DO3 M'DItOQILORIDE/AC SO Pharmacy Party Rejected $53.36 $DO $53.36 ea. 00093- Stonarivar Third Party David Faulk. Othata 05/18/2012 Generic 0058- TRAMADOI HO TAE SOMG 40 Y awe MD $0.46 $38.16 $7.30 Agonies OS Solution CYCLOBENZAPRINE 05/18/2012 Generic 5656- Ha.TAB 40 Third Party David Faulk Paid f59.71 $49.57 $10.14 05 lOMG Solutions & MD 63629- Stoneriver MD Joseph Kutz 1 00118/2012 Generic 2066- TRAMADOL Ha.TAB 50MG 40 MD ' Paid $84.00 $69.32 $14.68 Agonies 02 Solubone Drug History View pharmacy information including prescriptions, generic or brand dispensing, and amount paid in and out of network ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care""Agreement)must be signed before access to the Care""system. CORVEL Sample Screenshots Claims Management Attention:The form contains intormat on re,ating to I i� OSHA's Form 300 I6 3t9W41 employes MGM andmustoeusedinaroamer:hat Year 2013 prof c ho oonfldertia)ry of employees to:he extent Log of Work-Related Injuries and Illnesses 6.W ' �ery d ato hi for U.S.Depart ment of Labor PUMOSES Occupat onal Salrty and MWn Admnneaaion Y6.,tdlemd116etidtdpRMq■11H.1741/WilrrtYiiiiiiMdOwiiMLnloilir/iil 011itAlekr.let ant fit...-.' :^^.rR•c.aa eve+o:,e-c+>s neora5eteetenentenni vermtelesnannipelimennealonliennaillinamenandeemenyangellimbevannene rae vores.ea Yew mum ra wmeeaternd rpm reilMMtnetegelheMa emai"WIWI MM.newt iota war 1N1t2 PedWe in we Noest.a vgie ow s0 you rriret carne*..eta/SIM MOW moor,CSIM.arre xi'7re0.0.1..1rearI147 they•e00ide7 or 7th tee`.your nX care s6ewer a Cie 5*caner Cal yir=I Mnallateweee Establishment name ACME Braros City Portland State OR identity the person Describe the case Classify the case (3) x81 iC) IC) 1E) (F; CHECK CMKY ONE Ix..for each case Er..r...or of Car l'to E 's vane (as No Omar Were 4.e ewe omw!1 iescree r}vy a ness ern d tory ole lee ans based on the molt senan...Lee to daps In in)ved Chock er"injury down. ;e c Merl rvemm :e;-oaring 3091 ire nOt meziulerair!lit.arty hued a rode ten r that Case: es i eats was: or rhos ors Noe et fYns, onsetd ',eg Inc..degee err*ce.grt'aern'en"acerysne fates ; Remafted X'Work c.,oe 7a04"rer de►eafer Mumma- &my'sees ars.,d Demo *rim* 6.1.52133 me rases rat x16.0' ■0) (F) t') {J) IK, (f., 11) (2) 13) (4)(5) i5) Ae-•24'0323 Poe,U. 3'.•3 _ X Sae ca+©MMIIIMMIM X San Can©IMMEIM� e3-•24.0333 Far:Par 2@ X 3en 36.+©MMEM�� 4&'24'0077 :•t aaarrr 3Y•9 6.e-'24'aes MN Joie. 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WIr...s'XMle0 3s..e'aaeeslaeee taw•Man. .3)^666 :.4.w aao.e3 3+"523+2 p ae r or r al.. AMOS OSHA This is an internal screen that can be used to capture information for OSHA reporting. ©2014 CorVel Corporation.All rights reserved. Confidential CorVel's form of License Agreement(Care"'Agreement)must be signed before access to the Care""system. CO R V E L Sample Screenshots Claims Management :laim Details-Nelson.Andrew:A8-12.500005-01[EC]5i oisry4MS 0 0sgssssb/Notes Olnjury/Olagnosis OFinancial 0Medical OLegal 0 Illeforetoos All Auto Lieerirty CbanTyrpe (ALBi) Date of Birth 01/01/1978 Flags CCRx SSN 801-22-1104 Multiple Claims No Insured Name South-Operations Date of Hire Date of Incident 09/01/2011 Adjuster Adjusters,DEMO Policy Effective Date Policy Term Date Policy Number ;e Male Marital Status Jurisdiction State OR Exposure Type 91 Steti,s Active Liability BI Claimants Employer As Dewy Claimants Occupation Driver Accident State Z,c Bea StramfWholash Nature 8 Extent of Injury Phyer al T1Nnpy Medical Treatment Comments Regarding Bodily Injury Claim Witness List Wally Onderspot Nome Phone (555)222-2222 Work Phone Address 222W Overbaa Ave City Portland 3'a i e 30 2; 97222 Observed Wxer kaxhlg pier to calking net rear of clamtlnrs Cu Summary of Nitness Statement ,sured Driver Profile insured Driver Name endeur 9-t11rm 0188 of Site tnney9 Andress 101 didetrMWay Mime none (503)558-t212 Met Rase* p13 i 558-2121 Age 35 !!M 891-22-x304 Unease No 5448888 Plesiftg Is matt •Safety Information Accident Type Vehicle Type Paaaanes Vera. Posted Speed Lied 0 Actual Speed 0 Referred to Omar Trafab)11 r Deductible 0.00 Evidence or DrasAiconoi — Wee.19 Seat 500 Accident involve Mier), fr MOWP Ussy Nature Struck ee Veneta Type Maur Eel Environment Inlmslam Cause Veneta-Osut Conditions Swept Factor NAM III Our Auto Liability Claim Details Liability Claim Professionals and customers can view information about non-Workers Comp Auto Liability claims under Claim Details in CareMc ©2014 CorVel Corporation.All rights reserved. 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C a. _a _ i L o�S QJ 3 Da Q. .� a .x u In +, H c cv N o C ,� o a C cc o a E a h °� -a a D cu +O' voi 41 p u C :° • a }' c 4 v n aci V N C O a1 7 •- O x E c c 'a C -o +� ,...C -C2 a a C +- L a OD u Z. o�S E co c a s C 0 L ' y, .0 a) .. v of 73 i t0 .a .� ▪ n w O u a E �, +, L c '47, c 3 > u u n Ci v E o ry o s Z v` Z > c U = to o2$ v H O u f° s VC '^ CO m o o E E C L a+ i (A — 0 +a+ o a1 u a. h0 .^ C u 0 O v O ro CL C 7 v, a` a '++ ` E a Sam 4- +� H O Q Z U o oC 4 v c C1 C V 0 W a. a. or c E 7-; N a E u. o a E E_ o a) N ru a Q f0 (C U lC O x u Q (.) u w = - a I o CU ki Q o x- +, N < a, V .� C7 a) CU y a) _c Q ` > o., a 0 ••v, c U O U U L LI Q ►., in 0 a U cc Izt E Cr)i Gl � �-1 a i--4 i--I N N H H H CORVEL CorVel's Exceptions CorVel Enterprise Comp Inc.'s Legal Exceptions to the Miami Beach Request for Proposal (RFP 2014-302-SW)for Claims Administration Services by a Third Party Administrator for Workers' Compensation and General Liability Page 8 Section 28 Optional Contract Usage - CorVel will provide services under this Agreement to other entities, provided the City is responsible and liable for the actions of the other entities as well as payment for such services. If not then CorVel is willing to provide similar services to other entities with similar terms and conditions to this Agreement and fees shall be based on the volume and types of services provided to those entities. Page 8 Section 31 Indemnification — See redlined version: The contractor shall indemnify and hold harmless the City and its officers, -I- a employees, - e"' - •e •• - ---• - ' - from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, - -- - - •: - --- • - - may incur as a result of third party claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting to the extent from the negligent acts, errors, omissions, willful misconduct or fraud under the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all third party claims and losses in connection therewith, incurred thereon. The contractor expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, and employees, instainaentalities as herein provided. Notwithstanding that, contractor shall not responsible or liable to the extent of City's negligent acts, errors, omissions, willful misconduct or fraud under the performance of the agreement. The above indemnification provisions shall survive the expiration or termination of this Agreement. © 2014 CorVel CONFIDENTIAL I I I CUSTOMER SPOTLIGHT - City of Stockton r CAlit Early Intervention "CorVel's approach has always been The Company a partnership and this has been The City of Stockton, California, has a population dose truly reflected in all aspects of the to 280.000. The City employs approximately 1,600 full- program. time and over 300 part-time and seasonal employees. Workers Compensation Analyst,City of StJcIcton Employees cover a diverse range of occupations that include police, fire, parks. maintenance, garbage, water, clerical and managerial. The Partnership The City of Stockton partnered with CorVel in October 2010 Reduced Lag Time The City was looking for a third party administrator that would focus on a collaborative approach to claims _ . administration and cost containment for their workers' compensation program. Improved Lag Time Reporting The decision to bundle their program has already had a tremendous impact on the City's bottom line, CorVers approach to early intervention focuses on reporting a wor(place incident or injury the moment it occurs, improving lag time and potentially avoiding the largest exposure. The City embraced this approach by . . implementing mandatory training to educate employees _ _ _ and supervisors on the importance of timely reporting. The Results Prior to their partnershp Wttrl CorVel, the City avt_rogcri up to 56 days in lag time reporting of claims. They a-e now averaging only 14 days. Not only are injured viorkers receiving timely medical care, but there '1 dS been a 24/0 decrease in the average incurred cost per claim. The City is very pleased with the results and looks forward to a continued partnership with CorVel. CORVEL w ID 2013 CorVel Corporation.All rights reserved. EL 5.13 CUSTOMER SPOTLIGHT Trillium Staffing 111■401, 0111111 Advo c a cy 24/7 www.trilliumstaffing.com "We are very satisfied with the The Company results achieved through the Established in 1984, Trillium Staffing Solutions is an Advocacy 24/7 program with employment service specializing in staffing, training, CorVel." testing, on-site services, human resources and safety consulting to over 5,000 companies nationally. lirr7 Reid,Risk Manager Innovation In 2012. Trillium Staffing chose to partner with CorVel. Trillium was impressed with CorVel's integrated model, • where claims and managed care services are provided on 9% Decrease in Claims a single platform. From the beginning,Trillium developed a strong relationship with CorVel's team which resulted in a seamless transition. Included in Trillium's integrated `+ `• program was CorVel's Advocacy 24/7 program which offers I' " a nurse triage call center for their employees that would be available 24 hours a day, 7 days a week. Now at the time j , , f. of an incident or injury, employees call and speak with a • registered nurse who evaluates the nature of the incident and determines the employee's immediate medical needs. The Partnership During implementation of t he Advocacy 2417 p program,ran , Trillium understood that employee compliance was a critical element to the success of their program. CorVel worked with Trillium to coordinate training to all key • 3. " personnel and distributed wallet cards to all employees. Based on this extensive program roll-out and Trillium's commitment to program success,the partnership has been Results very successful. By utilizing CorVel's Advocacy 24/7 program fewer incidents a r are tiled as claims.This reduced Trillium's overall incurred costs, while reducing the number of lost-time claims reported.Trillium has been very pleased with the results and looks forward to continued success. CORVEL www.corvel.com 0 2013 CorVel Corporation.All rights reserved. EL 3.13 CUSTOMER SPOTLIGHT O'Reilly Auto Parts au • Seamless r Implementation "CorVel's level of industry experience The Company and workers' compensation knowledge provided the key elements for our Since 1957 O'Reilly Auto Parts has dominated the auto parts market, and currently has over 5,500 locations successful implementation nationally (and growing). O'Reilly's mission is to Wayne Price,Vice President of Treasury offer their customers the best combination of price and and Risk Management quality provided with the highest possible service level. The Partnership O'Reilly chose to partner with CorVel for their claims �+ management program in March 2012. They were A Checklist for Success impressed with CorVel's integrated approach that offers • all claims and managed care services on one platform. In addition,they hoped that CorVel's Advocacy 24/7 program which offers a nurse triage call center for their employees' • _: 24 hours a day,7-days a week,would help improve injury reporting to help reduce the overall cost of risk Implementation CorVel utilized the core principals of quality assurance and p roject management for O'Reilly's program, beginning -� � u, �.► ' - with implementation. CorVel's goal was to meet as early and as often as necessary with them to develop strategies, r y structure processes and assign resources. O'Reilly was assigned a dedicated and experienced Account Manager to oversee the implementation and ensure consistent • communication throughout the process. CorVel worked wit's O'Reilly to distribute Advocacy 24/7 workplace posters A Great Start to each of their locations to encourage use of the program. Everyone's planning and attention to detail paid off. CorVel understands the concerns that companies have CorVel was able to fully implement the program in less with change; to address these concerns we ensure a than 60 days. The launch included setting up over 5,500 successful implementation by following key tasks for locations and interfacing with over 6,000 providers every new account: nationwide. O'Reilly is very pleased with the ease of their implementation and looks forward to improved claims and return to work outcomes. CORVE L vwww.corvel.com 2013 CorVel Corporation.AU rights reserved. EL 5.13 J J J 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Decide with Confidence Supplier Qualifier Report To save report(s) to your PC, click here for instructions. ® Print this Report Copyright 2014 Dun & Bradstreet- Provided under contract for the exclusive use of subscriber 100150009 ATTN: CORVEL CORPORATION Report Printed: AUG 07 2014 In Date BUSINESS INFORMATION CORVEL CORPORATION CORVEL 2010 Main St Ste 600 Irvine, CA 92614 This is a headquarters location. D-U-N-S® Number: 62-036-6708 Branch(es) or division(s) exist. Telephone: 949 851-1473 D&B Rating: 5A1 Financial strength: 5A is $50 million and Fax: 949 851-1469 over. Composite credit Chief executive: V GORDON CLEMONS SR, appraisal: 1 is high. CHB-PRES D&B Supplier Risk: 1 Stock symbol: CRVL SUPPLIER EVALUATION RISK (SER) RATING FOR THIS FIRM : 1 Year started: 1987 �7 Employs: 3,172 (Undetermined here) 9 8 7 6 5 4 3 2 1 All amounts are displayed in local currency. High Medium Low Financial statement date: JUN 30 2014 Sales F: 429,310,000 Net worth F: 130,521,000 History: CLEAR Financial condition: STRONG D&B PAYDEX® D&B PAYDEX: 74 I When weighted by dollar amount, payments to [suppliers average 9 days beyond terms. 10a 120 stays slow 30 days slow prompt Anticipates Based on up to 24 months of trade. https://supplierportal.dnb.com/webapp/ cs/stores/senAet/SQRReportDisplaY?reportFormat=hardcopy&printPrompt 1/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION SUMMARY ANALYSIS D&B Rating: 5A1 Financial strength: 5A indicates $50 million and over. Composite credit appraisal: 1 is high. This credit rating was assigned because of D&B's assessment of the company's financial ratios and its cash flow. For more information, see the D&B Rating Key. Below is an overview of the company's rating history since 12/14/01: D&B Rating Date Applied 5A1 06/12/12 5A2 06/13/11 5A1 05/16/11 5A2 08/24/09 5A1 07/07/06 1R2 06/30/06 • 5A1 12/06/05 1R2 07/06/05 5A1 10/12/04 5A2 12/14/01 The Summary Analysis section reflects information in D&B's file as of August 6, 2014. RISK SCORE ANALYSIS SER COMMENTARY: - Higher risk industry based on inactive rate for this industry. PROBABILITY OF CEASED OPERATIONS/BECOMING INACTIVE SUPPLIER EVALUATION RISK RATING: 1 The probability of ceased operations/becoming inactive indicates what percent of U.S. businesses is expected to cease operations or become inactive over next 12 months. Probability of Supplier Ceased 1.3% (130 PER 10,000) Operations/Becoming Inactive : Percentage of US business with same SER 13% (1,300 PER 10,000) score : Average Probability of Supplier Ceased 5.60% (560 PER 10,000) Operations/Becoming Inactive : - Average of Businesses in D&B's Supplier Database CREDIT DELINQUENCY SCORE: 546 DIVERSITY Minority-Owned Business: N/A Historically Underutilized Business: N/A Women-Owned Business: N/A Veteran-Owned Business: N/A Disadvantaged Business Enterprise: N/A Vietnam Veteran Business: N/A Small Disadvantaged Business: N/A Disabled-Owned Business: N/A HUB-Zoned Certified Business: N/A Historical College Classification: N/A SBA 8(a) Certified: N/A Labor surplus area: YES (2014) hops://supplierportal.dnb.comlwebappMcs/stores/serviet/SQRReportDisplaV?reportFormat=hardcopy&printPrompt 2/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Small Business: N/A SPECIAL EVENTS 07/29/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the 3 months ended June 30, 2014: Revenue of $124,364,000, Net Income of $8,299,000; compared to Revenue of $118,113,000, Net Income of $8,609,000 for the comparable period in the prior year. 05/30/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the year ended March 31, 2014: Revenue of $478,816,000, Net Income of $34,392,000; compared to Revenue of $429,310,000, Net Income of $26,730,000 for the comparable period in the prior year. 01/30/2014 EARNINGS UPDATE: According to published reports, comparative operating results for the 9 months ended December 31, 2013: Revenue of $358,570,000, Net Income of $26,059,000; compared to Revenue of $317,351,000, Net Income of$19,150,000 for the comparable period in the prior year. CUSTOMER SERVICE If you have questions about this report, please call our Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. If you are outside the U.S. contact your local D&B office. *** Additional Decision Support Available *** Additional D&B products, monitoring services and specialized investigations are available to help you evaluate this company or its industry. Call Dun & Bradstreet's Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. or visit our website at www.dnb.com. HISTORY The following information was reported 11/18/2013: Officer(s): V GORDON CLEMONS SR, CHB-PRES-CEO-COO SCOTT F MCCLOUD, CFO DONALD C MCFARLANE, CHIEF INFORMATION OFFICER DIANE J BLAHA, V PRES SLS &ACCOUNT MANAGEMENT DIRECTOR(S): The officers identified by (+) and Steven 3 Hamerslag, Alan R Hoops, R Judd Jessup, Jean H Macino and Jeffrey J Michael. The company was incorporated in the State of Delaware on May 29, 1992. Business started 1987. The company was incorporated in 1987 and reincorporated in 1992. The company's common stock is traded on the NASDAQ Global Select Market under the symbol "CRVL". As of May 28, 2013, there were 1,390 shareholders of record. As of March 31, 2013, those shareholders identified by the company as beneficially owning 5% or more of the outstanding shares were: Corstar Holdings Inc (34.70% ); Wellington Management Company LP (6.66%); FMR LLC (6.26%); HealthCor Management, LP (5.30%); Jeffrey 3 Michael (35.68%) and V Gordon Clemons Sr (9.34%). As of the same date, officers and directors as a group beneficially owned 46.61% of the outstanding shares. V GORDON CLEMONS SR. Director of the company. He has served as the company's CHB since April 1991. He was recently reappointed as the company's CEO, President and COO in April 2012 upon the resignation of Daniel Starck from those positions. He also served as the company's CEO from January 1988 until August 2007, when he was appointed to that office and as President from January 1988 until May 2006, when Mr Starck was appointed to that office. SCOTT F MCCLOUD. He has been the CFO since August 2005. From June 1997 to August 2005, he was the company's Controller. DONALD C MCFARLANE. He has been the company's Chief Information Officer since February 2007. Before https://supplierportal.dnb.com/webapp/wcs/stores/senAet/SQRReportDisplay?reportFormat=hardcopy&printPrompt 3/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION becoming Chief Information Officer, he was Vice President, Information Technology from 1995 through January 2007. DIANE J BLAHA. She has been the company's Senior Vice President, Sales and Account Management since November 2010. From November 2008 to November 2010, she served as Vice President of Sales. From 1996 to November 2008, she served as Vice President of Regional Sales. STEVEN J HAMERSLAG. Director since 1991. He has been the Managing Partner of TVC Capital since April 2006. ALAN R HOOPS. Director since 2003. He has been the CHB and CEO of CareMore California Health Plan, since March 2006 until 2012. R JUDD JESSUP. Director since 1997. He has been CEO and a director of Combimatrix Corporation, from August 2010 to March 2013. JEAN H MACINO. Director since 2008. She was elected as the Managing Director of Marsh and McLennan Companies, from 1980 to 1995. JEFFREY J MICHAEL. Director since 1990. He has been President and CEO of Corstar Holdings, Inc., since March 1996. BUSINESS REGISTRATION CORPORATE AND BUSINESS REGISTRATIONS REPORTED BY THE SECRETARY OF STATE OR OTHER OFFICIAL SOURCE AS OF APR 21 2012: Registered Name: CORVEL CORPORATION Business type: CORPORATION Corporation type: NOT AVAILABLE Date incorporated: MAY 29 1992 State of incorporation: DELAWARE Filing date: MAY 29 1992 Registration ID: 2299227 Status: STATUS NOT AVAILABLE Where filed: SECRETARY OF STATE/CORPORATIONS DIVISION, DOVER, DE N ORPORATING SERVICES, LTD. 3500 SOUTH DUPONT HIGHWAY, DOVER, DE, Registered agent: I C LTD.,9 9 199010000 OPERATIONS 11/18/2013 Description: The company provides medical cost containment and managed care services to manage the medical costs of worker's compensation and auto claims. The company offers network solutions, including bill review, PPO management, professional review, reimbursement, pharmacy, directed care and clearinghouse services, as well as medicare solutions. It also provides patient management services comprising claims management, case management, nurse triage, utilization management, vocational rehabilitation, life care planning, disability management, liability claims management and auto claims management. Revenues are derived from services. Sells to commercial concerns. Territory : United States. Business slow in 3rd quarter. Employees: 3,172 which includes officer(s). Undetermined employed here. Facilities: Leases 12,000 sq. ft. in a building. Branches: This business has multiple branches, detailed branch information is available in D&B's linkage or family tree products. https://supplierportal.dnb.comlwebapp/wcs/stores/ser∎let/SQRReportDisplay?reportFormat=hardcopy&printPrompt 4/13 8/7/2014 D813 Supplier Qualifier Report:CORVEL CORPORATION Subsidiaries:This business has multiple subsidiaries, detailed subsidiary information is available in D&B's linkage or family tree products. FAMILY LINKAGE This business is at the head of its corporate family tree. It is not a subsidiary of any other business. UNSPSC UNSPSC (United Nations Standard Product and Services Code) is a globally accepted commodity (Product and Services) classification system. CORVEL CORPORATION offers the following product(s) and service(s): 84131602 Health or hospitalization insurance 85101601 Nursing services 85121600 Medical doctors specialist services NAICS Beginning in 1997, the Standard Industrial Classification (SIC) was replaced by the North American Industry Classification System (NAICS). This six digit code is a major revision that not only provides for newer industries, but also reorganizes the categories on a production/process-oriented basis. This new, uniform, industry- wide classification system has been designed as the index for statistical reporting of all economic activities of the U.S., Canada, and Mexico. 561110 Office Administrative Services 621111 Offices of Physicians (except Mental Health Specialists) 621491 HMO Medical Centers Sic Based on information in our file, D&B has assigned this company an extended 8-digit SIC. D&B's use of 8-digit SICs enables us to be more specific to a company's operations than if we use the standard 4-digit code. 87419907 Nursing and personal care facility management 80110100 Internal medicine practitioners 80110300 Medical insurance associations D&B PAYDEX The D&B PAYDEX is a unique, dollar weighted indicator of payment performance based on up to 225 payment experiences as reported to D&B by trade references. • 13-Month D&B PAYDEX: 73 i 1D&8 PAYDEX: 74 1 When weighted by dollar amount, payments to When weighted by dollar amount, payments to j suppliers average 11 days beyond terms. ' , ;suppliers average 9 days beyond terms V 1010 0 V 100 r I i 120 days stow 30 days slow Prompt Anticipates 120 days snow 30 days slow Ptompt Anticipates Based on trade collected over last 3 months. Based on up to 24 months of trade. When dollar amounts are not considered, then approximately 86% of the company's payments are within terms. PAYMENT SUMMARY https://suppl ierportal.dnb.comlwebapp/wcs/stores/seal et/SQR ReportD i splay?reportFormat=hardcopy&pri ntPrompt 5/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION The Payment Summary section reflects payment information in D&B's file as of the date of this report. Below is an overview of the company's dollar-weighted payments, segmented by its suppliers' primary industries: Total Total Dollar Largest High Within Days Slow Rcv'd Amts Credit Terms <31 31-60 61-90 90> (#) ($) ($) (%) (%) • Top industries: Public finance 14 157,250 100,000 100 - - - - Help supply service 12 56,100 1 15,000 71 , 29 - - - Short-trm busn credit 10 85,750 40,000 97 2 1 - - Whol office equipment 8 ' 13,850 7,500 91 - - - 9 , - Nonclassified 6 87,600 45,000 100 , - - - - Misc business service 5 , 25,000 10,000 30 ; 70 - - - Employment agency 4 38,500 20,000 99 - - 1 - Whol office supplies 3 60,750 r 60,000 100 ' - - - - Data processing svcs 1 95,000 95,000 50 50 - - - Gravure printing 1 60,000 60,000 ' 50 ' 50 - - - OTHER INDUSTRIES 101 83,200 5,000 81 5 4 3 7 Other payment categories: Cash experiences 52 10,050 1,000 Payment record unknown 8 2,400 500 Unfavorable comments 0 0 0 Placed for collections: With D&B 0 0 , Other 0 , N/A Total in D&B's file 225 775,450 100,000 The highest Now Owes on file is $60,000 The highest Past Due on file is $10,000 Dun & Bradstreet has 225 payment experiences in its file for this company. For your convenience, we have displayed 80 representative experiences in the PAYMENTS section. PAYMENT DETAILS Detailed payment history Date Reported �Paying Record High Credit Now Owes Past Due Selling Terms Last Sale ' (mm/YY) ($) ($) ($) Within (months) 07/14 Ppt 500 , 0 1 mo Ppt 5,000 0 . 0 6-12 mos Ppt 1,000 1,000 0 . 1 mo https://suppl ierportal.dnb.com/webapp/wcs/stores/serviet/SQRReportDisplay?reportFormat=hardcopy&pri ntProrrpt 6/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Ppt 750 0 0 1 mo Ppt 750 0 0 N30 6-12 mos Ppt 250 0 0 6-12 mos Ppt 100 ' 100 0 1 mo Ppt 100 50 0 1 mo (009) 100 Cash account 1 mo A®®® ®A®®Cash own option. 06/14 Ppt 250 0 1 mo Ppt 500 0 1 mo Ppt 40,000 20,000 0 1 mo • Ppt 20,000 7,500 0 , 1 mo Ppt 15,000 15,000 0 N30 1 mo Ppt 15,000 15,000 0 1 mo Ppt 7,500 7,500 0 1 mo Ppt 5,000 2,500 ' 0 1 mo Ppt 5,000 2,500 ' 0 1 mo Ppt 5,000 0 ' 0 2-3 mos Ppt 5,000 5,000 0 N60 1 mo Ppt 2,500 1,000 ' 0 , 1 mo Ppt 2,500 0 1 mo ' Ppt 2,500 2,500 0 : N30 1 mo Ppt 2,500 1,000 ' 0 1 mo Ppt 2,500 0 ' 0 . i 4-5 mos Ppt 2,500 1,000 0 1 mo Ppt 2,500 2,500 . 0 1 mo Ppt 2,500 0 2-3 mos Ppt 1,000 0 ' 1 mo Ppt 1,000 100 0 N30 1 mo Ppt 1,000 1,000 ' 0 . N30 1 mo Ppt 1,000 750 0 1 mo Ppt 1,000 500 0 . N30 1 mo Ppt 1,000 . 0 0 2-3 mos Ppt 1,000 1,000 0 . N30 1 mo Ppt 750 50 0 Lease Agreemnt 1 mo Ppt 750 50 0 ; 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 0 6-12 mos Ppt 750 0 ; 0 N30 1 mo Ppt 750 0 0 2-3 mos Ppt 750 0 : 1 mo Ppt 750 0 0 Lease Agreemnt 6-12 mos Ppt 500 0 0 6-12 mos Ppt 500 250 0 1 mo Ppt 500 ! 500 1 0 ' 1 mo Ppt 500 0 0 2-3 mos Ppt 500 500 ' 0 : N30 1 mo Ppt 500 100 0 1 mo Ppt 250 0 0 2-3 mos Ppt 250 0 0 6-12 mos Ppt 250 100 0 1 mo https://suppl ierportal.dnb.cornlwebapp/wcs/stores/serviet/SQRReportDisplay?reportFormat=hardcopy&pri ntPrompt 7/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Ppt 250 0 0 6-12 mos Ppt 100 0 0 6-12 mos Ppt 100 100 0 Lease Agreemnt 1 mo ∎ Ppt 100 , 0i 0 ; 6-12 mos Ppt 100 100 0 1 mo Ppt 100 0 0 6-12 mos Ppt 50 50 0 1 mo - Ppt 50 1mo Ppt 50 50 0 1 mo ' Ppt 50 0 ! 0 1mo Ppt 0 0 0 6-12 mos . Ppt 0 0 . 0 2-3 mos • Ppt 0 0 ' 0 2-3 mos Ppt 0 0 . 0 4-5 mos Ppt-Slow 30 100 0 1 mo Ppt-Slow 30 1,000 0 ; 1 mo Ppt-Slow 30 60,000 45,000 0 1 mo • Ppt-Slow 30 15,000 N15 1 mo Ppt-Slow 30 2,500 , 0 • 0 2-3 mos Ppt-Slow 30 500 0 ' 0 1 mo Ppt-Slow 60 1,000 : 250 0 1 mo Ppt-Slow 90 1,000 0 0 N30 6-12 mos Slow 30 10,000 5,000 0 1 mo Slow 30-60 50 ' 0 0 6-12 mos (078) 0 0 ' 0 Cash account 6-12 mos 03/14 ' Slow 90+ 500 0 ; 0 6-12 mos 09/12 Slow 120+ 50 50 50 Payment experiences reflect how bills are met in relation to the terms granted. In some instances payment beyond terms can be the result of disputes over merchandise, skipped invoices etc. Each experience shown is from a separate supplier. Updated trade experiences replace those previously reported. PAYMENT TRENDS SUPPLIER VERSUS INDUSTRY PAYDEX -> PRIOR 4 QTRS CURRENT 12 MONTH TREND • • 2012 --- 2013 --- --- --- --- - --- 2014 --- --- --- --- --- --- --- SEP ' DEC MAR ; JUN SEP: OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG Supplier, 75 75 76 77 75 75 76 76 77 76 75 75 75 75 74 74 PAYDEX , Industry PAYDEX (Based on 25 establishments in SIC 8741) UP QRT. 80 . 80 80 ! 80 80 80 80 80 MEDIAN 77 ! 77 78 . 78 I 78 i '' 78 i 78 . 78 LO QRT 69 70 71 70 70 70 70 ' 70 PAYDEX scores are updated daily and are based on upto 13 months of trade experiences from the Dun& Bradstreet trade file. https://supplierportal.dnb.corNwebapp/wcs/stores/servlet/SQRReportDisplay?reportFormat=hardcopy&printPrompt 8/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION All amounts displayed within this report are in local currency. STATEMENT UPDATE 08/06/2014 Interim Consolidated statement dated JUN 30 2014: Assets Liabilities Cash 34,134,000 Accts Pay 19,439,000 Accts Rec 57,186,000 Accruals 44,995,000 Customer Deposits 13,005,000 Deferred Income Taxes 7,139,000 Prepaid 4,933,000 Curr Assets 116,397,000 Curr Liabs 64,434,000 Fixt& Equip 51,832,000 Deferred Income Taxes 16,119,000 Goodwill 36,814,000 COMMON STOCK 3,000 Other Intangibles-Net 5,079,000 ADDIT. PD.-IN CAP 120,255,000 Other Assets 952,000 TREASURY STOCK (334,204,000) RETAINED EARNINGS 344,467,000 Total Assets 211,074,000 Total 211,074,000 From APR 01 2014 to JUN 30 2014 sales $124,364,000; cost of goods sold $96,664,000. Gross profit$27,700,000; operating expenses $14,205,000. Operating income $13,495,000; net income before taxes $13,495,000; Federal income tax $5,196,000; net income $8,299,000. Statement obtained from Securities And Exchange Commission. Prepared from books without audit. Explanations The net worth of this company includes intangibles. FINANCE 11/18/2013 Three-year statement comparative: Fiscal Fiscal Interim Consolidated Consolidated Consolidated Mar 31 2012 Mar 31 2013 Sep 30 2013 Current Assets 81,247,000 92,900,000 100,369,000 Current Liabs 44,762,000 52,755,000 62,141,000 Current Ratio 1.82 1.76 1.62 {Working Capital 36,485,000 40,145,000 38,228,000 {Other Assets 90,635,000 89,482,000 92,390,000 i Net Worth 110,382,000 111,402,000 112,393,000 jSales V 412,668,000 429,310,000 Long Term Liab 16,738,000 18,225,000 18,225,000 Net Profit (Loss) 26,552,000 26,730,000 Interim Consolidated statement dated SEP 30 2013: Assets Liabilities hops://suppl ierportal.dnb.com/webapp/wcs/stores/serAet/SQRReportD isplay?reportFormat=hardcopy&pri ntPrompt 9/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Cash 22,192,000 Accts Pay 17,203,000 Accts Rec 54,392,000 Accruals 44,938,000 Customer Deposits 12,497,000 Deferred Income Taxes 6,801,000 Prepaid 4,487,000 Curr Assets 100,369,000 Curr Liabs 62,141,000 Fixt& Equip 50,007,000 Deferred Income Taxes 18,225,000 Goodwill 36,814,000 COMMON STOCK 3,000 Other Intangibles-Net 5,427,000 ADDIT. PD.-IN CAP 114,383,000 Other Assets 142,000 TREASURY STOCK (321,053,000) RETAINED EARNINGS 319,060,000 Total Assets 192,759,000 Total 192,759,000 From APR 01 2013 to SEP 30 2013 sales $237,472,000; cost of goods sold $183,234,000. Gross profit $54,238,000; operating expenses $25,066,000. Operating income $29,172,000; net income before taxes $29,172,000; Federal income tax $11,888,000. Net income $17,284,000. Statement obtained from Securities And Exchange Commission. Prepared from books without audit. Explanations The net worth of this company includes intangibles. The report was updated using information the company filed with the Securities and Exchange Commission. KEY BUSINESS RATIOS Statement date: JUN 30 2014 Based on this number of establishments: 25 Firm Industry Median Quartile Rank (Supplier) Return of Sales: 6.7 Return of Sales: 6.2 N/A Current Ratio: 1.8 Current Ratio: 1.7 2 Quick Ratio: 1.4 Quick Ratio: 1.1 1 Assets / Sales: UN Assets/ Sales: 103.7 N/A Total Liability / Net Worth: UN Total Liability / Net Worth: 176.0 N/A UN = Unavailable PUBLIC FILINGS The following Public Filing data is for information purposes only and is not the official record. Certified copies can only be obtained from the official source. SUITS Status: Pending DOCKET NO.: 201400004510C Plaintiff: PETTIE, RICHARD, BALTIMORE, MD Defendant: CORVEL CORP, WHITE MARSH, MD AND OTHERS Cause: APPEAL Where filed: BALTIMORE COUNTY CIRCUIT COURT, BALTIMORE, MD Date status attained: 04/25/2014 Date filed: 04/25/2014 Latest Info Received: 05/02/2014 Status: Pending CASE NO.: 14S02348 https://suppl ierportal.dnb.com/webapp/wcs/stores/ser Aet/SQRReportD isplay?reportFormat=hardcopy&pri ntPrompt 10/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Plaintiff: WOODARD YOLANDA Defendant: CORVEL CORPORATION, ORANGE, CA Cause: SMALL CLAIMS (LIMITED JURISDICTION) Where filed: LOS ANGELES COUNTY SMALL CLAIMS COURT/INGLEWOOD, INGLEWOOD, CA Date status attained: 04/07/2014 Date filed: 04/07/2014 Latest Info Received: 04/14/2014 Status: Pending DOCKET NO.: 201300097246C Plaintiff: SIMMS, PATRICIA A, COLUMBIA, MD Defendant: CORVEL ENTERPRISE COMP INC, BALTIMORE, MD AND OTHERS Cause: TORT Where filed: HOWARD COUNTY CIRCUIT COURT, ELLICOTT CITY, MD Date status attained: 12/09/2013 Date filed: 12/09/2013 Latest Info Received: 12/27/2013 Suit amount: $1,880 Status: Pending CASE NO.: CC2013129932 Plaintiff: NELS LARSON DC Defendant: CORVEL CORP Cause: Breach of contract Where filed: MARICOPA COUNTY JUSTICE COURT/SOUTH MOUNTAIN, PHOENIX, AZ Date status attained: 07/23/2013 Date filed: 07/23/2013 Latest Info Received: 10/04/2013 Status: Pending CASE NO.: 2013661878CJC Plaintiff: NANCIE NGUYEN Defendant: CORVEL CORPORATION Where filed: ORANGE COUNTY SUPERIOR COURT, SANTA ANA, CA Date status attained: 07/10/2013 Date filed: 07/10/2013 Latest Info Received: 08/06/2013 If it is indicated that there are defendants other than the report subject, the lawsuit may be an action to clear title to property and does not necessarily imply a claim for money against the subject. There are additional Suits in D&B's file on this company available by contacting 1-800-234-3867. LIENS A lienholder can file the same lien in more than one filing location. The appearance of multiple liens filed by the same lienholder against a debtor may be indicative of such an occurrence. Amount: $74 Status: Open CASE NO.: 13-1612095 Type: County Tax Filed by: TAX COLLECTOR Against: CORVEL CORPORATION, CUCAMONGA, CA Where filed: LOS ANGELES COUNTY RECORDER OF DEEDS, NORWALK, CA Date status attained: 11/13/2013 Date filed: 11/13/2013 Latest Info Received: 12/20/2013 Amount: $74 Status: Void CASE NO.: 13-1613962 Type: County Tax Filed by: TAX COLLECTOR https://suppl ierportal.dnb.com/webapp/wcs/stores/serA et/SQRReportD i spl ay?reportFormat=hardcopy&pri ntPrompt 11/13 8/7/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Against: CORVEL CORPORATION, CUCAMONGA, CA Where filed: LOS ANGELES COUNTY RECORDER OF DEEDS, NORWALK, CA Date status attained: 02/06/2014 Date filed: 11/13/2013 Latest Info Received: 02/24/2014 UCC FILINGS Collateral: All Inventory - All Account(s) - All Chattel paper - All Contract rights - and OTHERS Type: Original Sec. party: BRCP RIVERVIEW PLAZA, LLC, SEATTLE, WA KASTNER, WILLIAMS, SEATTLE, WA Debtor: CORVEL CORPORATION, TUKWILA, WA Filing number: 2008 3009741 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 09/05/2008 Latest Info Received: 10/02/2008 Collateral: Business machinery/equipment Type: Original Sec. party: U.S. BANK EQUIPMENT FINANCE, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2012 2635979 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 07/09/2012 Latest Info Received: 08/10/2012 Collateral: Equipment Type: Original Sec. party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2010 2541062 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 07/21/2010 Latest Info Received: 08/11/2010 Collateral: Equipment Type: Original Sec. party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORP, ANCHORAGE, AK Filing number: 2010-691137-7 Filed with: SECRETARY OF STATE/UCC DIVISION, ANCHORAGE, AK Date filed: 02/01/2010 Latest Info Received: 02/10/2010 Collateral: Equipment Type: Original Sec. party: US BANCORP, MARSHALL, MN Debtor: CORVEL CORPORATION, MINNEAPOLIS, MN Filing number: 2009 3228142 Filed with: SECRETARY OF STATE/UCC DIVISION, DOVER, DE Date filed: 10/07/2009 Latest Info Received: 11/04/2009 There are additional UCC's in D&B's file on this company available by contacting 1-800-234-3867. The public record items contained in this report may have been paid, terminated, vacated or released prior to the date this report was printed. GOVERNMENT ACTIVITY https://supplierportal.dnb.com/webapp/wcs/stores/serdlet/SQRReportDisplay?reportFormat=hardcopy&printPrompt 12/13 817/2014 D&B Supplier Qualifier Report:CORVEL CORPORATION Activity summary Congressional District: 45 The details provided in the Government Activity section are as reported to Dun & Bradstreet by the federal government and other sources. Copyright 2014 Dun & Bradstreet- Provided under contract for the exclusive use of subscriber 100150009 https://supplierportal.dnb.com/webapp/wcs/stores/serAet/SQRReportDisplay?reportFormat=hardcopy&printPrompt 13/13 K K K C O R V E L Sample Performance Guarantee Implementation CorVel understands that change can be a challenge and that well executed implementations are crucial to a successful partnership. CorVel invests significantly in our implementation plans that include dedicated resources and implementation specialists. CorVel will put at risk $XXX to ensure a successful implementation that will meet or exceed Waste Industries' expectations. Once implementation is completed, we will solicit your feedback to ensure all expectations were met. While it is difficult to identify specific parameters around this performance guarantee, CorVel will provide Waste Industries the opportunity to express your satisfaction with our overall implementation performance. Claim Administration Impact to Total Cost of Loss - Reduce the Percentage of Lost Time Claims* Through CorVel's Enterprise Comp model, CorVel will reduce the percentage of lost time claims as a component of the overall claims mix. This is measured by calculating the percentage of medical only claims versus the percentage of lost time claims at eighteen months for claims occurring with a date of loss in the first year of the contract and comparing that to the same time intervals of development for the last year of the prior claims administration contract. $XXX will be at risk so that should the percentage of lost time claims be reduced by less than X% , a penalty will be paid by CorVel and if the percentage of lost time claims is reduced by more than X%, CorVel will be incented the same amount. * Nurse Advocacy program with compliance rate of XX% or better. requires mandated use of CorVel's 24/7 y p 9 P 1 I ©2013 CorVel www.corvel.com