HomeMy WebLinkAboutHumana Service Agreement
t>~f~a"~C7~~T~'r`' '~~:~1t13~ '~"t~L~ 114''~''~ 1~ 117~~t
SERVICE AGREEMENT
Between
;_
City of Miami Beach
And
HUMANA MEDICAL PLAN, INC., And
HUMANA HEALTH INSURANCE COMPANY
OF FLORIDA, INC.
For
HEALTH INSURANCE COVERAGE AND BENEFITS
INSURING CITY OF MIAMI BEACH EMPLOYEES
January 1, 2007- December 31, 2007
Doc#: 199099 Verl#:10 980326:0008
- 1 -
// /~
This Agreement is made and entered into this UJ t~ day of ~~ ~l ~~'`~ `~"`"; ~0~, by and between
the CITY OF MIAMI BEACH, a political subdivision of the State of Florida, hereinafter referred
to as "CITY".
AND
HUMANA MEDICAL PLAN, INC., and HUMANA HEALTH INSURANCE COMPANY OF
FLORIDA, INC., and each of their successors and assigns, hereinafter collectively referred to as
"HUMANA".
WITNESSETH, in consideration of the mutual terms, conditions, promises, covenants and
payments hereinafter set forth, CITY and HUMANA agree as follows:
ARTICLE I
DEFINITION AND IDENTIFICATIONS
For the purposes of this Agreement and the various covenants, conditions, term and provisions which
follow, the definitions and identifications set forth below are assumed to be true and correct and are
agreed upon by the parties.
1.1 AFFILIATE: Affiliate means (a) a predecessor or successor of a Person; or (b) an
entity under the control of any natural person who is active in the management of the
entity. The term "Affiliate" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in the management of
an Affiliate. The ownership by one Person of shares constituting a controlling interest
in another Person, or a pooling of equipment or income among Persons when not for
fair market value under an arm's length agreement, shall be a prima facie case that
one Person controls another Person. A Person who knowingly enters into a joint
venture with another Person who has been convicted of a Public Entity Crime in
Florida during the preceding 36 months shall be considered an Affiliate of such other
Person.
1.2 CONTRACT ADMINISTRATOR: Whenever the term "Contract Administrator"
is used herein, it is intended to mean the City of Miami Beach Human Resources
Bureau Director or such Director's authorized designee. In the administration of this
Agreement, as contrasted with matters of policy, all parties may rely upon
instructions or determinations made by the Contract Administrator.
Doc#: 199099 Ver#:10 980326:0008
1.3 DEPARTMENT: Department means the Florida Department of Management
Services.
1.4 EMPLOYEES: Employee shall mean the employees of the City of Miami Beach
and their covered dependents.
1.5 GROUP CONTRACTS: Group Contracts shall mean the contracts containing all of
the benefits available to an insured, which contracts are filed by HUMANA with the
Florida Department of Insurance.
1.6 HUMANA: HUMANA means (a) HUMANA MEDICAL PLAN, INC., and (b)
HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC., in each case
selected to provide health insurance benefits and coverage pursuant to the terms of
this Agreement, the RLI and the Offer.
1.7 HMO PLAN: HMO Plan means the HUMANA Health Maintenance Organization
"HMO" health insurance policy as set forth in the Offer.
1.8 HUMANA REPRESENTATIVE: HUMANA Representative means James
Murdakes, Account Executive, and Michelle Alvarez, Group Services
Representative, at HUMANA MEDICAL PLAN INC., or such individual as may be
designated by HUMANA.
1.9 MEMBERS: Members shall mean the employees who are members of one of the
Plans.
1.10 OFFER: Offer means the offer to provide health insurance benefits and coverage to
the Employees that was prepared by HUMANA for the CITY.
1.11 PERSON: Person means any natural person or any entity organized under the laws
of any state or of the United States with the legal power to enter into a binding
contract and which bids or applies to bid on contracts let by a Public Entity, or which
otherwise transacts or applies to transact business with a Public Entity. The term
Persons includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of an entity.
1.12 PLANS: Plans mean the HMO PLAN, the POS PLAN, the PPO PLAN and any other
plans for the payment of healthcare related services offered by HUMANA to or for
the benefit of the CITY or the Employees.
Doc#: 199099 Vert#:10 980326:0008
-2-
1.13 POS PLAN: POS PLAN means the HUMANA Point of Service health plan set forth
in the Offer.
1.14 PPO PLAN: PPO Plan means the HUMANA high and low options PPO Plan set
forth in the Offer.
1.15 PRIMARY CARE PHYSICIAN: Primary Care Physicians means a licensed
practitioner of medicine under the HMO PLAN and POS PLAN.
1.16 PROVIDER: Provider means a physician or facility providing health related services
pursuant to the terms of this Agreement, the RLI, and the Offer.
1.17 PUBLIC ENTITY: Public entity means the State of Florida, any of its departments
or agencies, or any political subdivision thereof.
1.18 PUBLIC ENTITY CRIME: Public Entity Crime means a violation of any state or
federal law by a Person with respect to and directly related to the transaction of
business with any Public Entity or with an agency or political subdivision of any
other state or with the United States, including, but not limited to, any bid or contract
for goods or services, any lease for real property, or any contract for the construction
or repair of a public building or public work, involving antitrust, fraud, theft, bribery,
collusion, racketeering, conspiracy, or material misrepresentation.
1.19 RETIREE: Retiree means a former Employee who has retired from the City of
Miami Beach with a minimum of 10 years of service under the Florida Retirement
System (FRS) (or is qualified for regular or disability retirement under the retirement
system of a contracted city), or with a full disability that has been accepted by the
FRS, and is drawing a benefit from FRS at the time of retirement (or within 36
months of retirement), and who has elected to participate in a HUMANA group plan.
1.20 ROI: Request for letter of intent
ARTICLE II
BACKGROUND
In order to establish the background, context and frame of reference for this Agreement, and to
generally express the objectives and intentions of the respective parties herein, the following
statements, representations, and explanations shall be accepted as predicates for the undertakings and
commitments included within the provisions which follow and maybe relied upon by the parties as
Doc#: 199099 Ver#:10 980326:0008
-3-
essential elements of the mutual considerations upon which the Agreement is based, to wit:
Negotiations pertaining to the health insurance coverage and benefits to be provided by HUMANA
were undertaken between HUMANA and the CITY.
ARTICLE III
TERM OF AGREEMENT
This Agreement shall commence on January 1, 2007, and shall terminate on December 31, 2007,
unless terminated sooner as provided herein.
ARTICLE IV
SELECTED POLICIES AND BENEFITS
HUMANA shall, in accordance with the provisions contained in this Agreement, provide group
health insurance benefits to the Employees under the following 3 types of insurance plans.
1. HMO
HMO
2. PPO
PPO
3. POS
Plan 2 Option 304 (Premium)
Plan 2 Option 27 (Standard)
Plan 6 Option 782 (Premium)
Plan 18 Option 783 (Standard)
Plan 14 Option 43 8
ARTICLE V
RATES
5.1 The following rates apply to the Employees electing coverage on an individual or
family basis. These rates reflect maximum monthly premium rates. In no event shall
the rates exceed the guaranteed maximum as listed below for the 12-month period
commencing on January 1, 2007, and ending on December 31, 2007.
HMO PLAN PREMIUM RATES (Premium).
Employee $424.06
Family $1,051.11
Doc#: 199099 Ver/#:10 980326:0008
-4-
HMO PLAN PREMIUM RATES (Standard)
Employee $330.73
Family $819.72
PPO PLAN PREMIUM RATES (HIGH)
Employee $851.85
Family $2,089.95
PPO PLAN PREMIUM RATES (LOW)
Employee $646.39
Family $1,585.90
POS PLAN PREMIUM RATES
Employee $491.88
Family $1,220.49
5.2 HUMANA agrees that the premium rates set forth in Section 5.1 are the guaranteed
maximum rates for the 12-month period of this Agreement, commencing on January
1, 2007, and ending on December 31, 2007.
ARTICLE VI
GENERAL PROVISIONS
6.1 ENROLLMENT MEETINGS -The CITY will schedule Open Enrollment sessions
at various locations and times. The CITY will provide HUMANA a complete list of
locations and times where and when such briefings will be held 30 days prior to the
commencement of the first session. HUMANA representatives will attend and
participate in every scheduled meeting to explain benefits and plan information.
HUMANA shall deliver complete enrollment packages for each PLAN to the CITY's
Contact Administrator at least 30 days prior to the start of open enrollment.
HUMANA shall provide complete new enrollment packages (including updated
provider directory) to the Contract Administrator. Updated provider directories shall
be available at the Employee's request through customer service. Employees may
also obtain current provider information through Humana's web site
(www.humana.com.)
Doc#: 199099 Vert#:10 980326:0008
-5-
6.2 IDENTIFICATION CARDS -Following enrollment, The CITY will provide
HUMANA with correctly completed enrollment forms, which will be continuously
batch-processed.. Humana shall, within 10 business days (plus mailing time) send
identification cards to Employees. The Contact Administrator must notify HUMANA
in writing of any Employees who do not receive the identification cards issued as a
result of the initial enrollment process.
Upon HUMANA's receipt of such notice from the Contract Administrator,
HUMANA shall, within 10 business days (plus mailing time), send identification
cards to those Employees who have not received them.
6.3 CLAIMSRESPONSES -HUMANA will process 90% of claims within 14 days of
receipt. Receipt date is measured from the date a clean claim is received to the date it
is processed, meaning paid or denied without requiring additional information from
an external source.
6.4 NOTICE REGARDING PERFORMANCE OF SERVICE PROVISIONS -The
proper party to receive notice on behalf of HUMANA regarding the service
provisions contained within this Article shall be:
James Murdakes Account Executive
Humana Inc.
3401 SW 160 Avenue, Building A, 2°d Floor
Miramar, FL 33027
(305) 626-5231
6.5 CLAIM QUALITY:
(a) Financial Accuracy: HUMANA will pay all clean claims made by Members
under the Plans in a manner that will assure that 99% of all such claims are
paid in the amounts required under the Plans.
(b) Procedural Accuracy: HUMANA will pay all clean claims made by
Members under the Plans using procedures that will assure that 97% of all
such claims are paid in accordance with the procedures required under the
Plans.
Doc#: 199099 Ver#:10 980326:0008
-6-
6.6 TELEPHONE RESPONSIVENESS:
(a) Agreement: HUMANA will be responsive to each and every telephone call
received from an Employee on the customer service line established for the
CITY. In connection therewith, HUMANA agrees that: (i) 80% of all such
telephone calls will be answered by HUMANA ready to assist such Employee
within 20 seconds (average of all calls made) of the time such call is placed
by such Employee (the Timing Requirement); and (ii) HUMANA's
abandonment rate on all such calls will be less than 3% (the Abandonment
Rate).
(b) Measurement: To assure HUMANA is attaining the requirements set forth in
subsection (a) above, HUMANA will deliver to the CITY, within 10 days of
the end of each quarter, specific reports and other measurements made by
HUMANA to demonstrate the rate at which HUMANA is answering calls,
and HUMANA's Abandonment Rate.
ARTICLE VII
TERMINATION BY CITY
Notwithstanding anything else to the contrary contained herein, City shall have the right to
terminate this Agreement, with our without cause, at any time and for any reason, and any
liability to CITY, upon providing HUMANA with at least 60 days prior written notice.
ARTICLE VIII
NOTICES
Whenever either party desires to give notice unto the other, other than notice for the service
provisions set forth in Article VI, such notice must be in writing, sent by certified United States mail,
return receipt requested, addressed to the party for whom it is intended at the place last specified; and
the place for giving of notice shall remain such until it shall have been changed by written notice in
compliance with the provisions of this paragraph. For the present, the parties designate the following
as the respective places for giving of notice:
Doc#: 199099 Ver#:10 980326:0008
-7-
FOR CITY:
Mayra D. Buttacavoli
Director Human Resources and Risk Management
1700 Convention Center Drive
Miami Beach, FL 33139
FOR HUMANA:
James Murdakes
Account Executive
Humana Medical Plan, Inc.
3401 SW 160 Avenue, Building A, 2"d Floor
Miramar, FL 33027
(305) 626-5231
ARTICLE IX
PUBLIC ENTITY CRIMES ACT
In accordance with Section 287.133, Florida Statutes, HUMANA verifies by means of the Florida
Statutes the convicted vendors list maintained by the State of Florida Department of General Service.
ARTICLE X
ENTIRE AGREEMENT
All provisions contained within this Agreement represent all the terms and conditions agreed to by
the CITY and HUMANA. The CITY and HUMANA recognize that in order to comply with
applicable State laws, HUMANA must file a document with the State of Florida Department of
Insurance setting forth the benefits and coverage to be provided by HUMANA under the terms of
this Agreement, and this Agreement is subject to the Florida Department of Insurance approval.
Doc#: 199099 Ver#:10 980326:0008
-8-
ARTICLE XI
AMERICANS WITH DISABILITIES ACT
HUMANA warrants that its coverage exclusions and limitations on coverage are based on
underwriting criteria and risks, in conformance with the Americans with Disabilities Act of 1991
(ADA), 42 U.S.C.S. 12101 et seq., and no attempt has been made to circumvent the provisions of the
ADA. HUMANA will administer the Plans, uniformly apply all coverage exclusions ad limitations,
and otherwise perform its obligations under the Agreement in a manner consistent with the ADA.
ARTICLE XII
ALL PRIOR AGREEMENTS SUPERSEDED
This document incorporates and includes all prior negotiations, correspondence, conversations,
agreements, or understandings applicable to the matters contained herein; and the parties agree that
there are no commitments, agreements or understandings concerning the subject matter of this
Agreement that are not contained in this document. Accordingly, the parties agree that no deviation
from the terms hereof shall be predicated upon any prior representations or agreements whether oral
or written.
It is further agreed that no modifications, amendment or alteration in the terms or conditions
contained herein shall be effective unless contained in a written document executed with the same
formality and of equal dignity herewith.
In the event that a conflict arises between this Agreement and the Group Contract, this Agreement
shall be controlling.
Both Humana Medical Plan, Inc. and Humana Health Insurance Company of Florida, Inc. agree that
each is jointly and severally liable for all obligations of HUMANA under this Agreement.
Doc#: 199099 Ver#:10 980326:0008
-9-
WHEREOF, the parties have made and executed this Agreement on the respective dates under each
signature.
FOR CITY:
CITY OF MIAMI BEACH, FLORIDA
ATTEST:
BY: ,~ ~ r ~ ~/ ~~~
City Clerk U
Robert Parcher
B'~: --
Matti Herrera Bower
~ Vice-Mayor
Date•
FOR HUMANA:
HUMANA MEDICAL PLAN, INC.,
ATTEST:
BY:
Secretary
BY:
President
Print Name Joan 0. Lenahan
Print Name ~ ~, ~ ~ ~~ ~ ~~
Date:
HUMANA HEALTH IN NCE COMPANY OF
FLORIDA, I
By
President
Print Name ~ L~ N ~ • J ~ ~ ~
By ~
cretary
Print Name Joan 0. Lenahan
Date:
Doc#: 199099 Vert#:10 980326:0008
APPROVED AS TO
FORM & LANGUAGE
8~ FOR CUTION
~ ~ Il~
omey a
- 1~-
m 1~I~\.^,^,JBEACH
HUMAN RESOURCES AND RISK MANAGEMENT DEPARTMENT Employee Benefits Division
MEMORANDUM
TO: Robert Parcher
City Clerk
FROM: Sue Radig~~wJ@-~
HR Administrator (~
Employee Benefits
DATE: August 17, 2007
SUBJECT: 2007 Humana Agreement
Enclosed you will find an original and two copies of the 2007 agreement between the City of
Miami Beach and Humana Medical Plans to provide medical plan benefits to the City's
employees.
Upon completion of the RFP and after considerable negotiations with Humana, the top ranked
firm, and Cigna, the secondary firm the Group Insurance Board unanimously approved the
renewal of the City's agreement with Humana for a period not to exceed two years. This decision
was shared with the City Commission during the September 2006 Commission Meeting who
adopted Resolution No. 2006-26326.
I am enclosing a copy of the Resolution for your reference.
lNe ore mrir,~i:Yeo`ro providing excellent public service and sod°rr' h~ ell who live, ,ti~erk, arc prey ;~ cur vi%ranr, r,~op;cci, his~`or+c cemar~ni,y.
Page 1 of 2
Hernandez, Kerry
From: Radig, Sue
Sent: Friday, August 17, 2007 1:37 PM
To: Hernandez, Kerry
Cc: Parcher, Robert
Subject: RE: Humana agreement
Bob and Kerry,
I think this should be it. But yell at me if you need more.
5/F ?~>P.;~~
From: Hernandez, Kerry
Sent: Thursday, August 16, 2007 11:18 AM
To: Radig, Sue
Cc: Parcher, Robert
Subject: Humana agreement
Sue,
Bob Parcher researched this agreement and said that this agreement was adopted by resolution 2006-26326
(please check enclosure).
Because the resolution authorized the administration to enter into contract negotiations with a primary or
secondary firm, Bob wants a memorandum issued by your Department stating the firm chosen (Humana) before
executing the agreement.
I will keep the agreement on hold until I receive the memorandum
Thanks,
Kerry
R7R A Resolution Authorizing The Administration To Enter Into Contract Negotiations For A Group Medical Plan
With The Top-Ranked Firm Of Humana, (Primary) And The Second-Ranked Firm Of Cigna (Secondary); And
Further Authorizing The Mayor And City Clerk Ta Execute Contract(s) With The Primary Or Secondary Firm Upon
Completion Of Successful Negotiations For A Premium Of $16,000,000; And Renewal Of The Group Dental Plan
With Compbenefits, For A Premium Of $2,000,000; As Proposed By Arthur J. Gallagher And Co., The City's
Broker Of Record.
(Human Resources & Risk Management)
ACTION: Resolution No. 2006-26326 adopted. Motion made by Commissioner Bower; seconded by Vice-Mayor
Libbin; Voice vote: 6-0; Absent: Commissioner Cruz. Mayra Buttacavoli to handle.
MIAMIEACH
Kerry A. Hernandez, Office Associate V
08/20/2007