HomeMy WebLinkAboutHumana Service Agreement - 1/1/08 to 12/31/08yy'y~ -~~~~v6,
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CITY OF NILYNII KEACH ~ ~`•' ~~~
And ~: ~n
HUNIANA NIF,DiCAL PLAN, INC., And
HUNIANA HEALTH INSI:'RANCE COMPANY
OF H'LORIDA, INC.
For
HI?ALTH INSLRANCH: COVERAGE ANll BI;NEFTTS
INSURING CITY OF MIAA11 BF.:~CH El\'TPLOYEES
.JANUARY ], 2(?IIR-DECEMBER 31, 2008
Page 1 of 13
uo,1r. 19 rp~„-, v~r is vs~., •:. noo*
This AkReemcn[ made is and entered into this 1" dap ofJanttary; 200A, by and bctvvcco the CITY OT
AILlA41 REACH. a political subdivision of the State of Florida, hereinafter referred to as "CI'IT"
ANl)
HUNIANA DiGDIC'AI. PLAN, INC., and IIUAT:IN:1 HEALTH INSUK.INC'L CObIP:1NY OF
FLORIDA, INC., and each of"their successors and assigns, hereinafter collectively referred to as
"H 1; ~4ANA".
~~'}TNESSE'1'H, in consideration ofthc mm~ral terms. conditions; protniscs, covenants and payments
hercinattcr set forth. CITY and HU(\IANA agree as fi~llotvs:
AR'I'ICLC I
DF.FINfI'IONS :1ND IDF.NTIF[CA'I'IONS
For the purposes of this .A~ cement and the various covenants, conditions. terms and provisions
which follovm. the delinitions and identifications set forth below are ;tssumed w he true and corral
and are agreed upon by the parties.
l .l AFFILLITF.::1FF'ILIA'fL means (a) a predecessor or successor of a PERSON: or
(bl an entity under the control ol'any natural person vvito is active in the mana,erncnt
of the entity.l'he temt "AFF}}.ltV"I"F." includes those ofticers, directors, executives,
partners, shareholders. employees. members, and agents who arc active in the
managcntcnt of an AFFll.L1"I L•'. 'fhe ova°nzrship of Ht l\1AN;1 by one PLKSON of
shares constituting a controlling interest in another PLKSON. or a pooling of
eyuipment or incontc among PF.RSOi\S when not for f~rir market value under an
arnt's length agreement, shall be a prima facie case that one PGKSON controls
another PERSOi\.:\ PGKSON vvho knowingly enters into a joint venture with
another PERSON tvho has been convicted o f a PU BLIC Ll\ TITY CRIT` f F, in Florida
during the preceding 3ti months shall he considered vt APPILI.4TF. of such other
PERSON.
I.? CONTR:ICT AD1111NIS'1'R:~TOR: 4L'hcncvcrthc term Conu~act Administrator is
used herein. it is intended to ntcau the City of iViiami Beach Human Resources
Director or such Directors designee. In the day to day adminisu~ation of this
:1e cement, as contrasted with matters of policy, all parties may rely upon
instructions or determinations ntadc by the Conu~xct Administrator.
Page 1 of 13
Ikck~ 'vvn99 Vre~. N 4893?L Gp?P
t.3 UI;YART~1Tl\T: Depurhnent means the Florida Department of 1+danultement
Services.
1.4 F.NiPL01'F,E: Employee shall mean the employees of4te City of Dliami Beach and
their covered dependents.
l.i CROL:P C'OVTRAC'I'S: Clroup Contracts shall mean the contracts containing all of
the hcnctits available to an insured, +vhich contracts arc filed b_v 11CIvL~NA +a ith the
l~lorida Deparnnent of Insurance.
1.6 llUNI:1NA: T111\gA~IA means (a) HUNLIN:~ D~IEDIC'AI. Pi..AN, INC.. and (b)
IIU?~4A~IA HF.;1l: I H INSUK:IKCL• C0~4P.4NY OF FLORIT)~\, INC.. in each case
selected to pmvidc health insurance benelits and coverage pursuant to the terms of
this :lgrecntent and the Offer (as defined hclo++~1.
1.7 HA70 PLAN: IIIvIO Plan means the Hl: fv1.11\;1 Health Dlaintcnance Organization
"Hb1U" health insurance polio}' as set forth in the Offer submiUed by Hi;1viANA.
1.8 IIUMA'_YA RF.PRESEN'l:a'I'L~~E: IIL'IvI~.NA Representative means Donne
Lambeni..Account Executive vu1 Y:unilet Abecassis. Group Services Kcpresentativc,
at Humana (\9edical Ylan htc.. or such other individual is designated by I IU\LAKA.
19 ~1F.)\16ERS: \4mbers shall mean the Employees and Ketirecs +vho are members of
one of the YLAKS.
I.10 ONFER: Oiler means the otter to provide health insurance benelits and coverage to
the Employees or the Ketirecs that +vas prepared by HUh~1:1N:'1 for the CITY.
I.1 1 YERSO>\: Person means vty natural person or any entity organized under the 1a+vs
ol• any state or of the i_?nited Buttes with the Icgal power to enter into a binding
contract and which bids or applies to bid ott couU•acts tel. by a Public Entity. or which
otherwise u-ansucts or applies to transact business with a Yublic Ltttity. The term
Persons includes those officers, directors. executives, partners. shareholders,
employees, members, and agents who are active in management of an eauitc.
1.12 YL.~VS: Plans mean the 1Lb1O PEAK. the POS PL!\V, t}te PYO PLAN and any other
plans li>r the payment of healthcare related services oil'ered by Hl I\1:1N:1 to or for
the benefit of the Cil.y ul' \4iami Beach or the Employees or the Ketirecs.
1.1 i POS PLAN: P(_)S Plan mean; the llll\9.AN.4 PointaCScrvieeltealthpltut set (irrth in
the Offer.
Page 2 of 13
1.1=} YPO YLAK: PPO Plan means the HU~4AN:1 lilgh and low• options PPO Plan set
tbrlh in the OI)cr.
1.1 S PRIMARY CAKl: 1'lIY'SICi:11\: Primary Cure Physicians means a licensed
practitioner of medicine under the H\90 PL;1N and POS YLA<v'.
1.16 YKOVIDER: Provider mesuts a physicivt or facility providing health related sen ices
pursuznu to the terms of This Agreement and the Offer.
1.17 PUBLIC El\'1'1'L1`: Public entity means the State of Florida, any of its departntcnts
or agencies, or any political subdivision thereof.
L l3 PCRLIC EN'1'1'l'1' CRI~'IE: Public F.nlity Crime means a violation of any state or
ledcral law by a Person with respect to and dircetl}° related to the transaction of
business with arrv Public Entity or with an agency ar political subdivision of am
other state or with t}tc l;ttitcd States, including, but not limited to. any bid or contract
litr goods or services, any lease lirr real property. or am• contract for the construction
or repair ofa public building or public ta'ork. involving untin•ust, fraud, then, hriber~.
collusion, racheteerine, conspiracy, or material misrepresentation.
1.19 RF.T[REE: Ketiree means a litrn~er Hmployce va'ho has retired from the City of
lvliami Beach f or is yuali tied titr regular or disability retuentent under the retirement
system of a cmuracted city, and to°ho has elected to patticipate in a HL~14L1NA plan.
~RF.NIAI)<llER OF TH1S PAGE IN'1'EN7~10'VALLY LEFT BLAKK~
Page 3 of 13
ARTtc><:r rr
A.~+:CKGROCVll
]n order to establish the bacl.ground. context and frame of reference fur this Acrecntent and to
generally express the ohjectives and intentions of the respective parties herein, the li>llowing
statements. represcnta[ious, and explanations shall ho accepted as predicates lirr the undertakings and
cc»nmiuncn[s included within the provisions which follota ttnd may he relied upon b}~ ttte parties as
essential clcmcrtts of the mutual considerations upon which the :lgrcemcnt is based. to wit:
Nceotistion~ pertaining to the health insurance coverage and bcnctits to be provided by Trr 7R1ANA
were undrrtal:cu hct`wcat 1ILT~~iAK,4 and the Cl'1'Y.
:1RTICLE III
TERM OF AGRT,TJIENT
This :\grccmcnt shall commence on January 1, 2008, and shall tcnninate un llcccmber 31, 2008,
unless terminated sooner as provided herein. The CITY and HU\1:1V:1 shall have the option to
rcucw this Agreement tier one (1) additional lenn upon mutual a~~ 'cement, <utd sunject Ihrther to the.
prior approval of the 'Mayor and the Cit.' Conmtission of the Citt.
ARrrc>,r rv
SELECTT'D POLICIES :1N1) 13EKPFITS
HU(\~I~VA shall, in accordance tvitlt the General Provisions contained in Atlicle Vi hereol, provide
group health insurance bcnclits to the F.mployces and Ketirees under the lirlhtwing three (±) i<~pes of
insurance plans.
1. HMO Plan 2 Option 304 (Premium)
1ID~7G Plan 2 Option 27 f Standard)
2. PPO Plan 6 Option 782 (Premium)
PPU Plan l8 Option 783 (Standard)
3. POti Plan 14 Option 438
Page 4 of 13
Lh~ a l ii:i_^i+ l cn• Ip q%~ I Vii. 'v'. C
ARTICLI: ~'
RATES
~.l The fi~llo~a°ing rates apply to the F.mployces and Retirees electing coverage on an
individual or family basis. 'lltcsc rates reflect maximum monthly premium rates. Lt
no event shall the rates cxczcd thz gu:n~anteed maximum as listed below for thz
hveh e (12)-month period commem ing .laouart° 1, 3008. tktrough f)ecemher 31.2008:
H~IO PLAI\ PKE~'11U~'1 R:~TF.S (Premium)
Employcc 548155
family $1203.12
H)<•i0 PLAN YKIr~IIC-A4 RATT•.S (Standard)
Employcc 5311 ?3
l amih $881.2(1
PPO PLAY PKL•'DHUNi RATES (Premium)
Employze 597136
Pantily $2392.99
PPO PLAN YK)!:N1IL-114 RATES (Standard)
Employee $694.87
family $1704.84
PUS PLAN PRF,A41UN1 KA'1'ES
Employcc 5141.07
1'wnily S l 342.14
13 HUII4AN_1 a~Rees that the prcntium rates set litrth in Section 1.1 are the guarantied
maximum rates li>r the rivelve (13)-month tcnn of this _~greement. commencing on
January 1.2008. and ending on December 31, 2008.
Page 5 of 13
ARTICLE Vl
[;El\EK:1L YKOVItilO>\S
G.1 F.NKOLLI\'1LNT >\TF.F.TINCS - fhe Cl'I'Y will schedule Open Enrollment sessions
at carious locations and tinter. ]'he CITY will provide HTJ~9AN1\ with a complete
list of ktcatious and times where and when such bricfmgs will be held thirty (30) days
prior to the commcnccmcnt of the first session. Hi:NI:\i\:1 rcprescntatiecs will
attend and participate in eveq scheduled meeting to explain the plans and the
respective benefits and infi~rmation related thereto.
HUNI:IN:>, shall deliver complete em'olhuent packages lire each Plan to the CI'1'Y's
Contract Administrator at least thirty (30) days prior to 4te start of open em•olhnent.
TTLJi\~1AN:1 shall provide a complete new enrollment packages (including updated
provider directory) to the Contract Admitustrator. Updated provider directories shall
also be available, at the Employee's or Retiree's request, through customer service.
Employees or Kctirccs may also obtain current pmcider infbnnation through
Hl1~lAVA'S web rile (~e~s~,.huntana.coat.)
G.2 1llL\TIFK'ATIO'V CAKllS -Following enrollment. the C1fY will provide
TTi_:M11.4N;'1 with correctly completed enrolhuent forms, which 4vill he continuously
batch-processed. Hi a\LAN;1 shall, within ten (10) business days (plus mailing time)
send identi f ication cards to Employees oral Retirees. "fhe Contact Adntittistratormast
noti ly HlJ~9:1N:'\ in writing of am I:mployces or Kctirccs who do not receive the
identification cards issued as a result of the initial em-ollment process.
T:putt HUY1.A~I~'s receipt of such notice from the Contract Adntit»sirator,
HUA7AN.A shall, within ten (] 0) business days (plus mailing time), send
identi lication cards to those Fntploycc or Kctirccs who have not received them.
G.3 CL:111L15 KFSPONSliS-HLT1A)\A will "process' 90°.%ofclaims within fourteen
(I =1) days of receipt. Receipt date is measured from the date a clean claim is received
to [hc date it is "processed", mcattine paid or denied without requiring additional
information Born an cstcrnal source.
G.9 C'LAID'L (jU:~LTTV
(a) financial Accuracy: lIL.'14AN.A e~ill pay all clean claims made by Aletttber
under the Plans in a manner that to ill assure Ihat 991'-'0 of all such claims are
paid in the amounts required under the Plans.
Page 6 of 13
(h) Procedural :\ccuracy: HUl\-0-\Vi\ will pay all clean claims made by
~Icmbers under the Plan, using proccdums that will assure that 97°%I of all
such claims arc paid in accordance kith the prl)ccdures required under the
Plans.
G.5 TELN:Y110NT, RTSP()VtiI\'F.VESS:
(a) I ILIV1aKA sill be rc,pousi~°e to each and erery telephone call rclcived tiotn
\~lembcrs ou the customer service line established exclusively for the CITY.
In cotnrection therewith. Hl!M:1NA agrees that: 8Q°/fl of all such telephone
calls will be answ°crcd by I ILI~LAN.A. ready to assist (•9crnbcrs w ithht twenty
(20) seconds of the time such call is planed by such ~~lembers (the Tinting
Requirement); and (ii'I HU.Rt:W:A's aE~andotmtent rile on all such calls will
be less than 3"6; (the ;\bandoluttent Rate}.
(h) lb assure 10.!AIaN.4 is attaining the requirements set. forth in subsection (a)
above, IILI\1.AN.A will doliver to the CITY. within ten (10) days ofthe end of
each quarter, during the teen hereof sped tic reports and other measurements
made h~ HU \d:1V ~ to demonstrate the rate at w•ftich I AlT•i.4N.a is answering
calls and I IL?NfAN:1's ;lbandawtent Rate.
ARTK'LF. Vtl
CiTY'S KIUH'I"1'O TIsRT<iTl\ATF.
7.1 Nona ithstanding anything else to the contrary contained herein, the CITY shall have
the rieht to terntinatc this :lgrerment al any tints and 1'or any reason upon providine
IICNL~N.A with at least sixty (60) days prior written notice.
AK'1'ICi,T•, VIII
nc) rlcl~:
\Vhcnevcr either party desires to rive notice unto the other, pursuant to this :'lgreement, such notice
mast he in vaTiting. sent by certified United States mail. return receipt requested, addressed to the
party lix whom it is intended at the place last specified; and the place li>r giving of notice shall
remain such until it shall have been chtutged by written notice in compliance with the provisions of
this Artiele. Por the present. the parties designate the i2tl lowing as the respective platys for giving of
ROtICe:
Page 7 of 13
Doe= i44nvv Va<f I~, o5°?>EirtmS
FOR CITI': FOR HU1•lAN:1:
Ramiro Tnauunzo Donna Lambcrti
Director Human Resources Account Executive
1700 Convention Center Drive Humana \4edical Ylan, Inc.
1vliami Reach, PL 33139 3401 S\A~ 1E~0 Avenue, Eiuilding A, 2"~ Floor
(305) 673-700(1 ext. 6(197 (Viiramar, FL 33027
ringuanzo'ucityoliniamibcach,gov (105)626-5805
dlambcrt i;~iluunvta.com
ARTICLE. IIX
FNTIKF. A<:RN:E~'lE'V'f
.All provisions contained within this %\gmemcnt represent all the teens and conditions agreed to by
I'hc Cll l" and 1Il i\9%\N.1. 'Chc CITY and HUiv1:1N:1 rccogrtizc that in order to comply with
applicable slate laws. 11L"M,AN.A must hlc a document with the State of Florida Department of
Insurance setting I~trth the benefits and coverage to be provided by I lU~4ANA under the teens uC
this Agreement, and this Agreemern is subject to the Florida Department of lnsurtnec approval.
[RF~IAINDER OF "IIIIS PAGE. INTF,N17ONALLT' LEFT IIL:INK]
Page 8 of 13
Uoza. i0^(^r4'ierlU Vgt:2_ry.000k
;YRTIC'LF. IX
PUBLIC E!\TiTY CRI~iF.S ACT
in accordance with Section 287.1 jj, Florida Statutes. Hl; M.\I\ Y verities by means of the Florida
Statutes the convicted vendors list maintained by the State ol'F7orida Deparhnent ofGcncral Service.
:Y person or al'liliate who has beat placed on the armicted vendor list folio. ine a conviction for
public entity crimes Wray not perfbnn wurl< as a contractor, supplier. sub-contractor, or consultant
under a contract with the CI'CY. and may not. transact business with the CITY in etcess of the
tlu'eshold amount provided in Sec. 247.Q17, lift C'rY'f6GC1KY'C1i~ U. far a period of 3(, months li-om
the date of being placed on the convicted vendor list.
ARTICLE X
AMERICANS R ITH 1)TSAR(LITIES AC:'1'
HUIIANA tvan~ants that its coverage exclusions and limitations on coverage :ue based on
undenvritin~ criteria and risks. in conlin-ntancc with the :ltuericans wish Disabilities ;Yet of 1991
1 An.A 1, 42 U•S.C.S. 12101 et sey.. and no attempt has been made to circumvent the. provisions of the
AD:1. Ht!~d:11\AwilladministerthePhuts,unifomtlvapplyullcovcragcc~chtsionsandlimitations.
and otherwise perfornt its obligations under Ore Agreement in a maturer consistem with the AD;1.
AR'1'1Cl.T XT
:1LL PRInR AGREENIL•'N'fS ST?PF,RS£.DF.I)
This docuntcnt incorporates and includes all prior negotiations, cotTespondenec, conversations,
agreements, or understandings applicable to the matters contained herein; and the parties agree that
there are no commitments, agrcetnents or understandings concerttittg the subject matter of this
Aarccment that are not contained in this document.:Yccordingly. the parties agree that no deviation
from the terms hereof shall he predicated upon am prior represcntations or agreements whether oral
or tvriuen.
It is further agreed that no modifications. amendment or alteration in the icrtns or conditions
contained herein shall be effective unless contained in a cnritten document executed with the same
tin-mality and of equal dignity herewith.
Page 9 of 13
fkv ID9099 V.d:,ld 456:)6 n0fX
Lt the event that a conlliet arises bers'een this Agreement and the Group Contracts. this Agreement
shall be controlling.
Lath of Humana ~9cdical Ylan, inc. and Humana Health insurance Comham~ ofFlotidat. Inc. agree
that each is jointly and severally liable for all obligations of Hl?i•9.AN:~ under this :~grccntcnt.
[RF,NIAINDEK OF THIS PAGE IN1'LN1'lON;~LLY LEFT BLANK
Page 10 of 13
u.„~~ rr:oo~: v;ro in ~xmSn.uuoS
IN N'1'fI~GSS \~ IiF.RF.OF. thz partizs have made and csccutcd this Aereement on the respective
dates under each signature.
FOR CITY: CITY OF lbHt117I I3C:1CH, FLORIDA
ATTES"1':
B1': ~ ~~ ~
Ciri' Clcrk 1Ta~• r
FOR ILl I<T:1N.A: ITL~TANA t\TF.DI(aL YLAV ,INC.
:1TTF.ST:
131': HY: _
~. ~ ~~
S rctarv President
._~oftN o. Ltin,ftk~wN ~r ~md
Print !Yamc Print Name
_ O.
Scc tarv (TL-~TAVAHEAL'I'HLnSUR:1NC'F.
COMPANY' OF FLORIDA, INC.
c~ O ItNy ~- f.N It H'RN
Print Name
13),.
-~~~ -
President
APPROVED AS TO
FORM & LANGUAGE Page ~ t of 13
~ FOR EXECUTION
Dace: IY41'Y: beru.In9Xrt:J.n>IOVB ~ -
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;1llllTi~lllU,'+1
ACCi•'SS TO CARE (GU1llEL1NCS
1liedical Etner~encv
Seek immediate medical attention lire symptoms such as chest pains, M-eathinG difficulties. bleedutg
or unconsciousness. Ciu to the nearest hospital emergency room. or call 911. All follo+v -up care
Waist be coordinated with your PR1TvT.ARY CAKE PH1'S1C[AN.
I. r~enl AApelntitlCnt
:1n urgent appointment for an acute medical conditions. or a condition that Wray become an
emergency ifnot treated (such as persistent fever. stomach pant ofwtlwo++m cause, new symptoms of
dizziness, or st~spcctcd broken hovel, should be scheduled within 24 hours of contacting pour
PRThL4RY C:~KL PIIYSTCLA~I'S ol3icc.
Routine Anpointmcnt (Svmntornaticl
A^ appointment for' a specilic health eonccm that is nut ofan urgeut naritre (such as skin rash or
allergies) or for continuing care. of a problem li~r++hich your doctor has already seen you should be
scheduled ta~ithin uvu weeks of contacting your PKllv1<'yRY C.ARF. PHl'S1C1,'~V'S office.
Page 12 of 13
Doc iven9v Vei flJ, Oy6i2<a000F
HuMAr. 2ESOUZCES D'tPARTMEt~T Employee Be•refivs Oiviswr MEM~RANDUIVI
TO: Robert Parcher
City Clerk
FROM: Sue Radig ~ `=~ ~ -.,
HR Administrator i ~~ '1
`"' :7
DATE: August 29, 2008 ~ w '-''
v, '-
SUBJECT: 2008 Humana Service Agreement -` ~'t
cn -)
~.i
Enclosed you will find three (3) original copies of .he City's 2008 Humana Service Agreement
signed by the approariate Humana representatives. These three controcts now require your
attestation and the Mayor's signature. Once they are signed, please return two originals to me so
I may forward one to Humana and have a copy of the signed ogreement for our f[les.
Upon completion of the RFP the Group Insurance Board unanimously approved the renewal of the
City's ogreement with Hur^or.a For a period net to exceed three years. This decision w sa shared
witTi the -Oily ommiss e epte- mGer 2 Commission Meeting who adopted
Resolution No. 2006-26326.
Please feel free to contact me with. any questions or concerns.
Thank you in advance ter your attention.