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Home My WebLink About06-29-2011 O CCU pearl 1_ Oa—Site 1 teafth Solutions Solutions THIS AGREEMENT, is between OCCUPATIONAL HEALTH SOLUTIONS, LLC, a Kentucky Company (hereinafter referred to as "OHS ") and Cit) ,it.Ielfer nn'il le, (hereinafter referred to as the "Company "). WHEREAS. 011S is in business of providing health risk assessment and wellness services to the Client located in Indiana. NOW THEREFORE, in consideration of the covenants contained herein along with other good and valuable consideration, the parties agree as follows: 1. PROFESSIONAL SERVICES All personnel and contract vendors providing health and wellness services to the Company will be qualified to perform such functions as deemed essential. These individuals are employees of OHS except for contract vendors. 2. OUALIFICAT1ONS AND CERTIFICATIONS All personnel and contract vendors providing health and wellness services to the Company will be fully qualified and meet OHS, state and federal guidelines of licensure and /or certification for the provision of such services. Copies of personnel credentials will be made available to the Company upon request, and will be kept on file with OHS. 3. RATE SCHEDULE Health risk assessments and wellness program management will be provided by OHS according to the following rates based on actual participants of the health screening program. See (Attached program details for all pricing) Blood profiles will include: Total Cholesterol, HDL, LDL, Triglycerides and Glucose levels and will be performed by a medical professional that specializes in blood draws. The professionals may include: R.N.'s, Phlebotomists, Medical Teebs and other qualified professionals. 80% Participation Rule- OHS will bill for a minimum of 80% of the participants scheduled by the company on each scheduled day. Example the schedule has 100 names and only 70 participate, we will bill the Company for 80. Travel which requires overnight or a 1 hr. outside of Louisville will be charged for hotel, mileage C,a .40 /mi. & meals. TBD and billed with invoice. 4. BILLING PROCEDURE We will detail the days and numbers of participants on each day. Payment for wellness program services rendered by OHS are due and payable upon receipt of the invoice. Contract (Page 2) 5. RULES AND REGULATIONS OHS personnel and vendors will observe rules and regulations as set by the Company and will act in a manner consistent with other Company personnel. OHS will not give any medical advice or prescribe any medications. Our role is to provide health education services to the employer and employee. This Is a voluntary program for all participants 6. CONFIDENTIALITY The personal information that is shared will remain just that, personal. Employee confidentiality must be respected by both the employer and Occupational Health Solutions (OHS). OHS will not send or disclose any individual medical information without proper authorization from individuals. No individual health information will be shared with anyone at Citv of.leffersonville. All programs and services are HIPAA compliant. 7. ORIENTATION The Company will provide to OHS personnel (Dave Berkemeier) a short period of orientation explaining the rules and regulations of the Company's work areas. I.E. policies and procedures, emergency procedures... 8. INSURANCE Throughout the tens of this agreement, OHS will maintain in their own name insurance coverage of at least 51,000,000 per person and $2,000,000 per occurrence covering each for all acts or omissions which may give rise to liability for services under this agreement. OHS shall provide the Company with a current certificate of insurance if needed. OHS does not carry liability insurance related to blood draw occurrences. All blood draw professionals will carry individual liability insurance policies and OHS will maintain appropriate professional liability insurance coverage. 9. WORKERS' COMPENSATION OHS shall comply with the State Worker's Compensation Law and provide for the payment of worker's compensation to its employees in the manner and to the extent required by such law. 10. CIYTI, RIGHTS ACT OHS agrees that they will comply with all laws, including but not limited to, Civil Rights Act of 1964 (P.l.. 88 -352) providing that no person in the United States shall, on the grounds of race. color, creed, national origin, age, sex. or handicap. be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination as a result of this contract. 1l. EFFECTIVE DATE This agreement shall become effective on and continue until at which time the contract is automatically renewed on a year to year basis if notice of termination is not given. 12. TERMINATION This agreement may be terminated by either party upon written notice. This agreement may be terminated without cause or for any reason upon 60 days written notice of termination to the party at the other party's principle address. email: $gTna he&3hyn0rksIte 80m c�. s•r.. 11c,r,111, 502.939.7585 • ...: ..., ;. ww.he3lthvaorksIte.GOT MAVERICK INSURANCE 2011 WELLNESS PROGRAM PRICING ay STARTED briliggiffifft <100 PARTIC PANTS 180.00 5125.00 13' - 5CC PARTIC PANTS 175.00 1120.00 SD:* PARTIC PANTS 170.00 3115.00 )GET STARTED) HEALTH RISK ASSESSMENT( HIPM & GINA COMPLIANT) INCLUDES THE FOLLOWING: _•�•� _,_ ,�„- ..�;,;, MINIMUM NUMBER OF PARTICIPANTS FOR ON -SITE TESTING IS 25 AND INCLUDES: QUESTIONNAIRE - HEALTH HISTORY. FITNESS, EATING. SMOKING. STRESS. SAFETY. MEDICAL CARE. PERCEIVED HEALTH 7 PAGE INDIVIDUAL REPORT MAILED TO RESIDENCE DETAILING HEALTH RELATED RISKS (7 -10 DAYS) CORPORATE REPORT - DEMOGRAPHICS - MAJOR HEALTH RISKS - RECOMMENDED TARGETED HEALTH ACTIONS - ECONOMIC IMPACT YEARLY GROUP PROGRESS REPORT SHOWS AREAS OF IMPROVEMENT ONLINE HEALTH CHALLENGES WITH COMPLIANCE REPORT SEND SUMMARY REPORT TO INDIVIDUAL PRIMARY CARE PHYSICIAN FOR CARE MANAGEMENT 800 K TO ANSWER QUESTIONS ONLINE WELLNESS LIBRARY a heatlhyxakstle can VEINIPUNCTURE • TRAINED PROFESSIONAL AT RISK PARTICIPANTS CONTACTED WITHIN 24 HOURS OF THE TESTING QUARTERLY HEALTH WEBINAR Jj10METRH:$ HEIGHT/WEIGHT Hi (GOOD) CHOLESTEROL BLOOD PRESSURE LDL (BAD) CHOLESTEROL BODY COMPOSITION -BMI TRIGLYCERIDES (FAT) ....,.. 17'lSTAL GHbLESTEROL GtUGAR) IFNGAGEMENT - CHANGE EMPLOYEE BEHAVIORSI HEALTH RISK ASSESSMENT (HIPM ek GINA COMPLIANT} INCLUDES ALL THE ABOVE: QUESTIONNAIRE - HEALTH HISTORY. FITNESS, EATING. SMOKING. STRESS. SAFETY. MEDICAL CARE. PERCEIVED HEALTH FITNESS ASSESSMENT - 20 MINUTES PER PARTICIPANT 81000 PROFILE • VEINIPUNCTURE BY TRAINED PROFESSIONAL HEIGHTNTEIGHT TOTAL CHOLESTEROL GLUCOSE (SUGAR) BLOOD PRESSURE HOL (GOOD) CHOLESTEROL TRIGLYCERIDES % BODY FAT - CALIPERS LDL (BAD) CHOLESTEROL 18 PAGE INDIVIDUAL REPORT MAILED TO RESIDENCE DETAILING HEALTH RELATED RISKS (7 -10 DAYS) CORPORATE REPORT - DEMOGRAPHICS. MAJOR HEALTH RISKS. RECOMMENDED ACTIONS. ECONOMIC IMPACT SEND SUMMARY REPORT TO INDIVIDUAL PRIMARY CARE PHYSICIANS FOR CARE MANAGEMENT YEARLY GROUP PROGRESS REPORT SHOWS AREAS OF IMPROVEMENT WELL SCORED CHALLENGE (INCENTIVE POINTS PROGRAM) ACCESS TO 800N INBOUND HEALTH COACHING SERVICES ' ON -SITE SESSIONS OR TELEPHONIC. TO ANSWER QUESTIONS FOR EMPLOYEES (GROUPS OR INDIVIDUALLY) PROVIDE EDUCATIONAL TRI -FOLDS TO DISBURSE THROUGH COMPANY ASK UP TO 30 OTHER QUESTIONS TO GATHER INFORMATION TO PROCESS RESULTS INFORM INDIVIDUALS OF DISEASE MANAGEMENT PROGRAMS WITH INSURANCE CARRIER HELP IN PLANNING WELLNESS PROGRAM TO BE INCLUDED IN BENEFITS DESIGN FOR MAXIMUM PARTICIPATION YEARLY CALENDAR OF WELLNESS EVENTS ON-SITE OR WEBINAR HEALTH EDUCATION CLASSES DEPENDING ON SIZE AND LOCATION ACCESS TO ON-LINE WELLNESS LIBRARY ACCESS TO HEALTH -E- LEARNING ONLINE SEMINARS & QUIZZES TWO INBOUND CALLS FOR HEALTH COACHING WITH TRACKING AND COMPLIANCE REPORT ONLINE HEALTH CHALLENGES WITH COMPLIANCE REPORT MONTHLY HEALTH WEBINAR ONE OUTBOUND CALL FOR "HIGH RISK' POPULATION OPTIONS' ONLINE HEALTH SEMINARS AND OUIZZES WITH COMPLIANCE REPORT 115.00 WELL $CORED CHALLENGE (INCENTIVE POINTS PROGRAM) 15.00 18 PAGE INDIVIDUAL REPORT MAILED TO PARTICIPANT HOME 15.00 NEXT STEP (3) COLOR TRI•FOLD EDUCATIONAL BROCHURES 15.00 PSA TESTING FOR PROSTATE CANCER ( VEINIPUNCTURE ONLY) 522.00 TSH TESTING FOR THYROID DISEASE (VEINIPUNCTURE ONLY) 117.00 COMPREHENSIVE METABOLIC PANEL (14) 510.00 NON FASTING I-tALC - GLUCOSE 510.00 ON-SITE HEALTH SEMINARS IN LOUISVILLE 5100.00/HR. ON-SITE FITNESS TESTS: 3 MIN. STEP TEST, FLEXIBILITY & CURL -UPS 810/PARTICIPANT INBOUND HEALTH COACHING WITH TRACKING AND COMPLIANCE REPORTING TBD TRAVEL WHICH REQUIRES OVERNIGHT OR 1 HR OUTSIDE LOUISVILLE HOTEL, MILEAGE— 45W., MEAL ALLOWANCE TBD SITE FEE FOR GROUPS LESS THAN 25 PARTICIPANTS 5250.00 Contract (Page 3) 13. NOTICES Any notice required or permitted to be given shall be in writing and shall be effective if sent by certified mail: to OHS at: and the Company at: OCCUPATIONAL HEALTH SOLUTIONS, LLC ci n 01 JEI JtRSOM 11.1.E 9005 RESERVE DRIVE 500 QUARTERMASTER COURT PROSPECT, KY 40059 JEFFERSONVILLE, IN 47130 14. INDEMNIFICATION As a Company, l do hereby waive, release and forever discharge (OHS - provider of health screening services) and its officers, agents, employees, representatives. executors, and all others from any and all responsibilities or liability from injuries or damages resulting from Company participation in any voluntary health activities. l also understand that fitness activities involve a risk of injury and even death, and that the Company and all participants are voluntarily participating in these activities. 15. ENTIRE AGREEMENT This agreement constitutes the entire agreement between the parties. The provisions herein shall be to the benefit of and shall be binding upon the parties hereto. This agreement may only be modified by written agreement executed by all parties. In Witness whereof, the undersigned have executed this agreement as of the day and year first written above. OCCUPATIONAL HEALTH SOLUTIONS CITY OF 3 ' r: ONVj .F David 93evdevrelen. 44 i d /� Signature S • ure , David Berkemeier Name Name President Title Title Date Date Please fax the signed contract to Occupational Health Solutions @ 502.426 -1177 You can e-mail the signed contract to dave4Zltcalth'worksitc.com Once OHS receives the signed contract we will coordinate logistics and timeline for implementing the on -site testing dates and times. Company Contact Phone Number E -mail