Loading...
HomeMy WebLinkAboutStewart Miller ADMINISTRATIVE CONTRACT Inc., hereinafter referred to as "Administrator~" WHEREAS, it is the intent of this Agreement that Stewart C. Miller & Co., Inc., is to be retained by the Employer to perform specific services as hereinafter set forth to the extent and upon the conditions herein described; NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, the undersigned parties agree as follows: SECTION I - GENERAL ADMINISTRATION SERVICES In performing their services as Administrative Managers of the City of Jeffersonville, the Administrator shall: 1. Perform all administrative functions from offices located in Lafayette, Indiana, such offices to be open during normal working hours Monday through Friday. Provide and maintain an adequate and properly trained staff to perform the services and answer the inquiries of Employees and the Employer with respect to Administrator's obligations and procedures as outlined by the Plan Document of the Plan. Administrator has no authority to waive or change the Plan of benefits or provisions without an agreement/amendment, in writing, from the Employer. SECTION II - ADMINISTRATIVE ASSISTANCES In addition to performing required services, Administrator under this Agreement, shall: 1. When invited, attend meetings of the Employer, COmmittees, or any other authorized meetings. 2. Assist the Employer in the drafting and promulgation of rules of eligibility or rules of operation and the drafting or redrafting of legal documents when needed. 3. Implement any requirements of the District Director of Internal Revenue Service, along with the Employer's Attorney, as needed. Assist in the design of the Summary Plan Descriptions booklets, forms and announcement material necessary to provide proper communication between the Employer, when applicable, and the participants of the plan. "Assist" means that Administrators will offer suggestions and ideas based on their expertise. Employer assumes financial responsibility for the printing and binding costs related to the physical formation of the Summary Plan Description booklets as well as any postage costs involved in the distribution of such. 10. 11. Provide "Lag Study Reports" which shall indicate incurred dates of service and paid dates of service and promptly relay this information to the actuary, if needed. Aid in the compliance with the Employee Retirement Income Security Act of 1974 and tax laws under the jurisdiction of the U.S. Department of Labor and the Internal Revenue Service with advice, recommendations, and assistance in preparation of necessary reports and documents. Work with Employer's Accountants in their respective areas such as contract, general ledger, tax matters, and compliance under E.R.I.S.A. Help to keep Employer informed of Federal and State legislative developments and court rulings affecting their responsibilities and Plan administration. When invited, attend meetings to explain benefits or Plan operations directly to Employees. Claims and Eligibility: Discuss difficult claims or eligibility questions with the Employer on request. As necessary or desirable, the Administrator shall review any policy used by the Administrator and/or the Employer. SECTION III - REQUIRED ADMINISTRATIVE SERVICES Administrator shall perform the following required services. Billing and Receipt of Administrative Fees. a. Prepare and pre-address monthly remittance report for the Employer. The report shall pre-list the billing for the administrative fees. Administrative fees, as determined in Section V of this agreement, are payable by the Employer within 30 days of the date of the billing. Thereafter there will be a penalty for late payment of one and one-half percent (1 1/2%) of the total amount payable per month. Balance and Recording of Employer Remittances of Administrative Fees. a. Maintain a master file of the Employer remittances including monthly totals, along with historical records of such payments. Correspond with Employer verbally or in writing with respect to: i. Corrections, over- and under-payments and missing information relating to the Employer's remittance of administrative fees. ii. Special operating procedures as may be requested by the Employer concerning handling of corrections and unusual situations relating to the Employer's remittance of administrative fees. 2 Maintenance of Employee Records. a. Maintain employee records which indicate the employee's name, social security number, mailing address, date of birth, name and address of beneficiary, marital status, name and date of birth of spouse, and information regarding eligible dependents, if any, along with a complete history of all claims submitted for payment. Employer will notify Administrators of participant eligibility and classification. Administrator will update eligibility information no less frequently than once per week. Administrator will determine participant's eligibility in accordance with the Plan provisions and maintain a record of such eligibility. Claims, COBRA, and HIPAA Administration. a. Calculate and adjudicate all claims properly payable under terms of the Plan Document after first determining eligibility of claimant. Retain hard copy claim information, including all claim documents of claims submitted, the claimant's name, whether employee or dependent, location of employment, nature of claim, payment information and cause code for at least three years. All such records will be maintained on electronic media (soft copy) for seven years. c. Generate a completed claims check register for review by the Employer. d. Cooperate with th'e Plan's financial and claims audits as prescribed by the Employer's accountant and communicate all such results to Employer. Maintain claims processing on a current basis with no more than a 14-calendar- day average claims turn-around-time, except in the case of coordination of benefits claim, or when additional information is requested to complete the claim. Turn-around-time is defined as the time period commencing upon receipt of a claim and ending with the date the claim is paid. The 14-day turn-around-time will be maintained provided that all of the information is available to properly adjudicate each claim. The average turn-around-time shall be computed on an annual basis. Advise employees on status of payment and appeal rights when a claim is denied (or submitted to the Employer for a decision). Such communication will be in accordance with rules adopted by the Employer, the Plan Document and ERISA. Administrator will perform administration of COBRA and HIPAA provisions according to the Plan Document and the Consolidated Omnibus Budget Reconciliation and the Health Insurance Portability and Accountability Acts, as amended. Administrative services include all legal notification, formal invoicing and related communication, collection of premium and the classification and tracking of participants. Printing costs of associated forms and postage costs 3 will be borne by the Administrator. The Employer is responsible to approve all forms prior to use. Other Office Records. a. Maintain Employer, employee and administrative files which include: i. A master file of the communication between the employee and the Employer and/or the Administrator and historical files for such communications. ii. All correspondence to and from Administrator. iii. Plan Documentation, amendments and administrative directives. b. Maintain records of all bank deposits and statements, if applicable. Miscellaneous. i. Maintain and update address files. ii. Create form letters and forms necessary for the adjudication of claims. Administration, Management, and Control. a. Maintain claim fund receipts and disbursements. Such disbursements shall include reports which indicate and summarize all deductibles, co-pays, coordinations of benefits, ineligible charges and payments, by employee and by benefit area. Maintain financial records as prescribed by the Plan Auditor. The accounting system must provide an accurate record of all receipts and disbursements for the Plan. Respond to any management letters provided by the Auditor. c. Supervise all data processing work, establishing proper control procedures, confidentiality procedures, and internal audit operating procedures. d. Write job instructions and keep current as to: i. Due date of reports to the Employer. ii. Changes in benefits of the Plan. iii.Changes in eligibility rules. iv. Changes in data processing procedures. v. Changes in procedures for processing reports. vi. Administrative policies and requirements of the Employer and the laws of the State of Indiana or the Federal Government. e. Update all form letters used in connection with the administration of the Plan as needed. The Administrator will provide for the printing and distribution of forms required in the administration of the Plan, such as claim forms, announcement letters, and similar material. Printing cost and postage related to these items will be paid by the Administrator, except for the postage and printing costs associated with the initial employee notification which will be paid by the Employer. Check stock, identification cards, explanation of benefits forms if printed exclusively for the Employer, and Summary Plan Descriptions will be paid for by the Employer and will remain the property of the Employer. 4 Maintain all office files for the Plan including the basic documents such as reinsurance contracts, insurance contracts, audit reports, minutes of meetings; also, files of correspondence with regard to participants, banks, insurance carriers, Employer, plan rules and regulations, etc. h. Maintain a complete file of pertinent correspondence, reports and financial data which can be distributed at meetings. Furnish all office supplies and telephone service with regard to the handling of the business of the Plan. The Administrator agrees to establish and maintain an 800 telephone number to receive incoming calls during the hours of 8:00 am until 4:30 pm Mondays through Fridays, Lafayette, Indiana time. Respond to all telephone calls and all mail or personal inquiries of employers or employees with respect to the requirements and procedures of the Plan. This includes the details regarding eligibility requirements, the manner in which contributions are made, schedule of benefits, etc. Maintain fidelity and errors and omissions bonding covering the Administrator and each of its employees to the extent required by law. The bond shall be issued by a first-line bonding company acceptable to the Employer. Notify the Employer of the termination or cancellation of any insurance policy, fidelity bond, or errors and omissions coverage. Administrator will maintain all necessary licenses and certificates to perform services and in the event such licenses are revoked or terminate this Agreement will terminate. mo When requested, attend meetings of the Employer. Expenses of the Administrator in connection with these meetings will be borne by the Administrator. Assist as needed with respect to special questions which may arise involving research into the Plan's records and conference with the Employer or its representatives. o. Establish claim record maintenance procedures subject to the approval of the Employer. p. Work with independent actuary hired by Employer as needed to develop data on Plan changes contemplated or ordered by the Employer. The Administrator agrees to maintain the confidentiality of all documents and records utilized in the provision of administrative services and to take reasonable precautions to assure patient confidentiality. Periodic Reports. Administrator will prepare on a routine basis the following reports: 5 Co A monthly claims report showing disbursements and year-to-date totals. Assist as needed with all government reports and notices to participants which may be required by law, such as Summary Annual Report, Form 5500, Summary of Material Modifications, etc. Such assistance shall consist of providing information needed to complete named reports and offering suggestions and ideas based on their expertise. (Employer's legal counsel, auditor, consultant, and other professional advisors will assist in the preparation and filing of such reports where necessary.) Administrators will complete and file Forms 1099 MISC with the IRS. Forward or communicate information pertaining to the Plan which may be requested by the Employer, Employer's attorney, auditor, actuary, consultant or other authorized parties. Monthly listing of eligible employees. Monthly reports of Plan'S claim experience, with claims sorted and compiled monthly and year-to-date into categories, such as hospital, surgical, medical, dental, etc. Claim reports which shall include the following: Monthly Check Register, Monthly Paid Claims Register, Coverage Analysis Report, Benefit Analysis Report, Procedure Analysis Report, Lag Study Report, Balancing Report, Claim Void Audit report and the Adjuster Report. Administrator will provide these reports monthly, quarterly, annually, or as often as requested by the Employer. Cost management reports which shall indicate hospital admission, hospital dismissals, average length of stay, dollar amounts of claims paid by condition or cause (such as heart attack or stroke), together with total hospital expense and a list of hospitals by employer identification number with a history of daily cost. Such reports shall include: Hospital Admissions by Group, Average Length of Stay by Procedure, Claim Detail Analysis, Individual Benefit Analysis, Individual Coverage Analysis, Paid/Incurred Claims, Benefit Reduction Analysis, Usual & Customary Cutback Analysis, Excess Dollar Analysis, Paid Claims Analysis by Age Table, Benefit by Provider Analysis and Physician Comparison Procedure. Administrator will provide the reports monthly, quarterly, annually, or as often as requested by the Employer. SECTION IV - ADDITIONAL ADMINISTRATIVE SERVICES In addition to the services set forth in Sections I, II, and III, the Employer and Administrator agree to the following: 1. Stewart C. Miller, C.E.B.S., shall be the "supervisor" for the administration of the Plan. Supervisor, for this purpose, means an individual who will be familiar with the day-to-day operations of the Plan and who will be available to have checks signed, if 6 10. required, resolve problems and provide information to the Employer as needed. This person is also knowledgeable as to the types of issues which require Employer involvement. Administrator shall maintain all books, records, lists of names, plates, seals, journals and ledgers, tapes, cards, and drums, and understands that these items are the property of the Plan and shall be used exclusively for the Plan at the discretion of the Employer. Administrator acknowledges that compensation is to be received by or on behalf of the firm in connection with the administration of the Plan shall be that which is paid directly by the Employer. Fees, commissions, production or other administrative allowances from any other source will not be received by the Administrator in connection with the Plan. This contract shall have a minimum one year term, renewable on its anniversary date, including a sixty (60) day notice prior to the anniversary date for proposed changes in fee structure and a sixty (60) day advance notice prior to the anniversary date of intention to terminate the contract at any time by either party. The anniversary date shall be April 1st each year. Notices should be directed to Mr. Stewart C. Miller, Stewart C. Miller & Co., Inc., P.O. Box 5769, Lafayette, Indiana 47903-5769. This contract shall continue from year to year unless terminated by advance notice as provided in Section IV, item 4 of this contract. The Employer may negotiate an administrative fee for the purpose of running out incurred by unreported claims after the termination of this Contract. Administrator agrees to hold the Employer harmless against any loss, damages, or expenses arising out of negligence, fraud or dishonesty of Administrator. Administrator has no authority to bind Employer and Employer has no authority to bind Administrator. The Administrator is independent of the Employer. Nothing in the Administrative Contract shall be construed or deemed to create any other relationship other than that of independent parties contracting with each other solely for the purpose of carrying out the provisions of the Administrative Contract. The Employer and the Administrator agree to meet and confer in good faith to resolve any problems or disputes that may arise under the Administrative Contract. No assignment of the rights, duties or obligations of the Administrative Contract shall be made by the Administrator without the express written approval of a duly authorized representative of the Employer. 7 SECTION V - REMUNERATION Beginning April 1,2001 , and ending March 31, 2003, as a fee for the Administration Services performed by Stewart C. Miller & Co., Inc. herein set forth, the Employer agrees to pay: · A fee of $12.50 per eligible participant per month for medical claims administration including drug card administration; · A fee of $2.25 per eligible participant per month for COBRA and HIPAA administration; and An amount equivalent to the cost of living, based on the Federal Consumer Price Index for the prior 12-month period, will be added to the fee each year thereafter. For purposes of this section, "eligible participant" is defined as either a covered employee or a covered dependent but in no case shall more than one fee be charged in each family unit per month. On and after the date of termination of this Agreement, and except as otherwise agreed upon by the parties in writing, Stewart C. Miller & Co., Inc., shall not be obligated to perform any of the services specified in this Agreement, or any amendments thereto. Notwithstanding anything in this Agreement to the contrary, this Agreement shall terminate in any event thirty (30) days after the Plan is for any reason terminated. The Undersigned hereby authorizes the City of Jeffersonville to employ Stewart C. Miller & Co., Inc. to perform the services described and Stewart C. Miller & Co., Inc. agrees to perform said services. Date: Date: 8