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HomeMy WebLinkAboutCity of Tamarac Resolution R-2001-369Temp. Reso. #9607-November 28, 2001 Revision 1 12/12/01 Page 1 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-2001-369, A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, AUTHORIZING THE APPROPRIATE CITY OFFICIALS TO EXECUTE A TWO- YEAR CONTRACT FOR THE CITY'S EMPLOYEE ASSISTANCE PROGRAM WITH MAGELLAN BEHAVIORAL HEALTH, INC. EFFECTIVE JANUARY 1, 2002; APPROVING THE APPROPRIATE BUDGETARY TRANSFER OF FUNDS; PROVIDING FOR CONFLICTS; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the City's Employee Assistance Program with Psych/Care, Inc. is scheduled to expire on December 31, 2001; and WHEREAS, experience confirms that early identification and intervention for behavioral health problems through an Employee Assistance Program is a sensible and economical approach to maintaining the health and well being of a work force; and WHEREAS, the City has established an Employee Assistance Program for eligible City employees which offers services in connection with the behavioral difficulties of employees and family members relating to family problems, marital discord, drug or alcohol use, stress or other personal matters; and WHEREAS, an Employee Assistance Program serves the interests of the City by assisting employees and their families, thereby supporting the goals of attracting and retaining competent personnel; and WHEREAS, the City recently entered into an agreement with Aetna US Temp. Reso. #9607-November 28, 2001 Revision 1 12/12/01 Page 2 Healthcare to provide health care insurance to the City's employees; and WHEREAS, Aetna's US Healthcare utilizes mental health/substance abuse coverage through Magellan Behavioral Health, Inc. as a third party provider; and WHEREAS, the City recognizes that using Magellan as the provider of EAP services would ensure the continuity of care for employees who need additional assistance beyond that which is offered by the Employee Assistance Program; and WHEREAS, the City has contacted other Cities that have contracted with Magellan Behavioral Health, Inc. and has obtained favorable recommendations for the company; and WHEREAS, it is the recommendation of the Director of Personnel and the City Manager that the City of Tamarac execute a contract with Magellan Behavioral Health, Inc. in substantially the same form as attached in Exhibit A, as provided by Magellan Behavioral Health, Inc. for an Employee Assistance Program for City of Tamarac employees effective January 1, 2002; and WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in the best interest of the citizens and residents of the City of Tamarac to execute a contract with Magellan Behavioral Health, Inc. in substantially the same form as attached in Exhibit A, subject to any revisions consistent with the plan as negotiated by and between City staff and Magellan Behavioral Health, Inc and approved by the City Manager and the City Attorney as the City's carrier for an Employee Assistance Program for City of Tamarac employees effective January 1, 2002. 1 Temp. Reso. #9607-November 28, 2001 Revision 1 12/12/01 Page 3 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA: SECTION 1: That the foregoing "WHEREAS" clauses are hereby ratified �4 and confirmed as being true and correct and are hereby made a specific part of this Resolution. SECTION 2: That the appropriate City officials are hereby authorized to execute the contract with Magellan Behavioral Health, Inc. in substantially the same form as attached in Exhibit A, subject to any revisions consistent with the plan as negotiated by and between City staff and Magellan Behavioral Health, Inc and approved by the City Manager and the City Attorney as the City's carrier for an Employee Assistance Program for City of Tamarac employees for a two-year period, effective January 1, 2002 and ending December 31, 2003. SECTION 3: That the appropriate City officials are authorized to enact any appropriate budget transfers as needed for this purpose. SECTION 4: That all resolutions or parts of resolutions in conflict herewith are hereby repealed to the extent of such conflict. SECTION 5: That if any clause, section, or other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications of this Resolution. 41=C'.TIC)N A adoption. Temp. Reso. #9607-November 28, 2001 Revision 1 12/12/01 Page 4 This Resolution shall become effective immediately upon PASSED, ADOPTED, AND APPROVED this 12t" day of December, 2001. ATTEST: 'h'L4,, ;� L0� MARION S ENSON, CMC CITY CLERK I HEREBY CERTIFY that I have approved this RESOLUTION as to form. CITY ATTORNEY JOE SCHREIBER MAYOR RECORD OF COMMISSION VOTE: MAYOR SCHREIBER A e., DIST 1: COMM. PORTNER 6l q DIST 2: COMM. MISHKIN A el DIST 3: VIM SULTANOF fl er DIST 4: COMM. ROBERTS A e., 1 1 Temp Reso #9607-Exhibit A Revision 1 November 28, 2001 SERVICES AGREEMENT THIS SERVICES AGREEMENT (this "Agreement") is entered into as of this] s t day ofJ a n u,a r y 2 0 0 2 (the "Effective Date") by and between MAGELLAN BEHAVIORAL HEALTH, INC., and/or VISTA BEHAVIORAL HEALTH PLANS, as indicated on the signature page below, on behalf of itself and its/their Affiliates, (cnllectively, as appropriate, "Magellan") and City of Tamarac ("Sponsor"). As used herein, unless otherwise indicated, capitalized terms shall have the meanings set forth in Article V. RECITALS WHEREAS, Sponsor has requested Magellan to provide certain employee assistance program services and WHEREAS, Magellan agrees to provide such services in accordance with the terms and conditions of this Agreement. NOW, THEREFORE, in consideration of the mutual covenants and promises set forth herein and for other good and valuable consideration, the receipt, adequacy and sufficiency of which are hereby acknowledged, Magellan and Sponsor hereby agree as follows: ARTICLE I SERVICES; SERVICE ]FEES 1.1 Services. Magellan agrees hereby to provide the Services to Sponsor during the Term and according to the terms and conditions of this Agreement as well as the "Fee Schedule and Conditions of Offer" attached as Addendum C. (a) For purposes of this Agreement, "Basic Services" means the following Services: (1) Account Management. The Magellan Account Manager serves as the point of contact and is responsible for answering questions about Magellan products, resolving service delivery issues, facilitating consultation on behavioral health topics, and advising Sponsor how it can most effectively use the Magellan EAR (2) Toll -Free Telephone Access. Magellan shall maintain a toll -free 1-800 or 1-888 telephone access line (the "Access Line") 24 hours per day, 7 days per week, to provide Participants access to assessment, counseling, referral and emergency crisis intervention services. Magellan shall provide telephonic services only or up to a designated number of face-to-face Sessions (as defined below) per Participant per problem per year, based on the model selected by Sponsor designation on the "Fee Schedule and Conditions of Offer" attached as Addendum C. (3) Professional Services. Except as otherwise provided in this Agreement, all direct clinical services provided through the Access Line shall be provided by EAP Clinicians. All face-to-face clinical Sessions shall be conducted by Participating Providers who have at least a Master's level degree in the appropriate field or such other training and practical experience that qualifies them to provide the applicable EAP Services. (4) Employee Communications. Magellan will provide to Sponsor for dissemination to its Employees brochures, wallet cards, quarterly employee newsletters, posters and manuals. If ERISA is applicable, Sponsor, or its designee, shall be deemed the Plan Administrator and Named Fiduciary under ERISA with respect to other communications. Magellan Behavioral Health, Inc. Growing Business Services Agreement Rev. 07/27/01 (5) Treatment Compliance Monitoring. To the extent that an Employee so elects or if Sponsor makes a mandatory referral, then Magellan shall (1) monitor the compliance of the Employee with respect to treatment recommendations received in connection with EAP Services and (2) provide regular telephonic recovery support to the Employee with regard to chemical dependency treatment. (6) Management Consultation. Magellan shall respond to inquiries by Sponsor's managers and supervisors with consultation in dealing with troubled Employees whose problems are affecting job performance. Consultations may include (a) coordinating Employee referrals to EAP Services, (b) discussing high - risk situations which may lead to a threat of violence in the workplace, (c) facilitating the return of an Employee to work, and (d) assessing and facilitating critical incident intervention. Magellan shall not disclose confidential information relating to any Employee without the authorization of such Employee. Sponsor agrees to pay Magellan based on the Fee Schedule and Conditions of Offer attached as Addendum C for management consultation services performed by Magellan in excess of the number, if any, included in the Basic Services. (7) Critical Incident Stress Debriefin At Sponsor's request, Magellan shall provide CISD (as defined below) services to Sponsor's management and Participants to counter emotional distress caused by catastrophic or traumatic events. Sponsor agrees to pay Magellan based on the Fee Schedule and Conditions of Offer attached as Addendum C (excluding hours spent by Magellan planning and coordinating such CISD), plus expenses, for CISD services performed by Magellan hereunder in excess of the number, if any, included in the Basic Services. (8) Training and Orientations. Magellan shall provide training to Sponsor's supervisors and employees to explain how they can make use of EAP Services. Additional training beyond the number of hours set forth in the Fee Schedule and Conditions of Offer attached as Addendum C is available on a per hour basis as indicated in the Fee Schedule. Sponsor agrees to pay Magellan based on the Fee Schedule and Conditions of Offer attached as Addendum C for training services performed by Magellan in excess of the number, if any, included in the Basic Services. (9) Records and Reporting. Magellan shall maintain a record for each Participant who contacts Magellan for EAP Services. Subject to the restrictions of Section 3.1, Magellan shall provide one or more statistical reports of Participant utilization of EAP Services. Such reports shall reflect Sponsor -specific data however, the reports will not include Participant -specific clinical information or other patient -identifiable information. (10) Run -Off Services. Sponsor acknowledges that, at the time of termination of this Agreement, some Participants may be engaged in counseling. Accordingly, Sponsor shall allow Magellan to continue to provide such EAP Services or to make other clinically acceptable arrangements for continued provision of Services, provided, however that Sponsor shall not be responsible for payment for more than the maximum number of Sessions specified in Fee Schedule and Conditions of Offer attached as Addendum C. Sponsor agrees to pay Magellan additional Service Fees at the rate indicated in the Fee Schedule and Conditions of Offer attached as Addendum C for each Session of EAP Services provided to a Participant pursuant to this section. The rights and obligations set forth in this section shall survive the termination of this Agreement. (b) For purposes of this Agreement, "Optional Services" means the following Services: (1) MagellanAssist Coached Services_ If Sponsor has selected MagellanAssist Coached Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan shall provide Participants with access to Magellan's web -based multi -session program of individual coaching and feedback assembled and monitored by a licensed clinician, utilizing the principles of cognitive behavior therapy. (2) Letral Consultation Services. If Sponsor has selected Legal Consultation Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan Behavioral Health, Inc. Growing Business Services Agreement Rev. 07127101 Magellan shall provide Participants with access to attorneys who can assess and assist with the routine legal needs Of such Participants, except for legal needs relating to employment law. Participants engaging attorneys through this process shall be entitled to one free initial consultation per problem, either by telephone or face-to-face at the option of the Participant, and to a 25%n reduction in the attorney's usual and customary fees for legal work beyond the initial consultation. (3) WorkLife Resource and Referral Services. If Sponsor has selected Resource and Referral Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan shall provide Participants referral and information services for child and elder care, education and adoption assistance and other work/life services. (4) Convenience Services. If Sponsor has selected Convenience Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan shall provide Participants referral and information services for pet care, relocation and home repair/improvement. (5) Nurse Line Services. If Sponsor has selected Nurse Line Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan shall provide Participants access to registered nurses 24 hours a day, seven days a week, to respond to Participants' general health concerns and to furnish health education and counseling on health decisions. Callers will have a choice of talking to a nurse or being directed to an audio library of health information. (6) Financial Consultation Services. If Sponsor has selected Financial Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C, then Magellan shall provide Participants access to trained, degreed, financial professionals. Financial Services include consultation on debt management, basic financial planning, insurance, retirement, savings and investments, vacations, family issues and home issues. 1.2 Payments. As consideration for Magellan's agreement to perform the Services, Sponsor agrees to pay Magellan Service Fees on a timely basis for performance of the Services including, without limitation, the Basic Fees and all Supplemental Fees, as may be adjusted according to the provisions of this Agreement and in accordance with the following terms and conditions: (a) Magellan shall invoice Sponsor during the Term for Service Fees hereunder quarterly in advance. To the extent that any Service Fees are incurred on a fee -for -service basis, Magellan will invoice Sponsor for Supplemental Fees incurred at the next regular billing interval. After the Term, Magellan shall, at such times as it deems appropriate in its discretion, invoice Sponsor for all Service Fees which remain due and payable under this Agreement. (b) Sponsor shall pay invoiced Service Fees to Magellan within thirty (30) days of Sponsor's receipt of such invoice. All payments due to Magellan hereunder shall be addressed to: Magellan Behavioral Health, Inc. W4050 MBH P.O. Box 7777 Philadelphia, PA 19175-4050 (c) Sponsor shall pay interest at the rate of one and one-half percent (1.5%) per month on all payments due hereunder that are not received by Magellan within thirty (30) days of the date when due. In addition, Sponsor shall reimburse Magellan for any costs Magellan incurs, including without limitation reasonable attorney fees, with respect to the collection of any late payment of Service Fees. (d) No later than ninety (90) days prior to the Contract Anniversary Date, Magellan shall provide Sponsor with new rates for the Services under this Agreement to go into effect on such Contract Anniversary Date. Magellan Behavioral Health, Inc. Growing Business 5erviCes Agreement Rev. 07/27/01 ARTICLE II TERM; TERMINATION 2.1 Term. The term of this Agreement shall be for two years, extending from the Effective Date. Thereafter, the Agreement shall be automatically renewed for successive one-year terms from the Contract Anniversary Date unless terminated as provided in Section 2.2(a) of this Agreement or either party gives the other written notice of nonrenewal not less than sixty (60) days prior to the expiration of the term of this Agreement or any renewal thereof. 2.2 Termination. (a) Either party may terminate this Agreement for cause, provided that, the complaining party shall provide at least thirty (30) days' written notice to the breaching party specifying the nature and, so far as then known, the extent of the breach and the action required to correct the breach. The breaching party shall be afforded thirty (30) days (or such additional time as the complaining party may determine, as confirmed in writing, to be reasonable) to cure the breach or, as determined by the complaining party, to achieve substantial cure if a complete cure cannot be reasonably effectuated within the designated period. If the breach remains uncured at the expiration of the designated period, this Agreement may be terminated by written notice given by the complaining party at any time while the breach remains uncured thereafter. (b) Notwithstanding Section 2.2(a), Magellan may terminate this Agreement due to Sponsor's failure to comply with its payment obligations under Section 1.2 if payment is not received by Magellan within sixty (60) days of Sponsor's receipt of invoice, and such termination shall be effective, unless previously cured, as of the date fifteen (15) days from the date of written notice provided by Magellan to Sponsor. If Magellan receives such payment in satisfaction of delinquent Service Fees more than fifteen (15) days after the issuance of its notice of termination, Magellan may, in its sole discretion, either deny or accept Sponsor reinstatement. ARTICLE III GENERAL COVENANTS AND OBLIGATIONS 3.1 Confidentiality: Proprietary Rights; Records. (a) Confidentiality of Participants will be protected in accordance with applicable state and federal law. All client records will be held in a confidential manner and will be the property of Magellan. (b) Sponsor expressly acknowledges that Magellan has developed manuals, procedures, processes, publications, systems, management reports, knowledge, names, logos, trademarks, service marks and information related to the Services which are proprietary in nature and which constitute trade secrets or other intellectual property of Magellan (collectively, the "Proprietary Materials"), Sponsor agrees that the Proprietary Materials shall remain the sole property of Magellan and that Sponsor will refrain from interfering with and/or appropriating any of Magellan's proprietary rights therein. 3.2 Sponsor Cooperation. Sponsor agrees to cooperate with Magellan in Magellan's performance of the Services by furnishing, among other things, timely reports and information in a form and manner specified by Magellan, including the number of Employees covered under the Plan and such other information as may be necessary for performance of Services. 3.3 Employee Count. As of the Effective Date, the Employee Count will be as set forth on Addendum A. If at any time prior to or during the Term, the number of Employees increases or decreases by more than fifteen percent (15%n) relative to the last reported Employee Count, Sponsor shall notify Magellan of such change, and the basic fee(s) shall be adjusted in the next billing cycle to reflect the correct Employee Count. As appropriate, such Magellan Behavioral Health, Inc. 4 Rev. 07/27/01 Growing Business Services Agreement adjustments may be made retroactively. If Sponsor's Employee Count decreases to less than ten (10) Employees in any billing cycle, Sponsor will be billed for a minimum of ten (10) Employees. 3.4 Provision of Services. (a) Generally. Magellan, in its sole discretion, shall provide the Services hereunder either through its employees or the employees of an Affiliate of Magellan, or by retaining, directly or indirectly through an Affiliate of Magellan, independent contractors to provide the Services. (b) Compliance with Law. Magellan shall obtain and maintain, at its sole expense, all licenses and permits necessary for it to perform the Services. Sponsor agrees to provide such information and documents as may be necessary to assist Magellan in obtaining or maintaining such licenses or permits. Magellan and Sponsor agree to comply with all applicable Legal Requirements. (c) Insurance. Magellan agrees to obtain and maintain during the Term the following insurance coverages: (a) comprehensive general liability in a minimum amount of three million dollars ($3,000,000) in the aggregate and one million dollars ($1,000,000) per occurrence (in excess of deductible amounts) and (b) professional liability insurance in a minimum amount of five million dollars ($5,000,000) in the aggregate and per occurrence (in excess of deductible amounts). (d) Special Terms in California. If Sponsor has Employees in California, as indicated on Addendum A, special terms, set forth in Addendum B to this Agreement, apply in California in order to comply with the Knox -Keene Health Care Service Plan Act of California. In the event of any conflict between the provisions in Addendum B and the remainder of the Agreement, the provisions of Addendum B control with respect to Participants located in the State of California. ARTICLE IV MISCELLANEOUS 4.1 Survival. In addition to those covenants and obligations, if any, specified elsewhere herein to survive, the covenants and obligations contained in Sections 1.2 and 3.1 shall survive the termination of this Agreement. 4.2 Notices. All notices and other communications hereunder shall be in writing and shall be deemed to have been duly given when (i) delivered personally or (ii) received by the addressee, if sent by telecopier (receipt confirmed by telephone), Express Mail, Federal Express or other express delivery service (receipt requested) or by registered or certified mail, return receipt requested, in each case to the other party at the following addresses and telecopier numbers (or to such other address or telecopier number for a party as shall be specified by like notice; provided that notices of a change of address or telecopier number shall be effective only upon receipt thereof): To Magellan: Magellan Behavioral Health, Inc. 10150 South Centennial Parkway Sandy, Utah 84070 Attention: Legal Department telecopier: (801) 256-7088 To Sponsor: the address set forth on Addendum A 4.3 Status of the Parties. Magellan and Sponsor agree that Magellan and all Providers are independent contractors with respect to the Services performed under this Agreement and, except as otherwise specifically provided in this Agreement, (a) no Provider is the agent of Magellan or Sponsor nor is any Provider authorized to act on behalf of Magellan or Sponsor in any manner and (b) neither Magellan nor Sponsor is the agent of the other, nor is either party authorized to act on behalf of the other in any manner. Magellan Behavioral Health, Inc. 5 Rev. 07/27/01 Growing Business Services Agreement 4.4 Waiver. The failure of either party in any one or more instances to insist upon strict performance of any of the terms and provisions of this Agreement, or to exercise any option conferred herein shall not be construed as a waiver or relinquishment, to any extent, of the right to assert or rely upon any such terms, provisions or options on any future occasion. 4.5 Governing- Law. This Agreement has been entered into between the parties in the State of-Utdr Florida and the laws of such state, without reference to its choice of law rules, shall govern its interpretation and enforcement, except as such laws may be preempted by ERISA. y 4.6 Severabilit . If any of the provisions of this Agreement shall be invalid or unenforceable by a �1-4/Irl court with jurisdiction over the parties to this Agreement, such invalidity or unenforceability shall not invalidate or render unenforceable the entire Agreement. 4.7 Authority. Each party hereto represents and warrants to the other that the person executing this Agreement on behalf of such party has been duly authorized to execute and deliver this Agreement on behalf of said party. 4.8 Entire Agreement: Modification. This Agreement represents the entire agreement between the parties and supersedes any and all previously written or oral agreements or understandings. This Agreement may only be changed in writing signed by Magellan and Sponsor. 4.9 Limited Liability and Warranties. Magellan warrants that it or its subcontractors will make every effort to ensure the accuracy of the information or the appropriateness of any service or product provided to Participants. Referrals given by Magellan to Participants for elder or child care, legal services or other community services are not endorsements or recommendations for the referred programs or providers. The responsibility for selecting and engaging such providers lies solely with the Participant. Vendors and other providers of elder or child care, legal services, convenience services or other community services are not and shall not be deemed agents of Magellan or Sponsor. 4.10 Exclusions. (a) For purposes of this Agreement, the term "Participant" shall be deemed to exclude all Participants (as otherwise defined) whose residence or place of employment with Sponsor is located outside of the United States, Puerto Rico or Canada unless Sponsor has selected International Services as indicated by the designation on the Fee Schedule and Conditions of Offer attached as Addendum C and notifies Magellan of the location(s) of the Participants eligible for International Services. plan. (b) Coverage is not available to Sponsor's employees by employee choice under a cafeteria (c) EAP services do not include any of the following: (i) Gatekeeping to the behavioral component of Sponsors group health plan; (ii) Evaluations required by any state or federal judicial officer to other governmental official or agency mandating that a Participant undergo counseling; (iii) Performance evaluations or recommendations to be used in child custody proceedings, child abuse proceedings, criminal proceedings, workers compensation proceedings, or any legal actions of any kind; (iv) Performance of professional assessments for fitness for duty determinations or excuses for leaves of absence or time off; (v) Treatment for any problem or condition that is not amenable to resolution in brief counseling. Magellan Behavioral Health, Inc. 6 Growing Business Services Agreement Rev. 07/27/01 ARTICLE V DEFINITIONS For the purposes of this Agreement, the following terms shall have the meanings specified or referred to below. 5.1 "Affiliate" means a legal entity related by common ownership, management or control. 5.2 "Agreement" means this Services Agreement, including the Fee Schedule and Conditions of Offer attached as Addendum C and all other appendices, exhibits and schedules hereto, which are hereby incorporated herein by this reference. 5.3 "CISD" or "Critical Incident Stress Debriefing" means response to and consultation in connection with a sudden, unanticipated incident or circumstance that produces a high degree of distress in the affected workplace of Sponsor or an immediate or delayed emotional reaction by Participants, including Employees, that surpasses normal coping mechanisms. 5.4 "COBRA Continuee" means any natural person eligible to receive benefits under EAP by virtue of electing to continue group health benefits under the Consolidation Omnibus Budget Reconciliation Act or 1985 (COBRA). 5.5 "Contract Anniversary Date" shall mean the date that is two years after the Effective Date and each subsequent anniversary of such date. 5.6 "Contract Year" shall mean the contract period, commencing with the Effective Date or a Contract Anniversary Date, as applicable, and ending twelve months later. 5.7 "Dependent" means any natural person residing with an Employee on a non-commercial basis. 5.8 "EAP Clinician" means an employee of Magellan or of an Affiliate of Magellan who is a clinical professional licensed or certified under applicable state law to provide treatment in the areas of mental health and substance abuse. 5.9 "Effective Date" shall mean that date first set forth at the beginning of this Agreement, which shall be no sooner than thirty (30) days following notice to Magellan of Sponsors intent to enter this Agreement. 5.10 "Employee" means any natural person eligible to receive Services by virtue of being a current employee or COBRA Continuee of Sponsor. 5.11 "Employee Assistance Program Services" or "EAP Services" means those Services described in Section 1.1(a) to this Agreement. 5.12 "Employee Count" shall mean the number of Sponsor's Employees. 5.13 "ERISA" means the Employee Retirement Income Security Act of 1974, as amended. 5.14 "Fee Schedule" means that schedule of fees and charges attached to this Agreement as Addendum C and describing the fees and charges payable to Magellan by Sponsor pursuant to this Agreement. 5.15 "Legal Requirement" means any law, statute, ordinance, decree, requirement, order, treaty, proclamation, convention, rule or regulation (or any amendment or administrative or judicial interpretation of any of the foregoing) of any federal, state or local governmental authority of competent jurisdiction. Magellan Behavioral Health, Inc. Growing Business Services Agreement Rev. 07/27/01 5.16 "Named Fiduciary" means, if the EAP is governed by ERISA, Sponsor or such other party identified by Sponsor in accordance with Section 402(a) of ERISA. In no case shall Magellan act as a Named Fiduciary. 5.17 "Participant" means any Employee or Dependent; provided, that if Sponsor offers a Plan governed by ERISA, "Participant" shall have the meaning set forth in Section 3(4) of ERISA. 5.18 "Participating Provider" means an individual practitioner, group of practitioners, facility or other specialized provider of services which (i) maintains a practice or is an employee of Magellan or an Affiliate of Magellan (ii) has been credentialed by Magellan or an Affiliate or designee of Magellan in accordance with Magellan's credentialing policies and (iii) has been designated as "participating" by Magellan or an Affiliate of Magellan to provide specified services to Participants. 5.19 "PEPM" means "per Employee per month." 5.20 "Plan Administrator" means Sponsor or such other party designated by Sponsor as, or otherwise deemed to be, an administrator of the EAP for purposes of ERISA, if applicable, or any applicable state law of similar nature. In no case shall Magellan act as or be deemed, by virtue of its performance of the Services or otherwise for any reason, to be a Plan Administrator. 5.21 "Proprietary Materials" shall have the meaning set forth in Section 3.1 b . 5.22 Service Fee means the Basic Fee and Supplemental Fees. 5.23 "Services" means the Basic Services and the Optional Services, described in Section 1.1(b), selected by Sponsor by designation on the Fee Schedule and Conditions of Offer attached as Addendum C. 5.24 "Session" means each separate occasion, as determined by Magellan, when Magellan provides or offers personal consultation or counseling as an EAP Service to a Participant, whether by telephone or in person, provided that post -counseling evaluations and post -referral telephone follow-up calls shall not be deemed Sessions. 5.25 "Sponsor" means the undersigned party to this Agreement identified as such in the first paragraph of this Agreement. 5.26 "Supplemental Fees" means all fees and charges, except for Basic Fees, due and payable by Sponsor to Magellan for performance of Services at the rates listed on the Fee Schedule for such Services. 5.27 "Vista" means the wholly owned subsidiary of Magellan Health Services, Vista Behavioral Health Plans, a California corporation. Vista Behavioral Health Plans provides EAP Services in California as a licensed specialty health care services plan under the California Knox -Keene Health Care Service Plan Act of 1975, as amended, and is subject to the regulatory oversight of the Department of Managed Health Care of the State of California. Magellan Behavioral Health, Inc. 8 Rev. 07/27/01 Growing Business Services Agreement IN WITNESS WHEREOF, Magellan and Sponsor have executed this Agreement to be effective as of the Effective Date. MAGELLAN: SPONSOR: MAGELLAN BEHAVIORAL HEALTH, INC. —Li._.f, y of Tamarac (Only required if Sponsor has Employees located outside state of California) By: By: i .. Name: Name Title: Title: Mayor Date: Date: / Witness: Witness: ...J�� •:C. , ll . ,�_tl. I(._ tILJr.�lL"•i_4 VISTA BEHAVIORAL HEALTH PLANS (Only required if Sponsor has Employees located in state of California) By: Name: Title: Date: Witness: Magellan Behavioral Health, Inc. 9 Growing Business Services Agreement Rev. 07/27/01 1 1 -W1111ky, Sponsor Information Initial Employee Count as of Effective Date: Number of Employees in the State of California M Number of Employees in states other than California i 9�2 Total 19 S lEnter 0 or N/A if no Employees located in California. 2Enter 0 or N/A if no Employees located in other states. Address for Notice to Sponsor pursuant to Section 4.2 of the Agreement n. �'X46W�K&Tmefejq Room 201 Attention: Maria Swanqnn telecopier: (9 5 4 )7 2 4- 2 4 0 9 Magellan Behavioral Health, Inc. 10 Rev. 07/27/01 Growing Business Services Agreement ADDENDUM B California Special Terms If Sponsor has Employees in California, the following additional terms and conditions apply. B-1.1 Definitions. In addition to the definitions set forth in Article V of the Agreement, the following terms and conditions apply to Services in California. (a) "Department" means the California Department of Managed Health Care, acting in its capacity to administer or enforce Knox -Keene. (b) "Director" means the Director of the Department of Managed Health Care of the State of California. (c) "Disclosure Form" means a Combined Evidence of Coverage and Disclosure Form meeting the requirements of Knox -Keene. The initial Disclosure Form for use in connection with provision of the EAP Services hereunder is attached hereto as Exhibit 1, and the terms thereof (as such may be amended and superseded by subsequent Disclosure Forms) are hereby incorporated herein by this reference. (d) "Knox -Keene" means the Knox -Keene Health Care Service Plan Act of 1975, as amended, and regulations issued thereunder. B-1.2 Provider Contracts. Magellan shall provide written notice to Sponsor within a reasonable time of the occurrence of any termination of, breach by a Provider of, or inability of a Provider to perform its obligations under, any contract between Vista or an Affiliate of Vista and such Provider, if, in the reasonable estimation of Vista, Sponsor may be materially and adversely affected by such termination, breach or inability to perform. In the event of the termination of such a contract, Vista shall be liable for any EAP Services rendered by the Provider to a Participant who is under the care of such Provider at the time of such termination until such care is ultimately completed by the Provider, unless Vista makes reasonable and clinically appropriate provision for the assumption, continuation and completion of such care by another Provider. The rights and obligations set forth in this section shall survive the termination of this Addendum or this Agreement. B-1.3 Cancellation of Group Contract. (a) Upon the cancellation of, or failure to renew, this Agreement, Vista shall issue promptly to Sponsor a notice of cancellation meeting the requirements of Knox -Keene. Upon receipt from Vista of any notice of cancellation or termination, Sponsor shall promptly mail to Participants a legible, true copy of such notice of cancellation and inform Participants of the termination of this Agreement and the resultant cancellation of the eligibility of Participants to receive Services under this Agreement effective as of the date of such termination of this Agreement (subject to the provisions of Paragraph 1.1 a)( 10). Such notice to Participants shall be acceptable to Vista in form and content, and Sponsor shall provide Vista proof of timely mailing of such notice. (b) Upon the termination of this Agreement, and except for termination by Vista for cause due to fraud or deception by Sponsor in connection with the Services or this Agreement (or Sponsor's knowingly permitting such fraud or deception by another), Vista shall refund to Sponsor the portion of any Service Fees paid to Vista applicable to the expected performance of EAP Services for any period following such termination, less any amounts then due and owing from Sponsor to Vista pursuant to this Agreement. Magellan Behavioral Health, Inc_ 11 Rev. 07/27/01 Growing Business Services Agreement (c) If this Agreement is terminated due to the failure of Sponsor to make timely payment of Service Fees relating to EAP Services, then this Agreement shall be reinstated, as though it had never been terminated, upon the full payment of such Service Fees by Sponsor to Vista prior to or on the first due date for the payment of Service Fees under Section 1.2 following the due date with respect to which Sponsor was delinquent; provided, however, that if Vista receives such payment in satisfaction of delinquent Service Fees more than fifteen (15) days after the date of issuance of its notice of termination, then Vista may, in its sole discretion, either (1) deny such reinstatement by refunding such payment within twenty (20) business days of its receipt thereof or (2) within twenty (20) business days of its receipt thereof, issue to Sponsor a new group services agreement accompanied by written notice stating clearly those respects in which the new agreement differs from this Agreement in benefits, coverage or otherwise. B-1.4 Cancellation of Participant Benefits. In addition to any cancellation of benefits of a Participant hereunder due to cancellation of this Agreement pursuant to Section 2.2 and Paragraph B-1.3 a Participant's coverage for EAP Services may be terminated only by notice to Vista from Sponsor that such Participant is no longer eligible for such benefits. If a Participant alleges that his or her enrollment or subscription has been wrongfully cancelled (or not renewed), such Participant may request review of such cancellation (or failure to renew) by the Director. B-1.5 Notices. With respect to any notice under this Agreement by Vista regarding a material matter, Sponsor shall furnish notice to Participants by the earlier of its next regular communication to Participants or thirty (30) days following receipt of notice. B-1.6 Governing Law and Provisions. Vista and the provision of EAP Services hereunder are subject to the requirements of Knox -Keene, and any provision required to be in this Agreement by any of the above shall bind Vista and Sponsor whether or not provided herein. B-1.7 Participant Grievance Procedures; Public Policy. (a) Vista has established and maintains grievance policies and procedures in accordance with Knox -Keene and shall provide its grievance procedures to Sponsor in connection with the Disclosure Form. Vista shall also make them available to Participants upon request. Sponsor agrees to distribute the Disclosure Form to Participants on a regular basis. (b) Vista shall provide a toll -free telephone number for the filing of complaints by Participants. (c) Vista shall afford Participants the opportunity to participate in Vista's formulation of public policy pursuant to Knox -Keene. B-1.8 Limitations, Exceptions and Exclusions. The EAP Services offered hereunder shall not include (a) psychiatric services, (b) inpatient or outpatient treatment for physical illness, (c) direct treatment or services for mental retardation or autism, (d) counseling services beyond the number of Sessions provided in Paragraph A-1.2, (e) services by Providers not meeting the criteria set forth in this Agreement for Providers, (f) court -mandated counseling or treatment paid for by Workers' Compensation, (g) psychological, psychiatric or neurological testing and (h) medications. For purposes of this Addendum A only, the terms "Participant" and "Employee" shall be deemed to exclude all Participants (as otherwise defined) whose residence or place of employment with Sponsor is located outside of the State of California. In no case shall Vista reduce or decrease the EAP Services offered hereunder by Vista unless upon thirty (30) days' notice to Sponsor. Magellan Behavioral Health, Inc. Rev. 07/27/01 Growing Business Services Agreement 12 Employee Assistance Program Call 24 hours a day, 7 days a week, for confidential help with work, family, personal matters, legal or financial issues. Combined Evidence of Coverage and Disclosure Form The purpose of this Combined Evidence of Coverage and Disclosure Form is to let you know the terms and conditions of your EAP benefit. We encourage you to read this form completely and carefully. If you have any special mental health care needs, you should read carefully the sections of this form that may apply to those needs. If you would like additional information about your EAP benefit, please call us at the telephone number listed below. This Combined Evidence of Coverage and Disclosure Form constitutes only a summary of your plan. The EAP plan contract must be consulted to determine the exact terms and conditions of coverage. A copy of the plan contract will be furnished upon request. Vista Behavioral Health Plans 400 Oyster Point Boulevard, Suite 306 South San Francisco, California 94080 Telephone: (650) 742-0890 Magellan Behavioral Health, Inc. 13 Rev. 07/27/01 Growing Business Services Agreement What is the Employee Assistance Program? The Employee Assistance Program (EAP) is a confidential counseling and referral service that can help you and your dependents successfully deal with life's challenges. The EAP provides: is Face-to-face evaluations at an office convenient to your home or where you work. All calls and counseling sessions are confidential, except as specified by law (such as when a person's emotional condition is a threat to him or herself or others, or if there is child or elder abuse). Easy access to services and crisis counseling 24 hours a day, seven days a week, via a toll -free telephone number. Employee assistance professionals will listen to your concerns with an open mind and help you identify the cause of your problem. They will then work with you and our network of specialized providers to develop a practical solution as quickly as possible. We and your employer encourage you to read this form, share it with your family, and take full advantage of this program. We are ready when you are. It is your program The EAP is an addition to your employee benefits. It is a program designed to offer a professional and confidential source of help for personal concerns. This EAP, offered by Vista Behavioral Health Plans, Inc. ("Vista"), an affiliate of Magellan Behavioral Health, Inc, is regulated by the California Department of Managed Health Care as a specialized health plan. Why does your employer offer an EAP? Because your employer: ■ cares about the personal health and well-being of employees and their dependents; ■ wants you to maintain good job performance; ■ wants to retain valued employees. Who is eligible to use the EAP? All employees and any natural persons residing with an employee on a non-commercial basis are eligible to seek assistance through the EAP. Other related or non -related persons residing in the home may be seen only with the employee as appropriate. If you have questions about eligibility, you may call the EAP or ask your employer for clarification. How do I start using the EAP? To initiate EAP services call Vista's toll -free, 24-hour telephone number listed on your Vista EAP brochure or wallet card. You may choose to obtain EAP services either through telephone consultation or through an in -person appointment. An appointment will be made promptly at a time and location convenient to you. If you have an emergency medical condition that requires emergency treatment, you should call "91 F or the appropriate local telephone number for emergency services. Magellan Behavioral Health, Inc. 14 Rev. 07/27/01 Growing Business Services Agreement What kinds of problems can the EAP help with? The EAP offers assistance with a range of personal problems, including, but not limited to: ■ Work -related issues ■ Family problems ■ Marital and relationship issues ■ Alcohol and drug abuse, and co-dependency issues ■ Emotional problems ■ Physical concerns ■ Access to certain legal services ■ Access to dependent care referral services (if this option was selected by employer) What services are actually provided through the EAP? Through Vista's EAP you can access the services of licensed professional counselors, legal referral services, other community resources and, if your employer has so selected, dependent care referral services. (Dependent care referral services are an optional benefit. Please consult with the sponsoring employer's benefits representative.) You are eligible for up to the number of sessions indicated on the last page of this form per problem per year with an employee assistance professional. Vista EAP services are provided through a network of experienced professionals. These individuals are available to help you and/or your dependents with almost any personal concern. They will help you identify and assess the problems you may be facing, may offer referrals to other resources in the community, provide consultation and, if clinically indicated, may provide counseling up to the number of remaining sessions that have been prepaid by your employer. When clinical counseling is provided, your sessions will be performed by a licensed professional counselor who has at least a master's level degree in a behavioral health field and additional professional experience. Vista provides follow up to monitor the effectiveness of the assistance you have received. Who actually provides the assistance? Vista contracts with independent professional counselors to provide EAP services. EAP access is available to you 24 hours a day, seven days a week via a dedicated toll -free telephone number. Vista maintains referral arrangements with selected community resources for services from which you or your dependents may benefit. The Vista contracted counselors and other providers are paid for their services on a fee -for -service basis. Vista does not use any financial incentives for the providers to reduce or limit their services to you. If Vista terminates its contract with the counselor you are seeing, but you wish to continue to see the counselor to complete your EAP services, in most cases, you may do so, provided that the additional EAP sessions are available and clinically appropriate. You may simply continue seeing the counselor, without seeking Vista approval. However, if your counselor refuses to continue to see you on the same terms and conditions (for example, at the fee Vista offers to pay for EAP sessions), Vista will contact you to arrange for referral to another contracted counselor. Similarly, if Vista terminated your counselor because of fraud, criminal activity, incompetence or unprofessional conduct likely to be harmful to client Magellan Behavioral Health, Inc. t5 Rev. 07/27/01 Growing Business Services Agreement safety or delivery of client care, Vista will contact you to arrange for referral to another contracted counselor. If Vista offers you another contracted counselor but you choose to continue to see the terminated counselor, you will be responsible for paying for the counselor's services. Vista is part of the Vista Behavioral Health organization, the country's largest behavioral health, EAP and human services organization, serving more than 64 million individuals across the United States and Canada. The Vista Behavioral Health family of companies specialize in managed mental health and substance abuse services as well as employee assistance/work-life programs, and serves over 3,000 clients representing health plans, government agencies, unions, and corporations, including more than 20 percent of all Fortune 500 companies. Resource & Referral, legal, and other referral services If you need assistance with routine legal problems (except employer -related issues or third -party consultations), you may call the toll -free EAP number on your Vista EAP brochure or wallet card. A Vista EAP representative will connect you with an attorney referral service. This service will provide you with an initial consultation with an attorney without charge. If you decide to engage the attorney and additional time is required beyond the initial session, he or she will provide a twenty-five percent (25%) discount from the attorney's usual and customary fees. If your employer selected our optional dependent care referral services, a call to the toll -free EAP number indicated on your Vista EAP brochure or wallet card will also help you access elder and/or child care. Vista can also refer you to other community resources, as needed. Is the EAP confidential? The EAP is designed as a confidential program and Vista is committed to protecting your privacy. Your confidentiality is protected by law, except in certain specific circumstances. In most cases EAP counseling offices are located away from the worksite. The discussions you have with your counselor will not be disclosed to anyone outside Vista without your written consent, except in the specific instances required by law. You are encouraged to discuss the rules of confidentiality (and those exceptions) directly with your EAP counselor. A copy of Vista's confidentiality policy is available upon request. What costs are involved? The EAP is an employer -sponsored program. Your employer has prepaid the entire cost of the EAP session(s) for which you are eligible, including any of the EAP services which Vista may provide in person or over the phone. Through its contracts, Vista prohibits its contracted counselors from charging you for services rendered under this program, regardless of whether or not payment is received from Vista. The prepaid services provided through the EAP are often all that is required to address a personal problem. However, if you are referred to (and elect) services outside the Vista EAP system, you will be responsible for the cost of those services. You should check to see whether the costs of healthcare services to which you are referred are partly or fully covered by your employee medical benefits plan. Also, certain referral services (e.g., legal or dependent care referral services) may result in discounted charges for services beyond the initial consultation. Please make sure you understand whether you are responsible for any such charges. Magellan Behavioral Health, Inc. 16 Rev. 07/27/01 Growing Business Services Agreement Vista works hard to provide quality services, whether they are provided by contracted providers or through referrals to other community resources. However, referrals given in connection with EAP services are not endorsements or guarantees for the programs or providers to which you are referred. You are encouraged to discuss any concerns about resources with your EAP counselor. EAP limitations and exceptions As an employee or eligible dependent, you are eligible to receive the number of EAP sessions prepaid and sponsored by the employer each year. However, there are some limitations and exceptions. For example, the Vista EAP does not provide: ■ Psychiatric services ■ Inpatient or outpatient treatment for physical illness ■ Direct treatment or services for mental retardation or autism ■ EAP counseling services beyond the number of employer -sponsored, prepaid sessions ■ Services by providers who are not part of Vista's EAP network ■ Court -mandated counseling or treatment paid for by workers' compensation ■ Testing ■ Prescription drugs When does EAP coverage begin and end? Persons are eligible to receive Vista's EAP services if they are active employees, covered retirees, ex - employees if eligible for COBRA benefits, or dependents of such individuals. Your eligibility ends when the employer's contract with Vista terminates or when you (or the person through whom you receive benefits) separate from the employer. During your term of employment (or that of the person through whom you receive benefits), your coverage cannot be canceled, nor can you be denied renewed coverage because of your health status or your requirements for service. May I continue coverage after leaving employment? You may be able to obtain EAP coverage, at your cost, following the end of employment, if federal law requires the employer to offer it. Talk to the employer's benefits representative if you are interested. If federal law requires continuation of EAP coverage, you will have 60 days to elect to continue EAP coverage. May I obtain a second opinion? If you have questions about the counselor's assessment of your problem or the action plan developed with the counselor or the counselor is unable to make an assessment, you may contact Vista to discuss the assessment or action plan. You may also contact Vista to discuss questions regarding failure of your problem to improve within an appropriate time period. After discussing the issues with a Vista care manager, you may request a second opinion. If Vista determines a second opinion is clinically appropriate and you have EAP sessions left, Vista will refer you to an appropriately qualified professional who will provide a second opinion. In a case involving an imminent, serious health threat, Vista will process your request on an expedited basis. If you would like additional information regarding Magellan behavioral Health, Inc. 17 Rev. 07127101 Growing Business Services Agreement the availability of a second opinion, call Vista toll -free at the telephone number below or write to Vista at 400 Oyster Point Boulevard, Suite 306, South San Francisco, California 94080. Grievance procedure Member satisfaction is an integral component and primary goal of Vista's EAP program. We strive to ensure that the professionals to whom you are referred meet your needs. However, even in the best system, grievances may occur. When they do, we make every effort to resolve them quickly. If you are not satisfied with the services you are provided by the Vista EAP, please call a Vista EAP representative at the toll -free number listed on your brochure or wallet card. You may verbally report your complaint to the representative or may request that a complaint form be forwarded to you. If you request a complaint form, you should complete it at your earliest convenience and forward the completed form to Vista Behavioral Health Plans, Attn: Comment Coordinator, 400 Oyster Point Boulevard, Suite 306, South San Francisco, California 94080. If you need assistance completing the complaint form, please call your Vista toll -free number. If possible, Vista will respond to your inquiry immediately. Vista will offer you a resolution in writing, explaining the reasons for our resolution, within ten (10) business days following our receipt of your complaint. If you are not satisfied with Vista's response at this point, you may request consideration of your complaint through Vista's grievance procedure or you may file an administrative appeal. If you pursue review through the grievance process, Vista will acknowledge receipt of your grievance within twenty (20) days and notify you whom Vista may contact in connection with your grievance. Whether you pursue a grievance or an appeal, Vista will offer you a resolution in writing, explaining the reasons for our resolution, within thirty (30) days following receipt of your request. If your complaint or grievance is of an urgent nature, Vista will conduct an expedited review and provide you with a written statement of Vista's resolution within three (3) business days of receipt of the complaint or grievance. The Department of Managed Health Care The California Department of Managed Health Care is responsible for regulating health care service plans. The Department has a toll -free telephone number (1-800-888-HMO-2219) to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service's toll -free telephone numbers (1-800-735-2929 (TTY) or 1-888-877-5378 (TTY)) to contact the department. The Department's Internet website (www.hmohelp.ca. ov) has complaint forms and instructions online. If you have a grievance against your health plan, you should first telephone your plan at the toll -free telephone number on your EAP brochure or wallet card and use the plan's grievance process before contacting the Department. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your plan, or a grievance that has remained unresolved for more than 30 days, you may call the Department for assistance. The plan's grievance process and the Department's complaint review process are in addition to any other dispute resolution procedures that may be available to you, and your failure to use these processes does not preclude your use of any other remedy provided by law. You may file a grievance with the Department on the earlier of completion of Vista's grievance process or thirty (30) days after initiation of Vista's grievance process. Magellan Behavioral Health, Inc. 18 Rev. 07/27/01 Growing Business Services Agreement What can I do if I suspect fraud? Vista has implemented an anti -fraud program in order to detect, deter, and fully investigate suspected fraud on the part of its providers, affiliates, and/or staff. To maximize protection against fraudulent activity, an anti -fraud hotline is available to all Vista providers, affiliates and staff as well as employees (and their household members) of organizations that contract with Vista for EAP services. If you suspect Fraud related to submission of claims or other activities related to your EAP benefit, please contact the Vista anti -fraud hotline at 1-800-443-5704. Program renewal Vista and the sponsoring employer may negotiate changes in the EAP program periodically, typically at each anniversary of the contract. While the number or type of EAP sessions you receive may change in such cases, it is unlikely that your eligibility for EAP services will be affected. Public policy participation If you are interested, you can have a voice in our public policy -making process. Call us with your ideas at (800) 424-6038 or write to Vista's Public Policy Committee. Our address is: Vista Behavioral Health Plans Attn: Public Policy Committee 400 Oyster Point Boulevard, Suite 306 South San Francisco, California 94080 Summary of Vista's EAP In closing, here is a listing of the features and services we offer: Features ■ Up to counseling sessions per problem per year, as clinically appropriate ■ 24 hours/seven days per week availability in crisis ■ Confidentiality ■ Voluntary ■ Available to employees and families ■ Employer -sponsored and prepaid ■ Designed to assist with all types of personal problems Services • Consultation ■ Assessment • Counseling ■ Referral, if appropriate ■ Follow up Magellan Behavioral Health, Inc. 19 Rev. 07/27/01 Growing Business Services Agreement ADDENDUM C FEE SCHEDULE AND CONDITIONS OF OFFER BASIC FEES Fee PEPM Basic Services [Choose only one] X Face to Face Employee Assistance Program Model -- Choose selected model below: ® 3-session ❑ 6-session $ 1 . 4 9 ❑ 5-session ❑ 8-session Or Telephonic Only Services Optional Services MagellanAssist Coached Services X Legal Consultation Services $ . 1 0 Work Life Resource and Referral Services -- Choose model below: ❑ Basic $ . 3 0 ❑ Full ❑ Full, with Convenience Services Nurse Line Services Financial Consultation Services SUPPLEMENTAL FEES Additional Services Additional Trainings $125 per clinician hour Additional Mandatory Referrals $700 per referral Additional CISDs $200 per clinician per hour Additional Sessions $90.00 per Session Run -Off Services $100.00 per Session Additional Communications Materials Postcard and refrigerator magnet $0.60 per unit Additional Videos $14.00 per unit Additional Wallet Cards $0.10 per unit Additional Brochures $0.40 per unit Additional Posters $1.60 per unit Additional Newsletters $0.12 per unit Magellan Behavioral Health, Inc. 20 Rev. 07/27/01 Growing Business Services Agreement SUPPLEMENTAL FEES (cont.) International Services Set-up Fee US $3000 Face -to -Face Counseling Services US $225 per one - hour session Termination Fees Terminations effective in the l" contract quarter 25% of one month's fee Terminations effective to the 2" d contract quarter 15% of one month's fee 8% of one month's Terminations effective in the Yd contract quarter fee Travel costs to remote areas for training and CISDs will be reimbursed to Magellan by Sponsor at Magellan's cost CONDITIONS OF OFFER 1. Rates are initially for 24 months. Thereafter rates are evergreen with an annual rate adjustment at Sponsor's renewal. • Renewal rates are on a community basis effective on the customer contract renewal date. • Rate increases will be indicated 90 days in advance. 2. The Basic Fee for Basic Services (EAP) covers the following: • Trainings: none included if less than 100 employees, 1 hour at 100 employees, plus 1 hour for each additional 200 employees • C1SDs: one hour if Sponsor has more than 250 employees • Mandatory Referrals: Up to 2 mandatory referrals per year • Access to MagellanAssist and EPOTEC • Standard Magellan employee communications package, consisting of: > Brochures @ 1.3 per employee > Wallet Cards @ 1.3 per employee > Quarterly Employee Newsletter @ 1 per employee per quarter > Posters @ 1 per 150 employees > Supervisor manual @ 1 per 20 employees > Employee Videos @ 1 per 500 employees > Supervisor Videos @ 1 per 500 employees > One insert page for each ancillary product > Distribution of above materials to one location • One Sponsor -specific annual usage report if Sponsor has fewer than 250 Employees; if Sponsor has 250 or more Employees, four quarterly Sponsor -specific usage report. 3. Magellan offers no performance guarantees and will report on service center overall performance only. 4. Optional Services may be purchased only in conjunction with Basic Services (EAP). Convenience Services may be purchased only when Full Dependent Care has been purchased. Magellan Behavioral Health, Inc. 21 Rev. 07/27/01 Growing Business Services Agreement MAGELLAN BEHAVIORAL HEALTH GROWING BUSINESS ENROLLMENT FORM Pages I and 2 roust be completed in their entirety to enroll a group. * Required fields (all required fields must be filled in) For Growing Business Department use only: Date Completed: ID #1: ID#2: ID#3: Group Name: City of -T-amarac Aliases: Parent Name: Headquarters Location: F l o r i d a Type of Business: Municipal Government Contract Start Date: 01 0 1 0 2 (Effective implementation requires 30 days advance notice) Customer Contact: Name: Maria Swanson Street Address: 7525 NW 8 8 t h Avenue City: Tamarac Telephone: (9 5 4) 7 2 4 -1y3 5 Q Title: Director of Personnel Email Address-, marias@tamarac.org State: F L Zip: 33321 � Fax#:__(_954) 724-2409_____ Threat of Violence (TOV) / Critical Incident Stress Debrietine (CISD) Contact: Name: _Maria Swanson _ Title: Telephone (Day): (9 5 4) 7 2 4 -13 5 0 Telephone (Evening): ( 9 5 4) 9 8 7- 4 5 8 7.., ..._., __.. Billing Contact (if needed): Name: B i 11 N e a 1 o r Street Address: 7 5 2 5 NW 8 8 t h Avenue City: Tamarac Telephone: 9 5 4 7 2 4 -1310 Title: Co n t r n l l P r Email Address: b i 11 n@ t a m a r a c. o r9 State: F L _ _ Zip: , 33321 Fax#: (954) 724-1321 Group Insurance: Aetna (MC/FPR/HMO): H M 0 Select one Managed Behavioral Health Firm: ReeenceCare (HMO Washington): Select one Other: Regence Blue Shield Selections: Select one Other: Broker Information: Brokerage Firm: Contact Name: Address: Email Address: City: State: Zip: Telephone #: Fax #: Tax ID #/SSN: Notes: EAP Model with Price/EE/1blo. Other Services with Price/EE/Mo. © 1-3 $1 .49 ® Legal Services $_L0 ❑ 1-5 $ ❑ Financial Services $ ❑ 1-6 $ ® Basic LifeCycle Dependent Care $• 3 0 ❑ 1 8 $ ❑ Full LifeCycle Dependent Care $ ❑ Insights $ ❑ Convenience Services (must purchase Full LifeCycle R & R) $ ❑ NurseAccess Line $ ❑ Magellan Online Coached Series $ n International EAP $ Total Number of Employees* 3 9 5 _ x Total Rate* *$1B-9_= Total Price Per Month 1746, 5S 3 months = Quarterly Amount $ 2 , 2 3 9.6 5 *Total Number of Employees should agree with Location Listing total. **Kate .should equal to the total of the rates entered above for services selected. Location List: Division Name/Location Customer ContactlPhone Number # of EEs Outside CA # of EEs in CA Total Employee Count for Location Florida Communication Material: English Only English and Spanish Spanish Only 11 El ❑ To enroll in services, send this completed enrollment form, check and contract to: Teresa Thomas Magellan Behavioral Health 10150 S. Centennial Parkway Sandy, UT 84070 phone (800) 424-6074 fax (801) 256-7148