HomeMy WebLinkAboutCity of Tamarac Resolution R-98-3451
Temp Reso. 8460
October 17, 1998
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-98-_5.
A RESOLUTION OF THE CITY COMMISSION
OF THE CITY OF TAMARAC, FLORIDA,
AUTHORIZING THE APPROPRIATE CITY
OFFICIALS TO EXECUTE AN AGREEMENT
CONCERNING THE SELECTION OF A
HEALTH INSURANCE PROVIDER FOR CITY
EMPLOYEES EFFECTIVE JANUARY 1, 1999;
PROVIDING FOR THE CONTINUATION OF
THE EXISTING COST ALLOCATION OF THE
HEALTH INSURANCE PREMIUM BETWEEN
THE CITY AND EMPLOYEES; APPROVING
THE APPROPRIATE BUDGETARY
TRANSFERS OF FUNDS; PROVIDING FOR
CONFLICTS; PROVIDING FOR
SEVERABILITY AND PROVIDING FOR AN
EFFECTIVE DATE.
WHEREAS, the Agreement between the City of Tamarac and HIP Health
Insurance Plan expires December 31, 1998; and
WHEREAS, a Request for Proposal entitled "Health Benefits Program"
was issued and in response three (3) proposals were received, (1) AvMed, (2)
HIP, (3) Humana, and;
WHEREAS, the City of Tamarac created a Health Review Committee to
perform an analysis of the proposals submitted and recommend a Health
Insurance Provider, and
WHEREAS, the Health Committee consisted of the Risk Manager,
Benefits Coordinator, Interim Finance Director, Assistant City Attorney,
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Temp Reso. 8460
October 17, 1998
Personnel Analyst, Purchasing Officer, Senior Planner Community Development,
Operations Manager Public Works, Battalion Chief, an IAFF Representative and
two FPE Representatives; and
WHEREAS, each company was invited to present an overview of their
proposal to the committee; and
WHEREAS, after careful evaluation, the committee narrowed the selection
to HIP Health Plan of Florida; and
WHEREAS, it is the Health Review Committee's recommendation to
approve HIP Health Insurance Plan of Florida as the Health Insurance Provider,
and
WHEREAS, the City Manager concurs with this recommendation that the
City of Tamarac enter into an agreement with HIP Health Plan of Florida to
provide Health Insurance coverage for the City of Tamarac employees; and
WHEREAS, the current health insurance premium is paid by the City for
HMO single coverage and split between the City and the employee on an 80/20
ratio for all other coverages; and
WHEREAS, the City Manager recommends that this cost allocation for the
payment of the premium be maintained so that both the City and the employee
bear a portion of the premium increase; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems
it in the best interest of the citizens and residents of the City of Tamarac to
approve HIP Health Plan of Florida as the Health Insurance Provider and provide
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Temp Reso. 8460
October 17, 1998
for its proper execution.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA;
Section 1: The foregoing "WHEREAS" clauses are hereby ratified
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 accept and execute an agreement between the City of Tamarac, Florida, and
HIP Health Plan of Florida to provide Health Insurance for the employees of the
City of Tamarac effective January 1, 1999 (attached hereto as Exhibit 1).
Section 3: That the existing cost allocation of the Health Insurance
premium between the City and employees be continued.
Section 4: That all appropriate budget transfers required to fund the
provisions of this Resolution are hereby approved.
Section 5: That all resolutions or parts of resolutions in conflict
herewith are hereby repealed to the extent of such conflict.
Section 6: If any clause, sections, 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.
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Temp Reso. 8460
October 17, 1998
Section 7: This Resolution shall become effective immediately
upon adoption.
PASSED, ADOPTED AND APPROVED this A4C Day of 11998.
ATTEST:
�i�
CAROL GOL , CMC/AAE
CITY CLERK
I HEREBY RTIFY that I hav
A p ved i RES UTIO as
of
MI HELL S. KRAF
CITY ATTORNEY
(HIP Reso.bl)
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Ff ••
RECORD OF COMMISSION VOTE
MAYOR SCHREIBER
DIST 1: COMM, W'KAYE
DIST ? V(_ `.'i i',J!(�HKIN
DIST 3: ''EA. ANN0F
DIST 4: C(N,W,-i i-C)E3ER'fS
EXHIBIT 1
TEMP RESO #8460
s
GROUP MASTER CONTRACT
BETWEEN
HIP HEALTH PLAN OF FLORIDA, INC.
0 AND
CITY OF TAMARAC
HIP HEALTH PLAN OF FLORIDA, INC.
1911111 �dll
Steven M. Cohen
President and CEO
0 HIP 40084 (02/25/97) G-I
Binder and Agreement
HIP Health Plan of Florida, Inc., a Corporation licensed to do business in the State of Florida, (hereinafter referred to as "HIP")
agrees to provide Covered Services and other rights and privileges which are set forth in the attached Group Master Contract,
this Binder and Agreement, and all applicable attachments and riders thereto (hereinafter referred to as the "AGREEMENT"), to
�CITY OF TAMARAC (hereinafter referred to as the "GROUP"), subject to all conditions and provisions contained therein.
GROUP: CITY OF TAMARAC (HMO)
ADDRESS: 7525 NW 88TH AVENUE
CITY, STATE, ZIP: TAMARAC, FLORIDA 33321-2401
GROUP CONTACT PERSON: TIM HEMSTREET
PHONE: (954) 724-2454
HIP GROUP NUMBER: 2002163-000
EFFECTIVE DATE: JANUARY 1, 1999
TERM OF AGREEMENT, DECEMBER 31,"2001.
PREMIUM DUE DATES: COVERAGE EFFECTIVE DATE AND THE FIRST DAY OF EACH
SUCCEEDING CALENDAR MONTH
PREMIUM RATES: $136.29 EMPLOYEE/SINGLE
$379.82 EMPLOYEE/FAMILY
NOTE: The premiums are set up for annual terms.
I�►�i19�i]7���Ld1:31�yi'�
EVERY EMPLOYEE WHO MEETS THE GROUP'S FOLLOWING DEFINED PREREQUISITES OF EMPLOYEE CLASSIFICATION AND
PERIOD OF CONTINUOUS EMPLOYMENT SHALL BE ELIGIBLE FOR COVERAGE FOR HIMSELF/HERSELF AND DEPENDENT(S)
ON OR AFTER THE EFFECTIVE DATE OF THE AGREEMENT:
A. EMPLOYEE CLASSIFICATION: Executives/Management - 35 (thirty-five) hours per week
Staff - 40 (forty) hours per week
B. PERIOD OF CONTINUOUS EMPLOYMENT: Executives & Management: Effective on date of hire.
Staff: Effective 1st of month following 30 days of employment.
BENEFIT PLAN: HMO PLAN 100 (HIP 60013)
PRESCRIPTION DRUG $5/$10 w/ $5 contraceptive - formulary, retail & mail-order; $25 copay
non -formulary drugs - retail & mail-order HIP 50338 03/97 (R2HRCX)
MENTAL HEALTH: $0 Inpatient Hospital, $0 copay Outpatient - HIP 50346 11/96 (R2HMEN)
SUBSTANCE ABUSE: $0 copay Inpatient Hospital; HIP pays max of $35/visit for outpatient
visits. 44 visits per calendar year, $4500 lifetime max for In & Outpatient Substance
Abuse services HIP 50347 11 /96 (R2HADD)
VISION - $0 copay for exam - HIP 50219A (R2HVS0) 1296
DEPENDENT STUDENT - student dependent age to 25 if full-time student - HIP 40084
DEPAGE (03/97)
The above has been accepted and approved by:
CITY OF TAM AC
thou Signature)
Title
Date
HIP HEALTH PLAN OF FLORIDA, INC.
9[d:1111;12*111l�lt�l�til
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HIP 40084 (02/25/97) G-2
is AGREEMENT is entered into between HIP HEALTH PLAN OF FLORIDA, INC. and GROUP which is named and identified on
e Binder and Agreement and the Group Application. GROUP is acting on its own behalf and for its eligible employees and their
eligible Dependents who enroll pursuant to this AGREEMENT.
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HIP 40084 (02/25/97) G-3
Change of GROUP Eligibility Rules. The requirements determining eligibility of Subscribers or Dependents for Coverage as set
forth in this AGREEMENT are a material inducement to the execution of this AGREEMENT by HIP. During the term of this
AGREEMENT, no change in GROUP's eligibility or participation requirements under this AGREEMENT shall be permitted unless
such change is agreed to in writing by authorized agents of HIP in their sole discretion.
Billing Dates. The GROUP may, in accordance with this AGREEMENT, make changes as set forth in Section IV(A) of this
AGREEMENT, effective on any date of the calendar month. However, unless otherwise agreed in writing by HIP, if Coverage of
any Subscriber or Dependent commences or terminates on a date other than the first day of the calendar month, or if the
Subscriber's change in Coverage is made effective on a date other than the first day of a calendar month, the Premium payment
relating to such Subscriber will be computed as follows:
1 . if the Coverage of a Subscriber commences on a day which is the first through the fifteenth day of a month or
terminates on a day which is the sixteenth through the last day of a month, the full amount of the Premium
relating to such Subscriber shall be deemed to have been earned, and to be due and payable, for the month in
question; or
2. if the Coverage of a Subscriber commences on a day which is the sixteenth through the last day of a month or
terminates on a day which is the first through the fifteenth day of a month, no Premium relating to such
Subscriber shall be deemed to be earned, nor be due and payable, for the month in question.
Rates. The HMO rates effective January. 1, 2000 will have a maximum increase of eight (S) percent over the rates effective
January 1, 1999.'"The HMO rates effective January 1, 2001 will have a maximum increase of eight (8) percent over the rates
effective January 1, 2000,
Notwithstanding the above maximum increases any rate increase will'be calculatedupon the City of Tamarac group experience
for each respective plan. 'HIP will substantiate to the City any rate increase prior to the rate becoming effective. HIP'will
maintain or lower the rates charged the City in the event that the City of Tamarac group experience for any or all''plans° is lower
than expected.
Premiums. Premiums set forth in the Binder and Agreement and/or the Group Application shall be in effect for the term of the
AGREEMENT. Unless otherwise agreed in writing by HIP, written notice of any subsequent change in Premiums will be given to
the GROUP at least thirty (30) days prior to the Effective Date of such change, subject to approval by the Florida Department of
Insurance. If Coverage of a Subscriber commences or terminates on any day during a calendar month, the Premium due shall b�
calculated as outlined above.
The GROUP shall pay to HIP the aggregate of the Premium payments set forth in the Binder and Agreement and/or the Group
Application for all Members.
Premium payments are due to HIP on the first day of each month that this AGREEMENT is in effect, unless otherwise agreed in
writing by HIP.
Unless otl mi wi3e agreed ir, n. iting hV I W, this A6REEMENT- lies a ten H 0) dav arace peried. This . -.3 that if any
P'emitni- is ot paid o a befoie the date dtie, at inny be paid during the foil Veried. During the grace
poll d, the AGREEMENT will stay imi force. This Agreement has a thirty-one (31) day grace.`period. This provision means that if
any, required premium is not paid on or before the date it is due, it may be paid during the following grace 'period.. During the
grace period, the Agreement will remain in force.
If t1te full Prerrivan. is not paid within this giace peimad, 1 lip Allay, at its sole aption, and vvith vviotte.. notice to the GRE)UP
HIP will notify the City by telephone and in writing by the 10th day of the Grace period that the premium is due and has not
been paid.' HIP agrees that it will not terminate" this Agreement for non-payment unless written notice of delinquency has been
given to the City and at least ten (10) working days or the remainder of the grace period, whichever is greater, has been
provided for payment.
The GROUP agrees to pay all bills for Premiums submitted to it by HIP in the amounts specified therein. The GROUP may,
however, contest alleged billing errors in the event that the employer's written notice of objection is mailed to HIP within sixty
(60) days of receipt of the invoice. The employer waives any claim for adjustment or refund to the extent such notice of
objection is not filed within sixty (60) days of the receipt of the bill. Adjustments made as a result of this process will be
reflected on a succeeding month's bill.
Reports. Quarterly Claims Data reports will be received according to the schedule listed below. Separate reports for each
product provided to the City of Tamarac by HIP Health Plan of Florida will be delivered to the City no later than the date
provided below. If for any reason, except acts of nature beyond the control of HIP, the Quarterly Claims Data reports are not
received by the dates indicated, HIP Health Plan of Florida agrees to pay, the City of Tamarac the sum of One Thousand' Dollars
HIP 40084 (02/25/97) G-4
($1,000.00) per occurrence. The parties agree that damages consequent to HIP's failure to timely provide reports pursuant'to
this section are not readily, ascertainable at the time of execution of this Agreement, and agree that One Thousand ($1,,000.00)
per occurrence is an -amount proportionate to the cost incurred by the City as a.result of such failure by HIP. This Schedule and
payment provision' shall remain in,';effect for the entire term of this. Agreement,'.
October, November, December Receive no later than February 15
January, February, March Receive no later than April 1.5
April, May, June Receive no'later :than July 15
July, August, September Receive no later than October .15
October, ,November, December Receive no later than February 15
Termination. If Coverage is terminated, the GROUP shall be liable to HIP for all Premiums for the period commencing when the
date payment was due, up to and including the date of termination. HIP will not assume financial responsibility for services
rendered by Health Professionals, Hospitals or any other provider (even if a referral or preauthorization had been issued by HIP)
to Members for the periods for which payment provisions have not been met, except as outlined in Sections V and VI of this
AGREEMENT.
1 • Volljn1gry Termination by GROUP. Unless otherwise agreed in writing by HIP, this AGREEMENT may be
terminated by GROUP at any time and for any reason by giving HIP at least forty-five (45) days prior written
notice of such termination, which notice shall specify the termination date and the reasons for termination. In
such event, no Coverage will be provided by HIP on or after such termination date, except as specifically set
forth in this AGREEMENT.
3.
Premitirris lisue beer. paid. I o eve t sl all terminatio i i elieve 6RE)UP of its obligation tj ider this
AGREEMENT to pay I IIP any pro rated portion of the Pre On a d,'o offier charges applicable to all pe -iods of
In the event full payment
of Premiums and/or other charges required' under this Agreement are not paid when due (inclusive of grace
periods and the provisions stated under the Premiums section of this Binder and Agreement) this" Agrdemi 61 t
will terminate immediately, such termination to be effective, retroactive to the last 'day'of'the period`for which
Premiums have been paid. In no event shall termination relieve Group of its obligation under this. Agreement to
pay HIP'any prorated: portion of the Premium and/or charges, applicable to all periods of time during which HIP
has provided benefits; or for any amounts otherwise due HIP' up to the point of termination.
4. Notice gf Termination. A written notification of any termination or non -renewal of this entire AGREEMENT
shall be mailed to GROUP. This notification shall state the reason for the termination or non -renewal, as the
case may be. GROUP shall immediately forward to each Subscriber any and all notifications of termination or
non -renewal required by law, including those required by Florida Statutes, Section 641 ,3108,
Notice of Member Termination. If an individual becomes ineligible for continued Coverage under this AGREEMENT for any
reason, GROUP shall, if possible, provide HIP with prior written notice of the Effective Date of ineligibility. However, unless
otherwise agreed in writing by HIP, written notice of such ineligibility shall be provided by GROUP to HIP no later than thirty (30)
days after the date of such ineligibility.
Financial Responsibilities of GROUP. GROUP shall cooperate with and support HIP in obtaining recovery of any payments HIP
may have made for or on behalf of any Member whose Coverage hereunder has terminated if such payment was for services or
supplies rendered subsequent to the Member's termination date and prior to the date notice of the Member's termination is
4Fade by GROUP. In the event GROUP does not comply with the notice requirements set forth above in a timely fashion,
ROUP shall be solely liable to HIP to the extent of any payment made by HIP on behalf of such Member for services or supplies
rendered subsequent to the date notice of Member termination was due HIP.
HIP 40084 (02/25/97) G-5
General Provisions. The GROUP shall maintain records of the types of Coverage selected, the names, birth dates and current
addresses of all Members. Such information shall be furnished to HIP as may reasonably be required to maintain an accurate
record of all Members. HIP shall be entitled to rely on any information provided to it by the GROUP.
Certificate Provisions. The remainder of the AGREEMENT between the GROUP and HIP consists of the provisions of the
Certificate of Coverage issued to the Members of the GROUP. The provisions of the Certificate of Coverage, as well as any
Riders, Group Applications, Applications, Binder and Agreements and any other written agreements are hereby made a part of
the AGREEMENT. Any amendments to the Certificate of Coverage shall also constitute a part of the AGREEMENT.
Notice. Except as otherwise expressly provided herein, any notice given under this AGREEMENT will be given by mail as
follows:
HIP Health Plan of Florida, Inc.
300 South Park Road
Hollywood, FL 33021
City of Tamarac
7525 NW 88th Avenue
Tamarac, Florida 33321-2401
Acceptance. By execution of a Binder and Agreement or a Group Application, the GROUP agrees to the terms and conditions of
this AGREEMENT and assumes responsibility for the contents contained therein. The GROUP agrees to observe and comply
with all rules and regulations of HIP.
Changes to the AGREEMENT. I IIP maV changes this AGREEMENT vvith the approval of the Florida Depa -tment of I
change.0 iless athe -wise agieed in vniti ig by 1 1113, HIP ovill wive thirty (30) days' v me vv Otte i otmee to tI e GREW of any HIP
may change' this Agreement with the ,approval of the Florida Department of Insurance. Unless othorwise agreed it writinflby
HIP;' HIP will provide the City with thirty (�30) days written notice prior to submitting,, any change to'Department of insuraric'e and
will provide the City written notice within five (5) days of any subsequent approval by the Department. of. Insurance.
Relationship. HIP, Primary Care Physicians, Referral Specialists and other Participating Providers are independent contractors
and are not agents or employees of HIP. HIP and its employees are not agents or employees of such Providers.
Non -Discrimination. HIP shall not discriminate against any person because of color, race, creed, sex, place of origin or age.
Assignment. Benefits or payments due under this contract cannot be assigned to any person, corporation or organization.
Assignment means the transfer to another person or organization of the rights to Covered Services provided Members. is
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HIP 40084 (02/25/97) G-6