Loading...
HomeMy WebLinkAbout2001-272ORDINANCE NO je2QZ d "IX AN ORDINANCE ACCEPTING COMPETITIVE PROPOSALS AND AWARDING A CONTRACT FOR THE PURCHASE OF HEALTH INSURANCE, PROVIDING FOR THE EXPENDITURE OF FUNDS AND PROVIDING AN EFFECTIVE DATE (RFSP 2689- EMPLOYEE HEALTH INSURANCE AWARDED TO CIGNA HEALTHCARE IN THE ESTIMATED AMOUNT OF $5,354,000) WHEREAS, the City has solicited, received and evaluated competitive sealed proposals for the purchase of necessary materials, equipment, supplies or services in accordance with the procedure of STATE law and City ordinances, and WHEREAS, the City Manager or a designated employee has received and reviewed and recommended that the herein described proposals are the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals, and WHEREAS, the City Council has provided in the City Budget for the appropriation of funds to be used for the purchase of the materials, equipment, supplies or services approved and accepted herein, NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS SECTION 1 That the items in the following numbered request for proposal for materials, equipment, supplies or services, shown in the "Request Proposals" on file in the office of the Purchasing Agent, are hereby accepted and approved as being the most advantageous to the City considering the relative importance of price and the other evaluation factors included in the request for proposals RFSP NUMBER CONTRACTOR AMOUNT 2689 CIGNA HealthCare $5,354,000 SECTION 2 That by the acceptance and approval of the above numbered items of the submitted proposals, the City accepts the offer of the persons submitting the proposals for such items and agrees to purchase the materials, equipment, supplies or services in accordance with the terms, specifications, standards quantities and for the specified sums contained in the Proposal Invitations, Proposals, and related documents SE TION 3 That should the City and person submitting approved and accepted items and of the submitted proposals wish to enter into a formal written agreement as a result of the acceptance, approval, and awarding of the proposals, the City Manager or his designated representative is hereby authorized to execute the written contract, provided that the written contract is in accordance with the terms, conditions, specifications, standards, quantities and specified sums contained in the Proposal and related documents herein approved and accepted SECTION 4 That the City Manager or his designated representative is hereby authorized to execute a letter of agreement as per CIGNA HealthCare response to RFSP 2689 dated July 12, 2001, and incorporated herein and made a part hereof for all purposes, and contract with CIGNA HealthCare for Employee Health Insurance RFSP 2689 SECTION 5 That by the acceptance and approval of the above numbered items of the submitted proposals, the City Council hereby authorizes the expenditure of funds therefore in the amount and in accordance with the approved proposals or pursuant to a written contract made pursuant thereto as authorized herein SECTION 6 That this ordinance shall become effective immediately upon its passage and approval ASSED AND APPROVED this the j#—/ day of 2001 EULINE BROCK, MAYOR ATTEST JENNIFER WALTERS, CITY SECRETARY BY APPROVED AS TO LEGAL FORM HERBERT L PR TY, CITY ATTORNEY BY CIGNA HealthCare- RFSP 689 Jul 18 02 03:15p Tim Bridges 940-349-7803 p.2 Application for Group Insurance in ed and/or Administered by CIGNA Healt6Care Canneeticut General Life Insurance ODmpany Hartford, Cr 06152 rTV-TATA 1 NAMEOFAPPUCANT 2 MAIN ADDRESS - C1 9. NATURE OF BUSINESS C Cit Governor nt 1 AND LOCH INDMDUALS EUGIBIE a SU8$IDIARYANDAFFILIATEDCOMPANESINCLUDED All Employees 6 TOTAL NUMBER OF INDIVIDUALS ELIGIBLE TOR INDIVIDUAL BENEFITS FOROEPENDENTSENEFITS 1300 1 NAVE ANY OF THE CLASSES OF INDIVIDUALSOVE OUALS EUGIBIE BEENCRED UNDER AGROUP INSURANCE POLICY OR ANY OTHER FORM OFORIO PPLAN WITHIN THE PAST FIVE YEARS? [3 Yes ❑ NO IF 30, PUFASE SPECIFY THE BENEFITS THE UNDERWRITING COMPAW01 ORGANDATON AND THE CAMS THESE SEW" WERE TERMINATED 7 GROUP INSURANCEAPPUEOFOR (Pt"Nof eW INDIVIDUAL DEPENDENT ❑ ❑ Life Insurance ❑ ❑ Accidental Death & Dismemberment Insurance ❑ — Short Term Disability Insurance ❑ — Long Tenn Disability Insurance ❑ ❑ Hospital Benefits ❑ ❑ Surgical Benefits ❑ ❑ Doctors Attendance Benefits ❑ ❑ Laboratory and X-ray Examinatlon Benefits ❑ ❑ Major Medical Benefits ❑ ❑ Comprehensive Medical Benefits ❑ ❑ Dental Benefits Cl ❑ vision Care Benefits n ern a Effective Date Requested. 1/1/7po2 Group Insurance at the Insurance Company's rates and under the terms of the policy(s) applied for will take effect on the Effective Date Requested If the Application is accepted at the Home Office of the Insurance company If certain persons eligible are to contribute to the cost of the Group Insurance, such Group Insurance will take effect on the later of the date the required number have enrolled, or on the Effective Date Requested If this Application Is not accepted, no Insurance will become effective Any premium advanced by the Applicant will be Conditional Receipt refunded upon surrender of this a THE APPLICANT DECLARES: that he has read the above statement and the answers to the above questions are complete and true to the best of his knowledge and belief The AODlloant agrees (t) that this Application Is offered as an inducement for the Group Insurance applied for, (2) that this Application will form a part oft any policy Issuedd; (3) that only the Information on this Application bind the Insurance will Company; and (4) that no waiver or change will bind the Insurance Company unless signed by an Executive Officer of the Insurance Company Group Insurance will only be Provided for persons eligible under the pollcy(s) Issued ln 1 Dated at nk, Me i Off e�„ I Name of A c BY J� Title l-t4A,, Ma Ylo 4O.1— _ Witness Soliciting Agent Iff other than Witness ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR SENEFrT OR KNOWLINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN PRISON STATEMENTTOBE91(Q\NEDBYAPPLICA UPON PAYMENT OF THE PREMIUM OR ANY PART THEREOF I HER ;BY DECLARE that I have paid to` A rA C b Q jL. 4 Agent (](.7 Dollars for which I hold his receipt bearing the same number as this application Date Applicant 41414501 Cat. M2MINI eA9 Jul 18 02 03:16p Tim Bridges 340-349-7803 p.3 CIGNA HealthCare HIPAA Certification Declaration Agreement The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that a proof of prior coverage certificate be issued to individuals, who for any reason, have lost their medical plan coverage and/or COBRA certificate CIGNA HealthCare (Connecticut General Life Insurance Company) will automatically generate individual proof of prior coverage certificates for members and their dependents if the employer has not declined to have CIGNA HealthCare administer these services Please complete the requested information and return this Declaration Agreement to El/glbllrty Services CIGNA HealthCare P O Box 9077 Metcalfe, NY 11747-9077 08 Fax to 516 845 3464 1 Employer Name City of Denton 2 Contact Name Carol L Rucker Title Health !IPaefita Administrator Phone (940) 349-8388 3 Employer Address 215 S. McKinney City Denton State X- Zip Code 76201 — 0000 4 Account Numbers 3150096 Please state one of the following O We do not elect to use CIGNA HealthCare Certification services We will accept full responsibility to comply with the terms for Issuance of certifications of prior creditable coverage required by HIPAA and applicable state law We agree to hold CIGNA HealthCare harmless In the event that we or any party acting on our behalf fail to comply with all requirements for producing and issuing certifications set forth in HIPAA or State law ewe want CIGNA HealthCare to perform Coverage Certification services We acknowledge that CIGNA HealthCare's ability to provide certification may be dependent on the quality of information provided by us We understand that CIGNA HealthCare is responsible only for coverage periods administered by CIGNA HealthCare If You have elected CIGNA HealthCare to perform the services, please complete Box 5 to Box 10 5 START DATE For New Accounts, the start date will be upon effective date For existing Accounts, please indicate aae of the following p At renewal QR DAs of 6 Type of Medical Coverage (Check afi that apply) 21 Commercial HMO 2—T—Indemnity/PP0 ❑ Point-of-Service/Flexcare (EPP/DPP) ❑ Preferred Provider Access 7 Type of Funding Arrangement (Check one only) Insured Q ASO/Self Funded Q Both 8 If the ASO/Self Funded box is checked above, then please Indicate if the account is 0 ERISA Q Non-ERISA 9 is CIGNA 0 Yes Q-ltfp Signatur Date o2 �p U Note /f an employer has chosen CIGNA He re perform HIPAA certification service they will standardly receive a report whenever a group is moved or terminated within that account Th/s report may be used to track Individual or family movement between plan offerings or to provide coverage information to a new administrator or camer Please return this page to Eligibility Services, CIGNA HeaftliCere, P O Box 9077, Melville, NY 11747-9077 OR Fax to 516 845 3464 iIPA 06 04 99 Jul 18 02 03:16p Tim Bridges 940-349-7803 p.4 CIGNA HEALTHCARE OF TEXAS, INC. Face Sheet to the CIGNA HEALTHCARE GROUP SERVICE AGREEMENT which is incorporated herein by reference AGREEMENT NUMBER: PARTIES TO AGREEMENT: HEALTHPLAN: GROUP TERM OF AGREEMENT 6327 CIGNA HealthCare of Texas, Inc and CITY OF DENTON The initial term of the Agreement shall be from January 1, 2002, (the "Effective Date"), until December 31, 2002 The Agreement shall continue in effect for the moral term and shall be automatically renewed as of the Anniversary Date of Agreement on a yearly basis thereafter until terminated The Anniversary Date of Agreement shall be January 1, 2003 PREPAYMENT FEES AND GRACE PERIOD On or before the last day of each month, Group shall remit to Healthplan on behalf of each Subscriber and his Dependents the Prepayment Fee specified as follows in payment for services rendered under this Agreement in the following month Healthplan shall permit a grace period of thirty (30) days during which the Prepayment Fees may be paid without loss of coverage under the Agreement In the event this Agreement terminates and there are Prepayment Fees due to the Healthplan, Group will be financially responsible for the Prepayment Fees This responsibility will be in addition to any other financial obligation of the Group hereunder CHC—FS 0500 (11/98) Jul 18 02 03:16p Tim Bridges 840-349-7803 p.5 Group shall pay Prepayment Fees each month in the following amounts Mepabership Unit Prepayment Fee Single $189 57 Two -Party $417 04 Family $644 52 Parent/Child $398 09 ENROLLMENT Healthplan is only required to consider enrollment applications received by Healthplan (i) during the Open Enrollment Period or within fifteen (15) days thereafter, or (u) within thuty-one (31) days of the event creating eligibility Healthplan shall have the right, at reasonable times, to exaimne Group records, including the payroll records of Subscribers for the purpose of confurmng eligibility and appropriate Prepayment Fees under the Agreement An individual who did not enroll for coverage under the Agreement during the initial eligibility period or open enrollment period may enroll for coverage in accordance with the "Newly Eligible Outside of Open Enrollment Period" and "Special Enrollment Outside of Open Enrollment" provisions set forth in the "Enrollment" Section Newly eligible and special enrollees may enroll by submitting a completed Healthplan enrollment application and required Prepayment Fees within thirty-one (31) days of the eligibility or special enrollment event GROUP'S ENROLLMENVELIGIBILITY RULES Group's enrollment and/or eligibility rules for its Subscribers and their Dependents are as follows • New hires are eligible for coverage on the first of the month following date of hire • Dependent Children are covered to age 19 • Dependent Students are covered to age 25 • CIGNA Guest Privileges program is included • Coverage shall terminate on the last day of employment Unless otherwise stated above, the eligibility provisions set forth in the "Eligibility" Section of the Agreement will govern {uJ CHC — FS (11/98) 0500 Jul 18 02 03:16p Tim Bridges 940-349-7803 p.6 DISENROLLMENT Group shall notify Healthplan of all employment terminations or other losses of eligibility of Subscribers and of losses of eligibility of Dependents ("Notice of Termmation") Unless otherwise required by law, coverage for the Subscribers and/or Dependents shall cease at midnight on the day the loss of eligibility occurs, and Group shall remit Prepayment Fees in accordance to the rules described under the section entitled "Payment Method for Group", through the date coverage ceased, subject to the tollowing rules and exceptions Notice of Termination must be received by Healthplan within sixty (60) days of the date on which employment termination or loss of eligibility first occurred 2 If Notice of Terimnation is not received by Healthplan within sixty (60) days of the date on which employment termination or loss of eligibility first occurred, then coverage shall cease at rmdnight on the date which is sixty (60) days prior to the date Notice of Termination is received and Group shall be responsible for and shall subimt to Healthplan all Prepayment Fees due through the date coverage ceased CERTIFICATION OF COVERAGE Upon request, Healthplan shall issue Certificates of Group Coverage to Members who end coverage with Group, provided that Group reports enrollment, disenrollment and other necessary information to Healthplan, according to transactions arranged between Healthplan and Group Alternatively, Group may agree in writing to take primary responsibility or to assign responsibility to a third party for issuing Certificates of group Health Plan Coverage to Members who end coverage with Group At the request of Group and upon payment of the applicable fee by Group, Healthplan shall report Member enrollment dates and disenrollment dates to Group after open enrollment periods and upon termination of the Agreement CHC — FS (11/98) 0500 Jul 18 02 03:17p Tim Bridges 940-349-7803 p.7 PAYMENT METHOD FOR GROUP A. New En►oIlment 1 If coverage begins on or before the fifteenth (15th) day of the month, a Prepayment Fee is due for that month 2 If coverage begins on any other day of the month, no Prepayment Fee is due for that month B. Termination 1 If coverage ceases on or before the fifteenth (15th) day of the mouth, no Prepayment Fee is due for that month 2 If coverage ceases on any other day of the month, a Prepayment Fee is due for that month SCHEDULE OF COPAYMENTS The Schedule of Copayments designating the amounts charged to Members for receipt of covered services and benefits is attached hereto TOTAL COPAYMENTS IN A CONTRACT YEAR There 1s a limit on the total amount of Copayments a Member and Membership Unit are required to pay for specified services during a contract year The limit are as follows Individual Member Total Copaynient Maximum Membership Unit Total Copayment Maximum $2,000 CHC — FS (ry ) 0500 (11/98) Jul 18 02 03:17p Tam Bridges 940-349-7803 P e TERMINATION OF AGREEMENT 1 Termination on Notice The Agreement may be terminated without cause by Group upon sixty (60) days prior written notice to Healthplan The Agreement may be terminated by Healthplan (i) upon ninety (90) days prior written notice to Group of Healthplan's decision to discontinue offering this particular type of coverage, or (it) upon one hundred eighty (180) days prior written notice to Group of Healthplan's decision to discontinue offering all coverage in the applicable market 2 Termination for Non -Payment of Fees The Agreement may be terminated by Healthplan for non-payment of any Prepayment Fees owed to Healthplan by Group under this Agreement 3 Tersmnation for Fraud or Misrepresentation The Agreement may be terminated by Healthplan upon thirty (30) days prior written notice to Group if, at any time, it is determined that Group has performed an act or practice that constitutes fraud or intentionally misrepresented a material fact 4 Termination for Violation of Participation or Contribution Rules The Agreement may be terramated by Healthplan upon thirty (30) days prior written notice to Group, for the failure of Group to comply with a material plan provision relating to Group contributions or Group participation rules as established by Healthplan 5 Termination due to Association Membership ceasing Healthplan may terminate this Agreement, as to a Group member of an association with which Healthplan has entered into this Agreement, when and if the Group membership in the association ceases, in accordance with applicable State or Federal Law 6 Termination due to a change m Group's Size The Agreement may be terminated by Healthplan upon thirty (30) days prior written nonce to Group if, at anytime, it is determined that Group's size has changed, making Group eligible for the small group reform product, as determined by the applicable State Law 7 Termination in accordance with State and/or Federal Law The Agreement may be terminated by Healthplan, upon prior nonce to Group, in accordance with any applicable State and/or Federal Law 8 Termination Effective Date (i) When termination is due to non-payment of amounts described in paragraph 2 above, coverage under the Agreement shall cease on the last day of the month for which payment is due (it) When termination is due to any other reason, coverage shall cease at midnight on the date on which termination occurs Group shall be responsible for the payment of all Prepayment Fees due through the date on which coverage ceases Subscriber will be financially responsible for services rendered after such date If Group fiuls to give written notice to Subscriber prior to such date, Group shall also be financially responsible for, and shall submit to Healthplan all Prepayment fees due after such date until Group gives such notice 9 Notice of Termination to Members In the event the Agreement is terminated under this Section, Group shall notify Members of the termination effective date and any applicable rights Members may have under the "Continuation of Group Coverage" Section {vj CHC — FS (11/98) 0500 Jul 19 02 03.17p Tim Bridges 940-349-7903 p.9 AMENDMENT OR MODIFICATION OF AGREEMENT Consent of Parties The Agreement may be amended at any time through a subsequent written agreement between Group and Healthplan Amendments are effective immediately unless otherwise provided Modificaugn by Law or Re ]anon The provisions of the Agreement are subject to the approval of all regulatory bodies and in the event that regulatory bodies request any modification of the Agreement, such modification shall supersede the provisions of the Agreement Furthermore, any State or Federal Laws or regulations enacted or promulgated which are in conflict with the provisions of the Agreement shall be deemed modifications of the Agreement on the date such enactment or promulgation is applicable to this Agreement Healthplan may modify the Prepayment Fees upon any change in State or Federal Laws affecting the Agreement by giving to Group at least flinty (30) days prior written notice Yniform Modtfrcanon of Coverage At renewal, the provisions of this Agreement may be modified to reflect product revisions which have uniformly been made to this produce Modification by Notice From Healthnlan Healthplan may modify the provisions of the Agreement including any Prepayment Fees, Copayments and Supplemental Charges on any Anniversary Date of Agreement by giving to Group at least thirty (30) days prior written notice Unless Group within fifteen (15) days of receipt of such notice provides written notice to Healthplan of its intention to terminate this Agreement at the end of the term, the modification shall become effective on the date contained in the notice and shall apply to all Members whether or not the applicable Prepayment Fee has been paid CHC — FS ( vi J 0500 Jul 18 02 03:17p Tim Bridges 940-349-7803 p 10 NOTICE Any written monce required under the Agreement shall be hand -delivered or mailed through the United States Postal Service, postage prepaid, addressed as follows GROUP: Mark Carol Rucker City of Denton 215 East McKinney Denton, TX 76201 Or, if Group elects to have notices delivered or mailed to a designated Agent, such notices shall be deemed as having been received by Group if hand -delivered or marled to the following person and address AGENT- Mark Chronister William M Mercer 3500 Chase Tower, 2200 Ross Avenue Dallas, TX 75201 HEALTHPLAN. CIGNA HealthCare of Texas, Inc 600 East Colinas Boulevard, Suite 1100 Irving, TX 75039 MEMBER: To the latest address furnished by Group or by the Member to Healthplan AMENDMENTS, RIDERS, AND ADDITIONAL PROVISIONS • Schedule of Copayments 151150 • Durable Medical Equipment Rider • External Prosthetic Appliances Rider • Prescription Drugs Option 7/20/40/OC Rider (vu) CHC — FS 0500 Jul 18 02 03.18p Tim Bridges 940-349-7803 p.11 DISCRETIONARY CLAIM AUTHORITY The Plan Administrator (Employer) named below hereby delegates to Healthplan the discretionary authonty to interpret and apply plan terms and to make factual determinations in connection with Its review of claims under the plan Such discretionary authority is intended to include, but is not limited to, the determination of the eligibility of persons desiring to enroll in or claim benefits under the plan, the determination of whether a person is entitled to benefits under the plan, and the computation of any and all benefit payments The Plan Adimnistmtor (Employer) also delegates to Healthplan the discretionary authority to perform a full and fair review, as required by ERISA, of each claim denial which has been appealed by the claimant or his duly authorized representative This language should be made a part of your Summary Plan Description CHC—FS 1 vui ) 0500 Jul 18 02 03:18P Tim Bridges 940-349-7803 P.12 ACCEPTANCE OF AGREEMENT In witness whereof, the Parties enter into the CIGNA HEALTHCARE GROUP SERVICE AGREEMENT through the execution of this Face Sheet by their duly authorized representatives In the event Group does not sign this Acceptance of Agreement section, Group's payment of any Prepayment Fees will be considered acceptance of the terms and conditions of this Agreement HEALTHPLAN- By. Title Date GROUP Address By Title Date• 6327/DK CIGNA HealthCare of Texas, Inc Ken S Malcolmson, President and General Manager — North Texas September 2 2001 DE ON 215 Ea t c ney D!Mton. TX 76201 1 i?aIPM CHC — FS l x ) 0700 (11/98) Jul 18 02 03.18p Tim Bridges 940-349-7803 p.13 DISCRETIONARY CLAIM AUTHORIZATION PLEASE RETURN THIS SIGNED FORM TO YOUR SALES REPRESENTATIVE Plan Administrator City of Denton Policy Number 3150096 Policyholder City of Denton The Plan Administrator named above hereby delegates to the Claim Administrator the discretionary authority to interpret and apply plan terms and to make a factual determination in connection with its review of claims under the plan Such discretionary authority is Intended to include, but is not limited to, the determination of the eligibility of persons desiring to enroll in or claim benefits under the plan and the computation of any and all benefit payments The Plan Administrator also delegates to the Claim Administrator the discretionary authority to perform a full and fair review, as required by ERISA, of each claim denial which has been appealed by the claimant or his duly authorized representative NAME ' POSITION/TITLE Ci� W� DATE ((j I �� f o 1 If you sign this form, this language should be made part of your Summary Plan Description If the Summary Plan Description appears in your certificate, a rider for your certificate will be Issued adding the above statement to those pages in the certificate OISCL01 04 18 98 Jul 18 02 03:19p Tim Bridges 940-349-7803 p 14 TEXAS SPEECH AND HEARING THERAPY REJECTION FORM NOTICE OF REJECTION OF OPTIONAL AUDITORY CARE The undersigned policyholder rejects the benefits for treatment of auditory care described below V 7 Charges made by a Physician or Audiologist for an Audiometric Examination and for a Hearing Aid Evaluation Test IK 2 Charges made for one Hearing Aid of an approved functional design Such coverage will be available at a later date only if specifically requested by the Policyholder Date O la IV 10 Policyholder City of Denton byAW, 1W C-rn o-licy(hooldee(R r ati e l ,I ,tQ `J 1 1 1lljTitle TXSPH 0418-98 Jul 18 02 03:19p Tam Bridges 940-349-7803 P.15 TEXAS IN VITRO FERTILIZATION REJECTION FORM NOTICE OF REJECTION OF OPTIONAL IN VITRO FERTILIZATION BENEFITS In accordance with the provisions of Texas Insurance requirements, the undersigned policyholder hereby rejects the benefits specified below REJECT A benefit covering charges for in vitro fertilization procedures performed on a married couple who have a history of infertility for at least five consecutive years or who suffer from certain specified health conditions which have caused their Inability to conceive a child The undersigned group policyholder understands that such coverage will not be provided at a later date unless he or she specifically requests it City of Denton Name of Policyholder by$j Y�P- Ndme Title 0 Dated This d�0 Day of QL-VpbQr *a- goo I TXINV 04 18 98 Jul 18 02 03:19p Tam Bridges 940-349-7803 p.16 TEXAS OPTIONAL HOME HEALTH CARE BENEFIT REJECTION FORM NOTICE OF REJECTION OF OPTIONAL HOME HEALTH CARE BENEFITS In accordance with the provisions of Texas Senate Bill 263, the undersigned policyholder hereby rejects the benefits specified below for charges for a formal home health care plan prescribed by a physician, in favor of those described to the insurance proposal A home health care expenses benefit having a maximum of 60 or more visits in a calendar year The undersigned group policyholder understands that such coverage will not be provided at a later date unless he or she specifically requests it City of Renton Name of Policyholder by Name Title Dated This J I Q` Day of TXOPT 04 18 98