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HomeMy WebLinkAboutIsland Group Admin ELIZABETH A. NEVILLE TOWN CLERK REGISTI~ OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 5 OF 2005 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TO%VN BOARD ON JANU.~RY 18, 2005: RESOLVED that the To~vn Board of the Toxvn of Southold hereby authorizes and directs Supervisor Joshua Y. Horton to execute an agreement with Island Group Administration, Inc. for the administration of the Town of Southold Employee Health Plan for the 2005 calendar year, said agreement subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk Isfanar group arministmtion, Inc. Corporate Offices 3 Toilsome Lane, East Hampton, New York 11937 Phone: (631) 324-2306 or 1-800-926-2306 Fax: (631) 324-7021 or (631) 32%0152 December 31, 2004 Mr. John Cushman Southold Town 53095 Main Road Southold NY 11971 Dear John: Enclosed please find 2 copies of the Island Group Administration contract with the Town of Southold for the period 1/01/05 through 12/31/05. In order for us to complete the file for the new contract year, we would appreciate it if you would return one signed copy as soon as possible. If you have any questions, please do not hesitate to contact our office. Preside ADICdm Enc. Island Group agdministration, Inc. Corporate Offices 3 Toilsome Lane, East Hampton, New York 11937 Phone: (631) 324-2306 or 1-800-926-2306 Fax: (631) 324-7021 or (6311 329-0152 ISLAND GROUPAD~INISTRATION, with corporate offices New York 11937, agrees self-insured client: INC.{IGA), a New York Corporation, located at 3 Toilsome Lane, East Hampton, to render Health Benefits Services to its TOWN OF SOUTHOLD 53095 Main Road Southold NY 11971 for a period of ONE (1) year, commencing on the 1st day of January 2005, and terminating on the 31st day of Dec.mher 2005. ISLAND GROUP ADMINISTRATION AGREES TO: 1. PROGRAM DEVELOPMENT A) Consult with key personnel of your staff on the necessary procedures, practices and coordination to meet your summary plan requirements. B) Participate in the orientation of all your staff involved directly or indirectly in the processing of health related claims. c) Provide information on changes in legislation, rules and regulations affecting the self-insured employer. D) Employ an automated claims-processing system. Reports generated by this system can be customized to meet the self-insured's needs, if required. E} Design and prepare the necessary claims media or assist in the modification of existing media where required. Typically, this material consists of: 1) enrollment cards; 2) identification cards; 3) prescription drug cards; 4) claim forms; 5)checks; 6)E.O.B.s, 7) PPO Bookle5s, etc. The cost of printing the required media is an expense of the self-insured. 2. ADMINISTRATION A) Maintain "hard" claim files, which shall be available to the self-insured at reasonable times for inspection or audit. The self-insured has the right to employ an independent auditor to perform an audit. All costs associated with the audit are the financial responsibility of the self-insured. B) Maintain current estimates of the cost of all anticipated benefits on each case. c) Island Group will recommend on behalf of the self-insured what benefits, if any, should be paid or rendered in accordance with the summary plan booklet, and make such payments on behalf of the self-insured from funds supplied by the self-insured, under a system agreeable to both the self-insured and Island Group Administration. D) Conduct investigations of cases by our staff as in its judgment are deemed necessary. E) Arrange where necessary for medical evaluation on behalf of the self-insured by consultants, as the summary plan will allow. The cost of these consultants will be borne solely by the self-insured. F) Conduct a pre-admission review (PAR) of elective surgery, if necessary. Findings will be rendered to the self-insured and covered individuals. G) Hospital reviews will be conducted weekly and/or as necessary. Cases that will be reviewed are as follows: 1) Ail New York hospital billings will be reviewed for accuracy, coding and pricing. 2) Medicare EOBs will be examined for accuracy and payment. 3) Charges not justified by length of stay. 4) Charges unrelated or normally unassociated with treatment. 2 H) I) 5) Charges in excess of Reasonable and Customary, or in excess of the Medicare allowance for the procedures. 6) Any unusual treatment or charges will be investigated. 7) Reports will be rendered monthly, to the self-insured as to any and all "providers" who consistently exceed reasonable and customary charges. Provide a Participating Provider Network {Physician PPO) for the benefit of the self-insured and covered individuals. The listing of Practitioners, Labs, etc., will be provided to the self-insured. The listing of PPO members will be updated as necessary. The cost of printed media in the form of a PPO Practitioner's Booklet will be the responsibility of the self-insured. Access fees for Hospital Discount Networks, for example, Galaxy Inc., Peconic Services, Inc., etc, and non Island Group Practitioner PPOs are the responsibility of the self-insured. The cost(s) of accessing the Island Group practitioner PPO is included in the capitated service fee expressed in this contract in Section 5. Perform the necessary functions to satisfy the dictates of the Federal Statutes regarding C.O.B.R.A., ERISA and all other applicable statutes that govern self insured Employee Health Plans. Island Group Administration, Inc., agrees to maintain professional liability insurance coverage of an amount not less than $1,000,000, and to additionally maintain fidelity bond coverage on all Island Group employees, in the amount of $10,000. The amount of the fidelity bond shall be determined by the self-insured as of the effective date of this agreement and shall be subject to change as of each anniversary of this agreement, or more frequently if the self-insured deems there has been a significant change in the total amount of funds handled by Island Group. The fidelity bond shall state that loss, if any, involving money or the property belonging to the self-insured shall be payable to the Town, as its interest may appear. The bond shall also contain a statement that if the bond is cancelled, K) L) M) N) written notice shall be given to the self-insured, thirty (30) days prior to such cancellation. Island Group will segregate the Town's claims reimbursement funds in a separate bank account. Funds on deposit will be collateralized in accordance with the recommendations on investment issued by the Comptroller of the State of New York. It is agreed tha5 Island Group will be deemed to be in full compliance with this requirement as long as the total funds on deposit do not exceed $100,000 and are held in a bank account with FDIC insurance. When funds on deposit exceed the FDIC limits, 102% collateral is to be deposited into a third party custodial account to be established by, and on behalf of the Town, written notice given to the self-insured. Island Group agrees to take such measures as may be necessary to protect the confidentiality of claims and records. Island Group will maintain and process claims on behalf of the Town at the level of benefits determined by the self-insured. Island Group will institute benefit revisions to the summary plan of benefits for the self insured as those benefits are amended by the self- insured. Revisions to the benefits will be made only with the prior written authorization of the Town unless such change is mandated by law. Revision of the benefits as instituted by the self insured will subject the service fees to be amended based upon any additional service responsibilities that must be assumed as a result of these amendments by Island Group Administration, Inc. Island Group Administration, Inc., in order to facilitate thorough and efficient plan administration, shall provide the following additional services: 1) Toll-free "800" telephone access to plan administrators; 2) Ease of access to claims service representatives, or their superiors; ISLAND GROUP ADM N~STRAT~ON' ~NC 3) Timely response to inquiries or need for assistance regarding the plan or their individual claims; 4) Expeditious claims processing and turnaround time on appropriately submitted claims. 3. REPORTING A) We will provide reports for the self-insured on a weekly, monthly, and annual basis. Our reports generally consist of check registers, E.O.B.s, drafts, and an analysis of what each particular component benefit costs the self-insured. A census report listing all enrollees and their dependents covered shall be provided to the self-insured on a monthly basis. c) Per diem hospital costs will be established and tracked. Special reports can be made available should the self-insured desire. Our automated system can interface with available health management reports and be made available to 5he self-insured. A comprehensive listing of all "special" reports will be provided upon request. The cost of reports that require custom programming to prepare will be at the expense of the self-insured. The self-insured's approval for said costs, will be required prior to the preparation of these special reports. 4. INSURANCE SERVICES AND CONSULTING A) Insurance- We will review annually the specific and aggregate insurance with the self-insured, including coverage and premium charges. B) We will discuss with your personnel the impact changes in the summary plan, as it may affect reinsurance costs. of c) We will secure the health reinsurance for the self-insured after reviewing the marketplace, and determining which carrier is offering the best coverage and terms for the premium dollar. 5 D) Island Group Administration, Inc. shall bill the Town for reinsurance premiums and shall remit said payments to the reinsurance carrier. 5. SERVICE FEE This agreement is in the nature of a service agreement, and does not constitute, nor is it meant to be, an insurance policy, an agreement of insurance, or an agreement to provide insurance. B) The fees billable by I.G.A.I. shall be based upon a capitated rate of $16.93 per eligible employee and or retiree. Additional eligible individuals and spouses shall be included at the per month capitated rate of $16.93 each. Additions and deletions to the eligible census shall be included for billing purposes on the 1st calendar day of the month following such addition(s) and deletion(s) to the eligible census. c) Island Group Administration, Inc., shall bill the Town on or before the 1st day of each month for services to be rendered on behalf of the Town for that month. Payments shall be received by the day of the month. 15th D) The costs and expense of any litigation or dispute between the Town and/or Island Group Administration, as agent for the Town, and a covered individual under the health plan shall be the responsibility of the self- insured, except if the litigation is the result of, or in connection with the negligence, willful misconduct, or fraud of Island Group Administration, Inc, its agents, servants and/or its employees. 6. TERMINATION A) This agreement may be terminated by the self insured upon 90 days prior written notice, and by Island Group Administration, Inc., with 90 days prior written notice, to the addresses indicated herein by regular mail or certified mail, return receipt requested. B) Upon the termination of this agreement by either party, Island Group shall within 30 days after the date of termination, deliver to the Town a complete and final accounting report as of the date of termination of this 6 SLAND Gf~OUP ADMt ISTRAT~ON, l~4C agreement. Ail books and records in its possession and control relating to the administration of the plan, except any records that Island Group is required by law to retain, if any, shall be returned within 30 days of the effective date of this termination. c) In the event of a breach of any material term of this agreement, the self-insured may terminate this agreement immediately, without any further responsibility. The unprocessed and unpaid claims held by I.G.A.I., and those claims that are received after such termination by I.G.A.I., will be resurned to the self-insured. The processing and payment of these claims will become the responsibility of the self- insured. 7. MISCELLANEOUS PROVISIONS A) If any provision of this agreement is not immediately enforced or is held invalid or unenforceable, such lack of enforcement or unenforceability shall not weigh future enforcement nor affect any of the other provisions. If any provision is unenforceable, this agreement shall be construed and enforced as if such provision had not been included. B) This agreement may be amended by the parties at any time by mutual written consent provided, however, that this agreement may not be amended to reduce any benefits which might be paid for any claim prior to the amendment or in any way prejudice such a claim. IN WITNESS WHEREOF, the following affix their signatures: ISLAND GROUP AD~MINISTRA TION, INC. TOWN OF SOUTHOLD WITNESS: 7