1989-47
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BENEFIT SERVICES MANAGEMENT AGREEMENT
89-04-7
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AGREEMENT by and between The City of Clermont, (the Employer) and
First Benefits, Inc. of Florida (the Benefit Services Manager) for
The City of Clermont Employee Benefit Plan.
Effective Date:
January 1, 1990
Beginning with the Effective Date, the Benefit Services Manager
agrees to provide administrative services with respect to the
Benefit Plan in consideration of the payment by the Employer of
administration fees as provided in the following paragraph and
following agreements.
I.
Claims Administration
1.
The Employer shall:
a.
b.
c.
Furnish the Benefit Services Manager with a detailed
description of the Benefit Plan.
Determine claims administration procedures and
practices to be followed which are not self-evident
from the Benefit Plan.
Assist Benefit Services Manager when necessary in
determining eligibility of members to receive
benefits.
2.
The Benefit Services Manager shall:
a.
b.
Prepare the Benefit Plan Document and any changes
thereto during the continuance of the servicing of
the Plan.
Prepare descriptive Summary Plan Description for
plan participants.
c.
Follow the claims administration procedures and
practices desired by the Employer and consult with
the Employer on any changes.
d.
Provide suitable facilities, personnel, procedures,
and instructions for the administration of claims
under the Benefit Plan.
e.
with the assistance of Employer, when necessary,
certify eligibility of employees to receive payments
under the Benefit Plan.
ADMINISTRATORS AND CONSULTANTS FOR EMPLOYEE BENEFIT PLANS
Affiliated Offices Located In Akron, Canton, Columbus, Copley, Loraln, Mansfield and Youngstown, OhiO,
Chicago, illinOIs; Dallas, Texas, Detroit, Michigan, and Tallahassee, Flonda
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h.
i.
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Determine, in accordance with the Benefit Plan and
claims administration procedures and practices, the
qualification of claims submitted, making as
required, such investigation as may be necessary.
Make payment, as provided in Section III, of the
amount due with respect to claims that qualify under
the Benefit Plan as provided above.
Provide advice on disputed claims.
Refer to the Employer, for consideration and final
decision, any claim or class of claims the Employer
may specify, including claims involving:
1)
A question with respect to qualification of
claims submitted under the terms of the Benefit
Plan;
2)
3)
A question with respect to the amount due; and
Any controversy, with an analysis of the issues
to assist the Employer in reaching a decision
and, when necessary, act as a third party in
the denial of any claim as controversial or not
payable under the Plan Document.
j .
Furnish the Employer essential information with
respect to the Benefit Plan and the procedure
thereunder and assist in the distribution of the
material furnished.
k.
Report to the Employer annually, matters of general
interest with respect to the Benefit Plan, e.g.,
problems of recurring nature, local situations, and
suspected misuses of benefits.
1.
Report to the Employer with respect to non-routine
claims in process.
m.
Submi t to the Employer a monthly accounting of
payments made, with sufficient detail to provide for
the audit and control of funds used.
n.
Furnish the Employer with a copy of the explanation
of benefits paid statement for each and every claim
paid.
o.
Provide advice on benefit and plan revisions.
p.
Submi t to the Employer an annual accounting of
benefit payments to participants and dependents by
major line of coverage.
ADMINISTRATORS AND CONSULTANTS FOR EMPLOYEE BENEFIT PLANS
AffIlIated Offices Located m Akron, Canton, Columbus, Copley, Loram, Mansfield and Youngstown, Ohio;
ChIcago. IIImols; Dallas, Texas; Detroit, MIchigan; and Tallahassee, Florida
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Make available to the Employer's Consultant all
records in order to do an annual audit on the
benefit program.
Submit to the Employer or to the Employer's
accountant all information needed for them to
complete and file any necessary City, state or
Federal tax forms.
s.
During the continuance of this Agreement, the
Benefit Services Manager agrees to indemnify the
Employer and hold it harmless against any and all
loss, damage, and expense with respect to this
Benefit Plan resulting from or arising out of the
dishonest, fraudulent, or criminal acts of the
Benefit Services Manager's employees, acting alone
or in collusion with others. The Benefit Services
Manager shall maintain Blanket Bond Coverage with
a limit of not less than $250,000.00.
II.
Claims Administration Fee
1.
2.
3.
The Employer shall pay to the Benefit Services Manager
a monthly fixed fee of $10.00 per each eligible
participant.
Increased expenses incurred by reason of changes in the
Benefit Plan will give the Benefit Services Manager the
right to adjust the fee effective on the date such
changes in benefits are effective. The Benefit Services
Manager shall pay all administration expenses out of the
Plan out of this fee. The Benefit Services Manager may
change the amount of the fee at any time more than
fifteen (15) months following the Effective Date of this
Agreement by giving the Employer written notice of the
change at least ninety (90) days before it is to become
effective.
The Employer shall reimburse the Benefit Services Manager
for any expenses it incurs for special printed material
produced especially for the Benefit Plan as well as
postage costs for mass mailing of any such especially
ordered items.
ADMINISTRATORS AND CONSULTANTS FOR EMPLOYEE BENEFIT PLANS
Affiliated Offices Located m Akron, Canton, Columbus, Copley, Loram, Mansfield and Youngstown, Ohio;
Chicago, IIImols, Dallas, Texas, Detroit, Michigan, and Tallahassee, Florida
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III. Benefit Plan Payments
It shall be the Employer's sole responsibility to provide the
Funds to make the Benefit Plan payments. The Employer shall
provide the funds to establish a special claim payment account
in the name of the Employees' Plan for the purpose of paying
the claims or the Benefit Services Manager may set up a
special claims account in its own name to facilitate the
reimbursement of this account for Benefit Plan payments made
payable to plan participants or to others in their behalf.
IV.
Liability and Indemnity
The Benefit Services Manager does not issue nor underwrite the
liability of the Employer under the Benefit Plan. The
Employer retains the ultimate responsibility for claims made
under the Benefit Plan. The Employer agrees to indemnify the
Benefit Services Manager and hold it harmless against any and
all loss, damage and expense, including attorney's fees,
occasioned by claims, demands or lawsuits brought against the
Benefit Services Manager to recover benefits under the Benefit
Plan.
First Benefits Inc. of Florida may rely on all information
appearing regular on its face furnished to it by you, your
employees or by a supplier, and First Benefits, Inc. of
Florida shall have no liability for any erroneous payment,
made in good faith, on any claim. However, if an erroneous
payment is made, First Benefits, Inc. of Florida shall correct
all overpayments and underpayments when discovered.
It should be noted that any claims that the Employer may want
paid that are not covered under the terms and conditions of
the Benefit Plan will not be included as covered claims for
purposes of the stop loss contract.
v.
Terms and Conditions
It is further agreed that the terms and conditions specified
in the Benefit Services Manager's proposal shall be
incorporated and part of this Agreement.
ADMINISTRATORS AND CONSULTANTS FOR EMPLOYEE BENEFIT PLANS
Afft/¡ated Offices Located m Akron, Canton, Columbus, Copley, Loram, Mansfield and Youngstown, OhiO,
Chicago, IIImols, Dallas, Texas; Detroit, Michigan, and Tallahassee, Florida
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VI.
Termination and Revision
Ei ther the Employer or the Benef it Services Manager may
terminate this Agreement by giving ninety (90) days prior
wri tten notice to the other. The Benefit Services Manager may
terminate this Agreement at any time upon notice to the
employer in the event the Benefit Plan Account contains a
balance which is insufficient to meet Benefit Plan and
Employer obligations, but such termination shall not relieve
the Employer of its obligation to reimburse the Benefit
Services Manager for payment of benefits of the Benefit Plan.
This Agreement may be revised by written agreement signed by
both parties, except as otherwise herein provided.
VII. Services Following Termination
In the event that this Agreement is terminated for any reason,
the Benefit Services Manager will continue to process pending
incurred claims on the following terms: The Employer will pay
the Benefit Services Manager 100% of the monthly fee in effect
at the time of termination for the first two (2) months of
service; 75% of the fee for the next month; and 50% for the
next two (2) months.
After five (5) months, any remaining incurred but unpaid claim
files will be returned to the Employer in an orderly manner.
THE CITY OF CLERMONT
BY:
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December 12, 1989
DATE:
FIRST BENEFITS, INC. OF FLORIDA
BY: ~Jt-4wJ4Ø
DATE: (1- - tf. ~ r
f" c-I .r..
ADMINISTRATORS AND CONSULTANTS FOR EMPLOYEE BENEFIT PLANS
Affiliated Offices Located in Akron, Canton, Columbus, Copley, Lorain, Mansfield and Youngstown, OhiO,
Chicago, l1IinOIS; Dallas, Texas, Detroit, Michigan, and Tallahassee, Florida