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R99-183 AUTHORIZING APPLICATIONS
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R99-183 AUTHORIZING APPLICATIONS
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Last modified
4/7/2016 9:33:42 AM
Creation date
4/7/2016 9:33:40 AM
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Template:
Resolution/Ordinance
Res Ord Num
99-183
Res Ord Title
AUTHORIZING APPLICATIONS FOR GROUP HEALTH INSURANCE COVERAGE
Approved Date
10/18/1999
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� <br /> C. The Claim Administrator has established and maintains written agreements with PPO Providers <br /> � which encourage such Providers to make referrals to other PPO Providers. <br /> VI. CERTIFICATE OF CREDITABLE COVERAGE <br /> A. The Claim Administrator,at the written direction of the Employer,shall issue to individuals,whose <br /> coverage under the Plan terminates during the term of this Agreement, a Certificate of Creditable <br /> Coverage, based upon coverage under this Agreement and information provided by the Em- <br /> ployer to the Ctaim Administrator, in a form acceptable to the Claim Administrator, regarding the <br /> individual's eligibility and termination of coverage under this Agreement. A Certificate of Credit- <br /> able Coverage will be issued subsequent to the following events: <br /> 1. At the time an individual's coverage under the Agreement is terminated during the term of <br /> this Agreement; <br /> 2. At the time an individual ceases to be covered under COBRA; and <br /> 3. At the request of such individual within twenty-four(24) months after the date of termination <br /> of coverage under this Agreement or continuance. <br /> B. A Certificate of Creditable Coverage shall include, without limitation, either (a) a statement that <br /> the individual has at least 18 months of coverage, or (b)the date any waiting period began and <br /> the date Creditable Coverage began and the date Creditable Coverage ended,unless Creditable <br /> Coverage is continuing at the time a Certificate is issued. <br /> VII. COMPENSATION TO CLAIM ADMINISTRATOR <br /> A. The Employer will pay service charges to the Claim Administrator as compensation for the pro- <br /> cessing of Claims and administrative and other services provided to the Employer.These service <br /> � charges will be the following percentage(s) and/or amount(s) and will be applied in accordance <br /> with the provisions of this Agreement: <br /> 1. Administrative Fee: <br /> $35.50 per Covered Employee per month for all Claim Payments <br /> $1.65 per Covered Employee per month for the Administration of the Medical Services Advi- <br /> sory Program <br /> 2. Claim Administrator's Provider Access Fee: <br /> 25% of Average Discount Percentage (ADP) savings for Group Number P06856 <br /> 50% of Average Discount Percentage (ADP) savings for Group Number 992844 <br /> 3. Reimbursement Fee: <br /> The Claim Administrator shall be compensated for its administration of the Reimbursement <br /> Provision by retaining 15%of net recoveries made on behalf of the Employer after attorneys' <br /> fees have been deducted. <br /> 4. Conversion Fee: <br /> The Claim Administrator shall be compensated $6,000 for each conversion policy issued <br /> during the term of this Agreement. <br /> The service charges will be computed and payable in accordance with the Section below entitled <br /> "Claim Settlements." <br /> B. The service charges,which are guaranteed for a twelve(12)month period from the Effective Date <br /> � of this Agreement, have been determined in accordance with the Claim Administrator's current <br /> regulatory status and the existing benefit program.Should future legislation or administrative rule <br /> - 4 - <br />
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