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BILL NO. 92-118
SPONSORED BY COUNCILMEN GREEN. NILGES. WOODMAN WRIGLEY
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ORDINANCE NO. 11827
AN ORDINANCE OF THE CITY OF JEFFERSON, MISSOURI, AUTHORIZING THE
'_. MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT WITH EMPLOYEE
BENEFIT ADMINISTRATORS, INC.
WHEREAS, The City has previous adopted the City of Jefferson Employee Health Care
Plan (hereinafter the "Health Plan"); and •
WHEREAS, The City has previously adopted a Cafeteria Plan under the provisions of
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Section 125 of the Internal Revenue Code of 1954; and
WHEREAS, The current agreement for Health Plan and Cafeteria Plan professional
y services teiminate at the end of this calendar year; and
• WHEREAS, The current reinsurance of the partially self-insured Health Plan terminates
,� December 31, 1993; and
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WHEREAS, Insurance coverages and professional services need to be put in place by
December 31, 1992.
NOW, THEREFORE,
BE IT ENACTED BY THE COUNCIL OF THE CITY OF
JEFFERSON, MISSOURI, AS FOLLOWS:
Sect_ ion I. The Mayor and City Clerk are hereby authorized and directed to
execute an agreement with Employee Benefit Admini
strators, Inc. for provision of
Administrative Services including Reinsurance in conjunction with the City's Flexible
Benefits Plan and Health Plan.
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Section 2. The agreement shall be substantially the same in form and content as
that agreement attached hereto as Exhibit A.
Section 3. This Ordinance shall be in full force and effect from an
� d after the date
Of its passage and approval.
Passed: A�qt- Approved:
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Presi g Officer yor
ATTEST.:
City Clerk
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ADMINISTRATIVE AGREEMENT
This Agreement, made and entered into this
].993, by and between the City of Jefferson, �—' day of
"City"; and Employee Benefit Administrators, Inc.,shereinafter referred teas 'E Aa�
WITNESSETH,
WHEREAS, City has a program of medical, hospital, and health benefits
("Plan") for certain of its employees and annuitants; and
WHEREAS, the City has adopted a Flexible Benefits Plan (hereinafter the
"Cafeteria Plan") under the provisions of Section 125 of the Internal Revenue Code
of 1954; and
WHEREAS, the City desires to delegate certain administrative
connection with the aforesaid plan; and functions in
WHEREAS, City has requested EBA to furnish administrative services in
connection with the Plan and the Cafeteria Plan, and
" WHEREAS, it is the
Purpose of this Agreement to establish an agency
relationship whereby EBA will Yindertake to act as agent for City in (i)receiving and
proeessing claims for benefits under the Plan and Cafeteria Plan;(ii.)disbursing clailn
payments under the Plan and Cafeteria Plan; and (iii) performing such additional
duties as set forth herein.
NOW, THEREFORE, in consideration of the mutual promises and covenants
contained herein, it is hereby agreed as follows:
SECTION 1. HEALTH PIAN.LkDMINISTRATORS
Sec 1-1. Duties and Responsibilities of City.
(a) The City shall be the Plan Administrator within the meaning of Section 3(16)(A)
of the ]Employee Retirement Income Security Act of 1974 and Section 414(g) of the
Internal Revenue Code of 1954 of the Plan, but it delegates all ministerial duties
associated therewith to the Claims Administrator.
(b) The City shall have final authority in the decision regarding the insurance .
company or companies chosen to provide the insured protection under the Plan.
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(c) The City shall have final authority regarding the choice of benefits and provisions
in the Self-Funded portion of the Plan, as outlined in the Plan Document. The City
agrees to abide by and observe the provisions of the Plan Document.
(d) The City shall be responsible for payment of all premiums required by the
's. insurance companies, the expense of the Claims Administrator as hereinafter agreed
to and the contributions to the Trust Account or Fund described in Section 1-3 hereof,
•if one is established. In addition, the City shall be responsible for withholding any
amounts from the pay of employees in the event employee contributions are required
under the Plan and a payroll deduction or similar procedure is utilized therefor.
(e) The City agrees to take the following actions with respect to the Plan to facilitate
proper administration by the Claims Administrator:
(1) Supply. the Claims Administrator with all information required with
respect to employees and dependents eligible to participate in the Plan and notify the
Claims Administrator of all changes occurring thereafter with respect to the
eligibility status of all Plan participants.
(2) Advise the Claims Administrator promptly upon acquisition of any new or
different insurance contract or upon changes in the City's organization which might
affect the status of the Plan as in effect at the time,
(3) Provide the Claims Administrator with such additional information with
respect to matters incidental. to the Plan as may be requested by the Claims
Administrator from time to time.
(f) The City shall be the named fiduciary under the Plan with the authority to
manage, acquire or dispose ofthe assets of the plan on a discretionary basis although
such authority may be delegated, in whole or in part, to other fiduciaries as provided
in the Trust Agreement, if there is one, or otherwise by an appropriate writing.
(g) The City shall be the final determiner of all appeals or denied claims insofar as
-the Self-Funded portion of the Plan is concerned.
(h) The City shall be responsible for the status of the Plan under state insurance
laws and under local, stale and Federal tax laws.
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See. 1.2. Duties and Responsibilities of Claims Administration.
(a) Upon receipt of a claim for benefits, EBA shall review the claim and determine
whether it has been properly filed and the amount, if any, which is due and payable
with respect thereto.
(b) EBA on behalf of the City shall disburse claim payments that EBA determines
to be due in accordance with the provisions of the Plan to the person or assignee
entitled thereto.
(c) EBA shall take all reasonable"steps to process claims and disburse claim
payments accurately and expeditiously.
(d) EBA also agrees to the fgHowing list-of duties and responsibilities:
(1) Notification to claimants and City of rejected claims and reason for the
rejection.
(2) Advising and aiding claimants in meeting requirements for additional
'information and proper completion of claim forms.
(3) Claim investigation.
(4) Performing on a sample basis internal audits on claim payments.
(5) Discussion of claims, where applicable, with physicians and other providers
of services.
(6) Obtaining and furnishing information, as necessary, regarding
non-duplicating or coordination of benefits.
(7) Application of claims control procedures necessary to the ef'ective
implementation of the basic principles of the Plan.
(8) Preparation of monthly, quarterly, and annual claim reports on'a timely
basis.
(9) Preparing for City information reports required in connection with claim
payments under the Plan to providers of health care services pursuant to Section
6041, MC.
(10) Preparing a reconciliation of drafts cleared for the Plan.
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(11) Design and print Plan doctunent.
(12) Design Plan booklets describing benefits of the 1 f the adliv it booklets
to City for issuance to employees eligible under the terms
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(13) Periodic review of claim experience and provision of underwriting advice.
(14) Evaluation and payment or declination of the amount of claim presented,
based on a schedule of benefits and- taking into account, as necessary, the
4 Coordination of Benefits provision.
(15) Investigation of claims whose charges appear higher than regular and
customary.
(16) Storage of claim payment records.
(17) Reporting to the IRS of payments to addressees as required.
(18) Return of all claim files and related information to the City upon
termination of the Agreement.
(19) Provide copies of employees' claim payment record to City for its
information.
x (20) Provide periodic educational classes for City employees on the health
insurance plan.
k (21) Administration of Consolidated Omnibus Budget Reconciliation Act
4 (COBRA), including notification to employees and bi ing.
(22) Solicitation of quotes from reinsurers as needed or directed by City.
(23) Filing of claims with reinsurers.
Sec. 1.3. Method for Payment of Claims
City shall maintain a Clearing Account with Central Trust Bank or such other
(a) C y
bank as City shall select, hereinafter "Bank", on behalf of the City which EBA shall
utilize. The City will provide, through EBA, sufficient funds at all times to pay
expenses incurred by the Plan. Any remaining balance an
Ctciaformed as to the
account is the property of the Plan. EBA shall keep Y
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balance in the clearing account and shall notify the City if additional deposits are
j needed to ensure prompt payment of claims.
(b) Claims under the Plan shall be paid by a check payable through Bank prepared
by EBA, as agent for City.
(c) In the event EBA pays any person less than the amount to which he is entitled
under the Plan, EBA will promptly adjust the underpayment. In the event EBA
overpays any person entitled to benefits under the plan, or pays benefits to any
person not entitled to them, EBA shall take all reasonable steps to recover the
overpayment except that EBA shall not be required to initiate court proceedings to
<r recover an overpayment. EBA shall promptly notify the City if it is unsuccessful in
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recovering any overpayment.
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3' (d) The determination of the extent of the benefits to which any claimant is entitle
f under the Plan shall initially rest with EBA. However, in the event that the City
determines that EBA has misinterpreted the Plan and so informs EBA in writing, all
claims reported after delivery of such writing to EBA shall be processed and paid in
accordance with City's interpretation as set forth in such writing.
Stec. 1.4. Adbninistration Charge
(a) The charge of City for services by EBA under this Agreement shall be $4.80 per
participating employee per month, plus -0- per participating dependent unit per
month. This charge shall remain in effect for 1994 and 1995 if the agreement is
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renewed for those years.
(b) By the 10th of each month, the City shall submit to EBA a statement showing
additions and deletions of the named employees along with payment for that month
i` of the administration charge determined. on the basis set forth in the preceding
paragraph.
(c) Not less than ninety (90) days prior to renewal of any year in which this
Agreement is in effect, EBA may request in writing a revision in the administration
charge for the following year if a change in duty occurs. City shall advise EBA in
writing as to the acceptability of such proposal within thirty (30) days after receipt
thereof. If agreement is not reached with respect to such proposal at least ninety(90)
days prior to such renewal, this Agreement shall terminate effective as of midnight
of such renewal date. The foregoing shall be subject to any revisions in the
administration charge pursuant to Section 4 hereof. If the parties are unable to
agree upon compensation for a change desired by one of the parties, then the change
shall not occur. As used herein, "year" means any period of twelve consecutive
months commencing on the effective date.
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SECTION 2. FLEXIBLE BENEFIT PLAN ADMINISTRATION
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Sec. 2.1. Duties and Responsibilities of City.
(a) The City, or appointed representative of the City, shall perform the following
services necessary for the administration of the Cafeteria Plan:
(1) Submit initial setup information as requested by EBA.
(2) Secure a signed Administrative Service Agreement op the provided contract
form with EBA.
(3) Ensure that the Flexible Benefits Plan documents are executed and provide
a. a copy of all such documentation to EBA.
(4) Ensure that salary reduction agreements are signed by the employee and
provide copies of these agreements to EBA.
(5) Enroll and submit new employee in accordance with the eligibility
requirements and re-enrollment periods specified in the plan documents.
(6) Ensure that completed employee expense vouchers and receipts are
returned on a timely basis to the City and a copy provided to EBA of these vouchers.
' (7) Review and counsel with employees whose vouchered expenses are not
equal to reimbLtrsements. Take any appropriate and legal action to ensure that
employees are not reimbursed more than actual expenses during the Cafeteria Plan
year or secure the return of any overpayment in accordance with the Cafeteria Plan
documents.
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(8) Conduct an annual review of employee benefit elections. Advise EBA of any
changes in employee benefits under the Cafeteria Plan. Provide EBA a copy of all
changes and signed Salary Reduction Agreements reflecting these changes.
(9) Make necessary changes in the payroll in accordance with each employee's
Salary Reduction Agreement and ensure that employee W-2 forms will reflect new
gross taxable wages after the salary reduction.
(10) Provide information on employee terminations to EBA so as to reflect the
termination.
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(11) Provide pertinent information to EBA that is requested for tax reporting
or Cafeteria Plan administration. •
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Sec. 2-2. Duties and Responsibilities of EBA
(a) EBA shall perform the following clerical and accounting services necessary for the
administration of the Cafeteria Plan:
(1) Establish a database of all pertinent employee and employer information
based on information to be provided by the City.
(2) Update database monthly for employee changes (i.e., terminations, new
f employee, benefit election changes, etc.) based on information to be provided by the
k . City.
(3) Where appropriate, as determined by EBA, EBA shall provide a monthly
statement of benefit accounts for each employee with reimbursement check prepared
by E13A on the employer account. This will be sent by EBA to the address designated
by each employee. This statement will also be the voucher for the actual expenses
incurred by the employee. This voucher and actual receipts will be returned to EBA
on a monthly basis. A copy of the original survey form signed by the employee along
with instructions for completing the voucher will be sent with this statement.
(4) Provide a review verifying compliance with federal discrimination rules
based on information received from the City.
(5) Assist City in preparation of an annual report to be filed in accordance
with the Internal Revenue Service.
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(6) Assist City in preparation of Department of Labor reporting requirements,
and other reporting requirements as may hereafter be established,if any, on a timely
basis.
Sec. 2-3. Administration Charge.
(a) EBA shall receive, as compensation for its services under the Cafeteria Plan, a
charge of$2.00 per participating employee per month plus an additional $2.00 per
employee per month for each employee who participates in any spending plan, either
medical reimbursement or dependent care or both.
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SECTION S. PRECERTIFICATION FOR HOSPITALIZATION
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(a) Pre-authorization of hospital confinement and surgeries shall be a requirement
with a 20%reduction of benefits for failure of the employee to obtain pre-certification.
(b) It shall be a requirement to obtain second opinions on non-emergency surgeries.
Deductibles shall be waived and benefits paid at 100% for second and third surgical
opinion. If this requirement is not met, benefits shall be paid at 60%.
(c) EBA shall receive, as compensation for its precertification program, a charge of
, z{ 2.00 per participating employee per month.
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SECTION-4. ADIDITiONAL DUTIES OF EBA
(a) The duties set forth herein may be modified by mutual agreement. The revised
duties and the administration charges therefore,if any, shall be evidenced by written
rn. agreement between the parties hereto.
(b) If any change in law or regulations imposes greater duties or obligations on EBA
than contemplated by the Agreement in force at the time of such change, EBA shall
promptly notify the City, and a change to this Agreement, including charges if
required, will be negotiated.
SECTION 6. DETERMINATION OF ELIGIBILITY
In determining an y person's right to benefit under the Plan or Cafeteria Plan, EBA
shall rely on eligibility information furnished by City prior to submission of the claim.
L' It is mutually understood that the effective performance of this Agreement by EBA
«� will require that it be advised by City periodically, but not less frequently than
ti monthly during the term of this Agreement, of the identity of individuals eligible for
benefits, the effective date or the termination date (as the case may be) of their
eligibility and the extent of the benefits to which they are entitled. City shall also
cause to be furnished to EBA such other information as may reasonably be required
for the proper administration of the Plan and Cafeteria Plan.
It is mutually agreed that EBA shall not be responsible for delay in the performance
of this Agreement or for the non-performance of this Agreement which delay or
non-performance is caused or contributed to by the failure of City to furnish any such
information.
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SECTION 6. RECORD RETENTION AND REVIEW
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EBA shall maintain records covering laims submitted under the '
g Plan and Cafeteria
Plan, as well as payments disbursed by EBA. Any duly authorized representative or
representatives of City shall have the right to examine or audit such records during
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SECTION 7. AGENCY AGREEMENT
(a) It is mutually recognized that EBA, in performing its obligation under -this
Agreement,is acting only as agent of City and shall not be designated or deemed the
administrator with respect to the Plan or Cafeteria Plan for the purpose of the
Employee Retirement Income Security Act of 1974 or any other Federal or State law
'- N of similar nature.
(b) In the event that its officers, directors, employees, or agents are made parties to
any judiciary or administrative proceeding arising in whole or in part out of any
?' function performed by one or more of them under this Agreement, City shall hold
them harmless for all judgments, settlements, and costs (including attorneys' fees)
which they incur or pay in connection therewith, except City shall not reimburse the
amount of any judgment or award (or attorneys' fees with respect thereto) if the
court rendering the judgment or the agency making the award decrees that it was
caused by the negligence, fraud, or criminal conduct of EBA, its agents, employees,
officers, or directors.
° (c) The defense of any legal action instituted on a claim for benefits under the Plan
and/or Cafeteria Plan shall not be ano obligation of EBA. EBA shall, however,
cooperate with City by furnishing such evidence as it has available in connection with
the defense of any such action.
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SECTIONS. LAWS GOVERNING CONTRACT
This Agreement shall be g overned by and shall be construed in accordance with the
laws of the State of Missouri.
SECTION J. TERM OF AGREEMENT
This Agreement shall become effective on January 1, 1993, and end as of midnight
December 31, 1993. This Agreement may be renewed for two successive periods of
twelve (12) months with the mutual consent of the parties. Said consent or intent to
not renew shall be provided the other party at least ninety (90) days prior to the end
of the then current period.
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SECTION 10. MODIFICATION OF AGREEMENT
This Agreement constitutes the entire contact between the parties and no
modification or amendment hereto shall be valid unless in writing and signed by the
parties.
SECTION 11. MODIFICATION OF PLAN OF, CAFETERIA PLAN
(a) Any modification or amendment of the Plan or Cafeteria Plan shall be duly
communicated in detail and in writing by City to EBA. Such communication shall
also set forth the effective date of the modification or amendment.
(b) City shall furnish EBA with a copy of each modification or amendment of the
` Plan or Cafeteria Plan as soon as is practicable and in advance of the effective date
of such modification, if possible. After receipt by EBA of a copy of the modification
or amendment, the term "Plan" or "Cafeteria Plan" as used in this Agreement shall
include each such modification or amendment as of the implementation date agreed
upon by the parties hereto.
SECTION 12. CONFIDENTIALITY
EBA acknowledges that the City is under a legal obligation to maintain the
confidentiality of employee records. EBA agrees to comply with such reasonable
procedures for maintaining confidentiality as shall be specified by the City. All
employee information shall remain the property of the City and shall be surrendered,
entirely to the City in the event of the termination of this Amendment. EBA reserves
the right to retain copies as to such information. EBA agrees to allow properly
authorized employees of the City to inspect the records on reasonable notice during
regular office hours upon request. The City acknowledges that it shall have no
ownership or other interest in any computer software or programs purchased or
created by EBA.
SECTION 13. TERMINATION OF AGREEMENT
(a) This Agreement shall terminate upon the earlier of the following dates:
(1) Ninety (90) days written notice by the City or EBA.
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(2) On any other date mutually agreeable to City and EBA.
(3) December 31, 1993, subject to renewal provisions in Section 9.
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(b) In the event of termination of this Agreement, EBA shall complete processing of
all claims for benefits under the Plan and/or Cafeteria Plan received prior to
termination of the Agreement.
.i SECTION 14. INDEPENDENT CONTRACTOR REtLATIONSHIP
EBA is a duly registered corporation within the State of Kansas rendering
administrative services to various employers and entities,including the City. For all
purposes, EBA shall be considered an independent contractor for payroll taxation,
workmen's compensation and liability purposes, and no employee of EBA shall be
s considered for any purpose to be an employee of the City. EBA reserves to itself the
right to determine duties, obligations and compensation of its employees and shall_
have the widest possible discretion in selecting its methods of operation.
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The duties of EBA in providing administrative services to the City on the Plan and
Cafeteria Plan shall be independent of and severable from any insurance policies or
benefits sold by third parties or by EBA.
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SECTION 15. PLAN UPDATES
EBA agrees to advise the City from time to time, as shall be necessary, of any
;;. changes in any lave or regulation affecting Flexible Benefits Plans which shall come
to the attention of EBA.
EBA shall not, without the consent of the City in writing, engage any professional
services for the benefit of the City.
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SECTION 16. CAPTION
The captions or headings in this amendment are made for convenience and general
is reference only and shall not be construed to describe, define or limit the scope or
intent of the provisions of this Agreement.
SECTION 17. NOTICE
Where notice is required or allowed under the terms of this Agreement, such notice
shall be mailed first class with postage prepaid as follows:
CITY: City of Jefferson
Attn: Personnel and Safety Officer
320 East McCarty
Jefferson City, MO 65101
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