HomeMy Public PortalAboutC-20-157 - Basic Benefits, LLC, Cobra Administration Service AgreementGQRRA_AQMINISTRATIQN SERVICE A,PREEMENT
This Administra 'on Service Agreement (Agreement) is made and entered into by and between
C i N of �a r6Dh ("Employer") and BASIC Benefits, LLC ("BASIC Benefits"), a
Delaware company.
WHEREAS, the EMPLOYER has established one or more employee welfare benefit plans
(hereafter referred to collectively as the "Plan") for the benefit of its eligible employees, spouses and
dependents; and,
WHEREAS, the EMPLOYER is the Plan Sponsor and Plan Fiduciary for the Plan and, as
such, -has determined that it is required to comply with the Consolidated Omnibus Budget
Reconciliation Act of 1985, as amended ("COBRA"); and,
WHEREAS, the EMPLOYER may appoint a third -party contract administrator to assist with
COBRA for the Plan, and shall remairmesponsible for the maintenance and operation of the Plan; and,
WHEREAS, BASIC Benefits is in the business of providing third -party COBRA administration
services to Plan Sponsors of such Plans; and,
WHEREAS, the EMPLOYER desires to enter into an agreement under which BASIC Benefits will
perform specified administration services to EMPLOYER with respect to the Plan in accordance with this
Agreement; and
WHEREAS, the Employer, separate and apart from this Agreement, also intends to enter into the
following separate agreements with Basic Benefits on or around the effective dale of this Agreement: (1)
Administrative Services Agreement (ASA) -- Flex Administration and POP Administration ("Flex ASA"); (2)
FMLA Ease Administration Agreement ("FMLA EAA"); and (3) Business Associate Agreement ("BAA").
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good and valuable consideration, the EMPLOYER and BASIC Benefits hereby agree as follows:
TERM
The term for services provided herein shall be effective as of0 and
shall automatically renew for additional successive terms of one year ( ch 'renews term"), unless
either partner provides written notice to the other party at least 60 days prior to the end of the then -
current term or renewal term, or terminates this Agreement in accordance with the below.
During each term or renewal term, this Agreement may be terminated for any of the following reasons
(in addition to the right of annual non -renewal as set forth above):
• As of the first day of any calendar month after sixty (60) days written notice is provided by either
party.
• As of any date upon which EMPLOYER and BASIC Benefits mutually agree in writing;
41 As of the end of a period of thirty (30) days after formal notice of termination for cause has been
given by either party to the other, provided that such cause has not been cured within such thirty
(30) day period;
• Upon teimination in accuidcnc:- with the Force Majeure paragiapie Lc.'uw;ui,
• Upon the voluntary or Involuntary dissolution of either party.
• Upon the termination of this Agreement, BASIC Benefits will, upon request by EMPLOYER, complete
the processing of this Agreement under the terms and conditions that would be applicable if this
Agreement were still otherwise in full force and effect through the date of termination. Upon receipt
of a directive from EMPLOYER, BASIC Benefits will provide EMPLOYER or an entity designated by
EMPLOYER all information requested and maintained by BASIC Benefits to ensure the smooth and
timely transfer of services to a new administrator. The data will be provided in the electronic format
requested by EMPLOYER. All information, claims, requests, and elections submitted by QBs to
BASIC -Benefits after the date of termination will be redirected to EMPLOYER or an entity designated
by EMPLOYER.
• BASIC Benefits will promptly matte employee benefit plan records and documents in its possession
available to EMPLOYER upon request.
• Should copies of employee benefit plan records or documents be requested by any QB, court or
governmental agency, BASIC Benefits will promptly notify EMPLOYER and will provide the
requested material in a timely manner.
BASIC Benefits will perform all Services diligently and professionally, and at all times, in accordance
with the standards and practices of care, skill, and diligence customarily observed by similar firms
under similar circumstances. BASIC Benefits warrants that 1) it has the full right, power, legal
capacity and authority to enter into, deliver and fully perform under this Agreement, 2) that its
performance hereunder will comply with all applicable laws, rules and regulations governing such
services; and, 3) that it will comply with all applicable privacy laws as defined in the Business
Associate Agreement executed by the parties.
• Assist EMPLOYER in fulfilling those duties and responsibilities required by the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, the regulations promulgated
there under by the Department of Labor (DOL regulations) and the Department of the Treasury. the
A efican Recovery ana hleinvestment Act of 2UU9,ana all other administrative law, guida46e aha
applicable decisional law under and/or impacting COBRA (collectively, "Applicable Law") with regard
to the employee benefit plans communicated to BASIC Benefits.
• BASIC Benefits will furnish all required notifications, including, but not limited to, the General Notice
of COBRA Continuation Coverage Rights ("General Notice"), the COBRA Continuation Coverage
Election Notice ("Qualifying Event Notice") and a notice of early termination that are consistent with
the DOL model notices. It will furnish such notices in the time and manner prescribed by Applicable
Law and the benefit plan documents.
• BASIC Benefits will make every reasonable effort to mail the DOL Initial (General) Notice and
Qualifying Event Notice within three business days following receipt.
• BASIC Benefits guarantees all notices will be mailed within the timelines required by Applicable Law.
• BASIC Benefits will mail all COBRA notices required by Applicable Law USPS First Class to the
address provided by EMPLOYER. A "hard" copy of the postage -prepaid envelope will be
maintained for a period of not less than six (6) months. Thereafter, BASIC Benefits will maintain
a copy of the envelope in .pdf format for a period of not less than seven (7) years. All other records
will be maintained in electronic format for a period of not less than seven (7) years.
• BASIC Benefits will provide all State required COBRA notices.
• BASIC Benefits will notify carriers (or the EMPLOYER if requested) of all COBRA enrollments,
terminations and changes of coverage in the manner instructed within three business days of receipt.
For COBRA enrollments, "receipt" means all required paperwork is properly completed and the initial
premium is received_ BASIC Benefits will notify QBs as soon as administratively possible if their
required paperwork is incomplete. This service does not guarantee that the carrier(s) will reinstate,
terminate or change the coverage as directed by BASIC Benefits.
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• BASIC Benefits will provide each Qualified Beneficiary ('QB') who elects COBRA with payment
coupons. New coupons will be provided whenever there is a change of coverage or premiums.
EMPLOYER understands and agrees that payment coupons are a value-added service and are not
required to be provided. As will be stated in the Qualifying Event Notice, QBs will remain fully
responsible to pay their COBRA premiums on a timely basis even if they have not received payment
coupons.
• BASK Benefits will provide QBs with the following options to pay COBRA premiums after initial
enrollment: (1) check; (2) ongoing ACH bank draft; (3) electronic/virtual check (additional charges
apply); or, (4) credit card (additional charges apply), The EMPLOYER may pay COBRA premiums on
behalf of a QB under a severance agreement.
• If a QB underpays their COBRA premium by an "insignificant amount", BASIC Benefits will issue a
notice giving them 30 days to make up the underpayment. EMPLOYER understands and agrees to
BASIC Benefits' definition of "insignificant amount", which is the lesser of $50 or 10% of the premium
due.
• BASIC Benefits will maintain all banking requirements necessary to receive and distribute COBRA
premiums in a timely manner.
• BASIC Benefits will provide 2417/365 EMPLOYER access to a full-service web portal. The portal will
provide detailed, real-time plan and QB information, including last payment made and next payment
due detail. EMPLOYER may run real-time management reports for all information needed, including:
(a) election notifications mailed; (b) DOL "General" notices mailed; (c) all active and terminated QBs;
(d) all QBs within their original election period; and, (e) all other notices mailed to QBs.
• BASIC Benefits will provide 24/7/365 QB access to a full-service web portal. The portal will provide
detailed, real-time plan and payment information, including last payment made and next payment due
.deter ..Thd QP will be able to ray 1'mmi--sm-Q.-Hre if desired
• BASIC Benefits will provide 24/7/385 broker access to a full-service web portal. The portal will
provide detailed, real-time plan and QB information, including last payment made and next payment
due detail. Broker may run real-time management reports for all information needed.
• On or about the 10th of each month, BASIC Benefits will remit premiums for the previous month to
EMPLOYER.
• BASIC Benefits will provide unlimited toll-free customer service for employers and QBs.
• If requested by EMPLOYER (and approved by BASIC Benefits), BASIC Benefits will pay COBRA
premiums directly to the appropriate carrier. This service is only available if the following conditions
apply: (1) The carriers must provide a separate bill 8 account number for COBRA participants; (2)
The carriers must permit bills to be adjusted; (3) the carrier must accept payment and eligibility data
up to 60 days in arrears; and (4) the carriers must accept BASIC Benefits' reporting forms. If
desired by the EMPLOYER (and approved by BASIC Benefits), the additional fee will be charged
each month for each carrier bill. In addition, a one-time hourly fee of $75 will be charged if the
EMPLOYER requests BASIC Benefits' assistance with carrier bills that are not in existence at the
time this service commences.
• BASIC Benefits will mail, assist QBs and process "open -enrollment" elections for QBs provided
EMPLOYER provides 13ASIC Benefits with a "mail -ready" enrollment packet in a timely manner.
Additional charges apply for packets that exceed 30 pages (60 sides),
• BASIC Benefits will assist EMPLOYER with an audit, whether initiated by a governmental agency or
internally by EMPLOYER. There is no charge to provide standard management reports that can be
generated directly from the administration system. BASIC Benefits will not charge EMPLOYER for the
first 30 minutes of staff time required to provide EMPLOYER with additional information requested,
including but not limited to: researching EMPLOYER records maintained outside the administration
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system, providing copies of checks, attending meetings an behalf of EMPLOYER and/or creating
custom reports. Time in excess of 30 minutes will be billed at the rate of $75 per hour. BASIC
Benefits will honor the terms of this section for as -long as records are maintained.
BASIC Benefits shall permit authorized representatives of EMPLOYER, at reasonable times, to have
access to, examine, and make coples of, such records and documents, at EMPLOYER's expense.
BASIC Benefits agrees that it shall amend and update any material that has been superseded by
changes in the regulations or applicable laws governing the services provided under this AgreemenL
•
EMPLOYER agrees to provide al carrier information necessary for BASIC Benefits to perform its
duties under this Agreement, including but not limited to the plan name, plan number, renewal date,
and eligibility contact information (including faxnumber).
• EMPLOYER agrees to report plan and eligibility information/changes in a timely manner.
• EMPLOYER agrees to provide accurate and complete information. Electronic information must be
provided in the format required by BASIC Benefits. The charge to
modify/correct/complete/customize/redo electronic enrollment and eligibility data because it is not
provided in the required format will be $150 per hour. However, BASIC Benefits will notify
EMPLOYER that the electronic enrollment and eligibility data was not provided in the required format
and allow EMPLOYER to make any modifications or corrections beforehand.
• EMPLOYER agrees to reconcile carrier and BASIC Benefits records monthly to ensure carrier
eligibility records are maintained accurately at all times, This means the EMPLOYER must compare
carrier and BASIC Benefits records monthly to ensure they: (a) are not paying premiums 10 the
^?. fir fnr rn.varane ft it has hnan tormlpat-d.' (b) are paying :-aT. ers fnr coveragg that has been
elected and paid for by a QB; and, (c) are paying the correct premium. EMPLOYER is responsible
for any premiums due as a result of EMPLOYER'S failure to maintain accurate and timely records
EMPLOYER understands and agrees that even if BASIC Benefits fails to notify carriers properly,
any liability, premiums, penalties, and other charges incurred as a result of EMPLOYER'S failure to
review and report discrepancies in a timely manner is and shall remain the sole responsibility of
EMPLOYER. This EMPLOYER liability only applies if EMPLOYER pays COBRA premiums to the
carrier. If BASIC Benefits pays the carriers, then BASIC Benefits accepts full financial responsibility
to maintain eligibility with the carriers.
• EMPLOYER agrees to generate and review management reports monthly and report all inaccuracies
and discrepancies immediately. EMPLOYER'S monthly responsibilities include:
(1) ensure that all required DOL General Notices were mailed; and, (2) ensure that all Qualifying
Event Notices were mailed.
It HIPAA requires that covered individuals (employee, spouse and dependent) receive a Certification
of Creditable Coverage when there is a loss of coverage, regardless of the reason, the EMPLOYER
may opt for BASIC Benefits' optional HIPAA Certification service. EMPLOYER agrees the service is
limited to Certificates mailed when coverage is lost as a result of a COBRA qualifying event and upon
termination of COBRA coverage for any reason. BASIC Benefits shall not be responsible to issue
HIPAA Certifications under any othercircumstances.
• EMPLOYER agrees to notify BASIC Benefits immediately upon an employee or spouse first
becoming covered under one or more COBRA qualified health plans_ EMPLOYER agrees that
whenever possible, BASIC Benefits must be notified prior to coverage taking effect but never more
than 14 days after coverage takes effect.
• EMPLOYER agrees to notify BASIC Benefits upon the occurrence of a COBRA "qualifying event" (as
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defined under Applicable Law) that results in a loss of coverage for an employee, spouse or
dependent. EMPLOYER understands and agrees that it is legally responsible to notify BASIC
Benefits of all COBRA Oualifying Events no later than 30 days after the eventdate.
• EMPLOYER agrees that all material generated by BASIC Benefits will be provided exclusively in
English.
• EMPLOYER agrees to pay the charge for all special delivery requests. If requested, EMPLOYER
must provide special delivery billing/payment information. BASIC Benefits will not ship special
delivery without the EMPLOYER'S paym ent information.
• EMPLOYER agrees to maintain an approved email address on file with BASIC Benefits at all times.
• EMPLOYER agrees to notify BASIC Benefits at least 30 days in advance of adding, dropping or
changing any health plan subject to COBRA, or, if less, immediately upon EMPLOYER receiving the
information from the carrier(s). A "change" includes, but is not limited to, a change of premium. If the
EMPLOYER fails to notify BASIC Benefits timely, EMPLOYER understands that they may be
required to absorb the cost/additional cost of the premium for any period during which the COBRA
participant did not receive timelyadvance notification.
• In performing its services under this Agreement, BASIC Benefits must rely upon EMPLOYER to
provide timely, accurate and complete information. BASIC Benefits shall not be responsible for any
losses, damages, claims or liability of any kind, caused by the failure of EMPLOYER to provide
timely, accurate and complete information.
• Except as specifically set forth in this Agreement, BASIC Benefits shall have no responsibility or
liability to any person to fund any Plan benefits or pay any Plan premiums.
• BASIC Benefits may seek instructions From EMPLOYER on any matter related to the interpretation
pertinent to the Plan or services provided and may await formal instructions from EMPLOYER without
incurring any liability under this Agreement whatsoever. If -at any time EMPLOYER should fail to
provide timely direction when requested, BASIC Benefits may act or refrain from acting, and shall be
protected in acting or refraining from acting without such directions, as BASIC Benefits reasonably
deems in good faith to be appropriate and advisable under the circumstances.
• EMPLOYER understands and agrees that should new and/or additional requirements that impact this
service be imposed upon EMPLOYER by any Applicable Law or by the Plan, BASIC Benefits may
modify this Agreement accordingly and may charge additional fees, if warranted. BASIC Benefits will
provide EMPLOYER with written notice at least sixty (60) days prior should additional fees be
required. Unless required by law, EMPLOYER will have the option to decline BASIC Benefits' offer to
comply with such newladditional requirements, which may necessarily result in termination of
services on a date mutually agreed upon by EMPLOYER and BASIC Benefits.
ADDITIONAL TERMS
• Confidential Information- All records, files, documents (including certain information that is known by
BASIC Benefits to be confidential and proprietary to EMPLOYER's general organization, operations
and structure) and the like relating to EMPLOYER's Plan, including, without limitation, personal
information of employees of the EMPLOYER or participants in the employee benettt_plans, with
which BASIC Benefits shall come into contact shall remain the sole property of EMPLOYER and
shall not be disclosed to third parties except as authorized in this Agreement, as authorized by the
BAA between the Employer and BASIC Benefits, as otherwise authorized by EMPLOYER in writing,
or pursuant to the direction or order of a governmental agency or a court of competent jurisdiction.
To the extent permitted, BASIC Benefits will give EMPLOYER adequate time to contest such
direction or order. However, any additional time spent by BASIC Benefits pertaining to an
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EMPLOYER that chooses to contest a governmental direction or order shall be billed to the
EMPLOYER at the rate of $150 per hour. Notwithstanding any of the foregoing, any examination or
copying of participant records shalt be carried out in a manner designed to protect the confidentiality
of such information. All written materials constituting or incorporating any such information
described herein shall be returned to EMPLOYER upon request.
No Leaal or Tax Services: EMPLOYER recognizes that BASIC benefits is not authorized to engage
in the practices of law or accounting and will not provide legal or tax services to EMPLOYER or any
other person. EMPLOYER agrees that they are responsible to obtain legal and tax guidance from
their counsel when appropriate. Whenever a legal or tax Issue arises in the course of the work to be
performed under this Agreement, EMPLOYER shall be responsible to obtain such legal or tax
guidance as may be necessary to resolve the issue. EMPLOYER shall notify BASIC Benefits of their
decision and BASIC Benefits shall be entified to rely upon direction from EMPLOYER in the
performance of its services.
Advice and Recommendations: EMPLOYER understands and agrees that, although BASIC Benefits
may from time to time call to EMPLOYER's attention and make recommendations concerning
potential or actual problems that may come to BASIC Benefits' attention with respect to the operation
and administration of EMPLOYER'S employee benefit plan(s), such advice and recommendations are
a matter of accommodation only and BASIC Benefits shall have no duty to give such advice, make
such recommendations, or otherwise to question any actions or decisions of EMPLOYER, any
employee benefit plan fiduciary, or any of their respective agents or employees.
Not a Fiduciary: EMPLOYER and BASIC Benefits understand and agree to the following:
A. EMPLOYER understands and agrees that BASIC Benefits is not the 'Plan Administrator" of
the Plan and that BASIC Benefits is not a fiduciary with respect to such Plan. BASIC
Q„naa-lr; nc!E in �! miristeriel capacity only
B. EMPLOYER and each Plan fiduciary shall retain their full authority, discretion and
responsibility for the operation of the Plan with respect to which BASIC Benefits is
providing its services under this Agreement. BASIC Benefits shall be entitled to rely on the
EMPLOYER's or other Plan fiduciary's decision with respect to any claim for benefits
under the Plan, and BASIC Benefits shall perform its services under this Agreement in
accordance with such decisions.
C. Unless expressly stated in this Agreement, or in a separate agreement, BASIC Benefits
accepts no responsibility for the distribution of summary plan descriptions (SPDs) to QBs
other than those provided as part of the annual operrenrollment packet
Independent Contractor Status: Neither BASIC Benefits. nor any party contracting with BASIC
Benefits shall be deemed to be an employee of EMPLOYER. BASIC Benefits is and shall be an
independent contractor with respect to EMPLOYER. The legal relationship of any person
performing services for BASIC Benefits shall be one solely between BASIC Benefits and such
person. Neither party has the right or ability to bind the other party to any agreement with a third
party or to incur any obligation or liability on behalf of the other party without the other party's
written consent,
Indemnity by EMPLOYER: EMPLOYER agrees to indemnity, defend and hold BASIC Benefits, its
partners, directors, officers, employees,=off tqs and successors harmless from any claim, damage,
loss, demand, benefit, payment, tax, costs, charges, penalties and reasonable legal expenses
(collectively, "Losses") resulting directly or indirectly from EMPLOYER's breach of its obligations
under this Agreement or violation of applicable law by EMPLOYER or as a result of EMPLOYER's
negligence or willful misconduct in performing its duties and responsibilities under this Agreement
except to the extent such Losses result directly of indirectly from BASIC Benefits' breach of its
obligations under this Agreement or from BASIC Benefits' negligence or willful misconduct in
A
performing its duties and responsibilities under this Agreement
Indemnity by BASIC Benefits: BASIC Benefits agrees to indemnify, defend and hold EMPLOYER, its
partners, directors, officers, employees, affiliates and successors harmless from any claim, damage,
loss, demand, benefit, payment, tax, costs, charges, penalties and reasonable legal expenses
(collectively, "Losses') resulting directly or indirectly from BASIC Benefits' breach of its Obligations
under this Agreement or violation of applicable law by BASIC or as a result of BASIC Benefits'
negligence or willful misconduct in performing its duties and responsibilities under this Agreement
except to the extent such Losses result directly or indirectly from EMPLOYER's breach of its
obligations under this Agreement or from EMPLOYER's negligence or willful misconduct in
performing its duties and responsibilities under this Agreement,
• Insurance: BASIC Benefits shall at all times maintain business & liability insurance coverage as well
as all coverage required by law for its services, obligations, employment, and physical assets as
described below. All coverage shall meet or exceed minimum required coverage levels and insurers
shall have AM Best rating A -VII or better.
(1) Comprehensive General Liability insurance with minimum limits of $1,000,000 each
occurrencel$2,000,000 aggregate;
(2) Professional Liability with minimum limits of $2,000,000 aggregate;
(3) Worker's Compensation and Employers liability insurance with minimum limits of
$1,000,000 each accident;
(4) Cyber Liability insurance with minimum limits of $1,000,000; and
(5) Umbrella Liability insurance with minimum limits of $10,000,000 each
occurrencel$10,000,000 aggregate.
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and BASIC will name EMPLOYER as an "Additional" insured on BASIC Benefits' General/Business
liability policy at no charge.
• Amendment: Except as otherwise provided in this Agreement, no waiver or modification of any part of
this Agreement shall be valid unless in writing and duly executed by both parties. This Agreement
may be amended at any time, in whole or in part, in writing signed by EMPLOYER and BASIC
Benefits that recites specifically that it is an amendment to the terms of this Agreement—
Governing Law: The laws of the State of Califomia, without regard to California's conflict of laws
provisions, shall govern the construction and interpretation of this Agreement In any action or suit to
enforce any right or remedy in this Agreement or to interpret, any provision of this Agreement, the
prevailing Party in a final determination shall be entitled to recover its costs, including reasonable
attorneys' fees.
• Audit Rights. The parties agree to cooperate in all reasonable audits. Audit fees shall be payable by
the party initiating the audit. Audits shall be conducted using procedures mutually agreed upon by
the parties. Results of the audit may be -shared with the party being audited at the sole discretion of
the party initiating the audit
• Non -Assumption of Liabilities. Unless specifically provided in this Agreement and Addendum(s), the
parties do not assume the existing or future obligations, liabilities or debts of -the -other party.
• Partial lnvarrdgy: The invalidity or unenforceability of any provision of this Agreement shall in no
way affect the validity or enforceability of any other provision of thisAgreement
■ Waiver. Failure to insist upon strict compliance with any provision of this Agreement shall not be
7
deemed to be a waiver of such provision or any other provision. Waiver of breach of any provision of
this Agreement shall not be deemed to be a waiver of any other provision or of any subsequent
breach -of such provision.
• Assignment: This Agreement is binding on the Parties hereto and their respective successors and
assigns. Neither Party may, or has the power to, assign this Agreement without the prior written
consent of the other, except that BASIC Benefits may assign its rights and oblgations under this
Agreement without the approval of Client (a) to an entity which acquires all or substantially all of
the assets of BASIC Benefits, or (b) to any subsidiary or Affiliate or successor in a merger,
acquisition, restructuring or reorganization of BASIC Benefits.
• Notice; Any notice required or permitted to be given under this Agreement shall be provided in
wflfing and delivered by the most expeditious means available including. but not limited to email,
facsimile, overnight courier or certified or registered mail -to the addresses set forth below,
Notice to EMPLOYER shall be sent to: Notice to BASIC Benefits shall be sent to:
Employer Name: City of Carson , Attn: Faye Moseley BASIC Benefits
_7Q 1 'ag {'arson'street_ C'arwm_ ('A 90745 3001 Lava Ridge Ct Ste 160
Roseville, CA 95661
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• Enforcement; In the event a dispute should arise regarding the interpretation or enforcement of any
of the terms of this Agreement, the parties shall attempt in good faith to resolve informally and
promptly any such dispute.
Force Maieure: In the event that either party is unable to perform any of its obligations under this
pnf ha ca { n nrrdirronro F+aunrd Iho "nfml 7nr1'&$1ff+n�df the fpJdf nrmiLmne-of—lbe
party affected and which by exercise or reasonable diligence such party is unable to prevent or
provide against. (e.g,, natural disaster, actions or decrees of governmental bodies, etc,) (Force
Majeure Event), the affected party shall immediately give notice to the other party and shall resume
performance within a reasonable time after the cause of such failure has been removed. Upon receipt
of such notice, all of the other party's obligations under this Agreement, the performance of which is
dependent upon the performance of the obligation that has been delayed by the Force Majeure
Event, shall be suspended. If the period of nonperformance by the affectedparty exceeds thirty (30)
days from the receipt of notice of the Force Majeure Event by the other party, the other party may
terminate this Agreement immediately upon written notice to the affected party.
• Additianal Fees and Charges: Fees and charges specific to an employee benefit plan or service
provided by BASIC Benefits are stated in Exhibit 2 made part of this Agreement. General fees and
charges are as follows:
A. Broker may pay the base monthly fee for COBRA services on the EMPLOYER'S behalf- The
agreement to pay the fees is between the EMPLOYER and Broker. Should Broker, at any
time and for any reason, not pay the fees when due, the EMPLOYER understands and
agrees to pay such fees, in accordance with the terms of this Agreement, upon receipt of an
invoice from BASIC Benefits.
B. All undisputed fees are due and payable within thirty (30) days of EMPLOYER's receipt of
the invoice. In addi 'on BASIC Benefits retains the right to suspend or terminate services if _
the delinquent payment is not received within ninety (90) days of the invoice date, provided
the designated individual at EMPLOYER is given at least thirty (30) days' written notice of
delinquency. An additional reinstatement fee will apply to reinstate services after suspension
or lermination due to EMPLOYER's failure to pay undisputed fees by the deadline stated
herein_
C. Fee rates will not be increased for at least the first 36 months of the term of this Agreement.
The annual total of payments from EMPLOYER to BASIC pursuant to this Agreement, the
Flex ASA, and the FMLA EAA, collectively, shall not exceed $25,000.00 without prior written
consent from EMPLOYER.
D. Upon termination of services, BASIC Benefits reserves the right to suspend all services
until all undisputed fees due are received from EMPLOYER.
E. BASIC Benefits reserves the right to modify charges for administrative services and
assistance effective on the contractrenewal date provided EMPLOYER receives 120 days
advance written notice.
F. Upon request by EMPLOYER, BASIC Benefits will assist EMPLOYER with issues that
existed prior to the commencement of services with BASIC Benefits. The additional
charge for this service is $75 per hour.
G. Work that must be duplicated or corrected resulting from late or inaccurate information from
EMPLOYER (e -g- resend COBRA notices, etc,) may be charged at the rale of $75 per hour
or the blanket per piece mailing fee, whichever is greater_
H. BASIC Benefits will charge EMPLOYER $20 for each wire transfer received from
EMPLOYER. There is no charge if the EMPLOYER sends an ACH payment to BASIC
Benefits,
• Entire Agreement: This Agreement as amended from time to time, constitute the entire agreement
between BASIC Benefits and EMPLOYER as it relates to the provision of COBRA administrative
services. This Agreement supersedes all prior and contemporaneous agreements, understandings
and representations between the parties, whether written ororal_
_ •_Signatures This Aqreement may be executed_ in separate counterparts. and by facsimile or
electronically, each of which when so executed and delivered shall be a legally -binding original and
all such counterparts shall together constitute one and the same instrument, binding on all parties,
notwithstanding that each of the parties may have signed different counterparts. The parties -agree
that delivery of an executed counterpart signature hereof by facsimile transmission, by electronic
mail in 'portable document format" ('.pdf") form, or by any other electronic means intended to
preserve the original graphic and pictorial appearance of a document, will have the same effect as
physical delivery of the paper document bearing the original signature.
Each of the undersigned individuals represents and warrants that he or she is expressly and duly
authorized by his or her respective entity or agency to execute this Agreement and to legally bind each
such entity or agency as set forth in this Agreement.
IN WITNESS WHEREOF, the duly -authorized officers of the Parties hereto have executed this
Agreement below.
0
BASIC Benefits
Signature- WMA _ IK -
Print Name:l'O �lytit- Fix
Employer: c4w a -r
Signature: -Z
yj��
Print Name: — _ l�90'loi�C'J� _ --
Title:'D1yt(,* r Li�i QS l�( DIS Title:
Date: A-uo_ .kli___YV Date: M 2.1 1 7020
Rncir4 9- „�.., . 1V1rC
�I.r� 1w
9246 Portage Industrial Dr.
Portage, Ml 49024
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Approved as to form
Sunny Soltani, City Attorney
..-;J0
ATTEST
Donesia Cause-Aldana, MMC
f ',�- roc, City of Carson
FEE SCHEDULE
$ waived First Year Setup Fee
$waived Renewal Fee
$0.70 Per Insured Per Month ( 40.00 Monthly Minimum)
$ 2.00 each DOL General Notice (Initial Notices) to Benefitted Employees 0 Yes 0 No
Additional Fees-
S 8.00 per event'Mass Layoff' Fee -- additional charge if employer lays off or terminates 15% or more
employee during a 30 -day period
2% Administration Fee (Charged on full premium, incl. severance): Retained by BASIC Benefits
Possible Fee Variances:
BASIC Benefits has the right to apply additional fees for any service outside the scope of its contracted
services. BASIC Benefits will notify the employer in advance of any additional fees being assessed.
Rates will be adjusted annually based on pricing below:
Monthly Fees:
# of Employees PEPM/Monthly Minimum
rt 1 .100 $0.701$40 00
101-250 $0.70/$40.00
251-500 $0.701$40.00
501-1000 $0.701$40.00
1,001— 5,000 $0.701$40.00
5,000+ $0.701$40.00
THE EMPLOYER TO INITIAL WITH ACCEPTANCE OF FEES HERE
COBRA Open -Enrollment Assistance Service
BASIC Benefits offers three service levels to assist employers with their open -enrollment responsibility for
COBRA participants. The three service options are referred to as; 'STANDARD — Open -Enrollment
Service"; "BUDGET - Open -Enrollment Outsource Service% and, "PREMIUM - Open -Enrollment
Outsource Service".
STANDARD — Open -Enrollment Service: Our default open -enrollment service level_ Prior to the annual
benefits open -enrollment period, the employer obtains a COBRA participant contact report from their secure
BASIC Benefits web portal. Employer provides open -enrollment material to COBRA QB's, assists QB's
with elections and processes elections. After open -enrollment closes, employer notifies BASIC Benefits of
the new QB elections for the coming year_ BASIC Benefits then sends a renewal confirmation with new
payment coupons to each COBRA participant.
BUDGET - Open -Enrollment Outsource Service: The Budget Open -Enrollment Outsource Service is
the perfect solution for employers that want full-service assistance, but also want to keep their cost to a
minimum.
The employer provides BASIC Benefits with the open -enrollment material (printed or electronic) prior to
their scheduled benefits open -enrollment period_ BASIC Benefits will then print (if necessary) and send the
packets to each COBRA participant (after adding a cover letter), assist participants with completing their
elections, receive the completed election paperwork and distribute the completed material as
necessary. As an alternative to mailing packets, BASIC Benefits may email packets upon request or post
some of the less critical material online and provide participants with a unique link to view/retrieve as
desired. BASIC Benefits will also notify carriers of the new elections and send a confirmation with new
payment coupons to each COBRA participant. There is no additional charge for this service. However, the
employer must meet ALL of the following conditions to avoid additional charges for open -enrollment
nutsrn irri rin•
• The employer must elect the Open -Enrollment Outsource Service each year when they complete their
implementation or renewal confirmation web form.
• The open -enrollment material must be received by BASIC Benefits "mail -ready" (meaning collated,
complete and in the proper order). If the material is received elecironicalty, packets must come as a
single PDF file (no multiple files).
• The open -enrollment material must arrive in its final, ready to distribute form (the employer should never
send preliminary, piece -meal or incomplete materia!).
• The open -enrollment material must include a clear explanation of all benefit plan changes for the new
year and provide contact information for COBRA participants who have questions about their health
plan coverage.
• The open -enrollment material should only include benefits that are being offered under COBRA. For
example, this material should not include information about a 401(k), group life or LTD coverage.
• The material cannot exceed 80 sides (40 pieces of paper).
■ It the open -enrollment material is provided to BASIC Benefits electronically, it will be printed in
grayscale (black & white).
• The complete packet must be RECEIVED by BASIC Benefits at least 7 business days prior to the start
of open -enrollment for active employees. The Regulations require that COBRA participants be afforded
the same election period as active employees. Employers that fail to provide COBRA participants with
an equal period of time to make their decisions are exposed to an increased risk of liability under
COBRA.
• Open-enrotiment packets are sent to each participant via email (if requested) or USPS First Class mail_
Employers may request courier shipping (e.g. Fed Ex or JPS) at no extra cost if the employer provides
the appropriate billing information (meaning the cost will be charged directly to the employer).
PREMIUM - Open -Enrollment Outsource Service: The Premium Open -Enrollment Outsource Service
applies any time an employer does not meet the conditions for the "Budget" service. When this occurs,
BASIC Benefits will assist the employer as needed (e.g. help gather missing information, build the
material into a single file, print more than 80 sides, etc.). The Employer will be charged $15 per packet if
the Premium service is required to complete the Open -Enrollment Outsource service. Even with the
additional charge, certain conditions apply:
The employer must deliver all materials to BASIC Benefits at least 7 business days prior to the start of
the open -enrollment period. Failure to do so may result in COBRA participants receiving their materials
late.
The MAXIMUM open -enrollment packet size provided to BASIC Benefits by the employer/broker for
this pricing is 70 physical pages (meaning up to 140 printed sides using two sided copies). An
additional $12 charge per additional 70 pieces of paper will be added to the base fee for larger packets.
For example, the charge for an 80 page (160 sides) packet wilt be $30, while the charge for a 150 page
(300 sides) will be $42 per packet.
Material sent to BASIC Benefits in separate correspondence may not be ordered properly and may
result in additional delays,
ACS or CERTIFICATE OF LIABILITY INSURANCE DATE (M 02p � YI
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACNAME:
M3
1 M3 Insurance Solutions, Inc. PHONE — Fax
828 John Nolen Drive LoAJ I40, k, 800-272-2443 _-.JA1C,Not:608-273.1725_
Madison WI 53713 �wRess, info@m3ins.com
_ INSURED TOTAADM-01
BASIC Benefits, LLC / BASIC Payroll, LLC
COVERAGES CERTIFICATE NUMBER: 435921D63
INSURERS) AFFORDING COVERAGE i NAIC9
INSURER A: Charter Oak Fire Insurance Com 25615
INSURER 8: The Travelers Indemnity Compan _ 25658
INSURER c: Travelers Prope" Casuals of 25674
INSURER o: The Travelers Indemnity Co of ! 25682
INSURER E:
RFVISInIJ IJI luAr-0•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
/
' V
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
!LTR
TYPEOFINSURANCE
�Ci$O
O POLICYNUMBER
MOWUDCDlYYYY
MSFF D WY
LIMITS
A
Y
H5305A888588COF19
101112020
10!112021
EACH OCCURRENCE 51000,000
PREMISES JEa occurrence S 500 000
TMERCIALGENERALLIABILITY
CLAIMS -MADE IJ OCCUR
MED EXP (Any one person) S 10 000
_
PERSONAL S ADV INJURY $1.000.000
_
GENERAL AGGREGATE $2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER
X POLICY ❑ JECOT- F-� LOC
PROOLCTS - COMPIOP AGG $2000.000
S
OTHER,
B
AUTOMOBILE
LIABILITY
BAGN165851 1011/2020
10/1/2021
COMBINED INGLEL,MIT ;1.000.000
Ea accitlent
BODILY INJURY (Per person) $
X
ANY AUTO
I
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) S
X
HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE S
Per emdent
S
C
X
UMBRELLA UAB X OCCUR
f CUP6J097403
10/1/2020
101112021
EACH OCCURRENCE $10000000
AGGREGATE $10000000
EXCESS UAB CLAIMS -MADE
I
DEO I X RETENTION15
$
❑
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
UB6J691951
1011/2020 1011/2021
X S ATUTEERH
E.L. EACH ACCIDENT S 1,000,000
ANYPROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUDED? NIA
E L. DISEASE • EA EMPLOYEE 51 000,000
in NH)
(MIt
f�andstory
OESs. descnbe under
C PTIION OF OPERATIONS below
E.L. DISEASE • POLICY LIMIT 31000,000
A ' Pmtessronal Uabelgy I
C Cyber Liability
PE0901502-01 10H12020 101112021 JAggregate2,000,000
ZPL31N32133 1011/2020 10/1/2021
Aggregate I 1,000000
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, rMy be attached It mora space Is requiredl
Verification of Insurance only. -,,,,r ,.)
The City of Carson is an additional insured with respect to general liability when required by written contract.
All insurance is written on a primary, non-contributory basis when required by written contract
A 30 Day Notice of Cancellation applies. �, C
3-2-/2-/2-02-0
It[a;Le11■1=1.1
Faye Moseley
Director of Human Resources 8 Risk Management
City of Carson
701 E Carson Street
Carson CA 90745
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
1te''ov
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD