HomeMy WebLinkAboutR-80-0208RFSOLUTI077 NO. 8 0 - 2 0 8.
A RESOLUTION AUTHORIZING THE, CITY MANAGER To
EXECUTE THE ATTACHED 1•TRITTFM ACP,FI'MI;^IT B.F,71JEEN
Uw THE CITY, OF MIAMI AND. THE EQUITABLF LIFE ASSITRANICF.
. SOCIETY OF THE UNITED STATES 1�7HICH PROVIDES .
ADMINISTRATIVE CLAIM SERVICE FOR CROUP HEALTH
INSURANCE, FOR THE PERIOD FROM JUKE 1, 197 8 ,
n,: 4,! t f,. AUTOMATICALLY RENEWABLE ON EACH XNNIVERSA.RY DATE -
UNDER SAME TERMS AND CONDITIONS, BY MUTUAL
t- CONSENT OF BOTH PART.IF S ' FOR. THEPURPOSE OF
F
-' ADMINISTERING TIISELF-.FTRIDED CITY OF MIAMI
EMPLOYEES' HEALTH AND ACCIDENT SELF- INSURANCE
.t U. PROGRAM.
Cn �
WHEREAS, by Resolution No. 7.8-?9�a, the City Commission
authorized the - City . Manag,er to enter into ,an agreerient with The
Equitable Life Assurance Societv.=of,the.United States to nrovide
Administrative Claim.Service for Group Hea.lth.Insurance;:and
WHEREAS,,Resolution.No. 78-294 required the annroval of the
City Commission prior to the execution of the �iritten agreement; and
WHEREAS, the agreement has been `f_inalize* and is attached
hereto for review and approval;,
IIOW, THEREFORE;_ BE IT RrSOLVED BY ;THF COTTISSIOM nF TF
CITY OF MIAMI, FLORIDAi "DOCUMD11 INDEX
Section 1. That the City ManaAWN' �i'��i _ o execute
the attached agreement between the City of Miami and The Equitable
Life Assurance Societv of the United States which provides Adminis-
trative Claim Service for Croup Health Insurance, for the period
June 1, 1978,-and'automaticall�7 renex,7able on each anniversary date
under.the.same terms -and conditions bv'mutual consent of -.both
parties.
PASSED AND ADOPTED -'this 19 day of MARCH 19$n.
MAURICE A. FERRE
MAITRICF A.. Fr.RREI: M A Y 0 R.
AT EST:
R.AL H G . ONGIE , CITY Clg;,kP.K
PREPARED AND APPROVED BY: A,, UK D AS T � T?nRM A. U) CORRECTNESS:
J1 MI AEL HAYCOOD GEOR F . ICNOX , JR . CITY COMMISSION
ASSISTANT CITY ATTO ..T..Y CITY. • TTnPMFY MEETING OF
MAR 1 9 1980
8-
�UT10N NO .. .. ............ 20
AWMM............................
administration charge is not acceptable pursuant to sub-
paragraph (b) of Section 12.
(v) On any other date mutually agreeable to CITY and
EQUITABLE.
(b) In the event of termination of this Agreement. EQUITABLE shall
complete the processing of all claims for benefits under the."Plan" recei11 ved by
it prior. to termination of the Agreement and shall be. reimbursed for,
administration.of such claims on the basis of the administration charge in
effect on the date of"termination.
Section 14. EQUAL EMPLOYMENT OPPORTUNITY. POLICY
A'. EQUITABLE, as administrators "o.f"the .CITY program "of Medical.`
and Hospital benefits, will make every "effort. to insure. -that Job "opportuni.ties
are made.known`.to'.the entire community and that no`qualified applicant is
rejected because of race, creed, "age, sex, or countryof origin. The CITY
will- impleme'nt an affirmative -action program of equal opportunity having as its
gnal.the employment "o.f minority.persons"and women.in aIpproximately`the ,same
ratio as such persons are available".in the:Fort Lauderdale area. labor force.
B. It will be the policy 'of"'EQUITABLE.to:
l'. Consider each applicant'.for:employment:on the'"basis .
of individual, qualificitions..for the job without
.``.�•
5 regard to race, color, creed, sex,'.age 'or national=
�
origin.. .
J O� iJ yv► Give all employees equal consideration with"respect,to,
compensation, benefits,.and promotion within EQUITABLE .
without"regard to race, color, icreed, sex,.age, or
national origin.
.C." The following procedures.will be adopted to "implement
EQUITABLE'S policy -of non-discrimination' with "regard"to race, sex, color,:
religion, national origin, or age:
so, 208
Page 8
)ir, D E F I N I T 1 0 N S IF,"
The following definitions apply to the terms used in this Plan:
Company:
City of Miami,.Fl.orida
Claims.Administrator*.',
The Equitable Life Assurance Society:of theiUnited
States
Employee (s):'
Any employee of City of Miami,Florida who
normally works f0 rty (40) hours -or more.,a,week
or,Retiree who continues uninterrupted coverage
upon Retirement...
,Dependent (s)
The following are consider en:de
"b6p nt' (s)
,
(a).: A covered employee's wi f e; or husband not legally
:
-d from separate the 'employee; ,
W A covered employee's u nmarried 'child,who has not
attained age.19-
(c) A.coveredp1oyee!s'-un'marrie-d:,child1who has
,en
aained-.age 19 but has." noattained age 23 and
who is: "a full time s , tuOen
A covered 6mployeets step -_children if they are
Wholly. dependent on'th.e.employe-e-and ireside in
thp'employeevs home.
NOTE: No person is a'Dependent if he', -is; eligible for
coverage as:an employee.
Effe'Ctive,Dates.ofCoverage:
See the,provisions:! WHEN'..YQUR COVERAGE BEGINS and
WHEN YOUR DEPENDENT'S COVERACE,BEGINS'in:lthe Group
ki' Florida.
Benefits,Plan,Boo et *'for City of Miami,
BENEFITS
The Company assumes the full
.he-,Med.ic.aI Care Expense
respon.sibility,f6r.'pr:bvid-ing.l.t.,
and.Majo'r-Medical Expense Benefits stated,in,,the GROUP, BENEFITS. PLAN Booklet for
City -of Miami, Florida which
is attached hereto.. The, Equitable Life:Assurance
Society of the United States
will act.as Claims Administratorlof the Plan, but
does,not insure the benefit s
-provid e d thereunder,
One copy of:the Booklet is attached.
11SU
P0
RTIVE
Ij IT
L L
COORDINATION OF BENEFITS
1. The purpose of this provision is to permit a covered person to receive from.his
benefit plans no more than 100% of his allowable medical expenses.
2. An allowable medical expense, is any necessary, reasonable and.customary.,item"
of expense for medical services, supplies or treatment,..at least -A portion1of
which is covered under.at least one of the plans covering the person for whom
claim'is made.
3. The"benefit plans that come within the scope of this provision are anymedical
or major medical benefits or services from any source (excluding,any,..individual
policy,which is not issued under an arrangement of coverage for individual.in
a group).
4. The benefits under.thi.s plan will be determined after the benefits.under all
primary plans have been determined. If,,the benefits under the..primary plans.
and the benefits payable under' -this plan would exceed allowable expenses,,`the
benefits •'.unde'r this plan.will.be reduced'., During all or part.of a",calendar
year that`a covered.person is.also,covered under a primary plan,;benefits 'under
this plan and all'primary plans.will"not exceed allowable.expenses;..
5. Another plan shall be' 'considered a primary plan if the other plan.
a - does not have a`provision coordinating itsbenefits,with.this plan.
person other than as ade en '
b covers".ttie: ,p dent and'this plan covered -him "as
a dependent."
c - covers the person as a dependent of _a male_ employee and this.p_lan _covers
him as a dependent of a female employee.
d has covered -the person longer than this, plan and 'neither a,,b,-or c applies.
6. To achieve the .,purposes of this.plan and'.o.f this provision the Claims Administra-
tor has`the:right
- to obtain from.or release'to.any person,',insurance.company.or other organiza-
tion",any.information'it deems necessary''
- to pay .any benefits to this plan.to any organization,`instead of the covered
individual, ,which .paid such benefits
- to recover from any.person or organization benefits paid in.exce'ss.of ,the.
maximum amount necessary` to satisfy the intent of this provision:
#.-., k f 1 f
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8'0-208.
a
WHEN COVERAGE TERMINATES
Employee. Employee coverage under this Plan will automatically
terminate on.the earliest of the following dates:
(1) The last day for which any required contribu-
tions have been paid.
(2) Tbe.day of termination of service as'a regular
employee (other than certain continuance herein-
after described which allow.continued participa-
tion in the Plan):
(a) injury or sickness - .sick.or injured employees
may be._continued during
the. fir st:year of such
injury or .sickness; —
(b), layoff -_employees, laid -off may be
continued during the first
3 months of:such layoff;
(c) leave of;absence - employees.:granted a leave
of absence:mav be continues!
DEPENDENTS: The
coverage for a dependent shall -automatically terminate
on the earliest of the following dates:
(1)
The date the employee coverage terminates ,"except.
that when such termination results from the death,
of the employee, the coverage if his dependents may
be continued immediately following the death of.the
employee for an unlimited number of.months as:long
as the premium.is paid'and the date of the widowed
spouse's remarriage.
(2)
The last'day•for which any required'contributions
'
'have been paid-.
(3)
When he ceases to be a dependent as defined.
(4)
If the dependent.is a'child, on thechild's attain-
ment of the .limiting,age as,provided for on'the
records of theemployingcompany'-or.the. date:,of"the
chilV s marriage; whichever is: earlier; except .that,
upon .the employee's submission to the.Claims
Administrator within. thirty-one days of the date a
dependent child's coverage -would .terminate due,'.to
attainment of the applicable limiting age,_.of:'written
proof that such child .is incapable, of. self-sustaining
employment byreason of menta].'retardation or.physical
handicap and that such child is . chiefly dependent_
upon the employee forsupport and maintenance, the
coverage of'such child may be continued'but,notebeyond
the .termination'of such incapacity or such'dependenee.
Subsequent written proof or continuance,of.such_._in-
capacity and such dependence must be furnished;;at-such
intervals -as the C1ai.ms Administrator"may` reasonably
require,during the first two years.following.such'.
Child's .attainment 'of the limiting age,:b"ut no more than
once each year'thereafter.
This exception,shall in no:event limit`,the application
''of any provision of the P,lan'.terminating such -child's
coverage_thereunder'.for' '
any reason other than his:
attainment of the applicable limiting age.
(5}
The date the dependent becomes eligible for coverage
as,an'employee under .the. Plan.
U F!i
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DOUR.
FOLLU VII
r..
GENERAL PROVISIONS
Payment of Claims. All benefits payable under this Plan will be paid to the
employee immediately upon receipt of due written proof.
Notice of Claim. Written notice of the event upon which claim may be:based must
be given to the Claims.Administrator, within 20 days after the date of'the.loss
for.which"is made. Failure to give notice within the time -required. --by the
Plan -shall not invalidate or reduce any claim if it shall be..shown not'to.have
been veasonably possible to give such notice -,within the required time and that
notice '"was given 'as soon as was reasonably possible.
Upon receipt of such notice,"the employee.will"be furnished forms for filing.proof
of claim. If such"forms.are not furnished within fifteen "days:after,the'receipt
of notice and claimant shall be deemed to have complied with the requirements.of
the,Plan.as_"to proof of "claim. upon submitting within ninety days after the date "of
the",loss for which claim is made, written proof ,covering the o-currence;"character
and extent of the loss for which claim is made.
Proof of "Claim.".Written proof of ,claim must.be.furnished to the Claims:Admin,istra-
tor on the: Claims Administrator's.forms_within ninety days.afte,r:the date of,the
loss for which'claim.is made. Failure to furnish written; proof of,Joss within"the
time required by"the;Plan:shall not invalidate or..reduce any claim if,it'-shall'..be
shown not to have been-reasonably"possible to:furnish such proof within "the required
time and that proof was. urnished As soon as'was reasonably possible.,
Examinations,. The Claims Administrator shall have tile right and opportun"ity
through its medical.representative'to examine any person, when and so often ""as.""it
may reasonably require during the., pendency .of`claim! hereunder.
Legal Proceedings No action at law or iiy equity'.shall be'"brought.to-recover .under
the Plan prior.to the"expiration of'60 days `after proof of.'claim „has.been.furnished
in accordance with the requirements of the. Plan, .nor ''shall any such ',action 'be brought
at all unless commenced"within _three (3) years.from_the'"expiration.of'the time within
which proof of claim is required by the provisions thereof:.
Change or.Continuance. The Company reserves the: right"-to.modify.or-discontinue
the Plan at".any time. " All provisions of the Plan are:set forth"in.the:booklet
which is the controlling document.
St o r,;; �.
w„
80-20 8
/^ ,+C"�,
SERVICES
The Equitable will furnish claims administration services providing
both bank reconciliation and 'monthly claim summariesr
Ac' Installation and Renewal
(1) .Field meetings.
(2) Issue of instructions in Group Claims Department.concerning'
plan..benefits and preparation for staff "needs.
(3)' Preparation.of accounting instructions 'including'arrangements.
for billings"and draft reconciliation,.by the -Controller's
Department.
(4). Preparation and issue of;a'contr,act or,.contracts specifying
the services to be.provided.by the�Equi.table`and."'.the charge's,for. ,
• such services.
(5). Periodicanalysis 'of- .expenses and -revision of expense, charge
rates as needed.
(6) Preparation -of contract amendments as required.
I..L,i 0-
7, (7) Estab lishment, of procedures .for obtaining exposure .data an
-- / persons covered by, the self funded plans.
_A_ { LJ_ (8) Development_of estimated manual premium rates for plan revisions
- and addition'-of.new plan coverages.`
B. Continuing Functions
(1) Preparation and delivery of Identification.Cards to""CITY for"'
issuance to eligible employees.under the.Plan.
(2) ,Preparation and„delivery'of, claim forms,'to•CITY for issuance to
eligible employees under the Plan."
(3) Notification to claimants of rejected claims and the reason for:
the rejection.
r-_
;e
(4) Advising and aiding claimants in meeting requirements for addition-
al information and proper completion of claim forms.
(5)
Discussion of,claims,"where.applicable, with physicians and other
providers of service.
(6).
obtaining and furnishing information, as necessary,..regarding.
non -duplication". or, coordination of benefits.
(7)
Application of.claims"control procedures necessary.to the
effective, implementation.of the basic principles.of the Plan..
(8)
Preparing for City information reports required in ,connection .
with claim payments under.the Plan.to-providers_ ofhealth'_"care"
services pursuant`to'Section 6041,.IRC.,
(9)
Preparing bank,reconciliation of drafts cl.eared-througti the
Special Account.-
(101j
Evaluation"and, payment or declination-of"the amount 'of ".claim
presented,..based on,a_schedule of benefits and.: taking into-.
account, as necessary, the Coordination "of.Benef_3ts provision..,.-
(11)"Investigation
of claims whose charges appear.higher-than.regular".
and customary.
(12).Maintenan"ce
'ofo office review of ,claims :calculated by Equitable
claim personnel.
(13)
Audit of claim procedures and calculations ona sample basis
l.l..) in
(14)
.Providing of medical advice .on questionable "procedures .or
usually high claim amounts.
CD r.�} �
(15)
Storage of.claim-paymegt records.
(16)
Providing of requisite -management support in training -Equitable:,,,"
personnel to process claims, in developing new forms and procedures,
v
and in controlling work flow."
(17)
For reasonable and customary benefits,.special determination.of`
appropriate benefit amounts.
CITY Of! MIAMI, I" l OPIDA
INTER -OFFICE MEMORANDUM
To. Joseph R.• Grassie
u^Te March" 3, 1980 FILE:''
City Manager
oue 1I:c:l , ACS Contract. "- Group, ,Insurance
1.
ror "scheduling before "the 'City.
Commission .
F140 eS C'�.buhQG'I$on..•..:
Itrrl rlr.rJrt(
Director of Finance
As requested by the .City
Attorney,'the AC$ Contract,Agreement has been signed
by The equitable, and
. is. now ready to -be Scheduled,: for the Commission agenda;
Signed"copy."has"been
£orwarded,to-the.City Aftorney.'s"office for.signature on
additional forms"" attached
to the contract.
JEG/ML/ci ..
cc: George F. Knox,_
Jr,., City Attorney
V p.
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FV
80-208
Edwin H. Cole, C.L.U. and -Associates, Inc. r-~
Life, Health and Group Insurance • Fina .I Planning • Retirement, Profit and Pension Ps ama
100 N. Biscayne Boulevard, Suite 1711, Miami, Florida 33132 • Telephone 305/377.1295
February 13, 1980
Mr. Jamds;E: Gunderson
Finance Director
City of - Miami _ Y
P.O. Box 330708
Miami, Florida 33133
Dear Jim:
Enclosed are the final:,papers<relating,-to.-the ACS Agreement
which has been signed'by"The Equitable. -.This is the same
document, actually; which you;forwarded to Tom Adams on
December 21, 1979 and which was initialed by your City
Attorney.
Please have the original executed by Mr,., Grassie, The City
Clerk and a witness. (See: page`10)._ It should then be re-
turned to my office. A copyis enclosed for the City.
Note that the last page of'the ACS Agreement is the Council
Resolution and this, 'also?' requires execution as shown.
Additionally, The Equitable requires a tax indemnification
agreement and you will find enclosed, a specimen hold harmless
agreement, which should be typed on the City's letterhead
and executed by Joe Grassie and the City Attorney.
Finally, the conversion agreement, dated December 4, 1978,
requires Mr. Grassie's signature.
All four documents, after,being executed, should be returned
to.my office as quickly as,possible. You will fnd.a copy of
each of these for your records.
Thank you for your cooperation.
Sincer ,
E win H. Cole, CLU
encl.
cc: Mr. Marshall Litvak Sur
� RTI� /(� ,
Risk Management r}
T.
rlular
Edwin H. ColeXhartered Life Underwriter .011..
T1
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7�7u11` cc_
fy p� ,^,`;V U )OSf.{'N R. CRASSR
luj u ��J/j Ctty Managerager
February 14, 1980
SPECIMEN HOLD HARMLESS AGREEMENT FOR TAXES
ADMINISTRATIVE CLAIM SERVICE PLAN
Mr. Ray Colleran, Manager
The.Equitable Life Assurance'Society-•
Box 2871
Pittsburgh, PA 15230
Re: Claim Administration Agreement Dated
Dear Mr., Colleran:
The arrangement entered-into..where'by The Equitable will furnish administration
services.in connection with,,The City of Miami Medical Benefits.Plan _is,',
predicated:on the assumption-.that:for;federal,'state and municipal' -,tax purposes,
payments into or.from said Plan do.not constitute. premiums.ieceived.by.The`:`
t' Equitable and.thaEquitableis 11 charge.s.for'such services°are"not'deemed to.be
premiums -or a part of its investment income.'
In the_.event The Equitable shall pay, pursuant`to the: -demand, of an;
appropriate federal,.state, 'or,munic.ipal_official',,any taxe.s`with respect,. to
the amounts, paid 'into ..or from,the said Plan' or the charges by..The.Equitable,
for.the services.performed, The City.of'Miami,'will.reimburse Equitable,:.upon
demand, the amount_of .such taxes paid, including any interest,thereon. We.
agree,to recognize and..abide by Equitable'.s'disposition of.any claims for
such 'taxes..whether paid in: full,,,compromised, settled or litigated. —
Very
Very truly yours,
Joseph R. Grassie
City Manage
APproved BY
Tffrg F. r:E TS
, ., , FOLLOW
•
V THE EQUITABLE LIFE ASSURANCES CIETYOFTHE UNITED STATES
Eo
IJRAQLE P. O. Box 2871, Pittsburgh, Pennsylvania 15230 (412) 262.5700 MIDEASTERN GROUP OPERATIONS / GROUP INSURANCE SERVICES
i
RAY 1. COLLERAN
Manager
December 4, 1978
mr. Joseph R Grassie.
City Manager:
The City, of.:Miam:
P. 0. Box 330708
Miami, Florida 33133
Dear Mr.i Grassier "
This is..to confirm that in connection with the program of employee group
hospitaland medical benefits under The City of Miami (hereinafter referred to.
as the "City") Employee Benefit Plan (hereinafter referred to as the "Plan"),
Equitable is agreeable to make available without the requirements of medical
evidence of insurability group health conversion coverage for employees and
dependents upon termination of participation in`the Plan under certain circum-
stances. This arrangement shall be effective as of June 1, 1978 and shall be
in accordance with the following understanding:
I., Group Health Conversion Coverage'
"Available
(a") The Equitable shall advise the City of various package
benefit plans which it generally makes available under
group health insurance conversion coverage. City shall
notify Equitable which of these package benefit plans are
to be made available to terminating participants under the
Plan who are eligible to apply for the group health con-
version coverage.
(b) Equitable shall prepare and furnish City with a supply
of Notice of Conversion Privilege Forms to be issued'to
individuals at the time they become eligible for conversion.
The form is to be completed and forwarded to Equitable.
Equitable will promptly send the individual complete infor-
mation about the specific conversion plans available together
with an enrollment form.
The form of the conversion coverage, the terms and conditions
thereof, the premium rate therefor and all other applicable
rules and requirements shall at all times be as determined by
The Equitable, but Equitable will not require of any applicant
any medical evidence of insurability as a condition for obtain-
ing the conversion coverage.
Group Health Insurance Group;Pensions
• ,i. - .FRS ' -. - (�'�/.� 1. `�'�.,��. �� � '•c^'� :, .�,vy �'r`,, •5
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(c)
Group Life Insurance
Mr. Joseph R. Grassie
Page Two
December 4, 1978
II.. Eligible Individuals
The:_following-persons shall be eligible for the -conversion coverage
upon occurrence of the indicated event:
(a) An employee, upon termination of participation in the plan
due to termination of employment in the class or classes
of employees covered under the Plan and following at least
three months of coverage under the Plan. The enrollment
form should include the employee's spouse and unmarried
children who have not attained the limiting age under the
Plan (if age 19 or older, coverage must have been continued
because the child was an unmarried dependent full-time
student under 23 or because the child was incapacitated)
who were covered under the Plan on the employee's termination
date. Other unmarried children covered under the Plan on the
employee's termination date shall also be eligible for the
conversion coverage on such date.
(b)
A spouse covered under the Plan, whose coverage terminates
due to change in marital status. The enrollment form should
include the spouse's unmarried children whose coverage also
terminates with the spouse's coverage and who have not attained
the limiting age under the Plan (if age 19 or older, coverage
must have been continued because the child was an unmarried
dependent full-time student under 23 or because the child was
incapacitated). Other unmarried children covered under the
Plan whose coverage terminates with the spouse's coverage shall
also be eligible for the conversion coverage.
A child upon termination of coverage under the Plan because of
attainment of a limiting age or marriage.
Enrollment for Conversion Coverage
(a) Enrollment forms for conversion coverage and the first premium
payment therefor must be submitted to The Equitable within 31
days following the date upon which the individual becomes
eligible to apply as provided under II. above.
(b )
The conversion coverage will not cover any person who U) is
eligible for Medicare or (ii) has similar coverage on an
individual or group basis, or is eligible to obtain similar
coverage on a group basis, which together with the conversion
coverage would result in over -insurance or duplication of
benefits according to Equitable's standards.
"SUPPORTIVE
DOCUIR IENTS.
Mr. Joseph R. Grassie
' Page Three
December 4, 1978
(c).
The conversion -coverage; if issued, shall become effective
upon the day following the date .of.termination of ',coverage,
under the Plan.
(d)
-City shallrequest, such information •'
fnmay uneeded�upon
itmay haveas beby Eq
Equitable to rocess enroll
went forms for'the conversi on':coverage. ,
IV. Charges
'to City.
(a)'
There-stiall be due and payable. by City to Equitable a charge
for processing of enrollment forms.for the conversion coverage
.
at the rate of $12.50 per enrollment form processed. The
processing charges shall be payable whether or not the con-
version coverage is issued or becomes effective.
(b)
At such time as Equitable may determine that an experience
selection charge should be imposed upon the issuance of conversion
coverage pursuant to this agreement, other comparable arrangements
and group health insurance contracts, Equitable shall notify
City in writing of the amount of the selection charge and its
effective date, which date shall not be earlier than 31 days
following the date of the notice. The selection charge here-
under shall be consistent with that imposed generally by
Equitable under group health insurance policies. The selection
charge will apply to each certificate for conversion coverage
issued on the basis of an enrollment form received on and
after the effective date of'the selection charge.
(c)
Equitable shall give City at least 30 days written notice of
a change in the processing charge or the experience selection
charge and the revised charge shall apply to enrollment forms
received on or after the effective date of the change in the
charge.
(d)
At the end of each calendar quarter following the effective
date of this arrangement, Equitable shall submit to City a
statement showing for the preceding calendar quarter, the enrollment
form processing charge together with the names of the individuals
and the experience selection charge together with the names
of the persons to whom conversion coverage certificates were
issued. Within 15 days after receipt of such statement, City
will pay to Equitable the amount of the charge.
Ou 0pr*.�l } i V E
1- 0 LLOU
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ti;��•i�h�t�.4,.�:.•'eKw�()b;. ,'w'..,yr „. .�ti��'C•.*o�..sR' y.•.,.+L.h... . , 'i•.• .. ,r•. •�'%� . .. ,'+..... ,._-• f.,....
• •
r
. Mr. Joseph
R. Grassie
Page Four
December 4,
1978
V.
Termination of "Arrangement
This arrangement may be terminated at anytime by City."or.The,"..,
Equitable'upon at least 30 days written notice to:the other party.
In the. -event this arrangement is.teraiinated;"Equitable shall,process"
all .enrollment forms received by it from. persons who ,became. `eligMe
to,enroll":for the conversion coverage priorto'termination '"of'!this
'arrangement.
Very .truly yours,
Manager
AGREED TO.
BY The City:of Miami-"
BY
.TITLE .
( { Mil C
D, a J
.'NC Lit�
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rt+�rJ.y i.{r�Irl��' ...ir��1 .,`�t �•'1!. ��.. "1../y• ice, •../ �•.1• �, •.• • r • � r ♦..�y ..t
{�
Joseph R. Grassie
March 3, 1980
City Manager
ACS Contract - Group Insurance
For scheduling before the;City
}
?
Commission
itnd�-rson
rDirector of Finance
As requested by the City Attorney,.the ACS
Contract Agreement has been signed
by.The Equitable, and is.now ready to be.scheduled for.the Commission';'agenda.
Signed copy has been .forwarded to theCity
Attorney'-s office for signature on
additional forms attached .to the contract.
JEG/ML/ci
cc: George F. Knox, Jr: ,,:City Attorney
"SUPPORTIVE
DOCUMENTS
FOLLOW
gp-208'
ADMINISTRATION AGREEMENT
THIS ACREEMENi, made and entered into as of the First day of June', 19718,by,
.
and between THE. CITY ,OF t1IAMI, FLORIDA ("CITY") and THE EQUITABLE LIFE
ASSURANCE SOCIETY Or, THE UNITED STATES ("EQUITABLE")
W I TN E S S E T li
WHEREAS;`; CITY,has:adopted a program of, medical and hospital bene
fits'("Plan") for its employees and annuitants and the eligible depend-
ents of such employees and, annuitants; a:true'copy of which.is attached-
hereto as .Exhibit -"A" and by this _'reference incorporated herein,, -,and' :
WHEREAS,' CITY has requested.EQUITABLE to furnish administration
services in connection with the "Plan", and
WHEREAS, it,is the purpose of this Agreement to establish an.,
agency relationship whereby ,EQUITABLE will "undertake to: act 'as agei�t...for
CITY in (i) receiving and processing claims for benefits under the "Plan",
(ii) disbursing.claim payments under the "PLAN', and (iii) performing such
additional:duties as set forth.herein.
NOW, THEREFORE, in consideration of .tile=mutual._nromises and
{ covenants contained he,rein*,.T it is hereby agreed .as follows:-
SUR'ORTIVE
DOCUMENT
' Section 1. Claims Administration FOLLOW
fir
(1);- Upon, receipt of a rlalin for bene-Fits, EQUITABLE shall review
the claim and determine whether it has beenproperly filed and the amount,
If:.any, which.is dfie and payable with respect thereto.'
(b) EQUITAIMP oil bohalr. of CITY sltal.1. disburse clai►ii payments
that EQUITABLE delerntins to be due In accordance with tile. provisions, 'of .
the "Plan" to the person or nssi gnee oil 1.t. Ie l- thereto.
(c) EQUITABLE shal l take all reitseinnble steps to process, claims
and di.shur:;e cl:.tim paVIIILMis r!xped-Itiously.
r-
0
Section 2. Payment of Claim
(a) CITY shall arrange for the establishment of a Special Account
with. The Chase Manhattan (lank, N.A. ("Chase"), 110 West.52 Street, New York,
New York, in an amount which will be sufficient: at all times "to:pay.claims under
the "Plan".
(b) EQUITABLE -shall pay claims under 'tile "Plan".by a.draft drawn
payable through "Chase". After presentment by "Chase", such draft -.will be
processed, and,, if in•order,.accepted.by EQUITABLE. Each day, Equitable shall
draw .on the .Special Account, a.clieck,:draft, or "other: order for the,,'payment
of money, payable to 'Chase" in",the'amount of the total dollar amount of drafts
presented and accepted: that, day, CITY; by execution of, this Agreement",
authorizes EQUITABLE to draw such checks,.drafts:.or.other orders,:for-,the payment
of ,money,and to "issue..and accept.drafts.for. the purpose of_.settling claims
under the "Plan". A claim.'foi medical or<hospital expenses incurred under -Group
Policy:1969tiff. and paid by Equitable claim draft shall be.Aeem.ed:a claim.;under the
"plan" upon presentment.to, and' acceptance by, Equitable of:such draft on.or
after June 1,. 1978.'.CITY authorizes EQUITABLE to reimburse itself the amount.
of.such claims by'issuance of - _a claim, draft drawn .on the Special, Account._payable
to:itself.
(c) In. the EQUITABLE event ,.rays'.aiiy person.Iess than"the amount
1
to whi.cli, he is entitled under the "Plan", EQUITABLE will. promptly adjust the:.
underpayment In the event EQUITABLE overpays any person.entit.led to"benefits
under the "flan", or pays benefits to any person who.is not entitled to theui,
EQUITABLE shall take all re,-isonable :Steps .to recover the over -payment .exlC0p:t
that EQU1TAB1,E* shall -not he .regiiLr.ed to initill te court..proceedi.ngs to recover
an over EQUITABLE, shall promptly. notify CITY. if it is unsuccessful. in
recovering any over -payment.
(d) The determin{ition of the extent of the lienef i.ts to 'which
any c11iman t is entitled under the "11hit " shaIi initially rest with 1:QULTABLE..
However. in the event CITY determines that EQUITABLX has mLsinterpreted .the
rft�
"Plan" and so informs EQUITABLE in writing, all claims reported after delivery
of such writing to EQUITABLE shall be processed and paid in accordance with
CIVI S interpretation as set Earth in such writing.
Section 3. Addi.tional Duties of EQUITABLE
In addition.to'receiving and processing claims and, disbursing
claim payments, EQIJITAL'LE .shal:l perform 'the duties set forth in-. the schedule..
which is attached hereto as EX1llBIT B and by t•his'.reference incorporated herein.
The duties set forth in EXHIBIT B may.be modified.by the mutual agreement of
CITY and EQUITABLE..' Such mutual agreement with respect to;such-duties and
the revised administration charge, if any, applicable thereto,,shall beevidenced
by Letter Agreement between the parties hereto, and upon such agreement,.
EXHIBIT B shall be deemed modified to the extent of such,:.agreement. ..
EQUITABLE. may request to revise the administration cl}arge under
this Agreement if-any'change in law or.regulations imposes greater, duties or .
g ,,.
obli` ations on EQUITABLE than , contemplated by._ the . Agreement i'n:.force at. the .time
of such changer .Failure of .the .parties to agree on the-.:cliange within ,thirty.
(30) days of. ,request of a'revised charge shall automatically_terminate'this
Agreement as of midnight of the day preceding the indicated effective date of.
the revised charge. The foregoing shall' be subject -to any revision in the
its administration aharge pursuant' to Sections 4 or 12 Hereof. 1 ly',Ji ; 111 L
Section 4. Administration Charge.
FOLLOW„
,
(a) The charge to'('ITY for services performed by, EQiII'L'ABLE :under
this Agreement shall: be four and`,thrce-quarters (4.75). percent: of the total
of the .�mount'of the drafts. accepted .by LQULTAI.ME pursuant 'to this Agrecment',,
plus, in connection.wlth claims to which the nondupl:ication or-_coordination._of
benefits provi.s:i.on of. the "Plan", 1111pl.ics, the amount of.. the, claim pnyments-
which would _have been disbursed by EQUITABLE pursuant to this Agreement .in the
absence or such a pr.ovi.si.on. The Mimini.slrative Clalms Service charge w11.1 he,
Four and three-quarters (4.75) percent of the claims paid, Limited to not more
than a total of Three DoLbirs and Forty-six Cents ($3.46) per enrolled employee
per month with the monthly enrollment averaged on an annual. basis.
(b) Each month after". June :l' of 1978,E"QUI'lABLE shall submit to .
CITY a statement showing the "administration charge for the preceding month
determined.on the basis .set forth in the preceding paragraph. Within fifteen
(15) days after receipt of such statement,. CITY shall pay EQUIIABLE ,the amount of
such administration charge.
(c) Not' loss. than' -sixty (60)_ days prior to June.1 of any year in
which this Agreement.is ineffect,..EQUITABLE may. propose in,.writing a.revision
in .the'adininistration,charge for the following year., CITY shall -,advise.
EQUITAL'LE_in writing as to the acceptability.of"such proposal within-thirty-(30)
days after -receipt thereof. If agreement is not reached with respect.Eo,.,such
pro po
sal "at least thirty (30) days prior"to.such.June 1, this Agreement shall
terminate -effective as of.m.idnight;of such May.31. The foregoing;'shall,be.
subject to any revision .in the administration.charge pursuant: to_ Sec tions. 3 or
12 hereof•: As used herein "year, means any,period"of twelve consecutivemonths
commencing June 1 and ending May 31_.
Section 5. Detertnination of Eligibility
In determinin
g right to benefits,underi"the "Plan';.,,
i EQUITABLE shall re•.l.y on eligibility information furnished :by, CITY prior. to"
submission of the "claim:. It'is mutually understood that the=,effective )erform-
ance of thisAgreementby EQUITABLE will` ".require that,. it, tics advised by. CITY.
peciod.ir_al.ly, _bcit-"not less fr.egiientl.y than monthly, during the. t"ernr 0E: this
Agreement of. the Ldenl-i.ty of i_ttdiVILILKi-ls c1:.iglble for hclnef:iti; under• the "P.1an"I
the_effective .d...Ite,,or. the' termination. date (as._the case may be) of their
eligibility,, and tlte_ extent of the, benefits. to which ,they are entitled:_,
shall al.so.ca6se to be" furnfished to-E:QUITAI;LE such other information its may
reasonably be recliti.red for the proper admi.n-i.stration of• .the'''Plan":
tt is mutualAy agreed that: 13QUIT,U.LE shall not be'.- responsible far_.. :u
delay In the performnnc•e c,f this Agre euient or for tlte, nc,n-performance c,f . this '
lgreement which delay or non-performance is caused or contributed to by failure
of CITY to furnish any such information.
Section b. Record Retention and Review
EQUITABLE shall maintain records covering claims submitted under
the "Plana', as well as payments disbursed by EQUITABLE'- The records shall be
maintained for the same period of time that EQUITABLE retains similar records
in connection with its insurance business. Any duly:authorized representative
i
or representatives of CITY shall have the right to examine or audit such
records. during'tile regular business hours 'of EQUITABLE, upon five (5) days
advance written notice to EQUITABLE.
Section 7. Agency�Agreement
(a). It,is:mLitually recognized..that..EQUITABLE,' in performing:'
its obligation under this Agreement, is acting only as ,agent -.of CITY and, shall
not.be.designated 0r,deemed the'administrator with_;respect to the "Plan" or
the: appropriate named fiduciary for review of claim L denials tinder' the "Plan
for the .purposes of the Employee.Retirement Income Security Act of 1974 or .
any other Federal or State ,law of 'Similar nature:
(b) In_the evecit EQUITABLE,.its, officers, directors, employees .
or_agents,are made.parties.to any judicial or.administrative proceding
arising .i.n,whole.or in part out of.any function performed by one or more of
them under ahis Agree -went; 'CITY shall hold, them harmless for all judgments,
t. •
� t•.� settlements and costs (inclucli.iig attorneys'' fees) -which they incur or pay in
1•._. ,,.zbconnection therewith, except that CITY shall. not ,-reiiiibur.se for: the amount- of any
Ll: L..i.J^^�
0 e1y V judgmOnt or award (ar aftornr_ys' fees with respect 'thereto)- if the court render-
ing the judgment .or the a},ency makIng . the awi'rcl determines, that the- liability
U. underlying the judgment or. .iward- was caused by , the neglAgence, fraud, or
criminal conduct of IQllt`TABLG, Jts agents, employees, officers or directors.
(c) The defence of any., jei;ril acti.un 1.11stit9tod on a claim for:
benefits under the "Plan" shall not be an obligation of RQU_LTAB1.E... EQUTTABLE
P, 5 '
shall, however, cooperate with CITY by furnishing such evidenre as it has
available -in connection with the defense of nay such action.
Section`8.. Subcontracting
The work, to be performed ',by EQUI'TABLE udder this Agreement may
be performed wholly or in part through a subsidiary or affiliate of EQUITABLE.
Section.9. `Laws Coverning Contract
This Agreement shall be governed by, and shall be construed in
accordance with the"laws of -the State of Vew York.
Section 10. Teknfof Agreement,
This Agreement: shall.become effective on June 1,',19,78 and end .
as of.midnight May 311 1979. It shall be renewed.a,utomatically for successive
periods of twelve .(12).'months unless CITY ;or,,EQUITABLE gives written notice
to .the':other'of in ten tion.not_to renew.. thee. Agreement. -at least thirty.(10days
prior to _the end'oC the then current period. "
Section 1.1.. Modification - of Agreement
This Agreement, constitutes, the entirc..contract betweeti the
par.ties.and `no.modification or .amendment liereto,shall be valid unless ;in
writing and.signed by the parties.
t
Section 12.' .Modification of"Plan"
(a) Any'modification or amendment of - the ".'Plan" si'all. �be ;duly;-.`"
communicated in detaILl. and in'writing by-. CITY .to EQUITABLE. Such 'coinnluni.catioil
shall -also set f:or.Lh. Lire effective date of the modification or;.lmendment .'
The date forimplementation of the.modif.ication or -amendment:
will be -mutually agreed cipon by. CITY and rQUITABI.L acid will.be" based on :a rcason-
able' appraisal of the effect thereof on IQUI.TAB1A`,S fuitcttons_;and ;dutie_s under
this Agreement, including Lire effect, if ally, of makini, !ddLtional cl.a"im'
payments oil uccciunt ' of. an cf fect.ive dati� prior to the .im1i.le14e11tat.ion date,.
(b) . If a revisLoyi in Hic administration charge, 1s .deemed
necessary by fQUITAL'LP by reason of the modification or amendment of the "Plan",
EQUITABLE within thirty (30) days after receipt of a copy of such modification
or amendment and agreement on the implementation date, ,Will! 'advise'CITY of
the revised adminisLrati.oli charge to be effective on the implementation date.
If Within thirty`(30) days after receipt of notice.o£ tine revised administration
charge CITY,'advises EQUITABLE in Writing that the revised : administration
charge is riot acceptable, such written advice shall constitute a termination of.
.this Agreement effective as of'midnight of the.last day of the month following
the month ivi which`EQUITABLE receives Such advice. However, the administration
charge on and after the implementation date shall be made on the basis of. such
revised administration charge.
(c). CITY shall furnish E UITABLE with a copy of eachmodification
or amendment of the "Plan" as soon asjs practicable and in advance of the
effective date.of such modification or amendment, if possible.. After receipt
by`EQUITABLE of a copy.of, the' modification or amendment the term "Plan" as used
in this Agreement_ sl•iall,. include each, such mod ification'or. amendment as of the
implementation" date.agreed,upon by the parties hereto.
Section 13. 'Termination of .:.Agreement
Agreement shall (a). This A terminate upon the earliest of the'"
following dates:
( ) 'The indicated date of termination set forth in
Section '3. if a, revised administration charge is not accepted.
by .:CITY. pursuant to Section 3.
(i.i) A'he .May_ .3.1 of the 'year in which L•liero has heera no
«n agreement oil any revised propo ed �admina stration charge for e tl .
JU'O ORr / enewal period pur.suant to :pub -paragraph (c) of Secti.otr; 4.
CUNil OJAI thi,r.ty f.. r:,t (3.1.:_t) day following thu delive y
FOLLOWof written not•i.ce of °termination pursuant to erection lo:
(iv) T1 icg: 1,iot day of: the mimth' Followhig the ❑ionth jn.
which f3QlJC'I'AI3Ld i-ecei.ves ,jdvicc from CITY that: the revised
I'a'- e 7
00,
administration charge is not acceptable pursuant to sub-
paragraph (b) of.. Section 12:
(v)- On any other date mutually agreeable to CITY and
EQUITABLE.
(b)" In the event of termination of Ellis Agreement: EQUITABLE,"shall.
complete the processing of all .claims for benefits under the "Plan', received by
it prior to termination of the Agreement, and shall be reimbursed for the
administration of such•, claims on- the basis "of'the administration.'charge in
effect on,the date of termination.
Section 14: EQUAL EMPLOYMENT. OPPORTUNITY POLICY
A. ._EQUITABLE, as administrators of the.CITY.program :"of Medical'
and Hospital benefits, will make every effort to insure that'job opportunities
are.made known' to the entire community and . that' no :quali£ied.'applicant is
rejected because of race,: creed, age,. sex;: or country of, origin.' Tile' CITY
will implement an: affirm at ive"action "program,:of equal" opportunity having'asjts
goal tiie employment of'.miiiority.persons and women'iit approximately" the "same,
ratio as such: person are available in the Port _Lauderdale area "labor force.
B.- It, will be -the policy.of EQUITABLE.to:
1. Consider. each aPpl.icant" for. ciuployinent on the �basifi
of individual qualifications for the. -.job without,
regard to race, color.., creed; sex; age or national
origin. .
2. Give, a1.1_ employees eq'ua1. consideration witii rc.srect.. to
j '' i Q I:
c.om�ens•rk.�on, bu►efxt.,c , and promotion w�.11ii.n 1. UIABL '1
without reg,lird torace, color," creed', sex, "age, -,or
na t iona.l..-r) r i i; in
C. ']'he [ol.luw.iug procedures wii.l be adopted to 1HIP1011ient
EQUL'1'ARI,L''S policy of non-discriuii.n Ooti.w.ith r0lard to -race, sex, co].or",
religion, national origi.n, or ,rives
— — ---- l'agc 8
1"""^
r 1
D E F I N I T I O N S
The -following definitions apply to the terms used.in L-his.Plan:
Company: City -of Miami, Florida
Claims'Administrator:. The Equitable Life Assurance Society of the United
States:'
Employee (s);. Any employee of City of ,Miami, Florida'who
normally works Forty'.(40) Hours.or.more:a,week
or Retiree who continues uninterrupted coverage
Upon Retirement.
Dependent (s): The following are considered "Dependent (s)",
(a) A -covered employee's wife or.husband.not legally
separated from the employee;
(b) A covered employee's unmarried child who has not
attained age 19;
(c) A_covered.employee's unmarried.child who has
attained age 19 but has.no_t attained age 23 and
who is 'a full time.'student.'
(d) A covered emp.o e'.s.stepTT'-children if they are
wholly. dependent on. the employee and' .reside in
the employee's home.
NOTE: 'No:-person'is a_Dependent'if he is. eligible for
coverage as an employee:
Effective Dates of.Cover.nge: See -the :pro visions: ',w11EN YOUR'COVERAGE,BEGINS and
LdHE,N YOL1R. DEPENDENT' S, `COVERAGE.' BEGINS in the Group
Uenefits.P-lan ,hookTet fc�,r.
j * . City of ;-�Iiaini.;.-Florid.
i
.47
B EN EI' T'rS
The Company �assumes'the fall reGponsE
ihiILty for -providing, the Medical. Care xpense
and 11,tjor..Mcdlcal L:xpense I en(Altt; Stated in the .GROUP B1.NEFT.;TS PI:AN, Booklet for
City ,_of Miami., Florid -a which is , attache( hereto'. Tlie Equitable Life' Assurance
Society .of the Unit State:;. wi_l.l. act as .Clalbis Administrator. of ; the I11ali, .but
does not, insure the.,bane.fits..provided .,thereunder.
*-One copy of the P,00kLet_i.s attached.
0( r
COORDINATT.ON Or 13FNGrI S
1.
The purpose of Lhis,prov:i.s.ion is to permit a covered person to receive from his
benefit plans no more than .1.00% of ,his allowable medical expenses._
2.
An allowable medical expense is,any necessary, reasonable and.customary.item
_
of expense'for medical services, supplies or treatment, at least a, portion of
_
wiiich is covered udder at least one of Lhe,plan's covering the person for whom
claiitt is made.
3:•.
T.he•benefit plans that come within .the scope.of•'this provision are any medical
or major medical benefits ,or services,, from any source (excluding arty.individual
..
policy which is not issued raider a►i arrangement of coverage for individual in
a, group):
4.
The benefits under this plan will bedetermined _after,the benefits under all
primary plans have been determined. If the benefits under,.,the primary plans
and:.the benefits payable under this plan would exceed allowable expenses„ the
benefits•under.this plan will'be.reduced. During all or part. of a calendar
year that a,covered:person is also covered under a primary plan, ,be nefit-s-,under
this plan and, all primary- plan.s,will.pot' exceed, allowable expenses,.
S.
Another plan shall b,e'considered a primary plan if the other plan
a - does no_t leave-a,provision coordinating it's.benefits with this plan.
b - covers tile, person outer than as a dependent `and this plan covered him as
a:dependent.
c - covers the person as a,dependent of a.mate_ employee and this pl._an covers
him as a dependent of. a.female employee.
d - has covered the person Longer than Eli -is plan and neither a, b, or c applies.
6.
To ac.hi.t:ve the. purposes of this, plan and of this provision. the .Claims,Adniinistra-
tor has, the right..
- to obtain .,from or . release' to .any person, ,i.nscirance-cotiipany or other- orgatri?n-
i
tion any i.nf.ormation -it dcems necessary -
- to pay any be to this h.Lr�n. tb :any:'or.gaitizati.oti, instead of:.the' covered
individual, whiCll paid such be-nerits
- to -recover from any, person. or organization benefits paid .i.n .oxcess cif'. the
maxi.tiium amount,necessar.y to: satisfy the intent of ih.is.provision..
/""`. oe `
IMEN COVERAGE TEIOUNAM
Employee.'. Employee coverage under this,
Ill n,will , ontatically,
terminate o1i the earl.iest: of
the following dates:
(1). The last day for which
any required.con tr•tbu-
ti.ons have been paid.
(2) The day. of termination
of service as a regular
employee (other than, certain continuance herein-
after described which allow continued participa-
tion in the Plan).
(a) injury or sickness - sick or injured employees
miiy be _continued during
the first year of such
injury or sickness;
(.b layoff.
- employees laid -off may be
continued.,uring the first
3 months of such layoff;
(c) leave of absence
-,employees granted a leave
of ;absence may be continuer
during the first 3 months
of. such :.leave;
...
subject'to payment of any. required _.Contribution for
any employee continued in class (a), (b),.and (c)
hereof:
(3) The date tliis,.Plan, terminates..
FOLLOW"
i
DEPENDENTS: The coverage for a dependent shill automatically terminate
on the earliest of the following dates:
(1) The date the .employee coverage terminates, except
that when such termination results from the death
of the employee, the coverage if ltis"dependents may
be continued itmnedi.'ately fo.11owittg..the, death -.of the
employee for anunlimited number of months as long
as the premium is "paid' acid the date of the widowed
spouse's remarriai;e.
(2) Thelast day for which any re'qui.r.ed contributions
have been paid:
(3) .When he ceases to be a dependent as defined.
(4) If the dependent'is a child,:. on, the::child's attain-
ment of the limiting age as proided for on the
records of the employing company or.the "date, of the
child's marriage, whichever is. earlier; except that,
upon the emp1oyee',s submission to the Claims
Administrator wi:t}iin thirty-one clays"o£ the date" a
dependent child's coverage would terminate due to
attainment of the appl.icable.li"miting age, of,"written
proof that such child, .is, incapable of self-sustaining
employment by reason of:.mental retardation or.:physical
handicap and that such child.is:chief ly,dependent
upon the employee for, support .and, milii.ntenance, the
coverage of such child may :be .contintaed"but",not.,"beyond
the termination of .such ,inc, "pacity or,such dependence.
Subsequent written proof.'or. conti.nuatice of such, in-
capacity and such dependence -must be"f:urhished"at such
intervals as:the Claims"Adniinistr.ato"r:may:.reasonahly
require during tiie first two years, following such
child's 1t"tainmenr" of the limiting age, but tio, more than
once each year thereafter."
This exception sha.l.l in no event_1.im:it "tile appi.ication
of. any provision .of:. the Plan terminating -such child's
coverage thereunder for any reason other than Aiis
1411EN COVERAGE TERMINATES
Employee. Employee coverage under this Plan will automatically
terminate .oil the .earliest of, the following dates:
(1) The "last day_£or which ,any required.contribu-
ti.ons have been paid.
(2) The day of termination.o'f"service,.a,a a regular
employee (other than certain continuance herein-
after described which allow continued participa-
tion in the Plan):
(a) injury or sickness - sick. or injured employees
may" -be continued during
the first ;yearof such
injury or -sickness;
(b) layoff. -,employees.-laid-off may be
.con tinued.-di.iring the first
3 months": o.f, ' such layoff;
(c) leave of ,absence - employees granted a leave
of absence, may, be continua(
during the ":,first 3 months
of such leave;
subject ,to payment" of ',any required contribution for
any, employee cont•iiiued" in class (a), (b)v and (c)
hereof.,.
(3) Tile date this Plan terminates.,
i
sun
DoCU Iy EI\,.IT.7
FOLLOW"
ye\.
GENERAL PROVISIONS
Payment of Claims. . All benefits payableunder this Plan will be' paid to the
employee immediately -upon receipt of due written. proof.
Notice of Claim. Written notice of the event upon t4hich.claim may.be.based must
be given, to the Claims Administrator, within 20 days -after the date of the loss
for whichis made, Failure to give notice within the time required by the
Plan shall- not . invalidate .or reduce any cl.aim if it shall be; shown;not to Have'
been reasonably possible to give.such notice within the required time,and that
notice was given as soon as was reasonably possible.
Upon receipt of such notice,. the employee will befurnished forms for filing'proof
of claim. If,such.forms are not furnished within: fifteen' days. after the receipt
of notice and.claimant shall be deemed.to.,hay.e_complie'd.with the requirements,of.
the Plan as'to.proof of claim upon submitting within -ninety days. if ter,., the date -of
the loss: for whichclaim is made, written proof covering the'.o-currence, character
and extent of the loss for which claim is_made.
Proof of Claim. Written proof of claim.must.be furnished, to the Claims;Administra-
tor on the Claims Administrator's..forms .within ninety days'after the date'.of,the
loss for ,which claim is made.Failure _,to .furnish written proof, of loss within, the
time required by the Plan. sltal.a, not invalidate or reduce `anv . claim -if it shall „be
shown not to Have .been reasonably possible to furnisli'such proof with n.the"required
time and that proof was furnished as soon as.was reasonably possible.
Examinations. The Claims Administrator shall.'have,the right., and opportunity,
through its medical representative :to examine any person when and so often asit
may reasonably require during; the pendency of claim hereunder.
Legal Proceedings. No ,action at law_ or,in equity shall be brought to. recover, under
the Plan prior to. the. expiration of 60:days after proof of claim .has been., furnished
in accordance with the requirements of the,Plan,,nor shall any'such action, be.brought
at all unless commenced within three,(3) years from the .expiration of- ,the (ime within
which proof:- of :clai.m .is required by .the provisions': tliereof.
1
Change or.Contintiance: The .Company. reserve's the right to modify or discontinue
the Plan at any time. All, provisions of'the Plan are set forth in the booklet_.
which is..the controlling document.
�4
SERVICES .
The ;I:yuitable. will furnish claims administration services providing -
both bank' reconciliation and monthly. claim summariCs. "
A.°
Installation. and Renewal
(1.)
Fie ld.meet i.ngs.
(2)
Issue of instructions "in Group Claims Department concerning
plan"benefits 'and preparation for staff needs.
(3)
Prepara"tion-of.accoutiting instructions, including arrangements
for billings",and draft reconciliation, by.the Controller's
Department.
(4)."'Preparation
and _issue o.f"a'contract or contracts specifying
the.services to be provided by"the "Equitable and ,the charges for
such services:
OY
Periodic analysis of expenses and revision of ..expense charge ..
rates as needed.
(6)
"..Prepnrati.on of,contrict,amendments a.s'required.
I
(7)
Establishment of procedures .for. obtaining e,,c osiirc data on
Persons covered by the self -funded plans.
(8)
Development a]. of estimated mann, premium rates for'plan.revisions
CIO
and addl.t.i.ott of new j,l,in coveroges.
Continuing functions
(1)
Preparation and deli.very' of; Tdentif::icatio , Cards to CITY .for
issuance to eligible employees under the Plan.
(2)
Preparation and de.l.i.very of c 1 a:i.m forms to C171 for issuance to
�-/ U.
eligible emp.l.oyee5 under the Plan.
(3)
Not iflcatlon to cla.imrmts, of r-ejectrd c1a0.1u5 and the "reason ",for.
the rojectfon.
ram.
040
t
i
t
(4) Advising and aiding claimants in tneeting requirements for: addition-
a]: information and proper completion of cl.aitn .t0rnis.
(5) Discussion of claims, wliere applicable, with pliysicinns acid, other
providers of: service.
(6) obtaining -and .furnishing information, as -necessary, regarding "
noti-duplication or coordination of benefits.
(7), Application of claims control procedures necessary ,to the
effectiveimplementation of the basic principles,of the Plan.
(8) Preparing for City information,reports required in_connection;
with ,claim pai yntents under tile Plan' to providers. of health c411re
services pursuant to Section 6041,1 IRC.
(9) Preparing bank recoiciliatioti of drafts.cleare& through the
Special Account. -
(10) ) valuation and payment or declination of, tile'amoiint of .claiim
presented; based on a schedule of benefits and t, Ung into
account; '_as -necessary,_. tile Coordination of Betiefits prlovlsion.
(11) Investigation of clalins_whose charges.appear.Iiigher than 'r.el;ular
and customary,
lice of office review of claims calculated by ,Equitable
ca.ai.m personnel.
(13) Audit of claim procedures and calculations on a sample,h,Isi,ti.
(14), Pr-ov.i.dinr•or niedicat advice on gtiestionable-1ir.ocedures oi'
ust.t-ILLy 1 i.l;h claim amounts.
(1.5) Storage of cla1.in payntelit records.
(,1.6) Prov.iding o1, r.egn-L ite ntanay,ement support in tr;ilnitip, 1.cltiitable
pc►-scntnri to :hroc ess cia.i.nts, !it clevc].opi-n�; new .fprms and. pl-ncedures,;.
,:lnd .in crtnir,ul.l iny; work FIow.
(17) For r.u:tStm:tblr and c•u:;tumary ltc1110fi.is, Special dete'rntinati.cni 6F
cii�l�r,tl,t•i:ttt� I,t�n��l�it nnunntt�,.
9 '�' /"`�
a.:
1 i1rf,� LL i +�r1 GR
� �, %' (� ", 5 1 F
.. t 01 ,Niana er
February 14,'•'1980
SPECIMEN HOLD HARMLESS AGREDMENT FOR TAXES
,ADMINISTRATIVE.CLAIM SERVICE PLAN
Mr. Ray Colleran', Manager
i
The equitable Life Assurance Society'
Box.2871
t Pittsburgh, PA 15230
Re: .Claim Administration .Agreement Dated
Dear Mr. Colleran:
Thearrangemententered into, whereby The Equitable wi11 furnish=:administration
services,in connection;"with The'City'.of Miami Medical:Benefits-Plan,is.
predicated. on the assumption that for federal, state and..municipal,.t'x.purposes,
payments into_or from''Said.Plan do not constitute;,"premiums-received by The
Equitable and that Equitable's charges,for,such services are'.not deemed -:to be
premiums', or a part of -its investment income.,.
In the event The_Bquitable,shall pay,pursuant, to the demand of an,
.appropriate federal, state or municipal official, any taxes with respect to
the amounts paid into or.from'.the:said Plan or.the charges by_Tile ,Equitable
.for the__services performed, The City of.Miami.will reimburse.Equitable, ,upon
demand, the amount of..such..taxes.paid, including.any interest thereon. We
agree to'recognize and.abide by Equtable's.,.disposition of any claims for
such 'taxes whether paid in full, compromised, settled'or litigated:..
a Very truly yours,
Joseph.R. Gras sie
( I t I• �;t 1 ` {, �; ! i `.t,rn :. •rnrr.r }'r, s nn ('.:.' er,r" ! U+:t'.;l ! k.li,ltni, I lutitla t 11 1.1 :' ( IOSI-'4.W5R
THE EQUITABLE LIFE ASSURANCE SOCIETY OF THE UNITED STATES
MN'
)U1lA[31� P. O. Box 2871, Pittsburgh, Pennsvivania 15230 (412) 262.5700
MIDEASTERN GROUP OPERATIONS I GROUP INSURANCE'SERVICES
,
Mr. Joseph R. Grassie
City,Manager
The City of Miami
P. O.'Box 330708
Miami, Florida 33133
Dear Mr. Grassie:
This is to confirm that,,in•connection with the program of employee group
hospital and medical benefits,under The City of Miami (hereinafter referred to
as the "City") Emplovee Benefit Plan (hereinafter referred to as the "Plan"),
Equitable.is agreeable. "to make available without the requirements of medical
evidence.of insurability group health conversion coverage for employees and
dependents up on..termination of participation in the Plan under certain circum-
stances. This arrangement shall be effective as of June 1, 1978 and shall be
in accordance with the following understanding:
I. Grouv Health Conversion Coverage Available
(a) The Equitable shall advise the City of various.,package
benefit plans-which.it, generally makes available under:,
group�health''insurance conversion coverage." City shall:.
notify.Equitable:which of`these package benefit ,plans are:.
to be made.available to terminating participants 'under: -the;
Plan::who..are:_eligible to apply for the group.health..con-::
I version..cove-rage
(b) Equitable shall prepare'and ,furnish City with a supply
of -Notice -of' -Conversion Privilege Forms to be issued to
individuals at the. time they become eligible for. conversion.
The; form is to be' .cumj1leted and forwarded to Equitable.
LU Equitable will promptly send the individual complete infor
�C/) oration about the specific conversion plans available together_`
with an enrollment forma
(c) The form of'ihe..conversion coverage,_.the.terms and conditions
thereof ,. the premium .rate therefor and:.alL,other applicable',
� .
CL rules ,and requirements shall'at'all.timesbe as det,ermined:by
d.. The. Equitable,: but Equitable will :not,require 'of .any;'applicant
anv medical evidence'of.insurability as ''a condition'for:obtain-
`� ing.the.conversion coverage.
Q .
1^
Mr. Joseph R. Grassie
Page Two
December, 40 1978
II. Eligible Individuals_
t
The following persons "shall be„eligible for ".the ""conversion coverage
upon Ioccurrence of.the-indicated event:
(a): 'An employee,,. upon termination,of participation in the plan
dueto termination of"employment"in the."class"or classes
of employees covered under the Plan and.following at least
three months -of coverage under -the The enrollment
form should -include the employee's spouse and unmarried
children who have not'ittained the limiting"age under the
Plan (ifage 19 or;older,.coverage.must.have been continued
because the child was an unmarried dependent full-time
student"under 23 or because the.child.was incapacitated)"
who.,.were covered under the Plan on the employee's termination
date. ,Other unmarried children. covered"under the Plan on the
employee's termination date"shall"al"so be eligible :for -'the
conversion coverage on such.date.
(b) A,spouse covered under the, -Plan, whose coverage terminates
due. to change in marital status.. The enrollment form; should
include the.spouse:'s.unmarried,children"whose`c"overage also
terminates "'with the s ouse s coverage,,and..who"'have.-not attained
the'"limiting,age :under .the Plan. (if'age.19 or.older,.,coverage
must have been continued because the:"-child:Was:"an..unmarried
dependent full-time:"student under 13.or because"the,child was
incapacitated).. Other unmarried children:covered under" the
Plan ;whose 'coverage terminates_ with the "..spouse's coverage shall
ti also be eligible for the conversion.coverage.
(c) A 'child -upon termination"of coverage.under,:the Plan because of
attainment"ot a limiting age or marriage.
III". Enrollment for Conversion Coverage
(a) Enrollment forms. for conversioncoverageand the first"premium
payment therefor must be submitted,"to The Equitable within"31
days following the date upon which -.,the individual-. becomes."
eligible .to apply.as provided..under II.,above.""
(b) The .conversion coverage will,not cover any. person who (i).is
"SUPPORTIVE eligible for Medicare or (ii) has":similar coverage on: an
individual or group basis, or. Is eligible.to-obtain similar
t
-. coverage on a group basis, which. together with the"conver.sion
.)OCU'!III �.t��lI coverage would result in over -insurance or .duplication 'of
FOLLC)dU:, benefits according to Equitable standards.
Mr. Joseph R. Grassie
Page Three t
December 4, 1978.
(c) The -conversion coverage, if issued, 'shall become effective
upon the day 'following the date of.tezmination,of coverage
under the Plan..
(d) City shall:furnish Equitable, upon request, such information.
it may. have as .may be:.needed,_by..Equitable to process enroll-
ment forms for the conversion coverage.
IV. CharQes_to City.
(a). There shall .be due..and payable by City to:.Equitable a charge
for processing. of enrollment - forms' -:for the_. conversion coverage
at -.the rate of,.$12.50.per.':enrollment...form,.processe& The
processing charges shall be payable. whet her or, riot the _con
version coverage is"issued or becomes effective..
(b) At such time.as Equitable may determine that an -experience
selection:charge-should,be imposed upon.the issuance of conversion
coverage pursuant to:this agreement, other..comparable arrangements
and,group health insurance contracts,'.,Equitable shall notify
Ci,t3i in writing of the amount of.the selection charge and its
effective.date, which date shall not be earlier than 31 days,
following the date of the notice.. .The selection charge here-
under shall be, consistent with that imposed -generally by
Equitable under group health insurance,policies. .The.selection
charge will apply to.each certificate -.for conversion coverage
issued on.the:basis of'.an enrollment -,form received on an
after the..effective-date,of.the--sehection.charge.
(c) Equitable shall give City least 30 days . written notice.of-
a change in .the processing charge or,.the,,.experience-..selection
charge and -the revised:charge.shall apply.to:enrollment.fo.rms
received.on or ofter the effective date of the change in:the
charge.
(d) At the end of each .calendar quarter following the effective
date of, this arrangement; Equitable, shall -'submit,. to,City,la..
statement`s
formhowing.for the preceding:_
receding: calendar quarter', the"enrollment
Pn�; .
rocessicharge .together:with the `names of:the individuals
and. the experience selection:charge together. with. -the'names,
of the persons to whom conversion coverage certificates were
Itsissued 1dithin .15 days..after receipt of such statement, City
Uppini I VWill pay' to Equitable the' amount' of the` charge
DO
Ufft. I..IQ,
FOLLOvV�,
�M�nn+r.unt4V•:.VI.'.Y,6�9�Y/-1CiC�'bl. �
-- � � - .
.'a*' .
-. �'�
to #_P�
ADMINISTRATION AGREEMENT ..
THIS AGREEMENT, made and entered into as of the First day of June-,,1978 by
and between THE CITY OF,MIAMI, FLORIDA'(11CITY1f) and THE EQUITABLE LIFE:.
ASSURANCE SOCIETY OF THE UNITED STATES ("EQUITABLE")
W-1 T N E S S E T. H
_WHEREAS, CITY has adopted a -program of'medical And hospital:bene-
fits .("Plan") for its employees and annuitants
uitants and the . eligible -depend-
eats of suchh-employees and annuitants, a true copy of which, is attached
hereto as Exhibit "A" and by this reference inc6rp6rat6 d herein. and
WHEREAS, CITY has.requesied EQUITABLE to furnish administration
services',in connection withthe "Plan". and
-WHEREAS., it is the,purpose of this Agreement to establish an'
agency relationship whereby EQUITABLE will undertake`,to a 6t` asagent for,
CITY -,in (i) ree-Eiiving'and:processing:cliim-S for benefits under - the- "Plan",
(ii)-dis'bursing claim-payrnents,under the."P'LAN" and (ift) performing:such
additional duties as set 'forth herein.
Now,.THEREFORE .'in consideration of.the mutual promis . es and
covenants contained :herein, it*js,hereby,agreed as follows:-
"SUPPORTIVP
Section l.; Claims Administration DC)
L L U
(a). Upon receipt of.'a c laimi -for.benefits, EQUITABLE shall review
.the,.claim -and determin6"whether it has,been properly r I operly filed and the amount,
if any,"which-'Is dde and payable with respect 'thereto.
(b) EQUITABLE on. befialf of CITY'shall disburse claim- payments
that EQUITABLE determine*s'to be due in accordance with the provisions of,,
the "Plan" to the person or assignee entitled thereto.
(6). EQUITABLE shall',take all reasonable steps to process claims
and disburse clalln
ous y -
Page I
Section 2. A iyment of Claim
Ob
(a) CITY shall arrange for the establishment of a Specfal',Ac_�Co'uni
with The Chase Manhattan Bank, N.A. ("Chase"), 110 West 52 Street, New York,
New York, in an amount which will be sufficient at all times,to,pay claims under
the "Plan".
(b) EQUITABLE shall pay. claims under the "Plan" by a draft drawn
payable through "Chase -After presentment by "Chase such draft will -be
proces sed, and, ifin order, :accepted by EQUITABLE. Each day, Equitable*shall
draw, ontheSpecial Account, a,check, draft, or other order for the payment
of'mon-ey, payable to "Chase" in the amount'of the total d,ollarlamo,un't,'of drafts
presented and accepted that day. CITY,.by execution'of this.Agre6ment,"...
authorizes EQUITABLE to draw such checks, drafts or other orders 'for.the payment
of money,' 'and'to.issue and accept drafts-for,t,he purpose urpose of settling. claims
undertihe "Plan". A.claim,fo'r. I medical o'r'.hospital , s' i I ncurred - under Group
Policy '19696H and paid byEquitable-claim draft- shall be. deemed. a claim"under the
"Plan" upon resentment
it: to, and- acceptance by, Equitable of such draft 'o n. or.: -
after June 1, 1978. CITYauthorizes EQUITABLE to, reimburse itself the amount
of such claims by issuance of claim drift drawn on the Special Account.,payable
to itself.
(c) In the event EQUITABLE pays any.person 'less than the .amount
Ld to which he is entitled under, the "Plan", EQUITABLE will promptly=adjust the,:..
'.
0underpayment. in 'the:event EQUITABLE overpaysf
vany person bene its
ZD _j
CD under the "Pia'n'11, or pay s.be'nefits to any person "who is notlentitled to.'th em,
CD Lj_
EQUITABLE shall take,all-reasonable st'eps'.to recover the overwpayment'except_
that EQUITABLEshallnotl�be required toinitiate -'.court proceedings to recover
an over- payment. EQUITABLE shall promptly- notify CITYif -it isunsuccessful.in
recovering any over -payment.
NY Th e2determ determination of the extent of the benefits to 1. .which'
ch,
any claimant is entitled under the "Plan" shall. initially rest With EQUITABLE.
However, in theeventCITY.determines that EQUITABLE has,misinter'preted the
is
8 0 2'08
11
"Plan" and so infor*ft EQUITABLE in writing, all clai - reported after delivery
of such writing to EQUITABLE shall be processed and paid in accordance with
CITY'S interpretation as set forth in such writing.
Section 3. Additional Duties of EQUITABLE
In addition to receiving and processing claims and disbursing
claim payments, EQUITABLE shall perform the duties set forth in the schedule
which is attached hereto as EXHIBIT B and by this reference incorporated herein.
The duties set forth in EXHIBIT B may be modified by mutual tual agreement of
g
CITY and EQUITABLE. Such mutual agreement with respect to such duties'and
the revised administration charge, if any, gpplicable.thereto, shall be -evidenced
-by Letter Agreement between the parties hereto, and,upon such agreement,
EXHIBIT B shall be deemed modified to the extent of'such,agreement...
EQUITABLE may request to ._revise the administration charge, under
this:Agreement if any change in law or regulations,imposes.greater duties or
obligations on EQUITABLE than contemplated by the Agreement in force at -the time
of such change. Failure of.the parties .to agree'on the change within thirty
(30) days of request of a revised charge shall automatically terminate this
Cn
Agreement.as o£;midnight'of ,the:day preceding the indicated effective date of
he revised.charge. The foregoing shall be subject,to any revision in the
,administration`charge pursuant to Sections 4 or 12 hereof.
n._ ZD .._,
Section A. Administration Charge
CD
CO 0 (a) The charge to CITY for services performed by=EQUITABLE under
this Agreement shall be four and three-quarters (4.75)*percent.of.the total:
of the,amount of the drafts accepted by EQUITABLE pursuant to'this Agreement, ?
plus, in.connection with claims to.which the nonduplication or coordination of
benefits provision of the "Plan" applies, the amount of..the claim payments,;.
which would have been disbursed by EQUITABLE pursuant to this Agreement in.the
absence of such a provision.. The Administrative Claims Service charge will be
four and three-quarters (4.75) percent of the claims paid, limited to-not.more
P'l c 1
than a total of Thr#v* Dollars and Forty-six Cents (46) per enrolled employee
per month with the monthly enrollment averaged on an annual basis.
(b) Each month after June 1 of 1978,EQUITABLE.shall submit to
CITY a statement showing the administration charge for the preceding month
determined on the basis set forth in the preceding paragraph. Within fifteen
(15) days'after receipt of,such statement, CITY shall pay.EQUITABLE:the amount of
such administration charge.
(c) Not less than sixty (60) days.prior to June l of.any year.in
which this Agreement is in effect, EQUITABLE may propose in writing a revision
in the administration charge for, the following year. CITY shall advise
EQUITABLE.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 4east thirty-(30) days 'prior.to.such;June 1, this -'Agreement shall
terminate effective as of.midnight.of such May 31.. The foregoing -'shall be
subject'to any, reeision in the administration charge pursuant to Sections.-3 or
12 hereof. As used herein "year" means any.per,iod'of twelve consecutive months.
commencing June 1 and ,ending, May 31:
Section S...Determination of Eligibility
In determining any person's right to benefits.under.the "plan",
Ljj co
EQUITABLE shall -rely on eligibility information furnished'by CITY*.prior to
submission of the claim. It.is-,mutually understood that the effective perform-
;ance
of this Agreement by EQUITABLE ,will,require�that it'be*advise& by. CITY :
periodically, but not less frequently than -monthly, during the term of, this:
C ;�
C•--'
Agreement of the identity, of individuals eligible for benefits under the "Plan
t"'
the effective date or the termination date (as the case may be) of their.
eligibility, and',the extent ofthebenefits to which: theyare entitled.. CITY
shall also cause to be furnished to .EQUITABLE such other information as may
reasonably be required for the -proper administration of the "Plan".
It is mutually agreed that' EQUITABLE shall not b.e responsible for
delay in the performance of this Agreement or forth non-performance of this
Agreement which del,#t• or non-performance is caused gp►pontributed to by failure
1
of CITY to furnish any such information.
Section 6. Record Retention and Review
,t
EQUITABLE shall maintain records,covering claims submitted under .
the "Plan", as well as payments disbursed'by EQUITABLE. The records.shall be
maintained for the.same,period of time that EQUITABLE retains similar records
iri connection with its insurance business. Any duly authorized.representative _
or representatives.of CITY shall.have the right to examine or.audit.such
records during the regular business. -hours of EQUITABLE, upon -five (5) days
advance written notice to EQUITABLE.
Section 7. AgencY Agreement.
(a) It is mutually.recognized that EQUITABLE, 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,
the appropriate named fiduciary for review of: claim denials under the "Plan':.,
for the purposes of the Employee -Retirement Income Security Act of J974_or.
any,other.Federal,or State law of. similar 'nature.
(b)'. In;the event,.EQUITABLE, its off icers,.directors , employees,,,.
or agents are made parties to any judicial, or administrative procedingL'LJ...',.
C,!'�
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,
.. •.i
c`;`
O settlements and costs,(includin attorne s' fees) which the incur.or a in,
g Y Y' P Y
_ ....J
--
-__J connection therewith, except that' CITY shall not reimburse for the amount of any
---} ( LJ.. judgment or award (or,attorneys' fees`with'respect thereto) if the court render- ?
ing the judgment. or the agency,making the award determines that the liability
underlying the judgment or award was caused by the negligence, fraud, ;or
criminal conduct of EQUITABLE,'its agents, employees, officers or directors.
(c)'`The defence of any legal action instituted .on a claim Jor„
benefits under the "Plan" shall not be an obligation of,.EQUITABLE. EQUITABLE
Page 5
r'
r
shall, however, coorprate with CITY by furnishing su-,,b,evidence as it has
available in connection with the defense of any such action.
Section 8. Subcontracting
The work to be performed by EQUITABLE under this, Agreement may
be performed wholly or in part through a,subsidiary or affiliate of EQUITABLE.
Section.9. Laws Governing Contract
This, Agreement shall be governed by, and,'shall be construed in
accordance with the 1aws.6f ,the State' of New York.
i
Section 10.. Term of Agreement
This Agreement shall become effective on June 1, 1978 andend
as of midnight May 319 1979. It shall',be renewed'automatically for successive
periods of twelve (12).months unless -CITY or EQUITABLE gives written notice.
to *the other.of intention.not.to renew the Agreement• at least thirty (30)days
prior to the end of the then current period.
Section 11. Modification of'Agreement
R
This Agreement constitutes t}te entire, contract between. the
parties and.no modification or amendment hereto shall be,valid unless in
CD
��- (D writing and signed by, the' parties.
Section 12. Modification of "Plan"
ZD
(a) Any modification or amendment of the "Plan" shall be 'duly_
communicated An -detail and. in ,writing by CITY to EQUITABLE'.. Such: communication
shall also set forth the effective date of the modification or'amendment.`
1
The date for implementation: of .the modification.:or amendment .'.
will be mutually_agre.ed upon by CITY and EQUITABLE and.will be. based:on.'a reason-
able
.appraisah of the effect thereof,,on EQUITABLE' S.ftinctions and dutie 11 s.'under
this Agreement, including the effect, if any, of. making additional claim
payments.on account of an effective date prior, to the--implementation-date....
(b) If a.revision in the administration charge is deemed
., r
necessary by EQUI114 LE by reason of the modi.ficati��,or amendment of the "Plan",
EQUITABLE within thirty (30) days after receipt of a copy of such modification
,or amendment and agreement on the implementation date, will advise CITY of
the revised administration charge to be effective on the implementation date.
If within thirty (30) days after receipt.of notice of the revised administration
. charge CITY advises EQUITABLE in writing that the revised administration
charge is not acceptable, such written advice shall constitute a termination of
this Agreement effective as of: midnight of the last day. "of the month.following
the "month in which EQUITABLE receives such advice." However, the administration
charge 'on "and"after the implementation date shall be made on',the basis;of such
revised administration charge.
(c) CITY shall•furnish.EQUITABLE with a,copy'of.each"modification
or amendment of the "Plan" as.soon"as is,practicable and in.advance of.the
effective date of such modification or amendment,".if possible.` After receipt
by:EQUITABLE of 'a copyof the modification or amendment the term "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 13. Termination -"of "Agreement
(a)'. This Agreement shall" terminate, upon the.earliest of<the
.following dates:
(i) The indicated -date of termination set 'forth -in
LLJ
i., Section 3..if a "revised administration charge is not --accepted
by CITY pursuant to Section 3.
(ii). The. May 31 of the year in which there has. been no
�.� .. .
CL
agreement on any revised proposed administration "charge fort"the
{....� U. renewal period pursuant to sub-paragraph",(c) of Section 4..'
The thirty-first (31st) day following the, delivery
of written notice,of.termination pursuant to -Section 10
(iv)" The last day of"the "month following the emonth "in
which"EQUITABLE."receives advice from CITY that the"revised'
Page 7
TO: . Joseph R. Grassie DATE: March' 19, 1980" FILE:
jittanagSu lementar Material for
SUBJECT:PPYCity'Commission„°Meeting of
March 19, 1980
FROM Knox, fr. REFERENCES:
torney
ENCLOSURES:
R600
The tta d items with explanatory comments ..should be'_distributed
to the ity Commission upon receipt,thereof',`s'o„that previously
distributed material can: be modified:
Agenda Item No.. 6 -- The attached,ordinance used, the words,"..
"Special Municipal Pro"secutor".as substituted,"language for":.the
term, "Special,Assi"stant State Attorney". -.Thisaccurately
ref"lects:the;app.icable'constitutional provi'sion:.and the pertinent
authorizing stat"e.statute.
Agenda T.tem No. 18'- This .is"'a resolution ratifying" the.Cityls
emplo"ymen,t., of an accountant! firm which has: alrea4y.,.conducted" pro
-
f.'s'ional services for the Retirement System Board..
Agenda,Item,No. 19 -- This resolutionconstitutes the:,final author-
izing legislation to provide administrative servicing
relations"hip between the City.aad Equitable Life Assurance,"Society
in:connection with -,City, employees' -'group "insurance medical benefits.
Agenda :Item. :No . 21 -- This sin8 le..resolution a P Plies i,othe:_City's
,
engagement of two,, f irms, each .of' which .will --,be, authorized'. to,
provide professional .cons:ultant service on. anus -needed "basis.
The agreements have" already been distributed but are also."at'tached
to'the:resolution.-
Agenda _I.tem.No. 28 -- This.ite-m reflects the expressed need..,for
amendatory":le'gislati'on`concerning the funding provisions for the
issuance ofrev "enu"e.bonds"for-this project (Watson Island).
Agenda Item No. 29_.-- This is the anticipated formal resolution
which will be.in order for the Commission to adopt, if it desires.
GFK/RFC/bbb
4A,