HomeMy WebLinkAboutExhibit ACQASSE TSB
Norkers Compensation
Medical Only
ndemnity
nd-Tier II-Flonda, New York, Ohio and Texas
City of Miami - 000757
2/15/2014 - 2/15/2015
EXHIBIT A
PRICING OPTION: COST PLUS -LIFE OF PARTNERSHIP OPTION
(Based on utilizing GBMCS)
Life of Partnership
Annual Cost Plus
Estimated Year 3
41*
@ASISE • '
All Fees included in salnes below
All Fees included in salries below
All Fees included in salves below
All Fees included in seines below
-lability
3eneral Bodily Injury
All Fees included in seines below
3eneral Property Damage
All Fees included in seines below
Auto Bodily Injury
All Fees included in salries below
Auto Property Damage
All Fees included in seines below
Auto Physical Damage
All Fees included in seines below
professional Liability
All Fees included in seines below
Actual Salaries at
Actual Salaries at
Actual Salaries at
Actual Salaries at
Commencement of 1st
Come nee ment of
Conmenee ment of 3rd
Cormtencernent of
Actual Salaries at
Year of City Option -
2nd Year of City
Year of City Option -
4th Year of City
Conmencement of 5th
Total Salary Expense
$682,515
Option - S641,114
$607,587
Option
Year of City Option
Total Estimated Service Fee (2.30 multiplier)
S1,603,910
S1,474,562
$1, 397, 451
TBD
TBD
Annual Fee for Licensing of SysFacs (up to six
users)
S0
$17,500
517,500
TBD
TBD
Grand Total $1,603,910
$1,492,062
51,414,951
TBD TBD
' Quoted as Second Year of Fie Additional Year Long Options
or the City of Miami to renew at their sole option. Total dollar
ncrease from year to year not to exceed 4% over expiring year
' True Salanes to be Calculated al Beginning at Service Penod
' Client and GB to Agree on Staffing Pnor to Beginning or Semce Penod
' GB will perform normal salary administration pursuant to GB Procedures
Quoted as third year of five additional year -long options for the City of Miami to renew at their sole option.
Total dollar increase from year to year not to exceed 4% over expiring year.
True Salaries to be Calculated at Beginning at Service Period
Client and GB to Agree on Staffing Prior to Beginning of Serivce Period
GB will perform normal salary administration pursuant to GB Procedures
14-00833-Exhibit A
Budgeted Staff Cost & Terms (Revision date: 12/5/2013) Page 1
I 02
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City of Miami - 000757
2/15/2014 - 2/15/2015
GR MANA(zFf CARP SFRVICFS
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SERVICES
CHARGES
Fee Schedule or UCR
$8.50 per bill
All Other Savings included: PPO Networks,
Specialty Networks, Clinical Edits, Clinical
Validation, Nurse Review, Out of Network
(Provider & Rx), Physician Rx Dispensing.
25% of savings
Enhanced Savings
No Charge
Electronic receipt of medical bills
$2 additional per bill or 2 line header in all
applicable states
Telephonic Case Management
$75 Medical Triage
$290 per Indemnity claim (each 30 days)
$130 per Medical Only claim (one time)
Hospital Certification Program
$120 per hospital certification
Utilization Review Program
$105 per review
Physician Review/Peer Review
$270 per review
Task -Based Field Case Management
• Task 1: One Visit Task
• Task 2: Two Visit Task
• Task 3: Labor Market Survey
• Task 4: Vocational Assessment
• Task 5: Home Visit
$530 per assignment
$705 per assignment
$635 per assignment
$590 per assignment
$660 ($730 in CA) per assignment
Medical Case Management and Vocational
Rehabilitation - Hourly
$92 per hour plus expenses
$103 per hour — AK, CA, HI, NY
Priority Care 365
$90 per call
HCN Service Options
Option#1 — unbundled rate: $17 per bill to
include bill review & network access, $75 for
triage
Options #2 — bundled rate: $27 per bill to
include bill review, network access & nurse
triage
Option #3 — percent of savings: 9.5% of total
savings to include bill review, network access &
nurse triage
Medical Cost Projection (MCP) and Clinical
Recommendations
$125 per hour
Dental Review Program
Charged on a per review basis
OSHA Reporting
$4,500 per year
(includes set-up, OSHA access & unlimited
OSHA logs and summaries)
Taxes
All applicable taxes will be added to the service
fees where required
Client and GB agree as follows: If another preferred managed care vendor other than Gallagher Bassett
Managed Care Services is utilized, an administrative fee may apply in exchange for bona fide administrative
services. The administrative services may include, but not be limited to overhead costs for the oversight and
management of Managed Care vendors which includes the development and oversight of quality standards,
development and maintenance of EDI interfaces and reports, monitoring of Managed Care vendor
performance, and ensuring proper mandatory state compliance and reporting.
Budgeted Staff Cost & Terms (Revision date: 12/5/2013)
Page 2
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City of Miami - 000757
2/15/2014 - 2/15/2015
OTHER SERVICES
SERVICES CHARGES
risxfacs.com - Additional Users
$1,000 per user
GB International Claims Services
Varies by Country (pricing provided upon request)
Consultative Services
Loss Control Consulting Services
$140 per hour
Appraisal Services
TBD
MountainView ClaimZone RMIS Module
TBD
Fraud Prevention — Gallagher Bassett Investigative Services (GBIS)
Special Fraud Investigations - SIU
$85 per hour plus expenses
Surveillance Investigations
$70 per hour plus expenses
Targeted Field Investigations
$80 per hour plus expenses
Targeted Database Investigations
Rate per report
Medlnsights MSA/MSP Compliance Services
(This pricing is for Medlnsights services only. If another vendor is selected, then other pricing applies)
Social Security Verification (Entitlement
Determination)
$175.00 per verification
Medicare Lien Evaluation
Conditional Payment Search
$250 per search
Manual Medicare Eligibility Inquiry (Rush Request)
$35
Conditional Payment Lien Negotiations
$150 per hour
Medical Cost Projection
$125 per hour
MSA Resolution Unit Service
$450 Fee
Pharmaceutical Drug Review
$450 per review
(If PDR doesn't prove to reduce lifetime costs by
$5,000 the fee reduced to $35)
Medicare Set -Asides
Workers Compensation Medicare Set -Aside
Allocation (WCMSA)
$2,300 per allocation
Rush Fees (MSA com.leted within 7 days)
$450 per case
Revisions:
$150 per hour
(One free revision within six months of
submission)
Liability Medicare Set -Aside Allocation (LMSA)
$1,535 Fee
MSA Submission to CMS
$850 Fee
Taxes
All applicable taxes will be added to the service
fees where required
Budgeted Staff Cost & Terms (Revision date: 12/5/2013)
Page 3
City of Miami - 000757
2/15/2014 - 2/15/2015
PROGRAM SPECIFIC TERMS AND CONDITIONS
Giq
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1. Billing and Payment Terms: Fees will be billed Monthly during the calendar year. Fees are payable within
30 days upon receipt of the invoice. Gallagher Bassett reserves the right to charge 1 % per month, or the
maximum legal rate, on balances unpaid after 30 days.
2. Budgeted Staffing Claim Pricing Terms:
Claims will be handled for the life of the partnership with no additional per claim fees. If you should
decide to non -renew or stop using GB in a specific state, the existing open files can be handled in
one of three ways.
O. Gallagher Bassett would continue to handle the open files at our prevailing rates fee per
year per open file.
► Gallagher Bassett would continue to handle the open files on a Time and Expense
basis.
► Gallagher Bassett would return the files to the client (contingent upon Carrier approval)
at the client's expense.
*Please see Claim Charges outlined in footnote 7 under Program Specific Terms and Conditions.
Note: There will be additional charges for ongoing Data Management (RISX-FACS®), risxfacs.com
users, Administration, Banking fees and monthly reports for as long as GB handles claims.
3. Account Administration includes the following:
a. Designated Account Manager
b. Detailed Status Reports @ $50,000
c. Settlement Authority @ $10,000 (WC), $3,000 (Liability)
d. Banking Administration (SIMMS)
e. Two Claim Reviews a Year or One Audit
f. Acknowledgement Letter to claimant
4. Data Management includes the following:
New Claim Setup
Historical Claims
• Monthly Report by Email or the Website
• Carrier Report Package by Email or Website
5. Pricing is based on using GB Managed Care (GBMCS) for Bill Review, PPO, utilization review,
Budgeted Staff Cost & Terms (Revision date: 12/5/2013) Page 4
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Enter Client's Full Legal Name
Start Date - End Date
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6. Claim Charges: The Claim charge is applicable per claim per line of coverage.
Example: A client employee during working hours is involved in an automobile accident with another
vehicle with two occupants. Both occupants were injured, both cars were damaged and our client
employee was injured. The claims handling charges (example only) will be:
Claimant #1 - Auto Liability Bodily Injury $0
Claimant #2 - Auto Liability Bodily Injury $0
Claimant Owner - Auto Liability Property Damage $0
Client — Workers' Compensation $0
Client — Auto Physical Damage $0
$0
All charges are included within Cost Plus Staffing model.
7. Gallagher Bassett Services, Inc. will not pay a fee, commission, or rebate to any party for the privilege of
presenting our proposal or in order to secure the awarding of any program to Gallagher Bassett Services.
8. Client and GB agree as follows: As part of our comprehensive claims service delivery model, Gallagher
Bassett (GB) partners with selected best -in -class third party providers. These services are generally
purchased on a wholesale or negotiated basis with GB delivering additional value-added customizations that
may include scanning, electronic bill processing, maintenance and operation of EDI interfaces, vendor
management, quality assurance, mandatory state compliance and provision of savings and outcome reports.
Within these arrangements, GB may receive revenue commensurate with our work product to integrate and
manage these relationships and services. As a company policy, we do not disclose the terms of these
contracts and arrangements. We are, however, confident that when compared to other providers in the
industry, our end -pricing as outlined in the Cost and Terms document is competitive in the marketplace and
provides excellent value to our clients.
Budgeted Staff Cost & Terms (Revision date: 12/5/2013) Page 5
Enter Client's Full Legal Name
Start Date - End Date
GENERAL CONTRACT TERMS AND CONDITIONS
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1. Independent Adjuster for Catastrophes - If applicable, any significant Property loss as a result of
a single event (i.e. hurricane, tornado, flood, earthquake, etc.), GB reserves the right to retain
outside resources (adjusters) when appropriate and those fees will be paid as an Allocated
Expense off the file.
2. Material Change - GB reserves the right to modify its fees upon sixty (60) days prior notice to
CLIENT if:
a. It is determined that the historical data upon which GB's fees and service charges
developed were based upon erroneous, obsolete or insufficient information, or that a
change in CLIENT's business will materially change the nature and/or volume of its
business or claims as contemplated at the inception of the Agreement
b. During the term of the Agreement, legislative and/or regulatory requirements materially
impact or change the scope of GB's services or responsibilities
3. Taxes - All applicable taxes will be added to the service fees where required
4. Allocated Expenses: Shall be your responsibility and shall include, but not be limited to:
Legal Fees
Medical Examinations
> Professional Photographs
> Travel made at client's request
Costs for witness statements
s Court reports
s Medical records
> Accident reconstruction
• Experts' rehabilitation costs
Chemist
Fees for service of process
Collection cost payable to third parties on
> Architects, contractors
Engineer
• Any other similar cost, fee or expense reasonably chargeable to the investigation,
negotiation, settlement or defense of a claim or loss which must have the explicit prior
approval of the client
Police, fire, coroner, weather, or other such reports
Property damage appraisals,
SIU, surveillance and sub rosa investigation
Official documents and transcripts
Pre- and post -judgment interest paid
Outside Investigation
Index Bureau Reporting
Second Injury Fund Recovery
Data Intelligence Self -Service Reports
Managed Care - Managed Care services may include, but are not limited to:
i. Preferred provider organization networks
ii. Utilization review services
iii. Automated state fee scheduling
iv. Light duty/return-to-work programs
v. Medical case management and Vocational rehabilitation network
vi. Prospective injury management services
vii. Hospital bill audit services
V V V V V V V V V V
Budgeted Staff Cost & Terms (Revision date: 12/5/2013)
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Enter Client's Full Legal Name
Start Date - End Date
DEFINITIONS
Workers Compensation - Medical Only Claims
A medical only claim is a work -related Claim that meets the following criteria: (i) payments for either
indemnity or vocational rehabilitation were not required, (ii) the Claim has not become contested or in
suit, (iii) investigation to determine compensability or subrogation requirements was not required, (iv) no
loss notices, captioned reports, client meetings (other than routine meetings where the claim is listed and
noted) or settlement authority approvals were required, and (v) payments on the Claim have not
exceeded $2,500.
Workers Compensation - Indemnity Claims
An indemnity claim is a Workers Compensation claim that is not a Medical Only Claim.
Incident - Electronic and Manual
An Incident is a loss reported electronically through ClaimLine and/or the Web, or set up manually at the
branch. GB will review the Incident and make a courtesy call [if necessary] to determine if it is a claim or
Incident. GB will have full discretion in the determination and handling of these Incidents and/or their
conversion into claim status.
Liability Claims
Investigate, evaluate and adjudicate ail third -party claims for which you may be legally obligated. Third -
party claims will be managed and administered in accordance with our product guidelines.
Auto Physical Damage (APD)/Property Claims
Investigate, evaluate and adjudicate all first -party claims which you report involving damage or loss of real or
personal property. First -party claims will be managed and administered in accordance with our product
guidelines.
Budgeted Staff Cost & Terms (Revision date: 12/5/2013)
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