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Home My WebLink About870246.tiff . RESOLUTION RE: APPROVE AMENDMENTS NO. IX, X, AND XI TO THE WELD COUNTY EMPLOYEE BENEFIT TRUST FUND AND AUTHORIZE CHAIRMAN TO SIGN WHEREAS , the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with Amendments No. IX, X, and XI of the Weld County Employee Benefit Trust Fund, and WHEREAS, after study and review, the Board deems it advisable to approve said Amendments to the Employee Benefit Trust Fund, a copy of each Amendment being attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that Amendments No. IX, X, and XI to the Weld County Employee Benefit Trust Fund be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is, authorized to sign said Amendments. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 6th day of April, A.D. , 1987, nunc pro tunc January 1 , 1987. � • BOARD OF COUNTY COMMISSIONERS ATTEST: &/nf,vw. bull [r1 WELD COUNTY, COLORADO Weld County Clerk and Recorder EXCUSED and Clerk to the Board Gordon E. Lacy,f, Chairman g 6y � C. . Ki le/117-1-4/ em Deputy County Jerk �'/ "- �.- At PC el APPROVED AS TO FORM: Gene R. Brantner 4:;eci >Jo s County Attorney EXCUSED Frank Yamaguchi 870246 "{ 0003 ec. ,Px AMENDMENT NO. IX to the Employee Benefit Fund of WELD COUNTY The above document is hereby amended, effective January 1, 1987, as follows: the following are .DELETED: — Page 9 - 7. Pre-existing Conditions New Employees. or Covered persons becoming eligible after January 1, 1983 will not be entitled to covered medical expenses that are incurred as the result of an injury or sickness for which the Covered Person has consulted with a Physician or received any medical care or services within the three month period immediately preceding the effective date of coverage, unless incurred after the expiration of a period of: a. three (3) consecutive months ending after the date the benefits are effective for the Covered Person during which no medical care or treatment of such injury or illness has been received, or b. After a period of six (6) consecutive months during which the Covered Person was continuously at work and a member of the plan. (This does not pertain to Covered Dependents) , or c. After a period of twelve (12) consecutive months during which the Covered Person has been continuously a member of the Plan. The following is ADDED : Page d - 12. Birthing Center: Any puolic or private place or other facility which is licensed oy the state to provide Medically Necessary services and supplies associated with childbirth . A Birtning Center is one in which a pre-paid flat amount is paid before delivery and covers every aspect of prenatal , delivery, and post partum care of the mother and limited follow-up care for the newborn. Page 9 - Pre-Existing Conditions - The term "Pre-Existing Condition" means an injury or illness of a Covered Person for which the Covered Person has been under the care of a licensed physician or has received medical care or services within the three (3) month period immediately preceding his/her effective date of coverage. AM7/WC-IX 870246 Claims resulting from—Rre-Existing Conditions are ex,r'Nded from coverage under the Plan except .s specified below: a. If the Covered Person does not receive medical care or services or is not under a physician' s care with respect to the pre-existing or related conditions for a period of three (3) consecutive months, the pre- existing conditions limitation will no longer apply and any charges incurred after the treatment-free=. period are allowable, or b. After a period of six (6) consecutive months during which the Covered Employee was continuously at work and a member of the Plan, the pre- txisting tonditi-on limitation will no longer apply. ;(his cues no.t per- tain to Covered Dependents,) or c. After a period of twelve (12) consecutive months during which the Covered Dependent has been continuously a member of the Plan, the pre- existing condition limitation will no longer apply. Added in entirety: BIRTHING CENTER AND/OR SHORT STAY MATERNITY BENEFIT Benefit Provision For Birthing Center: If a Covered Person incurs an expense which is Usual , Customary and Reasonable for a Birthing Center, the Plan will pay for such related medical Expense Incurred up to the maximum payment specified in the Summary of Benefits. Benefit Provision for Short Stay Maternity: If a Covered Person has a Hospital confinement consisting of one ( 1) day room & board charge or less, that confinement, and physician charges, will be treated the same as a Birthing Center expense and paid up to the maximum payment spe- cified in the Summary of aenefits. Any expenses for the newborn will be payable at 8070 after the deductible . Limitations Applicable to This Benefit Only: a. No payments under the Birthing Center and/or Short Stay Maternity Benefit serve to satisfy the Major Medical Deductible. b. No benefits will be payable until after delivery. IT IS AGREED BY WELD COUNTY that the provisions contained in the above document and Amendment No . IX tnereto, are acceptable and will be the basis for the administration of the WELD COUNTY EMPLOYEE BENEFIT TRUST FUND described herein. SIGNED at Greeley Colorado, this , 6th day of April .0 87. WELD COUNTY MitaX6MSX `� By1,.."-A-c* Attest: T ��/ C.W. Kirby BY Title Chairman Pro-Tem putt' County Cle AM7 WC-IX1 870246 AMENDMENT NO. X to the Employee Benefit Fund of WELD COUNTY The above document is hereby amended, effective January 1, 1987, as follows: The following is DELETED: Page 23 - 2. The benefits of a plan which covers the individual for whom claim is made as a Dependent of a male will be determined before the benefits of a plan which covers that individual as a Dependent of a female. However, for a dependent child of a divorced couple, the coverage of the parent who has custody of the child will be determined before the bene- fits of the other parent are determined (unless stipulated otherwise by a court decree) . The following is ADDED: Page 23 - 2. The benefits of a plan which covers the individual for whom claim is made as a Dependent of a person whose month and date of birth occurs earlier in a calendar year shall be determined before the benefits of a plan which covers such person as a dependent of a person whose month and date of birth occurs later in a calendar year. If the other Plan does not have this provision regarding birthdays which results: either in each Plan determining its benefits before the other; or in each Plan determining its benefits after the other; then this provision will not apply. The rule set forth in the Plan which does not have this provision shall determine the order of bene- fits. In the case of a person for whom claim is made as a dependent child whose parents are separated or divorced: If there is a court decree which would establish financial respon- sibility for the medical , dental or other health care expenses with respect to the child, the benefits of a Plan which covers the child as a dependent of the parent with such financial responsibility shall be determined before the benefits of any other Plan which covers the child as a dependent child. AM1/WC-X 870246 If there is not such a court decree: If the parent with custody of the child has not remarried, the benefits of a Plan which covers the child as a dependent of the parent with custody of the child will be determined before the benefits of a Plan which covers the child as a dependent of the parent without custody. If the parent with custody of the child has remarried, the benefits of a .Pl4aL.wh,icb: raric,xhe;=ch4U,d•4as:a- 4 SAte parent vitt% custody shall be determined before the benefits of a Plan which covers that child as a dependent of the stepparent. The benefits of a Plan which covers the child as a dependent of the stepparent will be determined before the benefits of the Plan which covers that child as a dependent of the parent without custody. IT IS AGREED BY WELD COUNTY that the provisions contained in the above document and Amendment No. X thereto, are acceptable and will be the basis for the administration of the WELD COUNTY EMPLOYEE BENEFIT TRUST FUND described herein. SIGNED at Greeley Colorado, this ,6th day of April 19 87. WELD COUNTY A t : By Attest: avtort t({ y testest: ` C.W. Kirby y; Title Chairman Pro-Tem D puty County C rk • AM7/WC-X1 870246 AMENDMENT NO. XI to the Employee Benefit Fund of WELD COUNTY The above document is hereby amended,._effective January 1. .1927, as follows.: Page 21 (GENERAL LIMITATIONS) The existing paragraph is hereby replaced in its entirety as follows: 32. treatment of periodontal or periapical disease or any condition (other than a malignant or benign tumor, surgical removal of bony impacted teeth or oral warts) involving teeth, surrounding tissue or structure. However, this exclusion does not apply to the benefits for dental treatment described under the "Supplemental Accident Expenses" Section; or IT IS AGREED BY WELD COUNTY that the provisions contained in the above document and Amendment No. XI thereto, are acceptable and will be the basis for the administration of the WELD COUNTY EMPLOYEE BENEFIT TRUST FUND described herein. SIGNED at Greeley Colorado, this 6th, day of .. April. . , 19P7* WELD COUNTY miconexx� 7"Qt,u By Attest: C.W. Kir y ,t 4 Title Chairman Pro-Tem De uty County Cler`%e AM7/WC-XI .. 870246 ADMINISTRATION CONTRACT Alta Administrators, a division of Alta Health Strategies, Inc., a Colorado corporation ("Alta"), and Weld County, Colorado (the "Plan Sponsor"), hereby agree that Alta shall provide administrative services, as hereinafter provided, for Weld County Employee Benefit (Medical, Dental & Vision) Plan (the "Plan"), as follows: • 1. Services to be performed. Alta Shall perform for the Plan the administrative services set forth in the Administrative Services Exhibit which is attached hereto and made a part hereof. The parties intend that Alta shall not be deemed a "fiduciary" for the Plan within the meaning of the Employee Retirement Income Security Act of 1974 ("ERISA"). Accord- ingly, the services to be performed by Alta shall be limited to the ministerial services set forth in the Administrative Services Exhibit and the performance by Alta of such services shall be subjeCt`in all respects to review by the Plan Sponsor within the framework of policies, interpretations, rules, practices and procedures made or established by the Plan Sponsor. Alta shall have no discretionary authority or control with regard to managing or investing the Plan's assets. 2. Manner of Performance. Alta shall perform the administrative services set forth in the Administrative Services Exhibit in accordance with the terms and conditions of the Plan and within the framework of policies, interpretations, rules, practices and procedures made or established by the Plan Sponsor, provided that such terms and conditions, and framework are consistent and compatible with the description of services set forth in the Administrative Services Exhibit and with all applicable laws or regulations. 3. Facilities and Personnel: Alta shall maintain the facilities and personnel necessary to provide the services to be performed by it under this Contract. 4. Fees. The Plan Sponsor agrees to pay or cause the Plan to pay to Alta for the administrative services provided under this Contract the fees set forth on the Fee Exhibit, which is attached hereto and made a part hereof. 5. Term. The term of this Contract shall be for a period of one year, commencing 1-01-87 and ending 12-31-87 ,and shall be automatically renewed for successiveone-year periods, unless terminated as hereinafter provided. Either party shall have the right to terminate this Contract effective on any anniversary date of this Contract, or, after the first anniversary date of this Contract, effective on the first day of any month, by giving the other party at least 30 days written advance notice of its intent to do so. Upon termination of this Contract, if Alta is to continue processing claims, the Plan Sponsor shall pay to Alta for such services the fees specified in the attached Fee Exhibit. 6. Liabilities and Obligations. Alta shall have no responsibility, risk, liability or obligation for the funding of the Plan or for any extended liabilities for the Plan whether resulting from the termination of the Plan or from a change to fully or partially insured funding methods.Such responsibility, risk, liability or obligation shall reside solely with the Plan Spon- sor, the Plan participants, and such other entities as are designated in the Plan. 7. Indemnification. Alta shall indemnify and hold harmless the Plan Sponsor against any expense, loss, claim or judgment, including reasonable attorneys' fees, resulting from the negligent acts or omissions or willful misconduct of Alta. The Plan Sponsor agrees to indemnify and hold harmless Alta against any expense, loss, claim or judgment, includ- ing reasonable attorneys' fees, arising out of or resulting from Alta's performance of its services hereunder where Alta has adhered to the framework of policies, interpretations, rules, practices and procedures made or established by the Plan Sponsor or has otherwise performed its services without negligence or willful misconduct and in accordance with industry practices. Weld County ALTA HEALTH STRATEGIES, INC. Plan nsor By 915 th Sree May, 19, 1987 (Address). Greeley, CO 80631 THIS AGREEMENT IS SUBJECT TO THE STANDARD TERMS AND CONDITIONS ATTACHED HERETO AND MADE A PART HEREOF. © Copyright Alta Health Strategies, Inc. 1986 AHS-1986A1 FEE EXHIBIT The fee payable to Alta for the services performed under this contract to which this Exhibit is attached shall be as follows: (a) an initial one-time fee of $ n/a payable on or before n/a for n/a plus (b) a monthly fee equal to $ 7.20 per employee per month times the number of participants in the Plan on the first day of each month. The monthly fee determined in accordance with the preceding sentence is based upon an expected maximum claims utilization factor (claims submitted per month per 100 participants) of n/a . Should claims utilization exceed such factor in any year, the Plan Sponsor agrees to pay Alta within 60 days after the end of such year an additional fee of $ n a per claim in excess of such factor. Alta is authorized to deduct its monthly fee from a Plan account as soon as the Plan enrollment on the first day of such month has been determined, provided, however, that if the Plan Sponsor so requests in writing, Alta shall provide a statement for such fees to the Plan Sponsor, which shall pay such fees to Alta on or before the fifth business day after receipt of such statement. From the date fees are due until paid, the Plan Sponsor shall pay or cause the Plan to pay interest on past-due amounts at the rate of one and one-half percent per month (18% per annum) or at the maximum rate allowed by law, whichever is less. The foregoing monthly fee is subject to adjustment by Alta effective on any anniversary date of this Contract, or, after the first anniversary date of this Contract, effective on the first day of any month, provided that Alta shall have given the Plan Sponsor at least 30 days written advance notice of its intent to effect such an adjustment, which notice shall state the amount and effective date of such adjustment. If after the termination date of this Contract, Alta continues to process run-off claims, Alta's fees for such services shall be based on the average of the fees paid under clause (b) of the first paragraph of this Fee Exhibit during the two months immediately preceding the termination of this Contract unless Alta has given the Plan Sponsor at least 30 days written advance notice of its intent to effect an adjustment on such amount, in which case Alta's fees for such services shall be based on the average of the fees that would have been paid under clause (b) of the first paragraph of this Fee Exhibit during the two months immediately preceding the termination of this Contract if the adjustment proposed by Alta had been in effect, in each case calculated as follows: 100% of such average fees for the first month after termination, 75% of such average fees for the second month after termination, 50% of such fees for the third month after termination and 25% of such fees for each month thereafter until Alta's services are no longer required for the processing of run-off claims. (e) Copyright Alta Health Strategies, Inc. 1986 AHS-1986F3 ADMINISTRATIVE SERVICES EXHIBIT Alta shall provide the following administrative services: 1. Respond to all telephone and mail inquiries from Plan participants regarding Plan benefits available to them and their dependents. 2. Provide information concerning the Plan benefits and participant eligibility requirements to all providers and partici- pants based on information provided by the Plan Sponsor. 3. Receive and review claims and claim documents submitted persuant to the Plan and verify claimant's eligibility for benefits based on eligibility requirements and information provided by the Plan Sponsor. 4. Review and analyze all claims and determine whether the charges of health care providers submitted are within reasonable payment guidelines and/or related to diagnostic related groups, preferred provider organization agree- ments or other industry standards. 5. Correspond with claimants if additional information is needed for processing their claims. 6. Ascertain from claimants whether other coverage, such as other benefit plans, insurance plans, health maintenance organizations and government sponsored plans exist, which might pay the claim in whole or in part. 7. Process, issue and distribute checks, drafts, and explanations of benefits to Plan participants, hospitals, doctors, Plan Sponsor, or others as applicable and document such disbursements. 8. Furnish Alta's standard internal forms and coordinate with the Plan Sponsor the design and printing of claim forms, ID cards, and other supplies designed specifically for the Plan. 9. Notify claimants in writing of claims determined to be ineligible, indicating the reasons for such determinations. 10. Provide the Plan Sponsor with the following claims reports in accordance with Alta's standard procedures and schedule—— A. Claim analysis by line of coverage and total B. Claim list by participant C. Coordination of benefits savings D. Incurred claim lag study E. Claims pending reports F. Cash transaction register G. Report to Internal Revenue Service regarding payment to health providers 11. Provide the Plan Sponsor with any data maintained by Alta required for preparing reports and filings under"ERISA". 12. Attend meetings with Plan Sponsor as reasonably requested by Plan Sponsor and as necessary for proper admini- stration of the Plan. 13. Instruct the Plan Sponsor on reporting employees' eligibility to Alta. © Copyright Alta Health Strategies, Inc. 1986 AHS-1986AE1 STANDARD TERMS AND CONDITIONS 1. Investment Records. If requested by the Plan Sponsor, Alta shall prepare and maintain records of the investment of the Plan's funds and assets based upon information provided to Alta for this purpose by the Plan Sponsor. 2. Professional Services. Except as otherwise specifically provided in any services Exhibit attached hereto, Alta shall not provide any legal services to the Plan nor shall it be responsible for providing the services of an independent accountant or auditor. 3. Additional Services. Without the prior written approval from Alta, the Plan Sponsor shall make changes in the Plan effective only on the anniversary dates of the documents governing the Plan, unless otherwise required by applicable law or regulation. In the event such changes require additional services to be performed by Alta, the cost of such services shall be borne by the Plan Sponsor, and the Plan Sponsor agrees to pay such costs upon receipt of an invoice for such services from Alta. 4. Books and Records. Alta shall maintain all records pertaining to the services to be performed by it hereunder. Alta shall disclose the information in such records only to the Plan Sponsor, or, as designated in writing by the Plan Sponsor, to the Plan Sponsor's designee, or to a person who has obtained an order of a court of competent jurisdiction requiring such disclosure. Upon termination of this Contract, Alta shall deliver to the Plan Sponsor, upon written request within a time period mutually agreeable, but in no event greater than six months from the date of termination, information on all claim histories for the two years immediately preceding the termination of this Contract if Alta has provided administrative services under this Contract and/or all files and documents pertaining to consulting services if Alta has provided consulting services under this Contract. If such information on claim histories is so requested, the Plan Sponsor agrees to pay all costs incurred by Alta in providing such information and records, including, but not limited to, the costs of programming, computer changes and mailing. Such information shall be provided on magnetic tape with industry standard labels, and will be in the standard format of Alta's database. If additional information is requested by the Plan Sponsor subsequent to the termination of this Contract, Alta shall take reasonable steps to provide such information, and the Plan Sponsor agrees to pay all costs incurred by Alta in providing such information, including, but not limited to, the costs of program- ming, computer changes and mailing. Alta shall be entitled to retain copies of all such records at its own expense. 5. Independent Contractor. It is understood and agreed by the parties hereto that Alta is engaged to perform under this Contract as an independent contractor. 6. Assignments. Alta shall not assign nor delegate to any other person or entity the duties, obligations or responsibilities imposed upon it by this Contract without the prior written approval of the Plan Sponsor. 7. Entire Agreement; Amendments. This Contract including the exhibits hereto and any amendments hereto contains the entire agreement between the parties, and all prior proposals, discussions and writings by and between the parties and related to the subject matter hereof are superseded hereby. This Contract may be modified or amended only pursuant to a written instrument executed by both parties hereto. 8. Invalidity. If any provision of this Contract or any portion thereof is declared invalid or unenforceable, the remaining provisions shall nevertheless remain in full force and effect. 9. Force Majeure. Notwithstanding any provision of this Contract to the contrary, neither Alta nor the Plan Sponsor shall have any liability to the other for a failure of performance resulting from any cause beyond its control. 10. Enforcement; Overpayments. Alta shall have neither the responsibility nor the obligation to take any action, legal or otherwise, against the Plan Sponsor or any participant in the Plan or other person to enforce the provisions of the Plan. In the event that the Plan Sponsor desires to engage the services of Alta for such purposes, such services shall be engaged in and rendered only pursuant to a separate written agreement between the parties. Alta shall use reasonable efforts to recover any loss resulting from an error in the processing of any claim under the Plan, but shall not be required to initiate legal proceedings for such purpose. 11. Expenses. Except as specifically otherwise provided in this Contract, the Plan Sponsor shall be solely responsible for the normal and usual costs and expenses incurred in providing the services contemplated. Alta shall be responsible for paying the costs and expenses incurred in connection with the maintenance and operation of its facilities. The Plan Sponsor, unless payment is made by the Plan, shall be responsible for the payment of all costs attributable to professional services contracted for in connection with administration of the Plan whether contracted by the Plan Sponsor or by Alta at the direction of the Plan Sponsor. 12. Plan Sponsor. Unless the context requires otherwise, the term "Plan Sponsor" as used in this Contract shall include any corporation, partnership or other entity or individual sponsoring the Plan or trustees of the trust sponsoring the Plan serving at the time of execution of this Contract and shall also include the trustees serving from time to time during the term of this Contract, provided, however, that when this Contract calls for direction or notice to be given to Alta by the Plan Sponsor, Alta shall be absolutely protected in relying upon any direction or notice received from the person described as the Plan Sponsor in the introductory paragraph of this Contract. co Copyright Alta Health Strategies, Inc. 1986 AHS-1986ST&C Hello