HomeMy WebLinkAbout992841.tiff RESOLUTION
RE: APPROVE GROUP MASTER CONTRACT FOR HEALTH CARE PROGRAM AND
AUTHORIZE CHAIR TO SIGN - BLUE CROSS AND BLUE SHIELD OF COLORADO
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 a Group Master Contract for the Health
Care Program between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, and Blue Cross and Blue Shield of Colorado,
commencing January 1, 2000, with further terms and conditions being as stated in said
contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Group Master Contract for the Health Care Program between
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, and Blue Cross and Blue Shield of Colorado be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 29th day of November, A.D., 1999.
BOARD OF COUNTY COMMISSIONERS
aor D COUNTY, CO O
NN
ATTEST: ✓ % vr‘O'
��es� rrr .ev r'a a K. Hall, Chair
Weld County Clerk to theioaa.4( t'� =� J.
Diu►►` b/
yr
rb a J. Kirkmeye Pro-Ter
Deputy Clerk to the Board - 00
Geor e . Baxter
APPROVED AS TO FORM:
M.
.. Geile
' my Attor y — `/ y'
Glenn Vaad
PE0015
992841
Qa BlueAdvantage Addendum To Application For BlueAdvantage
% From HMO Colorado
a a An Independent laeenoerol ho,
Blue Crass and Blue ShirW Assuoulion GROUP NU ER ANNIVERSARY MONTH ADDENDUM FFECTIVE DATE
UnaCI (—I I—f-d1Gfl
PLEASE PRINT FIRMLY TO ENSURE THAT ALL COPIES ARE LEGIBLE.DO NOT TYPE—DO NOT TEAR FORM APART
Complete all information on this Addendum to Application for BlueAdvantage(Addendum)if you are completing the Application for BlueAdvantage.
If you have previously submitted an Addendum,complete only information that is relevant to the change.If a change is not indicated,the previous
Addendum will remain in effect.
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This Addendum is issued to:Weld County Government
("THE EMPLOYER"—CORRECT LEGAL NAME OF ACCOUNT)
This Addendum amends provisions of the Application.If we approve this Addendum,we will return the approved Addendum with the effective date
completed. The Addendum will become a part of the Contract. If we do not approve this Addendum, it will be returned. Other than specifically
amended herein,the terms and provisions of the Application and Contract shall remain in full force and effect.
CLASSIFICATION OF EMPLOYEES ELIGIBLE The Employer requires that all eligible Employees have a regular work week of at least
20 hours per week(minimum of 24 hours per week). Eligible Employees do not include those on a temporary or substitute basis. If
other Eligibility,please explain
The Employer hereby certifies the following number of Employees in each category below:
Total Employees employed by the employer working at least 24 hours per week(include those not yet eligible) Enrolling for coverage
Total Eligible Employees who have met probationary period Enrolled elsewhere
COBRA or Colorado State law continuation of coverage enrollees No other coverage
Other,please explain:
DEPENDENTS—Unmarried dependent children are covered until the end of the month in which they become age 19,or 25 if financially dependent
upon the parent.
PROBATIONARY PERIOD
1"of the month following first full pay period worked,employer assigns effective date.
GROUP HEALTH COVERAGE APPLIED FOR(select only one):
BlueAdvantage HMO Plan Plan No. 15-1-15/25/40#of Employees enrolling
BlueAdvantage Point of Service Plan No. 15-1-15/25/40$250 deductible#of Employees enrolling
BlueAdvantage Custom Plus Deductible $200 single$400 family Coinsurance 80%to$5,000/$10,000 #of Employees enrolling
Eighteen months pre-existing clause for late entrants with no prior coverage for the Custom Plus.
OPTIONAL GROUP BENEFIT INFORMATION
❑ Optional Chemical Dependency Rehabilitation Program
❑ Other Eye Health Network eye exam once every 24 months
REMARKS Retirees age 55 through 64 will have an option to continue health insurance coverage until the date their age changes to 65,provided
they meet the following criteria and stipulations:
a) Eligible employees must retire from county service with at least ten years of service,or be a county elected official for at least one full four-year
term.
b) Eligible employees must be enrolled in the county's health insurance plan at the time of retirement or leave of county office.
c) Dependent coverage will be provided for eligible employees dependents who are enrolled at the time of retirement or leaving of county office.
d) Coverage for the eligible employee and dependents will only be provided until the employee reaches age 65, or becomes eligible for health
insurance coverage with another employer, or becomes eligible for Medicaid gp Medicare coverage before attaining the age of 65. Dependent
coverage if still applicable will be offered under the same terms of COBRA offered employee's dependents.
e) The county will offer to the retirees the same coverage at the same rates as regular county employees at the same time. The county will be
responsible for paying the 40%surcharge of the premium,and the county contribution for the employee and dependents in the same manner
as provided regular employees.
f) After COBRA,dependents will have the same conversion rights as regular employees and dependents.
The Employer understands that if we approve this Addendum,the employer agrees to be bound by the terms of the Contract and this Addendum.
Dated U this ,.72q dayof AJOAJL'rnh-tfl 1999
By qq CUI',� �'h ial 2 , i3a Ube la tl) untc5.01Pity
j SIG T E OF AU. HORIZED PERSON TITLE
Approved anacce, e O coil ado`+ :J'Cross a Blue.Shield of Colorado 99p
By .,� -:f c Date SOUV 1 5 1999
CNT—H ORADO
By `•+ � , Date NOV 1 5 1999
CHIEF EXEC IVE OFFICER—BLUE CROSS AND BLUE SHIELD OF COLORADO
Weld County Govt
992841
Act, BlueAdvantage Application For BlueAdvantage QQQ ti From HMO Colorado' INTERNAL USE ONLY
An Independent Licensee of the Blue Cross GROUP NUMBER ANNIVERSARY MONTH CONTRACT EFFECTIVE DATE
® and Blue Shield Association C0772e 1-1 1-1-2000
PLEASE PRINT FIRMLY TO ENSURE THAT ALL COPIES ARE LEGIBLE. DO NOT TYPE—DO NOT TEAR FORM APART
Application for BlueAdvantage(Application)group coverage is hereby made for eligible Employees of the Employer. If this Application is
approved by HMO Colorado and Blue Cross and Blue Shield of Colorado(if applicable),this coverage will be issued to:
("THE EMPLOYER"—CORRECT LEGAL NAME OF ACCOUNT)
(PHYSICAL ADDRESS—STREET,CITY,STATE,ZIP CODE)
(MAILING ADDRESS—IF DIFFERENT)
NOTE: 'We,""Us,"and"Our"refer to HMO Colorado.For group sizes of 51 or more Employees,BlueAdvantage is federallyqualified in Adams,
Arapahoe,Boulder,Clear Creek,Crowley,Denver,Douglas,El Paso,Fremont,Gilpin,Huerfano,Jefferson,Larimer,Otero,Pueblo,Teller and
Weld counties.For groups with 51 or more employees,countiesnot listed are not federally qualified.For group sizes of 50 or fewer Employees,
BlueAdvantage is a not a federally qualified HMO product.When the product is not federally qualified,BlueAdvantage coverage can differ from
those required by federal HMO laws and regulations.'We, "Us,"and"Our"also refers to Blue Cross and Blue Shield of Colorado if coverage is
provided for BlueAdvantage Custom Plus coverage.
IN CONSIDERATION of the submission of this Application by the Employer, approval thereof by us, and of the payment of premiums in
accordance with the Group Master Contract(Contract),we agree to provide group coverage as described in the Contract,the Benefit Booklet,
and this Application and the Addendum to the Application for BlueAdvantage(Addendum),for any eligible enrolled Employees and eligible
enrolled dependents,and the Employer agrees to abide by the terms,conditions,and limitations contained in such documents.
GENERAL AGREEMENT
I. NATURE OF BUSINESS(please be specific):
Type of organization: 0 Proprietorship'24Corporation 0 Partnership
2. Do you have current coverage in force?!Q Yes 0 No,if"Yes"do you intend to cancel that coverage? 0 Yes 0 No. If you are applying for
or retaining other group health coverage in addition to this coverage on some or all Employees specify coverage(s),Carrier,amounts,and
give details:
3. Do you intend to enroll retirees under this group health Plan?(Retirees may enroll for coverage if there are 51 or more Employees enrolled
under this coverage.) /Yes 0 No If"Yes,"give details:
4. CONTRIBUTION—The Employer will be required to contribute a minimum of 50%toward the Employee's single or 50%of the Employees
portion of the family-cost of membership premiums.
5. PREMIUMS—It is understoodthat the premiums quoted change based on the actual enrollment of the group.Premiums will be billed
by us monthly,and will be reviewed in accordance with fife Contract and State or Federal requirements.
6. CLASSIFICATION OF EMPLOYEES ELIGIBLE—All eligible Employees of the Employer who have a regular work week as stated on the
Addendum,shall be eligible to enroll.If the Employer reduces the working hours of such Employees to less hours per week than stated on
the Addendum,coverage will be continued for such Employees and their dependents under the same conditions and for the same premium,
if the following conditions are met and the Employer so certifies:
(a) The covered Employee has been continuously employed as an Employee of the Employer and has been insured under the group
Contract,or under any group Contract providingsimilarbenefits which said group Contract replaces,for at least six months immediately
prior to such reduction in working hours;
(b) The Employer has imposed such reduction in working hours due to economic conditions;and
(c) The Employer intends to restore the Employee to a full work week schedule as soon as economic conditions improve.
7. ENROLLMENT PERCENTAGE REQUIREMENTS— For all size groups to apply for and retain group coverage and rates if we are the sole
carrier,the Employer agrees to maintain the following enrollment percentage requirements,based on TOTAL ELIGIBLE EMPLOYEES:
• Group size 50 or fewer Employees must have 75%enrollment based on NET ELIGIBLE EMPLOYEES
• Group size 5I or more Employees must have 75%enrollment based on NET ELIGIBLE EMPLOYEES,with no less than 50%of TOTAL
ELIGIBLE EMPLOYEES.
To arrive at NET ELIGIBLE EMPLOYEES.Employees covered elsewhere with the following types of groupinsurancemay be excluded,unless
uch coverage is offered through THE EMPLOYER:
A Blue Cross and Blue Shield Plan.
A Health Maintenance Organization;
The Federal Employees Program;
Indian Health Services;
Federal Peace Corps;
Colorado Uninsurable Health Insurance Plan,or
Through a commercial carrier.
BLU228M.WPD FORM NO.96064(REV.11/97)
NOTE: In the event the group does not meet the minimum enrollment requirements,we reserve the right to accept this Application with
prior underwriting approval.
In ail cases the Employer must meet the minimum enrollment and eligibility requirements according to HMO Colorado underwriting
regulations and policies and Colorado State law.
If we are a dual carrier,to apply for and retain group coverage and rates,a minimum of three Employees must be enrolled at all times.When
we are a dual carrier,the enrollment percentage requirements do not apply
If the number of eligible Employees enrolled does not comply with the required percentage,we reservethe right to cancel the Contract upon
thirty day advance written notice.
Employers with 50 or fewer Employees may also be,sole proprietor's,a single full time Employee of a subchapter S or C corporation,
limitedliabilitycompany,or a partnership that has carried on significant business activity for a period of at least one year prior to application
for coverage.
The Employer agrees and warrants that no person who is not an eligible member under this provision will be listed,named,or otherwise
represented by it in any way to be an eligible member,and that the Employer will not remit membership premiums for any such person
or participant or assist in obtaining or maintaining a Benefit Booklet for such ineligible person. The Employer agrees to maintain complete
records and to furnish to us,upon request,such information as may be requested by us for our underwriting review. The Employer further
agrees to permit a payroll audit by us or by a representative appointed by us.This may include a request for business tax records.
8. DEPENDENT—Dependent children are covered until they attain the age as stated on the Addendum.
9. PROBATIONARY PERIOD—Probationary period selection is as stated on the Addendum.There will be one open enrollment on the group's
Anniversary Date for the BlueAdvantage HMO Plan and/or BlueAdvantage Point-of-Service Plan. For BlueAdvantage Custom Plus, late
entrants with prior coverage can be added at the group's anniversary date.In addition,if BlueAdvantage Triple Option coverage is selected
by the Employer,members will be allowed to choose between the HMO Plan,Point-of-Service,and Custom Plus coverage(for Employers
with 50 or fewer employees only out-of-state employees can enroll in the Custom Plus).
10. GROUP HEALTH COVERAGE APPLIED FOR—Coverage selection is as stated on the Addendum.
COLORADO INSURANCE LAW REQUIRES ALL CARRIERS IN THE SMALL GROUP MARKET TO ISSUE ANY
HEALTH BENEFIT PLAN IT MARKETS IN COLORADO TO SMALL EMPLOYERS OF 2-50 EMPLOYEES,
INCLUDING A BASIC OR STANDARD HEALTH BENEFIT PLAN,UPON THE REQUEST OFA SMALL EMPLOYER
TO THE ENTIRE SMALL GROUP,REGARDLESS OF THE HEALTH STATUS OF ANY OF THE INDIVIDUALS IN
THE GROUP.BUSINESS GROUPS OF ONE CANNOT BE REJECTED UNDERA BASIC OR STANDARD HEALTH
BENEFIT PLAN.
1 I. Employer represents,agrees,and warrants that the Employer is in compliance with all applicable local,state,and federal laws,rules and
regulations,including but not limited to COBRA,the Family Medical Leave Act,TEFRA, DEFRA, and OBRA.To the extent any part of this
application is inconsistent with such laws,rules,and regulations,such provision shall not be deemed a part of this application.However,
the application shall be otherwise enforceable.If the Employer has agreed to have us perform specific billing and notificationduties related
to COBRA,such information will be stated on the Addendum.
BROKER TELEPHONE NUMBER
STREET,CITY,STATE,ZIP CODE
The Employer represents,agrees,and warrants that the information contained in this Application is true and correct and forms an essential basis
for our issuance of Contract.EVEN THOUGH THIS APPLICATION IS SUBMITTED WITH PROPOSED PREMIUMSOROTHERFUNDS,THERE
WILL BE NO COVERAGE UNTIL THIS APPLICATION IS APPROVED BY US. If we approve this Application,we will send you a Contract of
which this Application will become a part.Your prior coverage should not be cancelled until you have been notified that your Application has
been accepted.No agent can bind coverage,set an effective date,or waive or alter any provision of this Application.The Contract will specify
the effective date of group coverage. If we do not approve this Application,the submitted funds will be returned to the Employer.
The Employer understands that if we approve this Application,the Employer agrees to be bound by the terms of the Contract.
Datedat Pi,, Z to 1 _ V this cJ day of /llUV-ein k(.rz '19 el
By \I'>,- 41A-124 Brl Weld L'L 6;44inflSs) elt .
R OF AUTHORIZED PERSON TITLE
Approved anrd accept-. • H O 'rad:,, .e Cross BIii Shield of Colorado
By '46�" �,w� Date
,I' 044 y7•'s LORA lii of ,
By Date
CHIEF EXECUT E • FICER—BLUE CROSS AND BLUE SHIELD OF COLORADO
BW228M.WPD FORM NO.96064(REV.11/97)
A Group Health
Care Program
Group Master Contract
HMO
ppp Colorado
® An Independent Licensee of the
Blue Cross and Blue Shield Association
HMO COLORADO
GROUP MASTER CONTRACT
TABLE OF CONTENTS
Page No.
SECTION I. APPLICATION—ACCEPTANCE 1
SECTION II. GENERAL AGREEMENTS 1
Contract effective date
Anniversary date
Employee
Employer 1
Remittance 1
Benefit booklet 1
Group administrator 2
Assignment 2
Contract provision changes 2
Notices 2
Governing Laws 2
Attorneys' fees and expenses 2
Enforcement of the contract 3
Interpretation of the contract 3
Termination of the contract 3
Reinstatement of contract 3
SECTION III. PREMIUM: CHANGES, PAYMENT, TERMINATION FOR NON-PAYMENT,
REFUND OF MEMBERSHIP PREMIUM, CASHING OF CHECK NOT ACCEPTANCE 4
Changes 4
Payment 4
Termination for non-payment 4
Refund of membership premium 4
Cashing of check not acceptance 5
SECTION IV. MEMBERSHIP/APPLICATION 5
Eligibility 5
Notification of cessation of membership 5
Acceptance of contract 5
Group eligibility requirements 5
6LUH 119QCOC
HMO COLORADO
GROUP MASTER CONTRACT
NO. 00-00772001
For
Weld County Government
Employer
C07720
Group Number
SECTION I. APPLICATION ACCEPTANCE
The application and addendum for group health coverage ("application/addendum") executed by the
employer has been accepted by HMO Colorado(sometimes referred to as "we," "us," and "our"). Such
application/addendum and their contents are incorporated in this group master contract("contract").
In the event of any inconsistency between the terms of the application/addendum and the terms of
the contract, the terms of the contract will control.
SECTION II. GENERAL AGREEMENTS
The purpose of this contract is to provide under the circumstances specified herein health and
hospitalization benefits to certain of the employer's employees and their dependents. Such persons,
when covered hereunder, are referred to as "members."
1. Contract effective date. The effective date of the contract shall be 12:01 A.M. on the first day
of January, 2000, at Denver, Colorado; the contract shall continue to remain in effect on an
annual basis from year to year thereafter unless terminated in accordance with the provisions
of the contract.
2. Anniversary date. The anniversary date is the effective date for (i) coverage; (ii) changes to
group enrollment and benefit eligibility implemented by the employer; and(iii)the date a group
is due for appropriate renewal rating.
3. Employee. An employee as defined in the application/addendum as eligible for enrollment; the
employee is the individual who is employed by the employer.
4. Employer. The employer or organization with whom HMO Colorado has contracted, and by
reason of the contract the employees and their dependents become eligible for the coverage and
benefits described in the contract.
5. Remittance.The employer shall pay to us monthly and prior to the first day in each month, the
required premium on behalf of all enrolled employees and dependents who meet the eligibility
requirements specified in the group application/addendum and benefit booklet that are
incorporated in this contract.
6. Benefit booklet. The definitions and other terms of the benefit booklet are incorporated herein
by reference.
iei.u11119G oc 1
7. Group administrator. The employer will designate a person as the principal contact for all
matters pertaining to HMO Colorado group coverage. That person will assist employees in the
administration and payment of claims. It is understood that HMO Colorado is not the
"administrator" within the meaning of the Employee Retirement Income Security Act (ERISA).
8. Assignment.None of the rights,benefits,duties,or obligations of the employer shall be assigned
without the prior written consent of a duly authorized officer of HMO Colorado. Any attempted
assignment will be void.
9. Contract provision changes.
a. This contract, the benefit booklet and any amendments thereto, and the group
application/addendum constitute the entire agreement between the parties hereto and
supersede all other contracts, either oral or in writing, between the parties with respect to
the subject matter hereof. No course of action, usage or custom or internal policy of HMO
Colorado may amend or become a part of this contract. Except as provided in paragraphs b.
and c. immediately below,no change or modification to this contract shall be valid unless the
same is in writing and signed by the parties hereto.
b. During the initial annual term or any renewal annual term of the contract, the provisions
of this contract may be amended at any time by an endorsement signed only by a duly
authorized officer of HMO Colorado. When the endorsement has been so signed, the
endorsement shall be deemed a part of the contract, effective as of the date specified by the
endorsement.
c. Any amendment resulting from state or federal law, or regulation, or ruling or approval by
the Commissioner of Insurance of the State of Colorado may be made at any time by
endorsement to the contract signed only by a duly authorized officer of HMO Colorado and
shall become effective as of the effective date of such law, regulation, ruling, or approval.
10. Notices. All notices to HMO Colorado shall be sent by United States mail or personal delivery
to HMO Colorado, 700 Broadway, Denver, CO 80203-3441. All notices to employees or the
employer shall be sent by United States mail to the last address appearing in the records of HMO
Colorado or by personal delivery to the office of the employer.The employer shall notify members
in the event that this contract is terminated within ten (10) days of the date that the employer
has notice that this contract is to be or has been terminated, whichever occurs first. If the
employer has engaged the services of a broker/consultant, then delivery of all notices to the
named broker/consultant meets the requirements of this contract. Notice shall be effective upon
mailing.
Notice mailed to the employer or broker/consultant shall be deemed effective notice to each
employee. However, the employer agrees to post each notice promptly in a place reasonably
calculated to facilitate the employees' reading of the notice. The employer agrees to hold us
harmless for its failure to provide notice to the employees of any contract provision changes or
termination.
11. Governing Laws. This contract is made and delivered in the State of Colorado, and will be
interpreted and enforced so as to remain in compliance with Colorado statutes and regulations.
Nothing contained herein shall be interpreted to mean that HMO Colorado is doing business in
any other state of jurisdiction. Any legal action against us must be brought in the City and
County of Denver, Colorado.
12. Attorneys' fees and expenses.
a. Should it become necessary for either party to this contract to seek the assistance of an
attorney for the purpose of litigating or arbitrating any action against the other party arising
2 HLllH1196DOC
from any part of the contract,the prevailing party shall be entitled to recover from the losing
party its reasonable attorneys' fees. In addition, the prevailing party shall be entitled to
recover from the losing party all other reasonably incurred costs and expenses.
b. The Employer shall indemnify and hold harmless HMO Colorado from its costs including
losses, claims, settlements,judgments, or fees, including attorneys' fees and other litigation
costs,and our internal costs if such costs were incurred by us by our participation in lawsuits
or arbitration proceedings related to the obligations undertaken or acts performed by us
under this contract. However, except for costs incurred by us in participating in lawsuits or
arbitration proceedings brought by persons who are ineligible for coverage hereunder, the
employer's obligation to indemnify us shall apply only to costs incurred after this contract
has been cancelled or terminated.
13. Enforcement of the contract. Failure of HMO Colorado or the employer to enforce any of the
provisions of this contract shall not constitute a waiver of rights for that or subsequent breaches.
14. Interpretation of the contract.This contract shall not be interpreted against any party for the
reason of having prepared its language and provisions.Rather,it shall be construed so as to effect
the purposes of the parties in a manner consistent with the terms of this contract and sound
principles of contract interpretation.
15. Termination of the contract.
The employer may terminate the contract at any time during its term upon giving 30 days
advance written notice of termination to HMO Colorado. A group which voluntarily cancels
coverage will not be considered for re-enrollment until a two-month period has elapsed from the
date of cancellation.Such re-enrollment shall be subject to then current operating procedures and
underwriting regulations of HMO Colorado.
HMO Colorado may terminate the contract at any time during its term for(i) employer's failure
to make timely payment of amounts due hereunder, (ii) failure of the group to meet eligibility
requirements, (iii) failure of the group to maintain enrollment percentage requirements, as
provided in the application/addendum, or (iv) misrepresentation of material facts or any other
breach of the contract; any such termination shall be subject to the terms of the contract and any
endorsements.
16. Reinstatement of contract.HMO Colorado, at its sole option,may reinstate this contract after
it has been terminated. We may impose such conditions on the contract's reinstatement as we
deem appropriate, including,without limitation, acceptable health statements. It is understood,
however, that there is no right to reinstatement, and any reinstatement will be in the sole
discretion of HMO Colorado.
Bum nec roc 3
SECTION III. PREMIUM: CHANGES, PAYMENT,
TERMINATION FOR NON-PAYMENT,
REFUND OF MEMBERSHIP PREMIUM,
CASHING OF CHECK NOT ACCEPTANCE
1. Changes.HMO Colorado may change monthly premium as outlined in any endorsements to this
contract.
HMO Colorado reserves the right to review monthly premium whenever a group, section, or
classification of employees is added to or deleted from enrollment under the contract. The
employer shall notify HMO Colorado no later than 30 days prior to the effective date of such
addition or deletion, and any change in monthly premium which may be required as the result
of an increased or decreased total group enrollment will become effective on the same date as
such addition to or deletion from total enrollment under the contract. This provision shall apply
regardless of the employer's normal rate review date or any other advance rate notification
agreement which may be in effect between HMO Colorado and the employer.
2. Payment. Initial premium shall become payable on or before the effective date of the contract.
Subsequent premium shall be payable on or before the first of each month thereafter. Eligibility of
members, claims processing, and payment will be suspended if premium is not timely paid. In no
event shall coverage under the contract become effective until we accept the
application/addendum and payment of the initial premium is received by HMO Colorado.
3. Termination for non-payment. The contract shall terminate by its own terms if premium is
not paid on or before 30 days after the first day of the month, and no notice of cancellation other
than this provision shall be required. However,we may by sending notice thereof terminate this
contract before 30 days after the first day of the month if premium is not paid on or before the
first day of the month. When the contract is terminated or cancelled, the effective date of such
cancellation or termination shall be the date to which membership premium was last paid.
Members shall no longer be eligible to receive covered health services and all claims shall be
refused when dates of service are beyond the last day of the month for which payment has been
received. Claims that we deny because the employer fails to submit premium payments in a
timely manner should be submitted for payment to, and may be the responsibility of, the
employer.
4. Refund of membership premium.
a. If the employer terminates the coverage of a member or terminates this contract for any
reason, a refund of membership premium paid beyond the first of the month following the
termination date will be granted only if written notification of termination is received by
HMO Colorado at least 30 days before the termination date,covered health services have not
been provided and benefit payments have not been made for services rendered subsequent
to the termination date. If notification of termination is received less than 30 days before the
termination date, no refund of membership premium will be made and coverage shall cease
on the first of the month following the termination date.
b. If HMO Colorado terminates coverage of a member or terminates this contract for any
reason, a refund of membership premium paid beyond the termination date will only be
granted if covered health services have not been provided and benefit payments have not
been made for services rendered subsequent to the termination date.
4 eLc11119c coc
5. Cashing of check not acceptance. It is understood that negotiation and deposit of checks sent
to us shall not be deemed to be acceptance by us of such payment, nor shall such negotiation and
deposit of the check prevent us from later returning such payment by issuance of a check for the
amount of the check to us.
SECTION IV. MEMBERSHIP/APPLICATION
1. Eligibility.All employees,who have a regular work week as indicated on the application and/or
addendum, paid for such employment by the employer, and listed as an employee on the
employer's State unemployment insurance tax returns,and the dependents of the employees,are
eligible to enroll for membership under the contract. We may inspect such records, public and
private, as are necessary to verify employment.
Applications of employees and dependents at open enrollment must be received prior to the
anniversary date to be effective on the anniversary date. If applications are not received prior
to the anniversary date, they will not be effective until the next anniversary date.
2. Notification of cessation of membership. The employer shall advise us when the employer
has notice that a member is no longer employed by the employer or otherwise does not satisfy
membership requirements. The employer shall so notify us, at the latest, by the first day of the
month after a member ceases to be employed by employer or otherwise ceases to meet
membership requirements. Such coverage shall terminate at the end of the month in which the
member is no longer employed or does not satisfy membership requirements. The employer
agrees that no person will be kept on the employer's payroll or otherwise be represented as an
employee of the employer for the purpose of obtaining or maintaining coverage when no longer
eligible for such coverage hereunder. The employer agrees to observe the terms thereof, and hold
us harmless for all costs incurred, including attorneys' fees, in the defense of any claim or suit
brought at any time by a person who is ineligible for coverage.
3. Acceptance of contract.The employer's signature on the group application/addendum and this
contract constitutes acceptance of this contract.
4. Group eligibility requirements. If the employer does not comply with the group eligibility
requirement, we reserve the right to cancel the contract upon 30 days advance written notice.
Weld County Government HMO COLORADO
(Group Name
By \ By
13C.- E i t C. David Kikumoto
Printed or Typed Name Printed or Typed Name
(Title) ( f+t , —8 c - I2/el A) outfit,ss,cnd/ (Title) President
(Date) l //2y/ `/ (Date) November 15, 1999
HUH 119G roc 5
aoa HMO
•
® Colorado
An Independent Licensee of the Blue Cross and Blue Shield Association
HMO Colorado
700 Broadway
Denver, Colorado 80203
ENDORSEMENT NO.: 1
TO GROUP MASTER CONTRACT NO.: 00-00772001
The Contract identified above is hereby amended by this endorsement which is issued to form part
of the Contract between HMO Colorado(HMOC) and Weld County Government(the Employer),
effective as of the Contract Effective Date as follows:
For the period beginning on the Contract Effective Date(January 1,2000)and ending on December
31, 2001, paragraph 1. Changes of Section III. Premium: Changes, Payment, Termination For
Non-Payment, Refund of Membership Premium, Cashing for Check Not Acceptance of the
Contract, shall be replaced in its entirety with the following provision:
1. (a) Subject to the provisions of subparagraph (c), below, the premiums specified in Exhibit
A to this endorsement shall remain in effect for a period of 12 months from the Contract
Effective Date.
(b) For the second year of this Contract, i.e., the period commencing the first day of the 13th
month of this Contract through the last day of the 241h month of this Contract, HMOC may
increase the premiums due by not more than 14.84%above the required rate increase of
27.9%for the first year of this Contract. In the event the premiums due are adjusted under
subparagraph (c) (i, ii), below, during the first year of this Contract, the maximum
premium increase allowed shall be 14.84%above the required rate increase of 27.9% for
the first year of this Contract as adjusted. The rate calculation for this period will include
a 5%margin. The 14.84%maximum increase is inclusive of the 5% margin requirement.
BCBSC shall advise the Employer of the second-year premium rate at least 60 days prior
to its implementation, and subject to the provisions of subparagraph (c), below, such
premium shall remain in effect throughout the second year of this Contract. .
(c) Notwithstanding the provisions of subparagraphs(a) and (b), above, HMOC may change
the monthly premiums due hereunder, effective immediately, whenever (i) benefits are
changed by endorsement or by federal or state law; or (ii) the number of Employees
covered under the Contract in any given month differs from the number of Employees
covered under the Contract as of the Contract Effective Date by 20% of enrollment.
(d) For the period beginning on the Contract Effective Date, the Employer shall remit an
advanced check for premiums of $200,000 to HMOC/BCBSC upon signature of this
Endorsement or no later than January 15, 2000. This payment will be used to offset the
required rate increase of 27.9%to decrease the billed premium rates for a rate increase of
17.0% for the period of January 1, 2000 through December 31, 2000.
2. For the period beginning on the Contract Effective Date (January 1, 2000) and ending on
December 31, 2001, paragraph 15. Termination of Contract of Section II. General
Agreements, of the Contract shall be amended by adding the following sentence to the end
of the second paragraph:
"Notwithstanding the foregoing,HMOC agrees not to terminate this Contract solely
because of poor claims experience of Employees and Dependents covered under
this Contract."
3. Effective on the earlier of(i) any date on which HMOC changes the premiums due hereunder
in accordance with the provisions of subparagraph I(c)(ii) of Section III of the Contract, as
amended above, or (ii) two years from the Contract Effective Date, the provisions of this
endorsement shall be of no further effect and the original provisions of paragraph 1 of Section
III and paragraph 20. of Section II of the Contract shall be reinstated as if they had never been
Weld County 2'yr Rale Guar.wpd
amended.
4. Except as otherwise specifically amended hereby,all terms and conditions of the Contract shall
remain in full force and effect.
Weld County Government HMO ORADO
(Group Na )
ByJ � • By
\
-)ra I E I y I / C. David Kikumoto
//V�
GM(
�� Printed or Typed Name Printed or Typed Name
l.�'V ( la , 1Jcl t&''ld A1.LmmtSSiunexx5 President 'MeV 4 C 1999
(Title) (Title)
Weld County Ya yr Rate Guar.wpd
Weld County 2°d yr Rate Guar.wpd
A Group Health
Care Program
Group Master
Contract
Blue Cross
pQ� ® Blue Shield
C
da.m
m
An Independent licensee of the Blue Cross and Blue Shield Association
THE BLUE CROSS AND BLUE SHIELD OF COLORADO
GROUP MASTER CONTRACT
TABLE OF CONTENTS
Page No.
SECTION I. APPLICATION—ACCEPTANCE I
SECTION II. GENERAL AGREEMENTS 1
Contract Effective Date 1
Anniversary Date 1
Annual Renewal Date 1
Employee 1
Employer
Remitting Agent 1
Remittance 1
Membership Certificate Terms 2
Group Administrator 2
Assignment 2
Contract Provision Changes 2
Reserve Funds 2
Notices 2
Governing Laws 2
Attorneys' Fees and Expenses 3
Warranties and Representations 3
Enforcement of the Contract 3
Interpretation of the Contract 3
BlueCard Program. 3
Termination of Contract 4
SECTION III. PREMIUMS CHANGES, PAYMENT, SERVICE DATE, TERMINATION FOR NON-
PAYMENT, RETROACTIVE REFUND OF MEMBERSHIP PREMIUM,
CASHING OF CHECK NOT ACCEPTANCE 4
Changes 4
Payment 4
Service Date 4
Termination for Non-Payment 4
Retroactive Refund of Membership Premium 5
Cashing of Check Not Acceptance 5
SECTION IV. MEMBERSHIP/APPLICATION
5
Eligibility 5
Receipt of Applications 5
Notification of Cessation of Membership 5
i
BCB5427C[OC
BLUE CROSS AND BLUE SHIELD OF COLORADO
GROUP MASTER CONTRACT
NO. 00-00772000
For
Weld County Government
Employer
C07720
Group Number
SECTION I. APPLICATION-ACCEPTANCE
The Application for Group Health Coverage("Application")executed by the Employer has been accepted
by Blue Cross and Blue Shield of Colorado (sometimes referred to as "we," "us," and "our"). Such
Application and its contents are incorporated in this Group Master Contract ("Contract"). In the event of
any inconsistency between the terms of the Application and the terms of the Contract,the terms of the
Contract will control.
SECTION II. GENERAL AGREEMENTS
The purpose of this Contract is to provide under the circumstances specified herein health and
hospitalization benefits to certain of the Employer's Employees and their Dependents. Such persons,
when covered hereunder, are referred to as "Members."
1. Contract Effective Date. The effective date of the Contract shall be 12:01 A.M. on the first day of
January, 2000, at Denver, Colorado; the Contract shall continue to remain in effect on an annual
basis from year to year thereafter unless terminated in accordance with the provisions of the
Contract..
2. Anniversary Date.The Anniversary Date is the effective date for(i)enrollment or coverage changes
to the Employee's Membership or(ii)to group enrollment and benefit eligibility implemented by the
Employer.
3. Annual Renewal Date. The date a group is due for rate modification through application of the
appropriate renewal rating formulas.
4. Employee.An Employee as defined in the Application as eligible for enrollment;the Employee is the
Subscriber,and Identification Cards for the Employee and his or her covered Dependents are issued
in the name of the Employee as the Subscriber.
5. Employer. The Employer or organization with whom Blue Cross and Blue Shield of Colorado has
contracted,and by reason of the Contract the Employees and their Dependents become eligible for
the coverage and benefits described in the Contract.
6. Remitting Agent. The Employer agrees to (i) act as remitting agent for the enrolled Members, (ii)
make payroll deductions for that part of premium not otherwise provided for, and (iii) remit all
premiums to us not later than the due date for each remitting period.
7. Remittance.The Employer shall pay to us monthly, in advance, required premiums on behalf of all
enrolled Employees and Dependents who meet the eligibility requirements specified in the
Application.
1
8. Membership Certificate Terms.The definitions and other terms of the Membership Certificate are
incorporated herein by reference.
9. Group Administrator.The Employer will designate a person as the principal contact for all matters
pertaining to Blue Cross and Blue Shield of Colorado group coverage. That person will assist
Employees in the administration and payment of claims. It is understood that Blue Cross and Blue
Shield of Colorado is not the"administrator"within the meaning of the Employee Retirement Income
Security Act (ERISA).
10. Assignment. None of the rights, benefits, duties, or obligations of the Employer may be assigned
without the prior written consent of a duly authorized officer of Blue Cross and Blue Shield of
Colorado. Any attempted assignment will be void.
11. Contract Provision Changes.
a. This Contract constitutes the entire agreement between the parties hereto and supersedes all
other contracts, either oral or in writing, between the parties with respect to the subject matter
hereof. No course of action, usage or custom or intemal policy of Blue Cross and Blue Shield of
Colorado may amend or become a part of this Contract. Except as provided in paragraphs b.and
c.immediately below,no change or modification to this Contract shall be valid unless the same
is in writing and signed by the parties hereto.
b. During the initial annual term or any renewal annual term of the Contract, the provisions of this
Contract may be amended at any time by an endorsement signed only by a duly authorized
officer of Blue Cross and Blue Shield of Colorado. When the endorsement has been so signed,
the endorsement shall be deemed a part of the Contract,effective as of the date specified by the
endorsement.
c. Any amendment resulting from state or federal law, or regulation, or ruling or approval by the
Commissioner of Insurance of the State of Colorado may be made at any time by endorsement
to the Contract signed only by a duly authorized officer of Blue Cross and Blue Shield of Colorado
and shall become effective as of the effective date of such law, regulation, ruling, or approval.
12. Reserve Funds. Neither any Member nor the Employer shall be entitled to share in any reserve or
other funds that maybe accumulated or otherwise owned by Blue Cross and Blue Shield of Colorado,
unless and until a right to share in such funds is granted in writing by the Board of Directors of Blue
Cross and Blue Shield of Colorado.
13. Notices.All notices to Blue Cross and Blue Shield of Colorado shall be sent by United States mail or
personal delivery to Blue Cross and Blue Shield of Colorado, 700 Broadway, Denver, CO 80273. All
notices to Employees or the Employer shall be sent by United States mail to the last address
appearing in the records of Blue Cross and Blue Shield of Colorado or by personal delivery to the
office of the Employer. The Employer shall notify Members in the event that this Contract is
terminated within ten (10) days of the date that the Employer has notice that this Contract is to be
or has been terminated, whichever occurs first. If the Employer has engaged the services of a
broker/consultant, then delivery of all notices to the named broker/consultant meets the
requirements of this Contract. Notice shall be effective upon mailing.
Notice mailed to the Employer or broker/consultant shall be deemed effective notice to each
Employee. However, the Employer agrees to post each notice promptly in a place reasonably
calculated to facilitate the Employees' reading of the notice.
14. Governing Laws. This Contract is made and delivered in the State of Colorado, and will be
interpreted and enforced so as to remain in compliance with Colorado statutes and regulations.
Nothing contained herein shall be interpreted to mean that Blue Cross and Blue Shield of Colorado
is doing business in any other state or jurisdiction.Any legal action against us must be brought in the
City and County of Denver, Colorado.
2
xcesnm CDC
Should any provision of this Contract in any way contravene the laws of Colorado or the United States
of America, such provision shall not be deemed a part of the Contract. However, the Contract shall
be otherwise enforceable.
15. Attorneys' Fees and Expenses.
a. Should it become necessary for either party to this Contract to seek the assistance of an attorney
for the purpose of litigating or arbitrating any action against the other party arising from any part
of the Contract, the prevailing party shall be entitled to recover from the losing party its
reasonable attorneys' fees. In addition, the prevailing party shall be entitled to recover from the
losing party all other reasonably incurred costs and expenses.
b. The Employer shall indemnify and hold harmless Blue Cross and Blue Shield of Colorado from
its costs including losses, claims, settlements, judgments, or fees,including attorneys'fees and
other litigation costs,and our internal costs if such costs were incurred by us by our participation
in lawsuits or arbitration proceedings related to the obligations undertaken or acts performed by
us under this Contract. However, except for costs incurred by us in participating in lawsuits or
arbitration proceedings brought by persons who are ineligible for coverage hereunder, the
Employer's obligation to indemnify us shall apply only to costs incurred after this Contract has
been canceled or terminated.
16. Warranties and Representations. The Employer acknowledges that no warranties or
representations other than those contained in this Contract have been made or given by Blue Cross
and Blue Shield of Colorado or its representatives or, if so given, have not been relied upon by the
Employer.
17. Enforcement of the Contract.Failure of Blue Cross and Blue Shield of Colorado or the Employer to
enforce any of the provisions of this Contract shall not constitute a waiver of rights for that or
subsequent breaches.
18. Interpretation of the Contract.This Contract shall not be interpreted against any party for the reason
of having prepared its language and provisions. Rather, it shall be construed so as to effect the
purposes of the parties in a manner consistent with the terms of this Contract and sound principles
of contract interpretation.
19. BlueCard Program. The calculation of subscriber liability for covered services for claims incurred
outside the geographic area Blue Cross and Blue Shield of Colorado serves and processed through
the BlueCard Program typically will be at the lower of the provider's billed charges or the negotiated
rate Blue Cross and Blue Shield of Colorado pays the on-site Blue Cross and/or Blue Shield Plan.
The negotiated rate paid by Blue Cross and Blue Shield of Colorado to the on-site Blue Cross and/or
Blue Shield Plan for health care services provided through the BlueCard Program may represent
either(i)the actual price paid on the claim,or(ii)an estimated price that reflects adjusted aggregate
payments expected to result from settlements or other non-claims transactions with all of the on-site
Plan's health care providers or one or more particular providers,or(iii)a discount from billed charges
representing the on-site Plan's expected average savings for all of its providers or for a specified group
of providers.
Plans using either the estimated price or average savings factor methods may prospectively adjust
the estimated or average price to correct for over-or underestimation of past prices.
In addition, statutes require Blue Cross and/or Blue Shield Plans in a small number of states to use
a basis for calculating member/subscriber liability for covered services that does not reflect the entire
savings realized or expected to be realized on a particular claim. Thus, when your covered
employees/subscribers receive covered services in these states,their subscriber liability for covered
services will be calculated using these states' statutory methods.
3
20. Termination of Contract.
a. The employer may terminate the contract at any time during its term upon giving 30 days
advance written notice of termination to Blue Cross and Blue Shield of Colorado.A group who
voluntarily cancels coverage will not be considered for re-enrollment until a two-month period
has elapsed from the date of cancellation. Such re-enrollment shall be subject to then current
operating procedures and underwriting regulations of Blue Cross and Blue Shield of Colorado.
b. Blue Cross and Blue Shield of Colorado may terminate the Contract at any time during its term
for (i) Employer's failure to make timely payment of amounts due hereunder, (ii) failure of the
group to meet eligibility requirements, (iii) failure of the group to maintain enrollment
percentage requirements, as provided in the Application, or (iv) misrepresentation of material
facts or any other breach of the Contract.
c. Blue Cross and Blue Shield of Colorado,at its sole option,may reinstate this Contract after it has
been terminated.We may impose such conditions on the Contract's reinstatement as we deem
appropriate, including, without limitation, acceptable health statements. It is understood,
however, that there is no right to reinstatement, and any reinstatement will be in the sole
discretion of Blue Cross and Blue Shield of Colorado.
SECTION III. PREMIUMS CHANGES, PAYMENT,
SERVICE DATE, TERMINATION FOR NON-PAYMENT,
RETROACTIVE REFUND OF MEMBERSHIP PREMIUM,
CASHING OF CHECK NOT ACCEPTANCE
1. Changes.Blue Cross and Blue Shield of Colorado may change monthly premium as outlined in any
endorsements to this Contract.
Blue Cross and Blue Shield of Colorado reserves the right to review monthly premium whenever a
group, section, or classification of Employees is added to or deleted from enrollment under the
Contract. The Employer shall notify Blue Cross and Blue Shield of Colorado no later than 30 days
prior to the effective date of such addition or deletion, and any change in monthly premium which
may be required as the result of an increased or decreased total group enrollment will become
effective on the same date as such addition to or deletion from total enrollment under the Contract.
This provision shall apply regardless of the Employer's normal rate review date or any other advance
rate notification agreement which may be in effect between Blue Cross and Blue Shield of Colorado
and the Employer.
2. Payment. Initial premium shall become payable on or before the effective date of the Contract.
Subsequent premiums shall be payable on or before the established Service Date of each month
thereafter. Claims processing and payment will be suspended if premium is not timely paid. In no
event shall coverage under the Contract become effective until we accept the Application and
payment of the initial premium is received by Blue Cross and Blue Shield of Colorado.
3. Service Date. The Service Date is the 1st or 16th day of the month as established for the group for
billing purposes (the "due date").
4. Termination for Non-Payment.The Contract shall terminate by its own terms if premium is not paid
on or before 30 days after the Service Date, and no notice of cancellation other than this provision
shall be required. However,we may by sending notice thereof terminate this Contract before 30 days
after the Service Date if premium is not paid on or before the Service Date. When the Contract is
terminated or canceled, the effective date of such cancellation or termination shall be the date to
which membership premium was last paid. All claims shall be refused when dates of service are
4
beyond the last"paid-to-date"of coverage according to the records of Blue Cross and Blue Shield of
Colorado.
5. Retroactive Refund of Membership Premium.
a. A retroactive refund of membership premium paid beyond the date of termination will be
granted if written notification is received by Blue Cross and Blue Shield of Colorado at least one
month before the termination date and benefit payments have not been made on behalf of a
Member's claim for services rendered subsequent to the termination date.
b. If notification is received less than one month before the termination date, no refund of
membership premium will be made.
Failure to comply with this provision shall negate any claim by, or on behalf of, the Employer or the
Member for a retroactive refund of membership premium.
6. Cashing of Check Not Acceptance. It is understood that negotiation and deposit of checks sent to
us shall not be deemed to be acceptance by us of such payment, nor shall such negotiation and
deposit of the check prevent us from later retuming such payment by issuance of a check for the
amount of the check to us.
SECTION IV. MEMBERSHIP/APPLICATION
1. Eligibility. All Employees, who have a regular work week as indicted on the application and
addendum,paid for such employment by the employer,and listed as an Employee on the Employer's
State unemployment insurance tax returns, and the Dependents of the Employees, are eligible to
enroll for membership under the Contract.We may inspect such records,public and private, as are
necessary to verify employment.
2. Receipt of Applications.Applications for Employees'coverage must be received by us within 30 days
of the Contract Effective Date or within 30 days of eligibility for coverage, whichever is later. If the
application is not received within this time period, the Employee is subject to current underwriting,
state or federal law for provisions for late enrolles.
3. Notification of Cessation of Membership.Employer shall advise us when Employer has notice that
a Member is no longer employed by Employer or otherwise does not satisfy membership
requirements. Employer shall so notify us, at the latest, by the first Service Date after a Member
ceases to be employed by Employer or otherwise ceases to meet membership requirements.
Employer agrees that no person will be kept on Employer's payroll or otherwise be represented as
an Employee of the Employer for the purpose of obtaining or maintaining coverage hereunder. The
Employer agrees to observe the terms thereof, and hold us harmless for all costs incurred,including
attorneys' fees, in the defense of any claim or suit brought at any time by a person ineligible for
coverage.
Weld County Government BLUE CROSS AND BLUE SHIELD
(Group Name) OF COLORADO
By
C. David Kikumoto
Printed or Typed Name Printed or Typed Name
(Title) (Title) Chief Executive Officer
(Date) (Date) November 15, 1999
5
PROGRAM ARRANGED
BY
Blue Cross
p6Q Blue Shield
oiCol or ado
Blue Cross and Blue Shield of Colorado
700 Broadway
Denver, Colorado 80273
Phone: 831-2131
®Registered Marks Blue Cross and Blue Shield Association
13CB59J2GCOC
ENDORSEMENT NO.: 1
TO GROUP MASTER CONTRACT NO.: 00-00772000
The Contract identified above is hereby amended by this endorsement which is issued to form part
of the Contract between Blue Cross and Blue Shield of Colorado (BCBSC) and Weld County
Government (the Employer), effective as of the Contract Effective Date as follows:
For the period beginning on the Contract Effective Date(January 1,2000)and ending on December
31, 2001,paragraph 1. Changes of Section of Section III. Premiums Changes, Payment, Service
Date, Termination For Non-Payment, Retroactive Refund of Membership Premium, Cashing
for Check Not Acceptance of the Contract, shall be replaced in its entirety with the following
provision:
1. (a) Subject to the provisions of subparagraph (c), below, the premiums specified in Exhibit
A to this endorsement shall remain in effect for a period of 12 months from the Contract
Effective Date.
(b) For the second year of this Contract, i.e., the period commencing the first day of the 13"'
month of this Contract through the last day of the 24R'month of this Contract, BCBSC may
increase the premiums due by not more than 14.84%above the required rate increase of
27.9%for the first year of this Contract. In the event the premiums due are adjusted under
subparagraph (c) (i, ii), below, during the first year of this Contract, the maximum
premium increase allowed shall be 14.84%above the required rate increase of 27.9% for
the first year of this Contract as adjusted. The rate calculation for this period will include
a 5% margin. The 14.84% maximum increase is inclusive of the 5% margin requirement.
BCBSC shall advise the Employer of the second-year premium rate at least 60 days prior
to its implementation, and subject to the provisions of subparagraph (c), below, such
premium shall remain in effect throughout the second year of this Contract.
(c) Notwithstanding the provisions of subparagraphs (a) and(b),above, BCBSC may change
the monthly premiums due hereunder, effective immediately, whenever (i) benefits are
changed by endorsement or by federal or state law; or (ii) the number of Employees
covered under the Contract in any given month differs from the number of Employees
covered under the Contract as of the Contract Effective Date by 20% of enrollment.
(d) For the period beginning on the Contract Effective Date, the Employer shall remit an
advanced check for premiums of $200,000 to BCBSC/HMOC upon signature of this
Endorsement or no later than January 15, 2000. This payment will be used to offset the
required rate increase of 27.9%to decrease the billed premium rates for a rate increase of
17.0% for the period of January 1, 2000 through December 31, 2000.
2. For the period beginning on the Contract Effective Date (January 1, 2000) and ending on
December 31, 2001, paragraph 20. Termination of Contract of Section II. General
Agreements, of the Contract shall be amended by adding the following sentence to the end
of subparagraph (b) of paragraph 20:
"Notwithstanding the foregoing,BCBSC agrees not to terminate this Contract solely
because of poor claims experience of Employees and Dependents covered under
this Contract."
3. Effective on the earlier of(i) any date on which BCBSC changes the premiums due hereunder
in accordance with the provisions of subparagraph 1(c)(ii) of Section III of the Contract, as
amended above, or (ii) two years from the Contract Effective Date, the provisions of this
endorsement shall be of no further effect and the original provisions of paragraph I of Section
Weld County 2"yr Rate Guar.wpd
III and paragraph 20. of Section II of the Contract shall be reinstated as if they had never been
amended.
4. Except as otherwise specifically amended hereby,all terms and conditions of the Contract shall
remain in full force and effect.
Weld County Government Blue C s an Ilue Shield o C orado
(Group Name)
By ; /�6 J By
That € K . ItA-1 � C. David Kikumoto
Printed or Typed Name �f Printed or Typed Name
(Title) C,h f i a , e UUef ci 4 it,,,, 5,On 643 (Title)President
Date /(/Zy Se/ Date NOV t S 1099
Weld County yr Rate Guar.wpd
EFFECTIVE JANUARY 1, 2000
EXHIBIT A
Group Name: Weld County Government
Coverage: Triple Option Modified
Employee Employee Plus
Only Dependents
1. BlueAdvantage HMO 15/1/15-25-40 RX: $173.35 $459.53
COBRA (Direct bill) $176.81 $468.72
2. BlueAdvantage Point-of-Service 15//15-25-40 RX: $182.38 $483.30
COBRA(Direct bill) $186.03 $492.97
3. Custom Plus $200/$00 deductible 80% coinsurance: $229.69 $608.70
COBRA (Direct bill) $234.29 $620.88
In addition a $200,000 payment to BCBSC/HMOC is required.
Weld County 2'a yr Rate Guar.wpd
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