HomeMy WebLinkAbout20191820.tiffRESOLUTION
RE: APPROVE AGREEMENT FOR COBRA SERVICES AND AUTHORIZE CHAIR TO SIGN
- AETNA LIFE INSURANCE COMPANY
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 an Agreement for Cobra Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Resources, and Aetna
Life Insurance Company, commencing January 1, 2019, with further terms and conditions being
as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, 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 Agreement for Cobra Services between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Resources, and Aetna Life Insurance Company, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of May, A.D., 2019, nunc pro tunc January 1, 2019.
ATTEST: L!Qa
Weld County Clerk to the Board
BY:?A1/(4-- erMel
Deputy Cle& to the Board
APP
y - i • rney
Date of signature:
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
arbara Kirkmeybr, Chair
Mike Freeman, Pro -Tern
ames
Steve Moreno
Cam: PRi'M9 sO )
(.O41Io►
2019-1820
PE0033
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Aetna COBRA Services Agreement
DEPARTMENT: Human Resources
PERSON REQUESTING: Patti Russell
DATE: 05/01/19
Brief description of the problem/issue:
Beginning in January we moved to Aetna for our Health and COBRA benefits. This contract is the COBRA
contract that needs approved. The County Attorney's Office has worked with HR and Aetna to ensure that it
meets our contract standards.
What options exist for the Board? (include consequences, impacts, costs, etc. of options):
1. Approve contract as it is written (Recommended)
2. Don't approve contract
Recommendation:
Recommend approval of the Aetna COBRA contract.
Sean P. Conway
Mike Freeman, Pro-Tem
Scott James
Barbara Kirkmeyer, Chair
Steve Moreno
Approve
Recommendation
O/'"
Schedule
Work Session
Other/Comments:
2019-1820
PEoo 33
5Il
COBRA SERVICES AGREEMENT
This Agreement, herein "the Agreement" entered into between Aetna Life Insurance Company, herein
"Aetna" and Weld County, herein the "Customer".
WHEREAS:
The Customer, in connection with the federal Consolidated Omnibus Budget Reconciliation Act
of 1986 (COBRA), is providing or may be required to provide certain employees and dependents
herein "Qualified Beneficiaries", with continuation of health benefits under its Plan; and
2. The Customer desires to contract with Aetna for certain notification, collection and direct
payment services on its behalf in connection with the COBRA continuation of health benefits
under the Plan.
NOW THEREFORE, Aetna and the Employer agree as follows:
ARTICLE I
DUTIES OF THE PARTIES
Aetna Responsibilities
1.1 The Customer hereby appoints Aetna, and Aetna agrees to provide, administrative services as
agreed to between the parties (the "Services"). Such Services shall be performed in a good and
workmanlike manner consistent with industry standards.
1.2 Aetna shall, at its expense, maintain adequate and necessary records on each Participant related
to the Services. The Customer shall furnish Aetna with all information necessary for the preparation of
such records. Aetna shall not be responsible for verifying the accuracy or completeness of the
information provided by the Customer.
1.3 At no time shall Aetna provide legal, tax or accounting advice or services in connection with
any Customer -sponsored employee benefits. The Customer shall be responsible for obtaining any legal,
tax or accounting advice they deem advisable in connection with any Customer -sponsored employee
benefits from their counsel or advisor.
1.4 Aetna shall hold all funds received from the Customer, Participant or on behalf of a Participant
as applicable, in an account established for such purpose at a financial institution of Aetna' choosing.
Aetna shall pay all fees associated with said account.
1.5 During the term of this Agreement, Aetna shall maintain the following insurance: (i)
professional liability insurance (One Million Dollars ($1,000,000) per occurrence; Two Million Dollars
($2,000,000) aggregate); and (ii) crime insurance (One Million Dollars ($1,000,000) per occurrence;
Two Million Dollars ($2,000,000) aggregate).
Customer's Responsibilities
1.6 The Customer shall be responsible for any delay in the performance of$eeyif.esi.caused by
the failure of the Customer to promptly furnish information or funds, as required, ..Ca A
2017
ADMINISTRATIVE SERVICES AGREEMENT
MAY 13 2019
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1.7 The Customer shall provide Aetna with complete and accurate information including, but not
limited to, proper accounting of all Participants, specific coverages and changes and corrections thereto.
Aetna shall not be liable for (and Customer releases and discharges Aetna and agrees to defend,
indemnify and hold Aetna harmless as permitted by Colorado law from and against) any and all claims,
damages, losses or expenses suffered or incurred as a result of any inaccurate or incomplete information
furnished by Customer to Aetna.
1.8 The Customer is responsible for maintaining reasonable internal control mechanisms as they
relate to the Services that Aetnaprovides, including, but not limited to:
(a) The Customer having its own administration functions and controls so users are removed
promptly when they no longer need access to system resources.
(b) The Customer having controls to ensure that all Aetna -generated reports and information
received from Aetna are reviewed for accuracy and Participant activity on a timely basis, with any
inaccuracies or discrepancies being communicated in writing to Aetna no later than thirty (30) days after
such report or information is first generated by Aetna.
(c) The Customer having controls to ensure that any erroneous data is re -submitted to Aetna
within thirty (30) days from the time it is first inputted erroneously.
(d) The Customer reconciling all cash activity to Aetna -generated reports as soon as
reasonably possible (and in any event within ten (10) days after such report is first delivered by Aetna to
the Customer). Customer shall advise Aetna in writing of any discrepancies or inaccuracies in connection
with such reconciliation within twenty (20) days thereafter.
(e) Notwithstanding any term herein to the contrary, Aetna shall in no event be liable or
otherwise responsible for any and all claims, damages, losses and expenses arising out of or otherwise
related to Customer's failure to notify Aetna in writing of any discrepancies or inaccuracies in any
information, report or data provided by Aetna, within thirty (30) days after such information, report or
data is first provided by Aetna.
ARTICLE II
PAYMENTS
2.1 The Customer agrees to pay Aetna the amounts set forth in the Fee and Expense Exhibit.
Such amounts are payable via an ACH debit which shall be initiated by Aetna ten (10) days
after the invoice is delivered to the Customer. Aetna shall initiate the ACH debit against an account
designated for this purpose by the Customer. This may be the same account designated for ACH funding,
or may be a unique account, at the Customer's discretion.
Customer shall promptly review and verify the accuracy of each invoice and notify Aetna in
writing of any inaccuracy or discrepancy with respect to any amount referenced therein within sixty (60)
days after receipt of such invoice, failing which such invoice shall be deemed final, complete and correct
for all purposes. Any payments which are not timely paid hereunder shall, at the option of Aetna, bear
interest at a rate of eighteen percent (18%) per annum until paid.
2.2 Nothing in this Article shall prohibit Aetna from performing any service not enumerated in this
Agreement for a reasonable fee. Any such service and corresponding fee shall be provided only if
agreed to by the Customer and Aetna in writing, in advance of such performance.
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2.3 If the Customer, for any reason whatsoever, fails to make a required payment on a timely basis,
Aetna may (in addition to its other rights and remedies), suspend the performance of the Services until
such time as the Customer makes the proper remittance and otherwise delivers adequate assurance to
Aetna, as reasonably determined by Aetna, concerning the Customer's performance hereunder. Aetna
shall use reasonable efforts to provide the Customer with up to three (3) days prior written notice of its
intention to take such action.
ARTICLE III
DURATION OF THIS AGREEMENT
3.1 This Agreement shall have an Initial Term of one (1) year and Effective Date of January 1,
2019. This Agreement shall automatically renew for succeeding twelve (12) month periods thereafter;
provided, this Agreement may be terminated by either party following the end of the Initial Term or any
twelve (12) month period thereafter, if a party has given at least ninety (90) days' prior written notice of
termination to the other party prior to the commencement of the first renewal term or any subsequent
renewal term, as applicable.
Except as referenced on the applicable Fee and Expense Exhibit, the amounts set forth on the
applicable Fee and Expense Exhibit shall remain unchanged during the Initial Term of the Agreement;
thereafter the fees will be subject to change by Aetna, so long as Aetna has provided the Customer with at
least ninety (90) days prior written notice of such change.
ARTICLE IV
TERMINATION OF THIS AGREEMENT
4.1 In the event of a material breach by Aetna of the terms hereof, the Customer shall provide
Aetna with written notice and an opportunity to cure the breach within thirty (30) days thereafter. If
Aetna does not cure the breach within such time period, this Agreement shall, at the option of the
Customer, terminate upon written notice to Aetna within ten (10) days thereafter.
4.2 This Agreement shall, at the option of Aetna, terminate in the event of:
(a) The Customer's failure to pay the amounts referenced in the applicable Fee and Expense
Exhibit by the due date;
(b) Commencement of a bankruptcy proceeding of the Customer or the insolvency of the
Customer;
(c) Failure of the Customer to promptly deliver any data necessary for the proper performance
of Aetna' duties hereunder within five (5) days following the request therefore;
(d) Merger, sale or consolidation of the Customer, unless written consent has been give by
Aetna to continue Services in advance of such event;
(e) The enactment or change of any law or regulation which makes the continuance of this
Agreement illegal or commercially impracticable; or
(f) Any other breach of this Agreement by the Customer which is not cured (if curable)
within thirty (30) days following written notice from Aetna.
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4.3 In the event of the termination of this Agreement, Aetna shall complete the processing of all
reimbursement requests received by Aetna which are due and payable prior to the termination of this
Agreement, provided that, Aetna shall have no obligation to complete the processing of any such
requests if the Customer has failed to provide funds for the reimbursement requests or payment or the
Customer has otherwise failed to pay any other amounts owed to Aetna hereunder. Aetna shall have no
obligation to process requests for reimbursement or payments presented after the termination date. All
payments made in accordance with Section 4.3 shall under all circumstances continue to be the sole
responsibility and liability of the Customer.
4.4 Upon termination of this Agreement, Aetna shall, upon written request, deliver to the
Customer, within a mutually agreed upon timeframe, a complete and final accounting as it relates to this
Agreement. All books and records in Aetna' possession with respect to the Services provided, any claim
files, and any reports and other papers pertaining to the Services will he maintained by Aetna for a period
of seven (7) years following their processing hereunder. All administration systems, computer systems
and software developed by Aetna in connection with the Services performed hereunder constitute the sole
property of Aetna and shall be retained by Aetna upon the termination of this Agreement. The Customer
hereby disclaims any interest in or to such items.
ARTICLE V
INDEMNITY/DAMAGE LIMITS/MISCELLANEOUS
5.1 Aetna is not and shall not under any circumstances be deemed the "Customer," a "named
fiduciary" or a "fiduciary" of any Customer plan, as defined in the Employee Retirement Income
Security Act of 1974, as amended, or for any other purpose under any federal, state or local law
applicable to or otherwise affecting or regulating any Customer -sponsored employee benefits, and the
Customer acknowledges such fact and otherwise releases and discharges Aetna from any such
obligation, position or role. Aetna shall not be required to advance its funds for the reimbursement
requests or payments under any Customer plan. Aetna shall not be considered the insurer or underwriter
of the liability of the Customer to provide benefits for the Participants. The Customer shall have the sole
responsibility and liability for the payment of all reimbursement requests. The Customer shall also be
responsible for all expenses incident to or otherwise related to the operation of any Customer plan.
5.2 As permitted under Colorado law, each party agrees to defend, indemnify and hold the other
harmless from and against any and all third -party claims, damages, losses and expenses which are
incurred or suffered by a party and arise out of the other party's performance under this Agreement,
except in relation to matters as to which the indemnified party shall be finally adjudged to be liable as a
result of their negligence or willful misconduct in the performance of their duties hereunder; provided
that, under no circumstances shall Aetna be liable or otherwise responsible if Aetna' action was based on
directions or instructions given by the Customer or its designee to Aetna.
5.3 Aetna makes no commitment or guarantee that any amounts paid to or for the benefit of a
Participant will be (or continue to be) excludable from the Participant's gross income for federal, state or
local tax purposes. It shall be the obligation of each Participant to determine whether a payment under
the Services provided is excludable from the Participant's gross income for federal, state and local tax
purposes. This Agreement constitutes the entire agreement of the parties with respect to the subject
matter hereof, and supersedes all previous agreements and discussions (whether written or oral) relating
to the subject matter hereof. In the event of a conflict between any of the provisions of this Agreement,
such conflict shall be resolved in favor of the more specific provision over a more general provision. No
terms that are additional to or different from the terms of this Agreement (including, without limitation,
the terms of any purchase order) shall be binding on either party hereto. This Agreement shall be
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governed by the internal substantive laws of the State of Colorado except to the extent superseded by
ERISA.
5.4 AS USED IN THIS AGREEMENT, THE TERM "LIMITATION EXCEPTIONS" MEANS (a) PROPERTY
DAMAGE OR PERSONAL INJURIES CAUSED BY PAYFLEX OR ANYONE ACTING ON ITS BEHALF
(COLLECTIVELY, THE "PAYFLEX PARTIES"), (b) PAYFLEX'S OBLIGATIONS TO INDEMNIFY COMPANY FOR
MATTERS OF INFRINGEMENT, OR ANY BREACH OF PAYFLEX'S OBLIGATIONS OF CONFIDENTIALITY,
INFORMATION SECURITY AND PRIVACY AS SET FORTH IN THIS AGREEMENT, (C) THE GROSS
NEGLIGENCE, WILLFUL MISCONDUCT OR BAD FAITH/FRAUD OF ANY OF THE PAYFLEX PARTIES, AND (d)
VIOLATION BY ANY OF THE PAYFLEX PARTIES OF ANY FEDERAL, STATE OR LOCAL LAW, RULE OR
REGULATION APPLICABLE TO THE PROVISION OR RECEIPT OF SERVICES OR PRODUCTS PROVIDED
UNDER THIS AGREEMENT. EXCEPT FOR LIABILITY ARISING IN CONNECTION WITH THE LIMITATION
EXCEPTIONS, IN NO EVENT SHALL EITHER PARTY BE LIABLE OR OTHERWISE RESPONSIBLE FOR ANY
INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY OR PUNITIVE DAMAGES, INCLUDING,
BUT NOT LIMITED TO, LOST PROFITS AND ATTORNEYS' FEES, REGARDLESS OF THE NATURE OR BASIS
OF THE CLAIM AND REGARDLESS OF WHETHER SUCH PARTY HAS BEEN ADVISED OF THE POSSIBILITY
OF SUCH DAMAGES. EACH PARTY'S MAXIMUM LIABILITY UNDER THIS AGREEMENT, EXCLUDING
LIABILITY IN CONNECTION WITH ANY OF THE LIMITATION EXCEPTIONS, TO THE OTHER PARTY OR ANY
PARTICIPANT FOR ANY CLAIMS, DAMAGES, LOSSES OR EXPENSES (INCLUDING, BUT NOT LIMITED TO,
THOSE ARISING UNDER THIS AGREEMENT), REGARDLESS OF THE NATURE OR BASIS OF THE CLAIM,
SHALL IN NO EVENT EXCEED $1,000,000. EACH PROVISION OF THIS AGREEMENT THAT PROVIDES FOR
A LIMITATION OF LIABILITY OR EXCLUSION OF DAMAGES IS INTENDED TO ALLOCATE THE RISKS OF
THIS AGREEMENT BETWEEN THE PARTIES. THIS ALLOCATION IS REFLECTED IN THE PRICING
OFFERED BY PAYFLEX TO THE COMPANY AND IS AN ESSENTIAL ELEMENT OF THE BASIS OF THE
BARGAIN BETWEEN THE PARTIES. EACH OF THESE PROVISIONS IS SEVERABLE AND INDEPENDENT OF
ALL OTHER PROVISIONS OF THIS AGREEMENT, AND EACH OF THESE PROVISIONS WILL APPLY EVEN IF
THE REMEDIES IN THIS AGREEMENT HAVE FAILED OF THEIR ESSENTIAL PURPOSE.
5.5 The failure of either party to strictly enforce any provision of this Agreement shall not be
deemed to be a waiver of such provision (or of any other provision of this Agreement), nor shall such
failure be deemed to be a waiver of any subsequent breach of such provision (or any other provision of
this Agreement). No waiver of any provision of this Agreement shall be binding upon any party unless it
is in writing and executed by both parties.
5.6 Any litigation involving any claim (whether legal or equitable) which relates to or arises from
the subject matter of this Agreement shall be brought exclusively in the appropriate state or federal
courts located in Colorado.
5.7 It is expressly agreed that the parties intend by this Agreement to establish between themselves
the relationship of independent contractors. This Agreement is not intended to and shall not be
construed to create between the parties, any affiliate relationship, partnership, joint venture, employment
relationship, agency, fiduciary or other special relationship. The provisions of this Agreement are only
for the benefit of the parties hereto and not for any other person. This Agreement shall not provide any
third person with any remedy, claim, reimbursement, cause or action or other right.
5.8 Aetna will not be liable for, or be considered to be in breach of or default under this Agreement
on account of', any delay or failure to perform as required by this Agreement as a result of any cause or
condition beyond Aetna' reasonable control, so long as Aetna uses commercially reasonable efforts to
avoid or remove such causes of non-performance.
5.9 If any part of this Agreement is found to be illegal, unenforceable, or invalid, such part shall be
severed from this Agreement and the remaining provisions of this Agreement will remain in full force
and effect.
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5.10 This Agreement may not be amended or otherwise modified other than by a written instrument
signed by the Customer and Aetna.
5.11 ANY CLAIM OR CAUSE OF ACTION ARISING FROM OR OTHERWISE RELATED TO
THIS AGREEMENT MUST BE COMMENCED WITHIN TWO (2) YEARS FROM THE TIME IT
FIRST ACCRUED, OR WILL BE FOREVER BARRED.
5.12 All notices will be delivered by first class mail (postage pre -paid) or by overnight commercial
delivery service (pre -paid) or delivered by hand to the party at their address listed below:
If to Aetna;
Aetna Life Insurance Company
151 Farmington Avenue, RW52
Hartford, CT 06156-3124
Attention: PayFlex COBRA Department
If to Customer:
Weld County
1150 O Street
Greeley, CO 80631.
Attn: Staci J. Datteri-Frey
5.13 Aetna agrees to assist the Customer as a business associate in complying with the requirements
of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (45
C.F.R. Parts 160-64) and the requirements of the Health Information Technology for Economic and
Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009 as they
relate to the obligations of a business associate, and to this end, Aetna and Customer agree to execute a
form of "Business Associate Agreement" mutually agreed to by both Parties in connection with the
Services performed hereunder.
ARTICLE VI
DUTIES OF THE PARTIES
6.1 Aetna shall undertake its obligations hereunder as directed by (and in accordance with
instructions provide by) the Customer. Aetna shall at no time exercise any discretionary authority or
control respecting the management or administration of the Plan(s), or the management or disposition of
any Plan assets. On all matters involving the exercise of discretion, Aetna shall seek direction from the
Customer and shall be fully protected, held harmless, and indemnified as permitted by Colorado law, in
so acting consistent with such direction. The Customer acknowledges that the timeliness of providing
information and direction to Aetna is critical to the successful completion of the services. All employee
data and other relevant information will be supplied to Aetna in a timely and accurate manner using a pre -
approved Aetna format. Aetna is not responsible for the actions of the Customer in processing or
interpreting data provided by the Customer or the Customer's failure to provide the necessary data.
Aetna agrees to provide the following services and Customer agrees to provide all information and data as
needed.
ARTICLE VII
INITIAL/GENERAL COBRA NOTICE
7.1 Customer will notify Aetna in writing within thirty (30) days of new enrollees in a group health
plan subject to COBRA, which notice will specify:
(a) the date and type of enrollment;
(b) the names and addresses of each new qualified beneficiary(ies), and
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(c) the names and addresses of family members of qualified beneficiary(ies),.
7.2 Within ten (10) business days after Aetna receives the notice described in paragraph 2.1 above,
Aetna will send with proof of mailing, a letter notifying the appropriate qualified beneficiary(ies) of their
right to COBRA continuation coverage upon the occurrence of a qualifying event.
7.3 If agreed to between Aetna and the Customer in writing, Aetna shall also include a "HIPAA
Notice of Privacy Practices" statement on behalf of the Customer. The notice shall be drafted by the
Customer and provided with the initial COBRA notice described above.
ARTICLE VIII
QUALIFYING EVENT NOTICE
8.1 Customer will notify Aetna in writing within thirty (30) days of a qualifying event occurring,
which notice will specify;
(a) the date and type of qualifying event (as set forth in Code Section 4980B(f)(3)(A) through
(F);
(b) the names, social security numbers, addresses and birth dates of all qualified beneficiaries
(and the covered Participant if not a qualified beneficiary) and their relationship to each other and to the
covered Participant; and
(c) the specific group health plan(s) and combinations of such plans under which the qualified
beneficiaries are entitled to COBRA continuation coverage; and
8.2 Within ten (10)' business days after Aetna receives the notice described in paragraph 8.1 above,
Aetna will send, with proof of mailing, a letter notifying the appropriate qualified beneficiary(ies) of their
right to COBRA continuation coverage, along with an election form specifying the group health plan(s)
and the cost of coverage thereof to such qualified beneficiaries.
ARTICLE IX
NOTICE TO QUALIFIED BENEFICIARIES OF ENROLLMENT
9.1 Within ten (10) business days after Aetna receives a properly completed and signed election
form for COBRA continuation coverage and initial payment from the qualified beneficiary(ies), Aetna
will send payment coupons or invoice to such qualified beneficiary(ies), provided the election form was
returned to Aetna by the qualified beneficiary within sixty (60) days of the date the election form was
mailed to the qualified beneficiary, or the loss of coverage date, whichever is later. The initial premium
must be postmarked within forty five (45) days after the COBRA election. Aetna will also provide a
method for automatic electronic premium payment from a qualified beneficiary's checking or savings
account.
9.2 If Aetna receives an election form for COBRA continuation coverage after such sixty (60) day
period has expired, Aetna will provide the affected qualified beneficiary(ies) with a notice of
unavailability of coverage. Such notice shall be provided within ten (10) business days after Aetna
receives the late election form.
ARTICLE X
NOTICE OF SUBSEQUENT QUALIFYING EVENT
10.1 Qualified beneficiary(ies) must notify Aetna in writing within sixty (60) days of a subsequent
qualifying event, which notice will specify:
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(a) Name and address of the COBRA Participant entitled to extend the period of COBRA
continuation coverage up to 36 months due to a second qualifying event; and
(b) The type of qualifying event.
10.2 Within ten (10) business days after Aetna receives the notice described in paragraph 10.1 above,
Aetna will send, by proof of mailing, a letter notifying the appropriate qualified beneficiary(ies) of their
right to such extended COBRA continuation coverage, along with an election form specifying the group
health plans and the cost of coverage thereof. Aetna will provide the affected qualified beneficiary(ies)
with a notice of unavailability of coverage if the event does not qualify as a subsequent qualifying event.
ARTICLE XI
NOTICE OF TOTALLY DISABLED QUALIFIED BENEFICIARIES
11.1 Qualified beneficiaries must notify Aetna within sixty (60) days of the date they receive a
determination letter regarding total disability. By providing Aetna with this letter, the qualified
beneficiary certifies that the qualified beneficiary is entitled to up to 29 months of COBRA continuation
coverage.
11.2 Within ten (10) business days after receiving the foregoing letter. Aetna will determine the
qualified beneficiary's ability to extend coverage as described in Code Section 4980B(f)(2)(B)(i). Upon
determination, Aetna will send a letter notifying the totally disabled qualified beneficiary of their ability
to extend the maximum period of continuation coverage to 29 months. Aetna will also provide notice to
the disabled qualified beneficiary of the increase in premiums to 150% for months 19 through 29 if the
Customer elects to charge the additional 48%. Aetna will provide the affected qualified beneficiary with a
denial notice if it is determined that the qualified beneficiary is unable to extend coverage.
ARTICLE XII
NOTICE OF EXPIRATION OR TERMINATION OF COBRA CONTINUATION COVERAGE
12.1 Aetna will notify COBRA Participants of the date of termination of their COBRA continuation
coverage within ten (10) business days following the date Aetna learns of one or more of the following
reasons for termination of COBRA continuation coverage:
(a) failure of the COBRA Participant to timely pay the correct premium for COBRA
continuation coverage;
(b) coverage of the COBRA Participant under another group health plan, if such plan does not
contain any exclusions or limitations with respect to any pre-existing condition of the COBRA
participant;
(c)
expiration of the maximum period for COBRA continuation coverage; or
(d) the Customer ceasing to provide any group health plan to any Customer employees and all
of its commonly controlled trades or businesses (within the meaning of Code Section 414).
12.2 If the reason for notice is the expiration of the maximum period for COBRA continuation
coverage, a notice of conversion rights (if available) shall be sent 180 days prior to expiration of COBRA
continuation coverage.
ARTICLE XIII
PREMIUMS FOR COBRA CONTINUATION COVERAGE
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13.1 COBRA Participants shall make premium payments, for COBRA continuation coverage and
who have made a valid election of COBRA continuation coverage, via mail to Aetna; electronic funds
transfer through the Participant's bank to Aetna; or online through the Aetna website. Alternatively,
Aetna may accept payments on behalf of the COBRA Participant from other third -parties. Aetna shall
deposit such funds received from COBRA Participants into a custodial account established for such
purpose at a financial institution of Aetna's choosing. Any interest generated on such account shall be
used to pay the fees of the financial institution with respect to such account. To the extent that such
interest is not sufficient to pay such fees, Aetna shall pay such fees. To the extent that such interest is in
excess of such fees, Aetna shall be entitled to retain such interest. Premium payments collected by Aetna
belong to the Customer, except that Aetna shall retain the surcharge administrative fee paid by such
COBRA Participants. Aetna shall act solely as an administrative collection agent for the Customer in
collecting premium payments and will remit payments to the Customer, appropriate insurance carrier, or
other entity directed by the Customer by the 15th day of the month following the month in which payment
was received.
13.2 When premium payments are received at Aetna, Aetna will notify the appropriate insurance
carriers /administrators of eligibility changes including new enrollees or terminations. When premium
payments are received by the Customer, the Customer is responsible to notify appropriate insurance
carriers/administrators of eligibility changes including new enrollees or terminations.
13.3 If the premium payment is deficient by an amount that is no greater than $50 or 10% of the
COBRA premium amount required for that coverage period, Aetna will notify the qualified beneficiary of
the deficient amount and provide him or her with a reasonable period of time (not to exceed thirty (30)
days) in which to make the payment as described in 26 C.F.R. §54.4980B-8, Q/A-5(d).
13.4 Aetna will provide the Customer with a monthly summary employer census report, COBRA
participant payment and refund report, COBRA participant paid through report, deficient payment report
and an address update report. The Customer will notify Aetna of any errors or corrections in such reports
within thirty (30) days following delivery by Aetna.
13.5 If Aetna receives written notice from the Customer of an increase in the premium amount for
COBRA continuation coverage, and such notice specifies the effective date of the increase (which must
be at least thirty (30) days after such written notice to Aetna), Aetna will notify the affected COBRA
participants of the amount and effective date of the increase within thirty (30) business days following
Aetna's receipt of such written notice from the Customer.
ARTICLE XIV
ANNUAL OPEN ENROLLMENT SERVICE
14.1 Where agreed upon between Aetna and the Customer, Aetna shall assist the Customer in
notifying COBRA Participants of open enrollment rights. Customer shall provide benefit material to
Aetna at least sixty (60) days prior•to the open enrollment period.
14.2 Aetna will send a letter notifying the COBRA Participant of their open enrollment options. This
mailing shall include enrollment forms and benefit communication material as provided by Customer.
14.3 The Customer will provide Aetna with a completed open enrollment document. Upon receipt of
the completed open enrollment document from the Customer, Aetna will process the documents and
notify the carrier(s) of any change in the enrollment status.
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IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their
respective officers duly authorized to do so.
Weld County
Dated at:
By:
Greeley, Colorado
rbara Kirkme er, Chair,
Board of Weld ounty Commissioners
(Official Title)
Aetna LIFE INSURANCE COMPANY
By:
i 1/i z4d i S Oyu
Vice President
(Official Title)
10
tAAY 13 2Di9
(DATE)
api 9- /P.9 -O
Proprietary
RE: AETNA COBRA SERVICE AGREEMENT
(APPR VEDA T UBSTANCE:
Elected OfficiaLor O partment Head
APPROVED AS TO FUNDING:
Controller
APPROVED AS TO F RM:
FEE AND EXPENSE EXHIBIT
COBRA ADMINISTRATIVE SERVICES - PER ELIGIBLE EMPLOYEE PER MONTH
Implementation and Annual Fees
Implementation Fee
Waived
Annual Fees
Waived
COBRA Fee Per Eligible Employee Per Month
$0.45 PEPM
Included in PEPM Fees
_Service
New Hire COBRA/HIPAA General Rights Notice
Included
Qualifying Event Notification
Included
COBRA Member Termination
Included
Minimum Monthly Billing
$150.00 per month
Optional Service Fees - NOTE: Only applicable if the service
is requested by the Customer and performed by
Term of the Agreement and are listed below for
PayFlex. Optional Service Fee pricing is fixed during the initial
transparency.
Re -notification New Hire COBRA/
HIPAA General Right Notice
$4.25 per notice
Annual Open Enrollment Services
(*Per package with a $300.00 minimum plus postage, available
after PayFlex has been providing administration for a minimum
of 90 days.)
$15.00 per package plus postage*
Annual Open -Enrollment Election Form Processing
(Service offered if the Plan Sponsor administers the open -
enrollment but wants the Open Enrollment form returned to
PayFlex for processing.)
$5.00 per form processed
Custom Mailings (Non -Standard Notices)
$5.00 per notice
Custom Mailings (Set Up Fee)
$150.00 per hour
Manual Notification Form Processing
$10.00 per form
Summary of Benefits and Coverage Form
$0.60 per page plus postage*
Late Payment Notice
$3.00 per notice
Optional Government Mandated Notice
$10.00 per notice
Premium Disbursement to Carriers
$50.00 per carrier per remittance
(No Fee for remittance to Aetna)
Customized Reporting and Web Development
$150.00 per hour - $2,500 Minimum
Rejected/NSF Customer Funding ACH transactions
$50.00 per occurrence of any Customer
funding ACH pull that is rejected
Wire Transfer Fee
$15.00 per wire transfer
By the 5th working day of each month, PayFlex will provide a bill for all administration from the prior month. Reports
detailing the prior month's activity will also be provided for your records. Prior to issuing the monthly invoice for the
COBRA administration fees, PayFlex will provide the plan sponsor with an email as a reminder to update the COBRA
eligible employee count on the plan sponsor website that will be used for the current month's Monthly Fee Per
COBRA -Eligible fee. The plan sponsor agrees to update this count prior to the end of the current billing month. If
PayFlex is not provided an updated number of COBRA eligible employees by the end of the current billing month, the
plan sponsor agrees to pay the fee based on the count used the previous month. A COBRA eligible employee is defined
as an active employee who is enrolled in one or more COBRA eligible plans (medical, dental, vision, FSA, EAP, etc.).
If an employee is enrolled in more than one plan, the employee is only counted once.
PayFlex shall retain the 2% administrative fee on the total premium administered for COBRA members.
Note: The above fees are based on approximately 750 benefit covered employees with approximately 10% annual
turnover.
Should there be a variance in turnover exceeding +1- 10%; the fees outlined above are subject to negotiation.
Services included in the PEPM fee include; COBRA Administration, New Hire COBRA / HIPAA General Rights
FEE AND EXPENSE EXHIBIT
FEE AND EXPENSE EXHIBIT
Notice, Qualifying Event Notification, and COBRA Member Termination Notice.
Fee shall remain unchanged during the initial thirty-six (36) months of the term of the Agreement; thereafter fees are
subject to change every twelve (12) months and shall not exceed a three (3) percent net increase per year for the Initial
Term of the Agreement.
PFS COBRA PEPM Pricing 9/1/18
FEE AND EXPENSE EXHIBIT
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