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HomeMy WebLinkAboutResolution - 2002-R0523 - Contract To Provide Health Insurance Plan - Blue Cross & Blue Shield - 11_21_2002Resolution No. 2002-RO523 November 21, 2002 Item No. 47 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a Contract to provide services for a group health insurance plan, by and between the City of Lubbock and Blue Cross & Blue sWeldand related documents. Said Contract is attached hereto and incorporated in this Resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council this 21st day of ATTEST: Rebecca Garza City Secretary APPROVED AS TO CONTENT: -�4g 4-'0- Mary Housely Managing Director of Human Resources APPROVED AS TO FORM: William de Haas Contract Manager/Attorney Mocs/kb/grouphlthinsplanres November 12, 2002 November 2002. 0 Resolution No. 2002-RO523 October 24, 2002 AMENDMENT #2 TO MINIMUM PREMIUM AGREEMENT Item No. 50 (Blue Cross Blue Shield of Texas) This amendment to the October 14, 1999, Minimum Premium Agreement between the City of Lubbock and Blue Cross Blue Shield of Texas, to provide group health insurance benefits for the City of Lubbock, effective as of January 1, 2003, the "Effective Date." WHEREAS, City entered into an Agreement with Blue Cross Blue Shield of Texas dated October 14, 1999, to provide group health insurance benefits for the City of Lubbock, and WHEREAS, both parties desire to renew and amend this Agreement; and NOW THEREFORE, for and in consideration of the mutual covenants herein, the parties do agree to amend the Agreement as follows: 1. Exhibit Number three is deleted and replaced with Exhibit Number Four attached hereto and made a part of this Agreement. 2. This Agreement may be renewed up to two additional one-year periods upon the mutual consent of both parties. 3. All other provisions contained in the original Contract shall remain in full force and effect and shall not be affected by this Agreement. 21st November EXECUTED as of this day of getobe-r- , 2002. CITYPF LUBB CK BLUE CROSS BLUE SHIELD OF TEXAS arc Mc Dou ayor Patricia Hemingway all, resident ATTEST: CQ te,r Rebecca Garza, City Secretary APPROVED AS TO CO ENT: Ck- . Mary House Managing Director of Human Resources APPROVED AS TO FORM: /4/"�&_y(c._ /Vtr, William de Haas Contract Manager, Attorney at Law Resolution No. 2002—RO523 EXHIBIT NUMBER FOUR Schedule Of Specifications For the MINIMUM PREMIUM AGREEMENT (the Agreement) between BLUE CROSS AND BLUE SHIELD OF TEXAS (BCBSTX) And CITY OF LUBBOCK (Employer, Policyholder) Group Number: 60167 The specifications are to apply for the period of time indicated herein and shall continue in force and effect until the end of the Policy Period, the Agreement is terminated or this Exhibit is superseded in whole or in part by a later executed Exhibit. Item I Contract Coverage This Minimum Premium Agreement will apply to benefits provided under the BCBSTX Group Contract(S) listed below: • Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program • Experience Rated Group Traditional Indemnity Benefit Contract with Prescription Drug Program • Experience Rated Group Comprehensive Dental Care Contract Item II Contract Year These specifications are for the current Contract Year, which shall commence on January 1, 2003 and end on December 31, 2003. Item III Accounting Period The current Accounting Period shall commence on January 1, 2003 and end on December 31, 2003. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, A Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association FORM NO. MPAIEX 1 60167JAN.03 Item IV Draft Authority Draft Authority shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of certificates exposed for a particular month by: A. $263.40 for each Employee or Retiree Only Health Certificate $437.25 for each Employee or Retiree/Child(ren) Health Certificate $487.29 for each Employee or Retiree/Spouse Health Certificate $671.67 for each Employee or Retiree/Family Health Certificate B. $18.77 for each Employee Only Dental Certificate $31.16 for each Employee/Child(ren) Dental Certificate $34.71 for each Employee/Spouse Dental Certificate $47.85 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. Item V Health Stop -Loss Insurance Health Stop -Loss Insurance applicable for benefits covered under the Health Contracts (excluding the Prescription Drug Program) is shown below. All monetary amounts and percentages shown shall apply for the current Contract Year. A. Specific Health Stop -Loss Insurance: Specified Paid Health Benefits in excess of the Point of Attachment which is $150,000 per Participant per Accounting Period. B. Aggregate Stop -Loss Insurance: None - not applied for. Item VI Settlement Payment Option The following Settlement Payment Options will apply: A. Specific Health Stop -Loss Insurance: 1. Monthly settlements 2. Time Period: 12 months 3. Applicable Contracts (from Item 1): • Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program • Experience Rated Group Traditional Indemnity Benefit Contract FORM NO. MPA/EX 2 60167JAN.03 - 41 i B. Aggregate Stop -Loss Insurance: Annualized Draft Authority percentage for deficit carry forward: 20.0% ITEM VII Termination Coverage Options The Termination Coverage Options shown below will apply for the Run -Off Period: Run-OffAdministration Charge Factors for calculating the Run -Off Period: $13.20 for each Employee or Retiree Only Health Certificate $21.88 for each Employee or Retiree/Child(ren) Health Certificate $24.40 for each Employee or Retiree/Spouse Health Certificate $33.64 for each Employee or Retiree/Family Health Certificate 2. $1.72 for each Employee Only Dental Certificate $2.84 for each Employee/Child(ren) Dental Certificate $3.16 for each Employee/Spouse Dental Certificate $4.36 for each Employee/Family Dental Certificate Run -Off Liability Factors for calculating the Run -Off Draft Authority: $168.60 for each Employee or Retiree Only Health Certificate $279.88 for each Employee or Retiree/Child(ren) Health Certificate $311.92 for each Employee or Retiree/Spouse Health Certificate $429.96 for each Employee or Retiree/Family Health Certificate 2. $12.16 for each Employee Only Dental Certificate $20.20 for each Employee/Child(ren) Dental Certificate $22.48 for each Employee/Spouse Dental Certificate $31.00 for each Employee/Family Dental Certificate ITEM VIH Home Bank or Employer's Bank Information The name and address of the Employer's Bank and financial contact person shall be maintained on file in accordance with procedures established between the Employer and the Comptroller Division of the Accounting Services Department of BCBSTX. Item IX Administration Charge The Administration Charge for the Contract Year shall be calculated monthly by multiplying the number of certificates exposed for a particular month by: A. $24.59 for each Employee or Retiree Only Health Certificate $40.82 for each Employee or Retiree/Child(ren) Health Certificate $45.49 for each Employee or Retiree/Spouse Health Certificate $62.70 for each Employee or Retiree/Family Health Certificate FORM NO. MPA/EX 3 60167JAN.03 d' x B. $2.63 for each Employee Only Dental Certificate $4.36 for each Employee/Child(ren) Dental Certificate $4.86 for each Employee/Spouse Dental Certificate $6.70 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. Item X Health Contract Stop -Loss Premium The Health Contract Stop -Loss Premium is the sum of the Specific Health Stop -Loss Premium and Aggregate Stop -Loss Premium amounts calculated as follows (amounts shown shall apply for the current Contract Year): A. Specific Health Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by: $10.93 for each Employee or Retiree Only Health Certificate $18.15 for each Employee or Retiree/Child(ren) Health Certificate $20.22 for each Employee or Retiree/Spouse Health Certificate $27.87 for each Employee or Retiree/Family Health Certificate B. Aggregate Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by: NA Item XI Minimum Balance The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the Banking Arrangement is $462,358 for the period beginning January 1, 2003 through December 31, 2003. Item XH Additional Charges/Fees/Rates The following charges and interest rates shall apply for the current Contract Year: A. The Daily Charge rate for the Contract Year shall be .0329% (which would equate to an annual percentage rate of 12%). B. Subrogation recoveries are subject to 15.0% of any amounts recovered. C. B1ueCard® Program (Out -of -Area Program) fees shall be the lesser of 10% of the discount or $2,000 per claim (Refer to ARTICLE I, Benefit Checks, for additional explanation) FORM NO. MPA/EX 4 60167JAN.03 Item XIII Letter of Credit The Letter Of Credit is not required under this Employer's Agreement. Item XIV If this Exhibit of Schedule of Specifications is not rejected in writing by the Employer within thirty (30) days of its receipt by the Employer, it shall be deemed to have been accepted by the Employer and will be in full force and effect for the Accounting Period and Contract Year identified herein. 21st SIGNED THIS DAY THE Blue Cross and Blue Shield of Texas Patricia Hemingway lifth,P4sident November OF October , 2002 ATTEST: Re ecca Garza, ` City Secretary APPROVED AS TO CONTENT: Mary House-, Managing Director of Human Resources APPROVED AS TO FORM: William de Haas, Contract Manager / Attorney at Law FORM NO. MPA/EX 5 60167JAN.03 Resolution No. 2002—RO523 AMENDMENT #1 TO MINIMUM PREMIUM AGREEMENT (Blue Cross Blue Shield of Texas) This amendment to the October 14, 1999, Minimum Premium Agreement between the City of Lubbock and Blue Cross Blue Shield of Texas, to provide group health insurance benefits for the City of Lubbock, effective as of January 1, 2002, the "Effective Date." r WHEREAS, City entered into an Agreement with Blue Cross Blue Shield of Texas dated October 14, 1999, to provide group health insurance benefits for the City of Lubbock, and WHEREAS, both parties desire to renew and amend this Agreement; and NOW THEREFORE, for and in consideration of the mutual covenants herein, the parries do agree to amend the Agreement as follows: 1. Exhibit Number One is deleted and replaced with Exhibit Number Three attached hereto and made a part of this Agreement. 2. All other provisions contained in- the Original Contract shall remain in full force and effect and shall not be affected by this Amendment. Executed as of the Effective Date. CITY OF LUBBOCK Windy Si on Mayor ATTEST: BLUE CROSS BLUE SHIELD OF TEXAS Jon W. Worley Chief Operating Offi r West Texas Division Rebecca Garza City Secretary Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas APPROVED AS TO CONTENT: Mary House Managing Director of Human Resources APPROVED AS TO FORM: William de Haas Contract Manager/Attorney Minimum Premium Agreement, City of Lubbock & Blue Cross Blue Shield of Texas. Page 2 EXHIBIT NUMBER THREE Schedule Of Specifications For the MINIMUM PREMIUM AGREEMENT (the Agreement) - - ---- - between BLUE CROSS AND BLUE SHIELD OF TEXAS (BCBSTX) And CITY OF LUBBOCK (Employer, Policyholder) Group Number: 60167 The specifications are to apply for the period of time indicated herein and shall continue in force and effect until the end of the Policy Period, the Agreement is terminated or this Exhibit is superseded in whole or in part by a later executedExhibit: - - Item I Contract Coverage This Minimum Premium Agreement will apply to benefits provided under the BCBSTX Group Contract(S) listed below: • Experience Rated Group PPO Managed Health Care Contract with Prescription Druk Program • Experience Rated Group Traditional Indemnity Benefit Contract with Prescription Drug Program • Experience Rated Group Comprehensive Dental Care Contract Item II Contract Year These specifications are for the current Contract Year, which shall commence on January 1, 2002 and end on December 31, 2002. Item III Accounting Period The current Accounting Period shall commence on January 1, 2002 and end on December 31, 2002. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, A Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association FORM NO. MPAIEX 1 60167JAN.02 B. Aggregate Stop -Loss Insurance: Annualized Draft Authority percentage for deficit carry forward: 20.0% ITEM VII Termination Coverage Options The Termination Coverage Options shown below will apply for the Run -Off Period: Run-OffAdministration Charge Factors for calculating the Run -Off Period. 1. $13.88 . for each Employee or Retiree Only Health Certificate $23.04 for each Employee or Retiree/Child(ren) Health Certificate $25.68 for each Employee or Retiree/Spouse Health Certificate $35.44 for each Employee or Retiree/Family Health Certificate 2. $1.72 for each Employee Only Dental Certificate $2.84 for each Employee/Child(ren) Dental Certificate $3.16 for each Employee/Spouse Dental Certificate $4.36 for each Employee/Family Dental Certificate Run -Off Liability Factors for calculating the Run -Off Draft Authority: $166.36 for each Employee or Retiree Only Health Certificate $276.16 for each Employee or Retiree/Child(ren) Health Certificate $307.76 for each Employee or Retiree/Spouse Health Certificate $424.20 for each Employee or Retiree/Family Health Certificate 2. $11.56 for each Employee Only Dental Certificate $19.20 for each Employee/Child(ren) Dental Certificate $21.40 for each Employee/Spouse Dental Certificate $29.52 for each Employee/Family Dental Certificate ITEM VIII Home Bank or Employer's Bank Information The name and address of the Employer's Bank and financial contact person shall be maintained on file in accordance with procedures established between the Emphbyer and the Comptroller Division of the Accounting Services Department of BCBSTX. Item IX Administration Charge The Administration Charge for the Contract Year shall be calculated monthly by multiplying the number of certificates exposed for a particular month by: A. $22.93 for each Employee or Retiree Only Health Certificate $38.06 for each Employee or Retiree/Child(ren) Health Certificate $42.42 for each Employee or Retiree/Spouse Health Certificate $58.47 for each Employee or Retiree/Family Health Certificate FORM NO. MPA/EX 3 60167JAN.02 Item IV Draft Authority Draft Authority shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of certificates exposed for a particular month by: A. $229.36 for each Employee or Retiree Only Health Certificate $380.74 for each Employee or Retiree/Child(ren) Health Certificate $424.31 for each Employee or Retiree/Spouse Health Certificate $584.86 for each Employee or Retiree/Family Health Certificate. B. $17.85 for each Employee Only Dental Certificate $29.63 for each Employee/Child(ren) Dental Certificate $33.02 for each Employee/Spouse Dental Certificate $45.51 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. Item V Health Stop -Loss Insurance Health Stop -Loss Insurance applicable for benefits covered under thd Health Contracts (excluding the — —Prescription Drug Program) is shown below. All monetary amounts and percentages shown shall apply for the current Contract Year. A. Specific Health Stop -Loss Insurance: Specified Paid Health Benefits in excess of the Point of Attachment which is $150,000 per Participant per Accounting Period. B. Aggregate Stop -Loss Insurance: None - not applied for. Item VI Settlement Payment Option The following Settlement Payment Options will apply: A. Specific Health Stop -Loss Insurance: 1. Monthly settlements 2. Time Period: 12 months 3. Applicable Contracts (from Item I): • Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program • Experience Rated Group Traditional Indemnity Benefit Contract FORM NO. MPA/EX 2 60167JAN.02 B. $2.63 for each Employee Only Dental Certificate $4.36 for each Employee/Child(ren) Dental Certificate $4.86 for each Employee/Spouse Dental Certificate $6.70 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. Item X - ---Health-Contract-Stop-Loss Premium The Health Contract Stop -Loss Premium is the sum of the Specific Health Stop -Loss Premium and Aggregate Stop -Loss Premium amounts calculated as follows (amounts shown shall apply for the current Contract Year): A. Specific Health Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by: $ 9.93 for each Employee or Retiree Only Health Certificate $16.49 for each Employee or Retiree/Child(ren) Health Certificate $18.38 for each Employee or Retiree/Spouse Health Certificate $25.33 for each Employee or Retiree/Family Health Certificate B. Aggregate Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by: NA Item XI Minimum Balance The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the Banking Arrangement is $388.683 for the period beginning January 1, 2002 through December 31, 2002. Item XII Additional Charges/Fees/Rates The following charges and interest rates shall apply for the current Contract Year: A. The Daily Charge rate for the Contract Year shall be .0329% (which would equate to an annual percentage rate of 12%). B. Subrogation recoveries are subject to 15.0% of any amounts recovered. C. BlueCard® Program (Out -of -Area Program) fees shall be the lesser of 10% of the discount or $2,000 per claim (Refer to ARTICLE 1, Benefit Checks, for additional explanation) FORM NO. MPA/EX 4 60167JAN.02 Item XIII Letter of Credit The Letter Of Credit is not required under this Employer's Agreement. Item XIV If this Exhibit of Schedule of Specifications_ is not rejected,in_writing by the Employer within thirty (30) days of its receipt by the Employer, it shall be deemed to have been accepted by the Employer and will be in full force and effect for the Accounting Period and Contract Year identified herein. SIGNED THIS DAY THE 12th OF December , 2001 Blue Cross and Blue Shield of Texas Jon W. W rley Chief Operating Offi West Texas -Division City of Lubbock K ATTEST: �1 Rebecca Garza, City Secretary APPROVED AS TO CONTENT: J24M 4J&� MaryHou Managing Director of Human Resources APPROVED AS TO FORM: J. William de Haas, Contract Manager FORM NO. MPA/EX 5 60167JAN.02 Resolution No. 2002-RO523 Resolution No. 2001-RO501 December 3, 2001 EXHIBIT Item No. 25 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a Contract between the City of Lubbock and B1ueCross BlueShield of Texas for insurance renewal for the City of Lubbock, and all related documents. Said Contract is attached hereto and incorporated in this resoluti6n as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council this 3rd day of December , 2001. ;or. - • ATTEST: Reb cca Garza City Secretary APPROVED AS TO CONTENT: Mary HotWe Managing Director of Human Resources APPROVED AS TO FORM: William de Haas Contract Manager/Attorney Dh/CcdocsBlueCross Blue Shield.res November 26, 2001 BlueCross BlueShield. �.� of Texas MINIMUM PREMIUM AGREEMENT (the Agreement) This Agreement is entered into by and between BLUE CROSS AND BLUE SHIELD OF TEXAS* (BCBSTX) Richardson, Texas and CITY OF LUBBOCK (the Employer, Policyholder) Lubbock, Texas Group Number: 60167 Effective Date: December 1, 1999 for the purpose of 1) determining the ultimate consideration to be paid by the Employer for the coverage provided under the applicable Blue Cross and Blue Shield Group Contracts as shown in Item I of the most current Exhibit attached hereto and made a part hereof, which are hereinafter collectively called the Health Contracts, and 2) to provide a funding method for payment of Health Contract benefits. * A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association ® Registered Marks of the Blue Cross and Blue Shield Association Form No. MPA-McWcal/Dental-99 ARTICLE I - DEFINITIONS When used in this Agreement Accounting Period Draft Authority means the sum of the Monthly Draft Authority for the Accounting Period involved, or any portion thereof. Administration Charge means the monthly consideration calculated in accordance with Item IX of the most current Exhibit, which is required by BCBSTX for the administration of the Policyholder's Health Contracts. The Administration Charge will be due and payable to BCBSTX by the first day of each Month. Banking Arrangement means the arrangement described in Article Il and Appendix A of this Agreement whereby funds required under the Agreement are maintained and accounted for and checks are issued, or caused to be issued, for the payment of health benefits under the Health Contracts. Benefit Checks means all benefit payments made on behalf of the Employer by BCBSTX issuing, or causing to be issued, a check under the Banking Arrangement for benefits under the provisions of the Health Contract and any amounts due such Participant as a result of BCBSTX's recalculation of the Participant's liability in certain instances involving claims incurred in states other than Texas. Any charges assessed to BCBSTX by another Blue Cross and/or Blue Shield Plan under the BlueCard® Program (Out -of -Area Program), including: 1. Charges by a health care provider who has contracted with another Blue Cross and/or Blue Shield Plan, for services and supplies rendered; and/or 2. Fees charged by such Blue Cross and/or Blue Shield Plan for access to their provider or facility pricing arrangements, if applicable, are included in the amounts of Benefit Checks. Such fees are not to exceed the lesser of 10% of the discount or $2,000 per claim. In order for access fees to be assessed, Blue Cross and Blue Shield Plans' (host plans' ) providers must not balance bill the Participant in excess of the negotiated rate. However, the provider is not prohibited from billing for deductibles and coinsurance. Critical Data are collectively defined as the: Accounting Period means each consecutive period of time commencing and ending on the dates indicated in Item III of the most current Exhibit. Contract Year means each consecutive period of time commencing and ending on the dates indicated in Item H of the most current Exhibit, Effective Date means the date on which coverage begins under the Health Contracts issued by BCBSTX as set forth on the cover page of this Agreement. Month means each succeeding calendar Month periodbeginning on the Effective Date of this Agreement. 3 Form No. MPA-DwM Med=W-99 Dental Certificate means the specific coverage issued for an individual employee and his or her covered dependent(s), if any, under the Experience Rated Group Comprehensive Dental Contract. The coverage is identified by a BCBSTX Subscriber identification number. Draft Authority means the monthly amount of funds that are authorized to be paid under the Banking Arrangement calculated in accordance with Item IV of the most current Exhibit. Exhibit means attached document of specifications setting out certain particulars of this Agreement or any other subsequent set of specifications supplied by BCBSTX to. replace any existing Exhibit. Final Accounting Period means that period of time described in Section B of Article IV of this Agreement which is the Accounting Period for settlement purposes immediately preceding the termination date of the Agreement. Medical Certificate means the specific coverage issued for an individual employee or retired employee and his or her covered dependent(s), if any, under the Contracts, excluding the Experience Rated Group Comprehensive Dental Contract, shown in Item I of the most current Exhibit, which is identified by a BCBSTX Subscriber identification number. Health Contract Accounting Period Deficit means that deficit amount calculated as described in Section B of Appendix B of this Agreement. Health Contract Accounting Period Surplus means that surplus amount calculated as described in Section B of Appendix B of this Agreement. Health Contract Stop -Loss Insurance means those stop -loss insurance benefits shown to be applicable in Item V of the current Exhibit attached to and made a part of this Agreement. Health Contract Stop -Loss Premium means the Monthly consideration required by BCBSTX for the risk assumed for the applicable Health Stop -Loss Insurance. Health Contract Stop -Loss Premium shall be calculated in accordance with Item X of the most current Exhibit. Health Contract Stop -Loss Premium shall be due and payable to BCBSTX monthly by the first day of each Month. Letter of Credit means an irrevocable letter of credit payable to BCBSTX guaranteeing all or part of the amounts owed by the Employer and all other funding required on termination of the Agreement, The Letter of Credit provision is explained in Section B of Article II of this Agreement and the specific amount of the letter is specified in Item XM of the most current Exhibit. Minimum Balance means the minimum amount of funds indicated in Item XI of the most current Exhibit which is required to be deposited and held in a specified bank account, as provided for in the Banking Arrangement, for the term shown. Paid Health Benefits means the total amount of all Benefit Checks issued on behalf of the Employer during the Accounting Period involved under the Banking Arrangement. Paid Health Stop -Loss Benefits means those Paid Health Benefits for which BCBSTX ultimate responsibility and risk for the payment which is the sum of the Paid Specific Health Stop -Loss Benefits and Paid Aggregate Stop -Loss Benefits shown to be applicable in Item V of the most current Exhibit. Paid Health Stop -Loss Benefits shall not include Paid Health Benefits which are paid after the end of the Final Accounting Period, regardless of the date they were incun-ed, unless explicitly provided for 4 Form No. MPA-DenM Medical-99 in the Termination Settlement arrangement in force. Settlements of Health Stop -Loss Insurance benefits shall be made either Monthly or for an Accounting Period as indicated in Item VI of the most current Exhibit. - -L ---Paid Specific Health Stop -Loss Benefits means that portion of any Paid Health Benefits paid under the Banking Arrangement during the time period indicated in Item VI of the most current Exhibit ending coincidental with the Accounting Period, which are incurred on, or subsequent to, the effective date of Specific Health Stop -Loss Insurance coverage under this Agreement, and which are in excess of the applicable Point of Attachment, if any, indicated in Item V of the most - current- Exhibit. -The time period shall be adjusted downward to coincide withthe Final Accounting Period. Paid Specific Health Stop -Loss Benefits shall include health benefits paid under the Contracts indicated in Item VI of the most current Exhibit. 2. Paid Aggregate Stop -Loss Benefits means the amount, if any, by which Paid Health Benefits, less Paid Specific Health Stop -Loss Benefits, if any (calculated as in 1. above), for the Accounting Period involved, exceed the applicable Point of Attachment indicated in Item V of ---------them®st-cur-rent-Exhibit.=-Such -excess,-if any, is the liability of..BCBSTX andmill_be.subtracted from any Health Contract Accounting Period Deficit which may result. Provided, however, no Aggregate_Stop-Loss Insurance Benefits will -be, -.paid_for the Final Accounting Period if this -----Agreement>is terminated prior -to -the -end of the -then current Contract Year and Aggregate Stop - Loss Premium already paid will not be returned.— Participant means an employee or retired employee and his or her dependents, if any, whose coverage has become effective under the Health Contracts shown in Item I of the most current Exhibit; however, retired employees and their dependents are not eligible for participation under the Experience Rated Group Comprehensive Dental Contract. Point of Attachment means that dollar or percentage amount of Paid Health Benefits which Health Stop -Loss Insurance benefits will apply. Run-off Period means the period beginning immediately following the Final Accounting Period and ending when the final valid benefit claim is paid. Benefit claims filed during the Run-off Period are subject to time limitations for Proof of Loss as provided for in the Health Contracts. Settlement Report means the detailed listing for a particular time period of all data required for settlements under this Agreement, including Health Stop -Loss Insurance settlements where applicable. ARTICLE H - BANKING ARRANGEMENT A. The Banking Arrangement to apply under this Agreement is described in Appendix A of this Agreement which is hereby incorporated and made a part hereof. B. Unless specifically waived in writing by the BCBSTX Comptroller and so indicated in Item XM of the most current Exhibit, the Employer is required, as an express condition of this Agreement, to obtain from a state or national bank in Texas an irrevocable Letter of Credit prior to this Agreement taking effect in a form acceptable to BCBSTX and in the amount and for the time period specified. C. Failure to maintain the Letter of Credit as specified can result in termination of the Agreement by BCBSTX without notice and the discontinuance of all claims payments. 5 Form No. MPA-DentaUMedical-99 D. The name and address of the Employer's bank and financial contact person shall be maintained on file in accordance with procedures established between the Employer and the Comptroller Division of the Accounting Services Department of BCBSTX. . - ARTICLE -III - CONSIDERATION A. By the first day of each Month, the Employer will remit to BCBSTX the full amount of the Administration Charge and all applicable Health Contract Stop -Loss Premiums. B. Within ten (10) days after issuance of a Settlement Report, including any Final Accounting Period and Run -Off Period Settlement Reports, BCBSTX will pay to the Employer the amount so shown to be due and payable, if any. C. Within ten (10) days after receipt of a Settlement Report, including any Final Accounting Period and Run -Off Period Settlement Reports, the Employer will pay to BCBSTX the amount so shown to be due and payable, if any. D. Within ten (10) days after the date of termination of this Agreement, the Employer will pay to BCBSTX all funds due under the termination settlement provisions of this Agreement as described in Article IV nd-Appendix-B-and G, ianytration-Charges-and-Heakh Btop Loss -Premiums covering the -Run -Off Period which may be required. E. Continuance of coveraZeunder the Health Contract is contingent upon the timely payment of all consideration due under this Agreement. F. Any consideration required to be paid under this Agreement will be automatically increased by the amount of any taxes imposed, increased or adjudged due by lawful authority on or after the effective date of this Agreement, which BCBSTX is required to pay, collect or remit, whether relating to fees, ---services,--benefits; payments -or any . other consideration or aspect of the Health Contract or this Agreement.__..-_ ARTICLE IV - SETTLEMENTS A. Monthly and Accounting Period settlements will be made as described in Appendix B of this Agreement. B. ---This Agreement shall terminate on termination of the Health Contract or thirty (30) days following the notice provided for in Section R of Article V of this Agreement. The time intervening between the end of the last previous Accounting Period and the termination date shall, regardless of the number of Months involved, be considered an Accounting Period and shall be termed herein as the Final Accounting Period Reports and settlements for the Final Accounting Period shall be effected in accordance with the provisions of this Article IV and Appendices B and C, except that Health Stop -Loss Insurance benefits will not extend beyond the Final Accounting Period. Provided however, Paid Health Stop -Loss Benefits for the Final Accounting Period may be carried forward, for combined settlement purposes, to the final Run -Off Period settlement, depending on the Termination Settlement arrangement in force. C. The Termination Settlement provisions of Appendix C will apply with regard to the processing and payment of all claims and benefits following the end of the Final Accounting Period. 6 Form No. MPA-Dental/Medical-99 D. Where Coordinated Settlements are required to be made between the Contracts and Settlements shown to be applicable in Item I of the most current Exhibit and other Policies or Contracts entered into between BCBSTX and the Employer, an Appendix D describing the provisions for such Coordinated Settlements will be added to this Agreement. ARTICLE V - GENERAL PROVISIONS A. Administrative Services Tax. In addition to the other services enumerated in this Agreement, BCBSTX agrees to provide an accounting to the Employer of the total amount of benefits paid under this Agreement, according to BCBSTX's accounts and records, for the Employer's use in determining Administrative Services Taxes due under the provisions of Article 4.1 IA of the Texas Insurance Code, if any. It is hereby acknowledged and accepted that any such Administrative Services Taxes due and owing for benefits paid under this Agreement are the sole obligation of the Employer and are apart from and in addition to any other amounts due under this Agreement. The Employer will pay directly to the State Board of Insurance the amount of any such Administrative Services Taxes due. B. Assigmnent. No.;part of this Agreement, or any rights, duties, or obligations described herein, shall be assigned or delegated without the prior express written consent of both parties. Any such attempted assignment shall be null and void. BCBSTX's standing contractual arrangements for the acquisition and use.Ofsern- ces,supplies,_equipment_ansLporsonnel from Qber-parties_shall not constitute an assignment under this Agreement. C. Audits. BCBSTX, or its duly authorized agent, shall have the right, upon reasonable notice given, to audit the books and records or Employer (and any agents, brokers, or administrators of Employer) during normal working hours, or to require that copies of pertinent documents be provided, in order to verify the validity of any benefits payable under the Health Contract which will result in payments being made under this Agreement. BCBSTX, or such agent, shall agree not to disclose any proprietary or confidential information. D. Captions. Captions appearing in this Agreement and its exhibits and appendices are provided for convenience only and in no way define, limit, construe or describe the scope of articles, sections or paragraphs to which they are inserted. E. Daily Charee. 'A daily charge shall be assessed for the late remittance of any amounts due and payable to BCBSTX by the Employer under the terms of this Agreement. This charge shall be equal to the amount resulting from multiplying the amount due times the lesser of: 1. The rate of .0329% per day (12.0% per annum); or 2. The maximum rate permitted by state law. F. Enforcement. Any delay or inconsistency in the enforcement of any part of this Agreement shall not constitute a waiver of any rights with respect to the enforcement of this Agreement at any future date nor shall it limit any remedies which may be sought in any action to enforce any provision of this Agreement. G. Entire . This Agreement, including any Exhibits, appendices and amendments shall constitute the entire understanding of the parties hereto for the purpose of this Minimum Premium Agreement and all prior contemporaneous representations, statements, understandings, negotiations, or agreements between the parties, whether written or oral, are hereby superceded. 7 Forth No. MPA-DentaUMedical-99 H. Execution. This Agreement shall be null and void and of no effect if not executed by the Employer named below and received by BCBSTX at its home office in Dallas County, Texas within sixty (60) days following the date BCBSTX executes this Agreement, as shown below. I. Force Maieure. Neither --party shall be liable for any failure to perform its obligations under this Agreement if prevented from doing so by a cause or causes beyond its commercially reasonable control including, but not limited to, acts of God or nature, fires, floods, stones, earthquakes, riots, strikes, wars or restraints of government. J. - Gender -And Mode..The -use herein -of -a personal -pronoun -in -the -masculine or feminine gender or in the singular or plural mode shall be deemed to include the opposite gender or mode unless the context clearly indicates the contrary. K. Governing Law. This Agreement shall be governed by, and shall be construed in accordance with, the laws of the State of Texas. All obligations created hereunder are performable in Dallas County, Texas and all disputes arising out of this Agreement will be resolved in Dallas County or Lubbock County, .Texas. L--- -----Legal Construction. _Should_any_provision(s) contained in this Agreement be held to be invalid, illegal, - - or wise-unen€orceable,-d,e-rrernaining-provisions-of-the-A-greernent-s WVbe construed --in their -entirety -asIf-separate-and apart from the invalid, illegal or unenforceable provision(s) unless such construction were to materially change the terms and conditions of the Agreement. M. Limitation Of Liability. Liability for any errors or omissions by BCBSTX (or its officers, directors, employees, agents, or independent contractors) in the administration of this Agreement, or in the performance of any duty of responsibility contemplated by this Agreement, shall be limited to the maximum benefits which should have been paid under the Health Contract or this Agreement had the errors or omissions not occurred (including BCBSTX's share of any arbitration expenses incurred under the Agreement), unless any such errors or omissions are adjudged to be the result of willful misconduct or gross negligence by BCBSTX. N. Modifications. Except for the Exhibit which may be changed at any time by notifying the Employer of such change, no modification, amendment, change, or waiver of any provision of this Agreement shall be valid unless agreed to by both BCBSTX and the Employer. O_ . Notice And Satisfaction. The Employer agrees to give BCBSTX specific notice in writing of any complaint or concern the employer may have about the ppe o ance cf this Agreement and to allow BCBSTX thirty (30) days in which to make necessary adjustments or corrections to satisfy any such complaint or concern prior to taking any further action with regard to the complaint or concern. P. Subsidiaries. BCBSTX and its subsidiaries and affiliates have reciprocal agreements under which they will allocate funds between its corporations resulting from any settlements, and the Employer shall have no responsibility for, or interest in, such allocation. Q. Term and Option to Renew. The term of this Agreement shall commence on December 1, 1999 and end on December 31, 2000 with an option to renew for two (2) one-year periods thereafter. 8 Fong No. MPA-DenmVMedkal-99 EXHIBIT NUMBER ONE Schedule Of Specifications For the MINIMUM PREMIUM AGREEMENT —.._.-_ (the Agreement) . _ _ . between BLUE CROSS AND BLUE SHIELD OF TEXAS (BCBSTX) And CITY -OF LUBBOCK (Employer, Policyholder) The specifications are to apply for the period of time indicated herein and shall continue in force and effect until the end of the Policy Period, the Agreement is terminated or this Exhibit is superseded in whole or in part by a later executed Exhibit. Item I Contract Coverage This -Minimum Premium -Agreement -wilt -apply to benefits -provided -under the BCBSTX Group Contract(S) listed below: • Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program • Experience Rated Group Traditional Indemnity Benefit Contract with Prescription Drug Program • Experience Rated Group Comprehensive Dental Care Contract _. Item H Contract Year These specifications are for the current Contract Year which shall commence on December 1, 1999 and end on December 31, 2000 (13 months). Item III Accounting Period The current Accounting Period shall commence on December 1, 1999 and end on December 31, 2000. FORM NO. MPA/EX-1 ' X-1 Item IV Draft Authority Draft Authority shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of certificates -exposed for aparticular month by: - A. $175.09 for each Employee or Retiree Only Health Certificate $290.66 for each Employee or Retiree/Child(ren) Health Certificate $323.92 for each Employee or Retiree/Spouse Health Certificate -$446.50 - for -each Employee or Retiree/Family Health- Certificate- - -- B. $13.19 for each Employee Only Dental Certificate $21.91 for each Employee/Child(ren) Dental Certificate $24.41 for each Employee/Spouse Dental Certificate $33.64 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. — -- ----- Item--V — -- —� --lEieaith�top=i-�ss-insurance health--Stop-Loss- Insurance -applicable -for -benefits -covered -under the Health Contracts (excluding the Prescription Drug Program) are shown below. All monetary amounts and percentages shown shall apply for the current Contract Year. A. Specific Health Stop -Loss Insurance: Specified Paid Health Benefits in excess of the Point of Attachment which is $150,000 per Participant per Accounting Period. B. Aggregate Stop -Loss Insurance: None - not applied for. Item VI Settlement Payment Option The following Settlement Payment Options will apply: A. Specific Health Stop -Loss Insurance: 1. Monthly settlements 2. Time Period: 13 months 3. Applicable Contracts (from Item I): • Experience Rated Group PPO Managed Health Care Contract with Prescription Drug Program • Experience Rated Group Traditional Indemnity Benefit Contract FORM NO. MPA/EX-1 X-2 B. Aggregate Stop -Loss Insurance: Annualized Draft Authority percentage for deficit cant' forward: 20.0% ITEM VII Termination Coverage Options The Termination Coverage Options shown below will apply for the Run -Off Period: Run-OffAdministration Administration Charge Factors for calculating the Run -Off Period. 1. $12.08 for each Employee or Retiree Only Health Certificate $20.08 for each Employee or Retiree/Child(ren) Health Certificate $22.36 for each Employee or Retiree/Spouse Health Certificate $30.84 for each Employee or Retiree/Family Health Certificate 2. $1.40 for each Employee Only Dental Certificate $2.32 for each Employee/Child(ren) Dental Certificate $2.60 for each Employee/Spouse-Dental Certificate $3.60 for each Employee/Family Dental Certificate Run-O, ff Liability Factors for. calculating the Run -Off Draft Authority: 1. $161.32 for each Employee or Retiree Only Health Certificate $267.80 for each Employee or Retiree/Child(ren) Health Certificate $298.50 for each Employee or Retiree/Spouse Health Certificate $411.45 for each Employee or Retiree/Family Health Certificate 2. $10.08 for each Employee Only Dental Certificate $16.71 for each Employee/Child(ren) Dental Certificate $18.63 for each Employee/Spouse Dental Certificate $25.66 for each Employee/Family Dental Certificate ITEM VIII Home Bank or Employer's Bank Information The name and address of the Employer's Bank and financial contact person shall be maintained on, file in accordance with procedures established between the Employer and the Comptroller Division of the Accounting Services Department of BCBSTX. Item IX Administration Charge The Administration Charge for the Contract Year shall be calculated monthly by multiplying the number of certificates exposed for a particular month by: A. $16.48 for each Employee or Retiree Only Health Certificate $27.36 for each Employee or Retiree/Child(ren) Health Certificate $30.50 for each Employee or Retiree/Spouse Health Certificate $42.03 for each Employee or Retiree/Family Health Certificate FORM NO. MPA/EX-1 X-3 B. $1.83 for each Employee Only Dental Certificate $3.04 for -each Employee/Child(ren) Dental Certificate $3.39 for each Employee/Spouse Dental Certificate $4.67 for each Employee/Family Dental Certificate The amounts shown shall apply for the current Contract Year. Item X Health Contract Stop -Loss Premium The Health Contract Stop -Loss Premium is the sum of the Specific Health Stop -Loss Premium and Aggregate Stop -Loss Premium amounts calculated as follows (amounts shown shall apply for the current Contract Year): A. Spec Health Stop -Loss Premium shall be calculated monthly and shall be equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by: $ 9.46 for each Employee or Retiree Only Health Certificate $15.71 for each Employee or Retiree/Child(ren) Health Certificate $17.50 for each Employ use -Health Certificate $24.12 for each Employee or Retiree/Family Health Certificate B. Aggregate Stop -Loss Premium shall be calculated. monthly- _and_shall be. equal to the sum of the amounts obtained by multiplying the number of Health Certificates exposed for a particular month by:. NA Item XI Minimum Balance The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the Banking Arrangement is $234,860 for the period beginning December 1, 1999 through May 31, 2000; and The Minimum Balance to be deposited by the Employer and held in the Employer's Account under the Banking Arrangement is $383,193 for the period beginning June 1, 2000 through December 31, 2000. Item XII Additional Charges/Fees/Rates The following charges and interest rates shall apply for the current Contract Year: A. The Daily Charge rate for the Contract Year shall be .0329% (which would equate to an annual percentage rate of 12%). B. Subrogation recoveries are subject to 15.0% of any amounts recovered. C. B1ueCard® Program (Out -of -Area Program) fees shall be the lesser of 10% of the discount or $2,000 per claim (Refer to ARTICLE I, Benefit Checks, for additional explanation) FORM NO. MPA/EX-1 X-4 Item XIII Letter of Credit The Letter Of Credit is not required under this Employer's Agreement. Item XIV If this Exhibit of Schedule of Specifications is not rejected in writing by the Employer within thirty (30) days of its receipt by the Employer, it shall be deemed to have been accepted by the Employer and will be in full force and effect for the Accounting Period and Contract Year identified herein. SIGNED THIS DAY THE 14th OF October ,1999 Blue Cross and Blue Shield of Texas City of Lu ock J . Worley dy Sitton, Mayor Chief Operating Officer West Texas Division a Darnell, Ci S tary APPROVED AS T07CONTENT. rM W . 0--'UA0W4 Mary Andrews, Managing Director of H an Resources APPROVED AS TO FORM: -- fit k / Y`V� William de Haas, Contracts and Competition Manager FORM NO. MPAIEX-1 X-5 CITY OF LUBBOCK Group Number 60167 APPENDIX A BANKING ARRANGEMENT The Banking Arrangement.described herein shall apply to the Minimum Premium Agreement between Blue Cross and Blue Shield of Texas* (BCBSTX) and the Employer to which this Appendix A is attached beginning December 1, 1999 and shall remain in full force and effect according to the terms of the Agreement unless amended or replaced by the parties to this Agreement in writing. All provisions of the Agreement, its Appendices, Exhibits and Amendments shall apply to this Appendix A, including any definitions. A. As used in this Appendix A: 1. The Bank means Fleet Bank, a national banking association organized and existing under the laws _ of the United-States,-whose-address_is:________.__. -777 Main Street .. _ _ Hartford, Connecticut, 06115 2. Home Bank means The Bank with which the Employer has entered into an agreement to carry out its banking obligations with The Bank in accordance with this Agreement. The name and address of the Employer's Home Bank and financial contact person shall be maintained in accordance with procedures established between the Employer and the Comptroller Division of the Accounting Services Department of BCBSTX. 3. Pool Account means an account established and maintained by The Bank for Minimum Premium Arrangements. The Pool Account will be used as a clearing account for all Benefit Checks issued on behalf of the Employer. 4. Suspense Account means an account with The Bank in the name of BCBSTX which will be used to reimburse the Employer's Account or to establish a compensating balance on a temporary basis, as required, if funds are not available in the Employer's Account or when the Accounting Period Draft Authority is exceeded. 5. Employer's Account means an account established by the Employer with The Bank, by executing an agreement as required by The Bank for opening an account, which will be used to reimburse the Pool Account for benefit payments and administration charges to the extent of Employer liability. The Minimum Balance to be deposited and held in the Employer's Account is indicated in Item XI of the most current Exhibit of Schedule of Specifications. 6. Draft means the transfer of funds among the various accounts belonging to BCBSTX, the Home Bank, the Employer and The Bank pursuant to this Agreement. * A Division of Health Care Service Corporation, A Mutual Legal Reserve Company, An Independent Licensee of the Blue Cross and Blue Shield Association FORM NO. MPA/A-FLEX-3 A-1 7. Prescription Drug Program means the coverage provided under the Prescription Drug Program as shown in Item I of the most current Exhibit. Prescription Drug Program benefits are to be paid under a special banking arrangement as described in Section C of this Appendix A, but for all other purposes under this Agreement, Prescription Drug Program benefits are to be considered as Health Contract benefits. B. Banking Authorization and Procedures: 1. BCBSTX is authorized to issue checks on the Pool Account to employees and providers of services -- -- ------in amounts --equal to health benefits payable under the Health Contract, or to draft funds from Employer's Account to reimburse BCBSTX for any Prescription Drug Program claims paid as described in Section C of this Appendix A. 2. The Bank is authorized on a daily basis and agrees to: (a) Transfer from the Employer's Account to the Pool Account funds equal to the Benefit Checks clearing the Pool Account which are issued by BCBSTX under its authority in Section B.1 above to the extent funds are available in the Employer's Account as determined by the Accounting Period Draft Authority. - (b)- -Draft--the Home Bank and deposit to the Employees Account funds equal to the checks --------- ------clearing the Pool Account for transfers in accordance with (a) above up to an amount not to exceed the Accounting Period Draft Authority. 3. BCBSTX will issue checks on the Pool Account for health benefits payable under the Health Contract. The Bank will transfer from the Employer's Account to the Pool Account an amount equal to checks clearing the Pool Account the previous day. If sufficient funds are not available in the Employers Account to cover checks clearing the Pool Account as a result of the Accounting Period Draft Authority being exceeded, BCBSTX will establish a compensating balance in the Suspense Account to cover such check amounts or will transfer funds from the Suspense Account to the Employer's Account. As soon as funds become available in the Employer's Account, Suspense Account funds will be reduced accordingly. The Bank will draft the Home Bank on a daily basis in an amount equal to the checks clearing the Pool Account not to exceed the Accounting Period Draft Authority. 4. The Employer agrees to deposit in the Home Bank, funds sufficient to meet all drafts authorized by this Agreement. 5. To the extent Benefit Checks are ultimately reimbursed or paid from the Employers Account, Health Contract benefits shall be considered self -funded, not insured,. and the premium payment requirements specified in the Health Contract shall not apply. All benefit payments made under this Agreement, whether by BCBSTX or the Employer, shall be collectively applied with regard to deductibles, coinsurance amounts, benefit maximums and other Health Contract requirements. C. Prescription Drug Program Banking Arrangement: 1. BCBSTX shall issue or cause to be issued checks for Prescription Drug Program benefits payable under the Prescription Drug Program benefits from a special banking account established for payment of such claims which is unrelated to the accounts described in Section A above. FORM NO. MPA/A-FLEX-3 A-2 2. On a monthly basis, BCBSTX will draft the Employer's Account for amounts sufficient to reimburse BCBSTX for Prescription Drug Program benefit checks issued on the special banking account including "good faith" payments made to BCBSTX Participating Pharmacies honoring Identification Cards issued on Employer's group coverage. 3. On a quarterly basis, BCBSTX will invoice Employer separately for amounts sufficient to cover any Administrative Services Taxes which may be due for benefits paid under the Prescription Drug Program, and will remit said taxes due, if any, to the State of Texas. FORM NO. MPA/A-FLEX-3 A-3 CITY OF LUBBOCK Group Number 60167 APPENDIX B MONTHLY AND ACCOUNTING PERIOD SETTLEMENTS The settlement provisions described herein shall apply to the Minimum Premium Agreement between Blue Cross and Blue Shield of Texas* (BCBSTX) and the Employer to which this Appendix B is attached beginning December 1,1999 and shall remain in full force and effect according to the terms of the Agreement unless amended -or -replaced by the parties to this Agreement in writing. All provisions of the Agreement, its Appendices, Exhibits and Amendments shall apply to this Appendix B, including all definitions. A. Monthlv Settlements Where shown in Item V of the Schedule of Specifications to be applicable, BCBSTX will furnish the Employer a Specific Health Stop -Loss Insurance Settlement Report within thirty (30) days after the end of each month occurring within an. Accounting Period -in which Specific Health Stop -Loss Benefits were paid. Within ten (10) days after issuance of such report, BCBSTX will settle with the Employ-er.for_any_Specific-Health Stop -Loss Insurance involved. Based on the report, the following applies: L -- --Based on--theBankingArrangement in force and the -settlement -results; Specific -Health Stop - Loss Insurance settlement amounts reported will either be paid directly to the Employer by BCBSTX or credited to a designated bank account. 2. To the extent that amounts are paid to the Employer by BCBSTX as a result of any monthly Specific Health Stop -Loss Insurance settlement, as described in paragraph 1 above, available Draft Authority will be restored by those amounts. B. Accounting Period Settlements 1. BCBSTX will famish the Employer an Accounting Period Settlement Report within ninety (90) days after the end of each Accounting Period. If the report reflects that the Accounting Period Draft Authority exceeds Paid Health Benefits (less Paid Specific Health Stop -Loss Benefits, where applicable, if any), the difference between the two amounts shall be termed the Health Contract Accounting Period Surplus; if the reverse is true, the difference between the two amounts shall be termed the Health Contract Accounting Period Deficit. 2. Based on the report provided for in the preceding paragraph, the following applies: (a) If the report reflects a Health Contract Accounting Period Deficit, all or part of such deficit, in an amount not to exceed the percentage of the annualized Draft Authority indicated in Item VI of the most current Exhibit, shall be combined with any deficits carried forward from previous Accounting Periods and shall be termed the Health Contract Standing Deficit. The resulting Health Contract Standing Deficit shall then be carried forward; *A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association FORM NO. MPA/B-PROS-2 B-1 (b) If the report reflects a Health Contract Accounting Period Surplus, such surplus shall _first be applied against any Health Contract Standing Deficit. Any remaining surplus shall then be reduced to zero, except that, any surplus resulting from the Final Accounting Period settlement will be carried forward on termination; (c) If the date of termination of this Agreement is within six (6) months after the beginning date of the then current Contract Year, the Accounting Period immediately preceding the Final Accounting Period will be combined with the Final Accounting Period for settlement purposes. C. Retroactive Adjustment 1. To the extent that later events such as those resulting from coordination of benefits, subrogation, or other legal or administrative actions or causes necessitate adjustments to prior settlements made under this Agreement, such adjustments shall be made at the time of the next occurring settlement provided for under this Agreement and shall be reflected. in the Settlement Report. 2. Should the event necessitating an adjustment occur after all settlements provided for under this Agreement have been made, notice of the adjustment action, in the form of an adjustment report, will be given to the Employer within thirty (30) days following identification of said event by BCBSTX. 3. If the adjustment action requires that payment be made by BCBSTX to the Employer, such payment will be made within ten (10) days after the adjustment or Settlement Report is issued to the Employer. If the adjustment action requires that payment be made by the Employer to BCBSTX, the Employer will remit such payment to BCBSTX within ten (10) days after receipt of the report. FORM NO. MPA/B-PROS-2 B-2 CITY OF LUBBOCK Group Number 60167 _----------__-_ _ ._..... - - -- APPENDIX C TERMINATION SETTLEMENT The settlement provisions described herein shall apply to the Minimum Premium Agreement between Blue Cross and Blue Shield of Texas* (BCBSTX) and the Employer to which this Appendix C is attached beginning December 1, -1999 and shall remain in full -force -and effect according to the terms of the Agreement unless amended or replaced by the parties to this Agreement in writing. All provisions of the Agreement, its Appendices, Exhibits and Amendments shall apply to this Appendix C, including all definitions. A. As used in this Appendix C: 1. Run -Off Draft Authority means the amount of funds that are authorized to be paid under the —Banking-Arrangement during the Run -Off Period which shall be equal to the sum of the total of all —Health Certificates exposed during the three (3) month period immediately preceding termination multiplied by each of the Run -Off Liability Factors indicated in Item VII of the most current Exhibit. 2. Run -Off Administration Charge means the amount of consideration required by BCBSTX for the administration of Run -Off Period claims which shall be equal to the sum of the total of all Health Certificates exposed during the three (3) month period immediately preceding termination multiplied by each of the Run -Off Administration Factors indicated in Item VII of the most current Exhibit. The Run -Off Administration charge shall be due and payable within ten (10) days after the date of termination. B. After termination, BCBSTX will continue to pay claims on behalf of the Employer under the Banking Arrangement, as provided in Article Il and Appendix A of this Agreement, and the Employer shall continue to fund the required accounts, up to the amount of the Run -Off Draft Authority, for a period of ninety (90) days. Prior to the 90th day following termination, funds equal to the amount of any remaining Run -Off Draft Authority and any Draft Authority remaining from the Final Accounting will be transferred by the Employer to a bank account designated by BCBSTX for the continued payment of outstanding claim liabilities. C. Within fifteen (15) months after termination, BCBSTX will furnish the Employer with a Final Settlement Report. If the report reflects that the Run -Off Draft Authority combined with the Final Accounting Period Draft Authority exceeds Paid Health Benefits for the Run -Off Period combined with the Paid Health Benefits for the Final Accounting Period (less Paid Specific Health Stop -Loss Benefits for the Final Accounting Period where applicable, if any), the difference between the two combined amounts shall be termed the Run -Off Period Surplus; if the reverse is true, the difference between the two combined amounts shall be termed the Run -Off Period Deficit. �Ir A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, An Independent Licensee of the Blue Cross and Blue Shield Association FORM NO. MPA/C-PROS-1 C-1 D. Based on the reports provided for in the preceding paragraph, the following applies: 1. If the report reflects a Run -Off Period Surplus, such surplus shall be payable to the Employer within ten (10) days after the report is issued to the Employer; 2. If the report reflects a Run -Off Period Deficit, any deficit then remaining would be the responsibility of BCBSTX. FORM NO. MPA/C-PROS-1 C-2 SERVICES AGREEMENT BETWEEN BLUE CROSS AND BLUE SHIELD OF TEXAS, INC. (hereinafter called BCBSTX) and CITY OF LUBBOCK - 60617 — (hereinafter -called -the Employer) - WHEREAS, the Employer has established a health benefit program for its employees and the eligible dependents of its employees; and WHEREAS, Congress has imposed certain statutory requirements regarding continuation of health benefits for those persons covered under the Employer's health benefit program; and WHEREAS, the Employer has requested-_ BCBSTX to furnish certain noninsurance services in connection with continuation of coverage under the Employer's health benefit program; NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, it is hereby agreed as follows: F1 V Article I - Definitions As used in this Agreement: A. Calendar Year means the one year period commencing on a January 1 and ending the following December 31. B. COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended. C. Collection Services means, except for the initial premium required to establish continued coverage, the process by which a continued Participant is billed for and remits premium for continued coverage. D. Dependent means any person who is both eligible for coverage and covered as a dependent spouse or child under the Employer's health benefit program on the day before a Qualifying Event. E. Election period means the period of at least sixty (60) days duration beginning not later than the date on which coverage under the health benefit program terminates by reason of a Qualifying Event and ending not earlier than sixty (60) days after the later of (1) the beginning date or (2) the date a Participant has been notified of the right to elect continued group coverage after the occurrence of a Qualifying Event. F. Emolovee means any person who is both eligible for coverage and covered as an employee under the Employer's health benefit program on the day before a Qualifying Event. G. Notification Services means those actions intended to: (1) notify a Participant of his or her right to elect continued group coverage after the occurrence of a Qualifying Event; (2) attempt to ascertain whether such Participant wishes to elect such continued coverage; and (3) collect the initial premium for such coverage if the Participant has elected to continue the coverage. H. Participant means an Employee or a Dependent as above defined. Use in this Agreement of the singular shall be deemed to include the plural unless the context clearly indicates the contrary. I. Qualifvin4 Event means the occurrence of an event which would result in the loss of eligibility of a Participant under the Employer's health benefit program but for the requirements of COBRA. 2 J. Subscriber means a participant who (1) elected to continue group coverage under COBRA; (2) submitted an application and the entire applicable premium; and (3) has a certificate number for continued coverage under COBRA. Article 11- Services Performed by BCBSTX A. Notification Services - If the Employer requests BCBSTX to furnish Notification Services, Once the Employer has notified BCBSTX in writing of the occurrence of a Qualifying_ Event and. has. given ..BCBSTX the name and current address of a�covered ` aficipant, BCBSTX will timely provide the applicable Participant notice of the right to continue group coverage directed to the address provided by. the Employer. 2. The ;otice-provided a Participant pursuant to Paragraph 1 of this Section A will also include premium information and an application card, and will state the time limitations for the election to continue coverage. Any Participant electing to continue coverage will be directed to communicate such election in writing to BCBSTX. BCBSTX will bill and collect the applicable initial premium rate from the date of the Qualifying Event to the , end of the month in which such election is received. No continued group coverage shall be effective until the entire initial premium rate is received by BCBSTX. 3. When an .Employee is eligible under COBRA to continue group _--coverage and makes an election, the election is deemed to include all Participants except as otherwise stated in such election. When the employee is not eligible under COBRA to continue group coverage and a Dependent spouse is eligible under COBRA to continue group coverage, an election by the Dependent spouse is deemed to include all Participants except as otherwise stated in such election. For purposes of this Section 3, an election includes a declination. B. Collection Services - Once a Participant has elected to continue group coverage and the entire initial premium rate has been received by BCBSTX. 3 1. BCBSTX will establish the membership information in the BCBSTX claims system and issue identification cards and a benefit booklet. 2. BCBSTX will provide a monthly statement to the applicable Subscriber. Such statement shall indicate a due date for receipt of the premium rate. Should the premium rate not be received by the due date, any claim(s) incurred after the last date for which the - - - - premium rate has been received will be suspended and a delinquent notice will be issued. If all of the premium rate is not received within thirty (30) days of the due date, the continued group coverage will be terminated as of the last day of the month in which the entire, proper premium rate was paid. In the event of such termination, the Subscriber shall be notified by BCBSTX of the termination of continued group coverage. :. 3. The S ubscriber-w-ilLbe-notified_.sixA-nionths-pr..iot_-toAhe maximum .- .--- period - --of-- continued -_group _coverage _ that.... such, -coverage will -- --terminate--in-six--months— The ---notice will contain information concerning any right to an individual conversion policy. 4. An additional notice will be provided sixty (60) days prior to the maximum period of continued group coverage advising that continued group coverage will terminate in sixty (60) days. The ___--additional notice will contain information concerning any right to an individual conversion contract. 5. Upon receipt of evidence satisfactory to BCBSTX that a continued Participant has become, after the date of election, ineligible for continued group coverage for reasons other than failure to pay the x-o-per---premiurn-mte_or_ the . expiration of the maximum period of continued- group- coverage, BCBSTX will -notify such ineligible continued Participant that the continued group coverage is being terminated and the date and reason for such termination. 6. BCBSTX shall notify a continued Subscriber of any benefit changes .which the Employer may make in regard to its health benefit program and any change in the premium rate. 7. At least semiannually, BCBSTX will provide the Employer a written report giving the status of each continued Subscriber covered on the ending date of such report. 4 Article III - Duties of the Employer A. If the employer has requested BCBSTX to furnish Notification Services: 1. Within thirty (30) days after the occurrence of a Qualifying Event, the Employer will provide a written notice of such event to BCBSTX. The written notice will be on a form satisfactory to BCBSTX and will describe the nature and date of the Qualifying Event, the name and last known address of each Participant, the certificate number(s) of each Participant, and the type(s) of coverage held by each Participant on the date of the Qualifying Event. Upon request, BCBSTX will provide the Employer with an appropriate notice form. 2. if the- Qualifying --Event is -either--the -divorce of the Employee or a Dependent child ceasing to be a Dependent child under the provisions of the Employer's health benefit program, and the --Eployer-had-no-notice-of-such - Qualifying -Event within 30 days of such Qualifying Event, the notice required by Paragraph 1 of this Section A will be provided in writing to BCBSTX no later than ---4ourteen (14) days following -the Employer's receipt --of -notice of the occurrence of such event. 3. Should any Participant communicate or attempt an election or declination of the continued group coverage directly with the Employer or its officers or agents, the Employer shall immediately present any and all information regarding such action to BCBSTX. For purposes of this Paragraph 3, "immediately" means within three (3) work days. B. If= theE--mployer --has----requested BCBSTX to furnish only Collection Services:__ _--- _ 1. Within ten (10) days of the receipt of a Participant's election to continue group coverage, the Employer will provide a written notice to BCBSTX of such election. The written notice will be on a form satisfactory to BCBSTX and will describe the nature and date of Qualifying Event, the name and current address of each Participant electing to continue group coverage, the certificate number(s) of each Participant and the type(s) of group coverage each Participant has elected to continue. Upon request, BCBSTX will provide the Employer with an appropriate notice form. 5 2. The Employer shall remit the entire initial premium rate with the notice required in Paragraph 1 of this Section B. BCBSTX will not provide any Collection Services unless and -until the entire initial premium rate has been received by BCBSTX. 3. After the initial premium rate has been received by BCBSTX, should any participant remit any premium rate directly to the Employer or its officers or agents, the Employer shall immediately present such - payment --and --any----other- -information --regarding the payment to BCBSTX. For purposes of this Paragraph 2, "immediately" means within three (3) work days. C. Effective performance by BCBSTX of its duties and responsibilities pursuant to this Agreement -requires that the Employer provide BCBSTX timely and accurate information. BCBSTX shall not be responsible for delay or errors in the performance or nonperformance of this Agreement ---whid -are-subs#aitie+ly-c-aused--by-or-contr-ibuted-to-in-whole or part by the failure -of the Employer to furnish -accurate -and timely information. All time —7equirements imposed-upon-the-Employer---by--this-Article III-- are of the essence.--- D. In the event of termination of this Agreement, the Employer shall notify Subscribers of such termination and the procedures to be followed to retain -the continued coverage. Article 1V - Compensation A. The compensation. to BCBSTX by the Employer for the services requested -by -the -Employer will --be based upon two separate components: a charge to the Employer per Subscriber and a charge (not to exceed two (2) percent of the applicable premium) made by the Employer to a continued Participant. B. The compensation amounts provided in this Article. IV shall remain in effect until the December 31 following the effective date of this Agreement. BCBSTX may amend the compensation for each succeeding Calendar Year by providing the Employer written notice of such amendment at least thirty (30) days prior to the commencement of the Calendar Year. The new compensation will apply to any Qualifying Event which occurs in the new Calendar Year. 6 C. The execution of this Agreement shall be deemed an assignment to BCBSTX of the right of the Employer to charge a Participant an administrative charge or percentage of premium. It is expressly agreed and understood that BCBSTX will charge and collect one hundred two (102) percent of applicable premium to a continued Participant and that the Employer shall not make or request any charge whatsoever from a Participant. D. Premium shall not be considered part of the Employer's compensation to -BCBSTX:--- In the -event a P-articipant- -is--entitled to an additional eleven (11) months of coverage because of a determination of total disability under the Social Security Act, BCBSTX shall receive 148% of applicable premium as premium and not as an administrative charge. E. The compensation for Notification and Collection Services is 150.00 per enrolled -Subscriber -for --those P-articipants who: --are- enrolled--on-.COBRA December 1. 1999, and after. The compensation for Participants who were_ enrolled on COBRA prior to December 1. 1999, is 100.00 per enrolled-subschber.-- - - - - - F. - -BCB-SIX-will-provide--a--statement-to-the Employer -for -Subscribers during the previous billing--period.--Payment. shall. -be made. in full to BCBSTX within thirty (30) days of the billing date. _.__-.. Article V - Termination A. This Services Agreement will terminate on the earliest of the following dates: 1. The date on which the compensation owing BCBSTX pursuant to this Agreement becomes overdue. 2. The last day of the month next following the date BCBSTX receives written notice from the Employer that the Agreement is to be terminated. 3. The last date the Employer no longer has any group health insurance contract or Administrative Services Agreement in full force and effect with BCBSTX. 4. The date on which a proceeding is filed by or against the Employer under bankruptcy statutes of the United States, or the Employer is 7 placed under receivership or trusteeship under any state or federal statute. 5. The last day of the month next following the month in which BCBSTX provides written notice to the Employer that the Agreement is to be terminated, provided, however, such termination may not be effective prior to the December 31 following the effective date of this - Agreement. - B. In the event of termination- of this -Agreement;- BGBSTX shall have no further duty or responsibility after the date .of termination. Any and all compensation due BCBSTX, whether or not previously billed, will be due and payable within thirty (30) days of the date of termination. ArticleM - General -Provisions A._-__ AMENDMENTS: This Agreement may be modified at anytime with the mutual eon_-_QP_nt of STY and the--E_mpaaye". ll-amendments-will be in writing --and signed -by -an -authorized --representative of -each party. Only ----the-President--or-a-Vice-President-of-BGB-ST-X is --authorized -to-amend this --Agreement-on-behalf of BCBSTX.-._.- B. ENTIRE CONTRACT: This Agreement is the entire contract between the parties. C. TEXAS LAW GOVERNS: This Agreement has been negotiated and executed in the State of Texas and will be governed by and construed in accordance with the law of the State of Texas. All services performed by BCBSTX shall be deemed to have been performed in Dallas County, Texas or in Lubbock County, Texas. D. AGENT: In performing its duties and responsibilities pursuant to this Agreement,-BCBSTX--is-acting-only as--an-agent-of_the -Employer and is --not-a-plan administrator -or -fiduciary. In performing under this Agreement, BCBSTX acts under the supervision and direction of the Employer. In the event of any dispute or disagreement concerning eligibility for continued group coverage, all final responsibility shall be made by the Employer. E. TAXES: In the event any taxing authority having jurisdiction over either (or both) of the parties determines that the compensation paid to BCBSTX by the Employer results in any tax liability (other than an income tax) to BCBSTX, such tax shall be the responsibility of the Employer, and the amount of such tax shall be paid by the Employer to BCBSTX, upon written request pursuant to Article IV, Section G, of this Agreement. 8 F. NOTIFICATION: Under no circumstance will BCBSTX be obligated to notify any Participant (regardless of whether or not the Participant has -elected to continue group coverage) of the termination of this Agreement. G. INFORMATION: All written information (including billings and compensation) and notices provided pursuant to this Agreement will be posted by .first class mail, postage prepaid to BCBSTX at P. O. Box 665730, Dallas Texas, 75265-5730 and to the Employer at City of Lubbock Attn: Lou Moore P. O. Box 2000, Lubbock. TX 79457. Article VII - Effective Date The effective date of this Agreement is December 1. 1999. V] City of Lubbock Signature Page IN WITNESS WHEREOF, BCBSTX and the Employer have caused this Agreement to be executed by their authorized representative. SIGNED THIS DAY THE CITY OF LUBBOCK: ATTEST: 14th APPROVED AS TO CONTENT: Andrews, Managing Director of Human Resources APPROVED AS TO FORM: jV it iam de Haas Contracts and Competition Manager of October , 1999. BLUE CROSS AND BLUE SHIELD OF TEXAS: KAREN 6 JONES REGIONAL SALES EXECUTIVE 10