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HomeMy WebLinkAboutResolution - 6154 - Contract - Canada Life Assurance Company - Short Term Disability Insurance - 01_28_1999Resolution No. 6154 Item No. 15 January 28, 1999 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 by and between the City of Lubbock and the Canada Life Assurance Company, to provide services for Short Term Disability Insurance, and all 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 28tb day of January , 19 99 . WINDY SIT N, MAYOR ATTEST: / 4 Kaythi larnell, City Secretary APPROVED AS TO CONTENT: Mary Andre , Managing Director Of Human Resources APPROVED AS TO FORM: lily U Simg,;�Assis t City A gs Canada Life Short Term Ins.res January 21, 1999 Resolution No.6154 Item No. 15 ADMINISTRATIVE AGREEMENT January 28, 1949 THIS AGREEMENT is made as of January 1st.1999 BETWEEN: THE CANADA LIFE ASSURANCE COMPANY hereinafter referred to as Administrator OF THE FIRST PART - and - Citv of Lubbock hereinafter referred to as the Company OF THE SECOND PART WHEREAS the Company is authorized to enter into this Agreement for the purpose of delegating certain of its authorities, rights and duties to an administrator for the purpose of the Short Term Income Replacement Plan. AND WHEREAS the Company desires the Administrator to administer weekly indemnity claims in accordance with the Short Term Income Replacement Plan and the Administrator is willing to do so pursuant to the terms of this Agreement. (A copy of the provisions of the Short Term Income Replacement Plan are attached hereto as Exhibit "A".) NOW, THEREFORE THIS AGREEMENT WITNESSETH that in consideration of the premises and of the mutual obligations and agreements herein set forth, The Company and the Administrator agree as follows: 1. The Company hereby appoints the Administrator to carry out services for the purpose of the Plan and the Administrator hereby accepts such appointment. The duties and the responsibilities of the Administrator shall be limited to carrying out the terms of this Agreement and directions of the Company in furtherance thereof: 2. The Company hereby authorizes and directs the Administrator and the Administrator agrees to provide services as follows: a. to provide the Company with the necessary type and number of forms as might be requested by the Company in the continued efficient operation of the Administrator's duties. b. to receive and review notices of claim from members eligible to receive benefits under the Plan, to make appropriate claims investigations (as agreed upon by the Company and the Administrator) and to advise the Company of the action that should be taken (e.g. approval of the claim, appropriate duration). C. to discuss claims with providers of hospital and medical services where appropriate. d. to maintain accurate and detailed accounts for receipts and disbursements and other transactions within the control of the Administrator, and all accounts, books and records relating thereto shall be open at all reasonable times to inspection and audit by any person or persons designated in writing by the Company. e. to provide annual reports and actuarial opinion to the Company at such intervals as the Company may direct regarding the financial experience under the Plan. Additional reports may be provided at a cost to be determined by the Administrator. City of Lubbock Pace No. 1 Dated January Ist, 1999. f, to advise the Company with respect to the administration and operation of the Plan. g. to attend meetings with the Company as agreed to by the Company and the Administrator at a mutually convenient time and place. h. to provide suitably qualified staff to assist in the co-ordination of all services provided by the Administrator in the resolution of any problems relating to such activities. 3. The Company agrees to determine who may become covered, how and when a person's coverage takes effect, the amounts of coverage, when a person's coverage terminates, the maximum benefit payment period, and the elimination period The Company will determine whether any and all conditions relating to the above have been met prior to submitting a claim to Canada Life for advice. 4. In the event the Administrator advises the Company to deny a claim, the Administrator will provide written notice to the Company. The employee may request a review of the denied claim within 60 days of receipt of written notice that the claim has been denied. The Administrator will make a decision within 60 days after the request for review is made, unless circumstances of the claim require an extension, in which event the decision will be made as soon as possible, but not longer than 120 days after the request for review is made. The decision will be in writing and will include reasons for the decision with reference to those provisions (found in Exhibit A) on which it is based. 5. Any premium or tax assessed against the Administrator in respect of the Plan shall be borne by the Company. 6. The Administrator in performing its administrative obligations under this Agreement with respect to third parties, including representatives of the employees and offices of the Company, is acting as a servicing agent of the Company and the rights and responsibilities of the parties shall be determined in accordance with the law of agency except as otherwise herein provided. 7. The Administrator shall not be responsible for any claim, demand or lawsuit brought against the Administrator for any loss which is the result of negligence or willfW misconduct by the Company. g. The Administrator shall use ordinary care and reasonable diligence in the exercise of its powers and the performance of its duties as Administrator and shall retain liability for any willful misappropriation or conversion and for negligence on the part of any employee or agent of the Administrator. 9. The services to be performed by the Administrator under this Agreement may, at its discretion, be performed directly by it wholly or in part through a subsidiary or affiliate of the Administrator or under a contract with any organization of its choosing. 10. Notices or communications from the Company to the Administrator shall be addressed to the Administrator and shall be deemed to be duly given or served, if the same shall be sent by post office mail, telegraph, telex, TWX or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communications to another address: City of Lubbock Page No. 2 Dated January 1st; 1999. The Canada Life Assurance Company 6201 Powers Ferry Road Suite 600 Atlanta, GA 30339 Notices or communications from the Administrator to the Company shall be addressed to the Company and shall be deemed to be duly given or served if the same shall be sent by post office mail, telegraph, telex, TWX or other similar or analogous means, to the address shown below, unless the Company has been requested to send such communications. to another address: The City of Lubbock P. O. Box 2000 Lubbock, TX 79457 Notices and communications described in this paragraph that are sent by post office mail will be deemed to be duly given or served on the third business day following the date the notice is mailed. 10. This contract shall be construed and enforced according to the laws of the State of Texas. The venue shall be Lubbock County, Texas. 11. The Company may tenninate the services of the Administrator at any time upon giving to the Administrator 60 days written notice of its intention to do so. The Administrator may resign at any time upon 60 days notice in writing to the Company. The Administrator upon its resignation shall complete the processing of all services described in this Agreement which have commenced prior to the effective date of the termination of this Agreement. 12. The Company shall pay fees to the Administrator in accordance with Exhibit 'B", which may be amended from time to time as agreed to by the Company and the Administrator. City of Lubbock Paee No_ 3 Dated January 1st, 1999. THE CANADA LIFE ASSURANCE COMPANY Steve Rulis Director of Group Underwriting and Actuarial Dated at Atlanta. GA this 19th day of January 1999 Citv of Lubbock Windy Mon, Mayor Attest: "/� 1 Ka a Darnell, City Secretary Approved as to Content: Mary Andrews, M ging Director of Human Resources Approved as to Form: 75C , Gs, Assistan�City Attorney Dated at Lubbock, T% this 28th day of January , 1999 City of Lubbock Page No. 4 Dated January 1st, 1999. EXHIBIT "A" The Short Term Disability Income Benefit which The Canada Life Assurance Company is covering under this Administrative Agreement is as shown on the attached pages. The applicable Plan provisions are attached. The Canada Life Assurance Company will advise the Company to pay claims in accordance with the attached. The Canada Life Assurance Company is acting solely as Administrator of this Plan as described in the Administrative Agreement to which this Exhibit is attached. EXIIIBIT 'B" The Company shall remit the following fees from the effective date of this agreement. 1. Initial Review and Advice for "clean" claims: We will review claims identified by The Company and advise on prognosis, appropriate frequency of further claim statements and will recommend further action, such as referral at a later date_ Fee for Service Retainer 2. Disbursements (medical reports, IME's surveillances, rehabilitation providers) 3. Appeals Fee for Service Fee for Service The above fees will be collected by the Administrator on a monthly basis as they are incurred. $250 per claim $275 per month at cost at cost The Administrator has the right to change the above fees or the basis used to determine such fees to a basis other than as described above, on January 1st, 2000 or any anniversary thereof. City of Lubbock Paae No. 5 Dated January 1 st, 1999. EXHIBIT A SHORT TERM INCOME REPLACEMENT BENEFIT DEFINITIONS All male terms shall include the female tern, unless stated otherwise. You to and "employer" mean the City of Lubbock. "We", "our", and "us" mean The Plan Administrator. "Plan Administrator" means The Canada Life Assurance Company. "Person" means an employee. "Actively at work" means that a person is capable of performing his normal duties as an employee at his normal place of employment. "Effective Date" means January 1 st, 1999. "Plan month" means a period of one month commencing on the Effective Date or on the first day of any month thereafter. thereof. "Plan year" means a period of one year commencing on the Effective Date or on any anniversary "Employee" means any one who is employed by you. "Plan" means the Short Term Income Replacement Plan established by City of Lubbock for the benefit of its employees. "Annual earnings" as used to determine the benefits of a person under this plan will be calculated as his annual gross base earnings as an employee. They exclude any income he receives such as but not limited to commissions, bonuses, dividends, overtime and profit sharing. "Weekly Earnings" will be the annual earnings of a person divided by 52. GC500-003 City of Lubbock Page No. 6 Dated January 1st, 1999. SCHEDULE CLASSES SHORT TERM INCOME REPLACEMENT BENEFIT All eligible employees An amount equal to 100% of the person's gross weekly earnings (rounded to the next higher $ l .00 of benefit). GC500-013 City of Lubbock Page No. 7 Dated January 1st, 1999. WHEN A PERSON'S COVERAGE TERMINATES All of a person's coverage under this plan will terminate at the earliest time shown below. When the person's employment terminates. A person's employment will terminate when he is no longer actively at work. However, if a person is not actively at work due to disease, pregnancy or injury his coverage will be continued in force under this plan until the date on which we receive written notice from you that the person's coverage is to be terminated. 2. When the person ceases to be a member of a class or classes of persons who may be covered. On the date on which this plan is no longer in force. 4. If a person is absent from work due to a temporary lay-off or due to a leave of absence, the earlier of a. The date on which we receive written notice from you that the person's coverage is to be terminated. b. The last day of the month that follows the month in which his absence from work began. 5. When the person goes on strike, or is locked -out. This will not apply if either: a. There is a written agreement between you and us that all persons will continue to be covered during the strike or lock -out. b. There is applicable statutory legislation or regulation requiring the continuation of coverage during a strike or lock -out. 6. The day before he enters active full-time service in any naval, military or air force. 7. On the date on which the person requests, in writing, to have his coverage terminated. On the date on which the person retires unless otherwise stated in the Who May Become Covered provision of this plan. If an event that is described above occurs, you must deposit written notice with us at our Head Office within 31 days. Failure to give written notice within such 31 day period will not continue coverage with respect to a person beyond the time it would otherwise have been terminated as shown above. GC500-212 City of Lubbock Page No. 8 Dated January lst, 1999. STANDARD PROVISIONS Currency All amounts payable under this plan must be paid in United States currency. Notice of Claim Written notice of a claim must be given within 30 days of the occurrence or commencement of any loss covered by this plan. If this is not possible, we must be notified as soon as it is reasonably possible to do so. Notice must be given to us at our Head Office or to an agent of ours_ The notice should include the name of the person with respect to whom the claim is made and the group plan number. GC500-310 Claims Forms When we receive a written notice of a claim, we will send the claimant our claim forms to file proof of loss. If the claim forms are not received within 15 days after written notice of claim is sent, the claimant can send us written proof of claim without waiting for the claim forms. Proof of Loss Proof of loss must be given, to us no later than 90 days after the occurrence or commencement of any loss covered by this plan. If it is not possible to give proof within the time required, it must be given as soon as reasonably possible. Proof of continued disability and regular attendance of a physician must be given to us within 30 days of the date we request the proof. The proof must cover. 1. The date disability began. 2. The cause of disability. The severity of the disability. Physical Examination We will have the right and opportunity, at the Company's expense, to have a physician of its choice examine anyone in respect of whom a claim is being made. We will have the right to do this when and as often as we may reasonably require. The benefits with respect to which the claim was made will not be paid during any period in which the person fails to submit to any medical examination requested by us. GC500-021 City of Lubbock Page No. 9 Dated January 1st, 1999. SHORT TERM INCOME REPLACEMENT BENEFIT Benefit We will advise the Company to pay to a person, who begins a continuous period of disability while he is covered under this provision, after he has completed the elimination period the Amount Of Coverage which applies to the person under the amount of coverage provision at the date on which such period began, subject to all of the following conditions. An absence from work for half or less than half of any one day will not be considered a day of disability for the purpose of this provision. 2. The amount of coverage which applies to him under this provision will be subject to reductions. These are outlined in the Reductions section of this provision. If the period during which a person is entitled to receive benefits under this plan is not a complete number of weeks, the amount of benefit payable with respect to him for each day that is in excess of a complete number of weeks will be at the rate of one -seventh of the weekly benefit which is applicable to him. Maximum Benefit Payment Period The maximum benefit payment period is 22 weeks. This period will commence on the first day immediately following completion of the Elimination Period. The person will cease to be covered under this provision at the end of the maximum benefit payment period if he does not then return to active work for his employer. The maximum benefit payment period will be applied separately to each continuous period of disability. City of Lubbock Page No. 10 Dated January 1 st, 1999. Definitions "Disabled" and "disability" mean the person is not able to perform with reasonable continuity the substantial and material duties of his own occupation in the usual or customary way due to injury, disease, illness, pregnancy or mental disorder. "Elimination Period" is the period that the person must have actually been disabled during a continuous period of disability before he may receive benefit payments under this provision. The elimination period is 31 days. However, if the insured person becomes confined to a licensed hospital during the elimination period, benefit payments will begin on the date of confinement. For the purposes of this provision, "confined to a licensed hospital" means: The insured person has been hospitalized for a period of not less than 24 consecutive hours in such hospital, or 2. The insured person receives out -patient surgery in such hospital. GC500-375 "Physician" means an individual who is operating within the scope of his license and is either: Licensed to practice medicine and prescribe and administer drugs or to perform surgery; or 2. Legally qualified as a medical practitioner and required to be recognized, under this plan for coverage purposes, according to the state law of the governing jurisdiction. It will not include an employee or his spouse, daughter, son, father, mother, sister or brother (as an attending physician). "Continuous Period of Disability" includes all periods of disability that meet all of the following conditions. 1. They commence while the person is covered under this provision. 2. Periods of disability due to the same or the related cause will be considered within the same period of disability until they are separated by the employee's return to active, full time work for a least 14 consecutive days. 3. Periods of disability due to unrelated causes will be considered within the same period of disability until they are separated by the employee's return to active, full time work for one day. "Pregnancy" includes child -birth or miscarriage and any disease or infirmity resulting from or aggravated by the pregnancy. It also includes therapeutic abortions or complications arising from any abortion. GC500-376 City of Lubbock Page No. 11 Dated January 1 st, 1999. Exclusions No amount of benefit will be payable under this provision with respect to the disability of a person during any of the following periods. a) Any period beyond the maximum benefit payment period. b) Any period of disability during which a person is not under the continuing care of a physician. c) Any period while the person is either permanently or temporarily outside of the United States or Canada. If he becomes disabled while he is outside the United States or Canada his disability will not be deemed to commence until the date on which he returns to the United States or Canada. d) For any period that the person refuses another job offered by you without a reduction in earnings for which he is reasonably suited, unless the disability prevents him from performing the duties of the alternate job. e) For any period that the person has been paid (in a lump sum or otherwise) a severance allowance because his employment was terminated. 2. No amount of benefit will be payable under this provision for any disability that resulted either directly or indirectly from, or was in any manner or degree associated with, or occasioned by, any one or more of: a) Any cause which entitles the person to apply for and receive indemnity or compensation under any Worker's Compensation Law. b) The person either, taking or attempting to take his own life whether he is in possession of his mental faculties or not at the time. c) War, declared or undeclared, or any act of war. d) Active participation in any riot or violent disorder. e) Committing or attempting to commit a felony. GC500-377 City of Lubbock Page No. 12 Dated January 1 st, 1999. Reductions If the person becomes entitled to receive benefits in accordance with the terms of this provision, the amount of the Short Term Income Replacement Benefit payments will be reduced by the amount of any payments, including retroactive and/or lump sum awards, which the person is eligible to apply for and receive with respect to the disability from the following sources: Any retirement program that is funded in whole or in part by you. The Social Security Act, The Railroad Retirement Act, the Canada Pension Plan or the Quebec Pension Plan. This includes dependents benefits by reason of such disability. Any other program or coverage required or provided by law or government agency. 4. Any other periodic payments from you. Any No -Fault Motor Vehicle Coverage, including benefits for lost income. This reduction will not apply if either: a) State law or regulation does not allow any reduction of group disability benefits by benefits received under No -Fault Motor Vehicle Coverage. b) The No -Fault Motor Vehicle Coverage, according to its rules or according to an election of a person who is covered, determines its benefits after the benefits paid or due under this plan have been paid. If, at the time of calculating the amount of any payments to be made under this provision, the benefit which a person is eligible to apply for and receive under any other source described in this provision has not been awarded nor denied, we will estimate the amount of such benefit. The estimate will be used to reduce the amount of the payments under this provision until such time as the benefit under such source has been awarded or denied. This estimated reduction will be used to reduce the amount of the payments under this provision even if the benefit which a person is entitled to apply for and receive has not been applied for. However, such estimate will not be used if the person meets both the following conditions. The person has applied for the benefit under the other source; and 2. The person completes and signs our Reimbursement Agreement. This agreement states that the person promises to repay to us any overpayment caused by an award of the benefit under the other source. If we have reduced payments under this provision by an estimate of the amount of the benefit under another source, we will adjust the amount of the payments under this provision when we receive written notice that the amount of the benefit received under such source differs from the estimate or that the benefit has been denied. If the amount of the benefit received under another source is less than was estimated or the benefit has been denied, we will make a lump sum refund of the amount by which we have underpaid the payments the person is entitled to under this provision. If the amount of the benefit received under another source is more than was estimated the person must make repayment to us of the amount of the overpayment. GC500-378 City of Lubbock Page No, 13 Dated January 1st, 1999. Reductions Continued If the person becomes entitled to receive benefits in accordance with the terms of this provision, the amount of the Short Term Income Replacement Benefit payments will be reduced by the amount of any payments, including retroactive and/or lump sum awards, which the person is eligible to apply for and receive with respect to the disability from the following sources: Any retirement program that is funded in whole or in part by you. The Social Security Act, The Railroad Retirement Act, the Canada Pension Plan or the Quebec Pension Plan. This includes dependents benefits by reason of such disability. Any other program or coverage required or provided by law or government agency. 4. Any other periodic payments from you. 5. Any No -Fault Motor Vehicle Coverage, including benefits for lost income. This reduction will not apply if either: State law or regulation does not allow any reduction of group disability benefits by benefits received under No -Fault Motor Vehicle Coverage. b. The No -Fault Motor Vehicle Coverage, according to its rules or according to an election of a person who is insured, determines its benefits after the benefits paid or due under this policy have been paid. If, at the time of calculating the amount of any payments to be made under this provision, the benefit which a person is eligible to apply for and receive under any other source described in this provision has not been awarded nor denied, we will estimate the amount of such benefit. The estimate will be used to reduce the amount of the payments under this provision until such time as the benefit under such source has been awarded or denied. This estimated reduction will be used to reduce the amount of the payments under this provision even if the benefit which a person is entitled to apply for and receive has not been applied for. However, such estimate will not be used if the person meets both the following conditions. The person has applied for the benefit under the other source; and The person completes and signs our Reimbursement Agreement. This agreement states that the person promises to repay to us any overpayment caused by an award of the benefit under the other source. If we have reduced payments under this provision by an estimate of the amount of the benefit under another source, we will adjust the amount of the payments under this provision when we receive written notice that the amount of the benefit received under such source differs from the estimate or that the benefit has been denied. City of Lubbock Page No. 14 Dated January 1 st, 1999. If the amount of the benefit received under another source is less than was estimated or the benefit has been denied, we will make a lump sum refund of the amount by which we have underpaid the payments the person is entitled to under this provision. If the amount of the benefit received under another source is more than was estimated the person must make repayment to us of the amount of the overpayment. GC500-378 City of Lubbock Page No. 15 Dated January 1 st, 1999.