Loading...
HomeMy WebLinkAboutR-1998-049 Agreement / Fisher Consulting Group / Health & Welfare Benefit ProgramRESOLUTION NO. R-98- 49 A RESOLUTION: authorizing the City Manager and the City Clerk to execute a professional services agreement with Fisher Consulting Group, to provide consulting and brokerage services in connection with the health and welfare benefit programs of the City. WHEREAS, the City desires brokerage and consulting services in connection with its health and welfare benefits programs; and WHEREAS, the City does not have the staffing levels and expertise necessary to provide said brokerage and consulting services; and WHEREAS, on February 2, 1998, the City issued a request for qualifications from interested parties to provide said brokerage and consulting services; and WHEREAS, Fisher Consulting Group provided an acceptable proposal, has sufficient personnel and expertise necessary to provide said brokerage and consulting services, and is willing to provide these services in accordance with the terms and conditions of the attached agreement; and WHEREAS, the City Council deems it to be in . the best interest of the City of Yakima to enter into an agreement with Fisher Consulting Group for said services in accordance with the terms and conditions of the attached agreement, now, therefore; BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA: The City Manager and City Clerk are hereby authorized and directed to execute the attached and incorporated "Broker/Heath Benefits Program Services Agreement", between the City of Yakima and Fisher Consulting Group. The final agreement shall be approved as to form by the City Attorney. ADOPTED BY THE CITY COUNCIL this 7 day of i ATTEST: City Clerk ,1998. John Puccinelli, Mayor BROKER SERVICES AGREEMENT THIS BROKER SERVICES AGREEMENT, hereinafter the "Agreement", is made and entered into by and between the City of Yakima, a municipal corporation, hereinafter the "City," and Fisher Consulting Group, Inc., a Washington corporation, hereinafter the "Broker." WHEREAS, the City desires healthcare brokerage services in connection with its health and welfare benefits programs; and WHEREAS, the Broker has the experience and expertise necessary to provide said brokerage services, has done so in the past, and is willing to continue to provide brokerage services in accordance with the terms and conditions of this Agreement. NOW, THEREFORE, in consideration of the mutual covenants, promises, and agreements set forth herein, it is agreed by and between the City and Broker as follows: 1. Scope of Services. The Broker shall provide healthcare brokerage services to the City in accordance with the following documents: a. February 12, 1998 Proposal of Fisher Consulting Group, a copy of which is attached hereto as Exhibit "A" and incorporated herein by this reference; b. Scope of Services description attached hereto as Exhibit "B" and incorporated herein by this reference. Any inconsistencies and/ or conflicts between the terms and conditions stated in this Agreement and the Exhibits shall be resolved in favor of terms, conditions, and obligations specifically set forth in this Agreement. 2. Obligations of the City. The City shall provide the following services to the Broker: a. Determine the eligibility of members to receive benefits; b. Establish a bank account for payment of claims; c. Make all payments to the bank account for the payment of eligible claims; Page 1 of 6 (Ik)agr/Iishet-broker health care/pm d. Make the final determination as to the coverage and governance of the Plan Document; e. Promptly respond to Broker's requests for information; and f. Meet with the Broker and/or third parties when necessary and requested to do so by the Broker; and g. Make decisions on matters which, in the professional opinion of the Broker, should be made by the City. 3. Compensation. As compensation for the services performed by Broker under this Agreement, the City shall pay the Broker an annual consulting and reporting retainer of Eight Thousand Five Hundred Dollars ($8,500.00). Additionally, Broker shall receive commissions paid on excess reinsurance and life insurance policies. Broker shall annually disclose in writing to the City all commissions and returns from claims administrator's fees received during the contract year. 4. Term. The term of this Agreement shall commence on May 1, 1998, and terminate at 12:00 p.m., April 30, 2001, unless sooner terminated by either party in accordance with Section 16; provided, however, that the City and the Broker may agree to extend this Agreement for an additional three (3) year period. On behalf of the City, the City Finance Director is empowered to authorize said extension and negotiate the terms thereof. 5. Property Rights. All claims and related files generated by Broker as a result of its services under this Agreement shall at all times be and remain the property of the City; provided, however, that any supporting data created by Broker to make accountings to the City or excess insurers shall be the property of Broker. 6. Status of Broker. Broker and the City understand and expressly agree that Broker is an independent contractor in the performance of each and every part of this Agreement. Broker and its employees shall make no claim of City employment nor shall claim against the City any related employment benefits, social security, and/or retirement. 7. Taxes and Assessments. Broker shall be solely responsible for compensating its employees and for paying all related taxes, deductions, and assessments, including but not limited to, federal income tax, FICA, social security tax, assessments for unemployment and industrial injury, and other deductions from income which may be required by law or assessed against either party as a result of this Agreement. In the event the City is assessed a tax or assessment as a result of this Agreement, Broker shall pay the same before it becomes due. Page 2 of 6 (1k)agr/licher-broker health care/pm 8. Nondiscrimination Provision. During the performance of this Agreement, Broker shall not discriminate on the basis of race, age, color, sex, religion, national origin, creed, marital status, political affiliation, or the presence of any sensory, mental or physical handicap. This provision shall include but not be limited to the following: employment, upgrading, demotion, transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training. 9. Compliance With Law. Broker agrees to perform those services under and pursuant to this Agreement in full compliance with any and all applicable laws, rules, and regulations adopted or promulgated by any governmental agency or regulatory body, whether federal, state, local, or otherwise. Broker, at its own cost, shall obtain and maintain at all times while this Agreement is in effect all licenses, permits and certificates required by state or federal law to enable Broker to perform the services set forth in this Agreement. Upon request of the City, Broker shall furnish the City with evidence of such compliance. 10. No Insurance. It is understood the City does not maintain liability insurance for Broker and/or its employees. 11. Indemnification. a. Broker agrees to hold harmless, indemnify, and defend the City, its elected officials, officers, employees, and agents from and against any and all suits, actions, claims, liability, damages, judgments, costs and expenses (including reasonable attorney's fees) which result from or arise out of the sole negligence of Broker, its officers, employees, and agents in connection with or incidental to the performance or non-performance of this Agreement. b. The City agrees to hold harmless, indemnify, and defend Broker, its officers, employees, and agents from and against any and all suits, actions, claims, liability, damages, judgments, costs and expenses (including reasonable attorney's fees) which result from or arise out of the sole negligence of the City, its elected officials, officers, employees, and agents in connection with or incidental to the performance or non-performance of this Agreement. c. In the event that the officials, officers, agents, and/or employees of both the City and Broker are negligent, each party shall be liable for its contributory share of negligence for any resulting suits, actions, claims, liability, damages, judgments, costs and expenses (including reasonable attorney's fees). d. Nothing contained in this Section or this Agreement shall be construed to create a liability or a right of indemnification in any third party. Page 3 of 6 (Ik)agr/frsher-broker health care/pm 12. Professional Liability Insurance Provided by Broker. On or before the date this Agreement is fully executed by the parties, Broker shall provide the City with a certificate of insurance as evidence of professional liability coverage with a limit of One Million Dollars ($1,000,000.00) per claim and an annual aggregate limit of at least One Million Dollars ($1,000,000.00). The certificate shall clearly state who the provider is, the amount of coverage, the policy number, and when the policy and provisions provided are in effect. The insurance shall be with an insurance company rated A -VII or higher in Best's Guide. If the policy is on a claims made basis, the retroactive date of the insurance policy shall be on or before January 1, 1998, or shall provide full prior acts. The insurance coverage shall remain in effect during the term of this Agreement and for a minimum of one (1) years following the termination of this Agreement. 13. Delegation of Professional Services. The services provided for herein shall be performed by Broker, and no person other than regular associates or employees of Broker shall be engaged upon such work or services except upon written approval of the City. 14. Assignment. This Agreement, or any interest herein, or claim hereunder, shall not be assigned or transferred in whole or in part by Broker to any other person or entity without the prior written consent of the City. In the event that such prior written consent to an assignment is granted, then the assignee shall assume all duties, obligations, and liabilities of Broker stated herein. 15. Non -Waiver. The waiver of either the City or Broker of the breach of any provision of this Agreement by the other party shall not operate and/or be construed as a waiver of any subsequent breach by either party or prevent either party thereafter enforcing such provision. 16. Termination. Either party may terminate this Agreement, with or without cause, at any time by giving the other party thirty (30) calendar days prior written notice of termination; provided, however, that the City has the right to terminate this Agreement upon three (3) calendar days prior written notice in the event that Broker fails to maintain all necessary licenses, permits or certificates required under Section 9 of this Agreement. In the event of termination, the City shall pay Broker a pro -rata share of the annual fee for that contract year through the date of termination. In the event that the Broker has already been paid the annual fee, Broker shall remit the excess portion of the annual fee to the City within thirty (30) calendar days of termination. Upon termination of this Agreement, Broker shall, at the City's option, continue to supervise and report to the City regarding all claims based on events which occurred Page 4 of 6 (Ik)egr/(lvherbroker health care/pm prior to the termination date until such time as the disposition of such claims is completed. 17. Severability. If any portion of this Agreement is changed per mutual agreement or any portion is held invalid, the remainder of the Agreement shall remain in full force and effect. 18. Integration and Modification. This Agreement sets forth all of the terms, conditions, and agreements of the parties relative to the subject matter hereof and supersedes any and all such former agreements which are hereby declared terminated and of no further force and effect upon the execution and delivery hereof. It is recognized that the City and/or Broker may, from time to time, request changes or additions to the terms of this Agreement. However, no such changes or additions to this Agreement shall be valid or binding upon either party unless such change or addition be in writing and executed by both parties. On behalf of the City, the City Finance Director is empowered to negotiate and execute such changes and/or additions. 19. Notices. Unless stated otherwise herein, all notices and demands shall be in writing and sent or hand delivered to the parties to their addresses as follows: TO CITY: TO BROKER: Finance Director City Hall 129 North 2nd Street Yakima, WA 98901 Dan Fisher, President Fisher Consulting Group, Inc. P.O. Box 67 Yakima, WA 98907 or to such other addresses as the parties may hereafter designate in writing. Notices and/ or demands shall be sent by registered or certified mail, postage prepaid, or hand delivered. Such notices shall be deemed effective when mailed or hand delivered at the addresses specified above. 20. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. 21. Venue. The venue for any action to enforce or interpret this Agreement shall lie in the Superior Court of Washington for Yakima County, Washington. Page 5 of 6 Ok)agr/lisher-hroker health care/pm CITY OF YAKIMA FISHER CONSULTIN GROUP INC. By: Date: Dick Zais, C Manager ATTEST: City Contract No. 9R-45 Resolution No. R-98-49 STATE OF WASHINGTON ) :ss. County of Yakima ) By: D n Fisher, President Date: I certify that I know or have satisfactory evidence that Dan Fisher is the person who appeared before me, and said person acknowledged that she signed this instrument, on oath stated that she was authorized to execute the instrument and acknowledged it as the President of Fisher Consulting Group, Inc., a Washington corporation, to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED: Page 6 of 6 (Ik)agrrnsher-broker health care/pm NOTARY PUBrIC in and Washington, residing at My commission expires: Al/Vu)-(a r the State of c c FISHER Consulting Group P.O. Box 67 • Yakima • Washington • 98907 Phone (509) 575-6497 • Fax (509) 457-3732 dfssherewscpa.net Health Benefit Board City of Yakima 129 N. 2nd Street Yakima, WA 98901 Re: Qualifications for Broker Services Dear Members of the Board: EXHIl., February 12,1998 In response to your Request for Qualifications (RFQ) from health insurance brokers dated this February 2.1, the following proposal outlines my experience, the scope of my proposed services, and the projected compensation for these services as presented. Also included are copies of all the appropriate licenses and other forms to meet your stated requirements. My firm incorporated on December 9,1997, for the sole purpose of allowing me to continue to meet the needs of the employee benefit programs of Central Washington employers. I am proud of the work I have done in partnership with my clients over the last nine years in the benefits consulting & brokerage business. However, this proposal comes from an independent practitioner in the benefits field. I am set up to be like no other local broker, and very much like other independents. I am not an insurance sales agency, nor offer a trade name, or a team of employees. I am offering the best local brokerage services available. I feel fortunate that my past service to the City has been successful, and am grateful for this opportunity to compete for these services again. The City of Yakima and the members of this Board have dedicated a lot of time and energy to your program these past few years. Still, you have more important things to worry about in your professional lives than the City's Health Plan; I don't. Please feel free to call me with any questions. I look forward to your decision. Sincerely, Dan Fisher Employee Benefits Consulting & Brokerage G Why Hire Dan Fisher of FCG? /Performance Why fix what isn't broken? Yakima is one of only a few City's that has passed the State Risk Manager's audit of Health Plans with positive results - twice! /Consistency I've worked for the City's Health Plan since 1991. /Price I set your Plan's existing broker fees and can work with them for the long term. The Benefit Board's last open bid RFP process in 1996 confirmed that I am priced below my competitors. /Experience With your Plan, and most local self- funded plans. I do not rely on the experience of individuals located outside the area to meet the City's minimum experience qualifications for broker services as stated in the RFQ. /Specialization I am in the employee benefits business. I have no ulterior motives to acquire the City's liability insurance program, nor am I in the business to sell individual auto, home, life or other insurance policies. /Local I am a local business owner. I will be responsible for your broker and consulting needs. I am not a "team" of people with varying degrees of commitment, responsibility and skills. G ✓PPO Discounts I have developed and maintained local hospital discount arrangements. The City's Plan has saved more from these discounts than it has paid for broker services for many years. I have never charged an access fee for this arrangement /Commitment I am service over sales. I spend the vast majority of my time serving my clients, not chasing new ones. /Control I encourage direct contact between the City, Board and your Plan vendors. I do not believe that controlling the flow of information between the City, SAFECO and HMA is in a client's best interest /Support The best technical backup available. I use the Internet, a professional network of peers, the Spencer's Compliance Guide, and have a joint operating agreement with Richard R. (Dick) Charles of The Charles Group, Inc. of Redmond, Washington. /Trust You are buying me, not an agency. I am quite comfortable comparing my professional resume with that of the entire benefit "teams" of my competitors. /Wellness Hope "Health Line" Newsletter I recognize the value of keeping people aware of health and wellness issues. I co-sponsor the Health Line newsletters with Memorial Hospital, which are mailed to the homes of every City Plan participant quarterly. City of Yakima RFQ 2-12-98 Scope of Services • Provide technical support to the City's Health Benefit Board in all matters relating to the medical, dental and vision plans as assigned. • Calculate the Plan accrual rates using current eligibility and claim data supplied by the third party administrator in the form of a twelve (12) or eighteen (18) month report in an actuarially sound method as directed by the City's Director of Finance. • Market the City's individual and aggregate stop loss and group life insurance coverage on an annual basis using only appropriate carriers rated A (or it's equivalent rating) or better. • Analyzing plan procedures and policies to comply with applicable State and Federal law and the City's stated requirements. • Negotiating on behalf of the City to obtain independent third party claims administration services that meet the City's requirements for local customer service (see Section 5 for HMA's commitment ), access for claims review and approval, utilization review and case management. • Assisting the City staff, Wellness Committee and Health Benefit Board in the development and implementation of wellness and health care education programs as directed. • Providing on-going assistance in all Plan compliance and reporting requirements as needed. • Providing on-going recommendations for benefit enhancement, cost containment and service provider contracting • Representing the best interests of the City of Yakima and it's employccs and their families. • Attending Health Benefit Board, employee education and management meetings as directed. City of Yakima RFQ 2-12-98 C Cost of Services • The cost of services described below duplicates the commission and fee structure of the City's existing broker agreement (Resolution # R-97-52, dated April 15,1997), with the exception of the HMA Service Fee split. Under your current contract, HMA shares a portion of their net fee with your broker, with a percentage specifically intended to subsidize the Direct Administrators local customer service. Once HMA opens their own Yakima Service office, the Direct Administrators portion would not be paid to the broker, but retained by HMA. The cost of the broker services paid by the City would remain the same. Annual Consulting and Reporting Retainer $8,500 Commissions paid on the Excess Loss (Stop - Loss) and group Life insurance policies: Safeco premiums 10% Healthcare Management Administrators service fee split HMA Monthly Fee per employee per month 15% Disclosure of total compensation paid to the broker is made annually. By law, your insurer (IRS Form 5500 Schedule A)and claims administrator (Schedule C) must report to you compensation paid on behalf of your Plan to all service providers. Full disclosure is not optional. City of Yakima RFQ 2-12-98 Daniel W. Fisher • Benefit Planning • Education, Licenses, Designations Client Partnerships with Independent Vendors Consulting, Compliance & Cost Containment Brokering Group Plans Certified Public Accountant BA, University of Washington State of Washington Agent License State of Washington Broker License Series 6 - Investments and Variable Contracts Series 63 - Uniform Securities Law • Business Experience 9 years insurance and employee benefits 5 years corporate financial accounting Instructor, City University: AC422 Corporate Tax and AC350 Managerial Accounting • Expertise Self-funded HealthCare plans Group medical, dental, term life & disability plans Group Retirement plans ERISA, COBRA, FMLA, HIPAA Compliance • Professional Activities Washington Society of CPA's (WSCPA) Board Member - 1997-99 WSCPA 1995-6 Chapter President of the Year Provident Services Board Member 1996 to present Yakima Kiwanis Board Member 1994-96 Chamber of Commerce, Leadership Yakima 1990 United Way Gold Award 1989 YMCA ASPIRE Program Fisher Consulting Group, Inc. February 199$ V� Management 6Ci1�11 YNJ��b Administrators, Inc. February 10, 1998 Dan Fisher Fisher Consulting Group P.O. Box 67 Yakima, WA 98907 Dear Dan, I have read with interest the RFQ you faxed to me last Friday. The key issue for HMA is item "d" under minimum duties and responsibilities of the City's Broker "local customer service for claims service..." HMA is aware of the City's requirement for local customer service and in the past has relied on Direct Administrators to handle the local customer service. HMA prides itself on quality customer service and feels it is in both the City's best interest and HMA's best interest to offer local customer service in Yakima. HMA is prepared to dedicate resources necessary to hire a customer service representative and open a service office conveniently located in Yakima. The office will have dedicated office hours for walk in business, local phone lines and remote access to our claims processing system for claims questions and investigation review. HMA's goal is to have this project completed as soon as possible, however, HMA is committed to taking the time necessary to find the right customer service representative. HMA's goal is to have the office in operation by May 1, 1998. Sincerely, afAi- Doug 'TD ps Sales Manager • htate of i; r nsflingtun OF4I `% OF THIVRNEWCAMMISSIQNFA CIC: EXPIRES: FI HB 02181 01/21/2000 eV 111 FISHER CONSULTING GROUPINC 3311 W YAK n'AVK YAKIMA, THE LICENSEE IS AUTHORIZED SELL TIE FOLLOYIE LINES OF INSURANCES LIFE, DISABILITY *tate of I:I; asilingtort OF4I‘A OF THIVEMEMEA ISSIMR PIC: FISHEDW379JQ EXPIRES: 04/18 1998 , ,el,,,,:; •FISHER, DANIEL W~F s . ! ` 3311 W YAKIMA Av YAKIMA, WA8 ' � s 1) • THE LICENSEE IS AUTHORIZED SELL TIE FOLLOYIN LINES OF INSURANCE: LIFE, DISABILITY RANCE COMMISSIONEF * * * PIC: FISHEDW379JQ EFFECTIVE: 01/21/1998 EXPIRES: 01/21/2000 INS. LINES: LIFE, DISABILITY FISHER, DANIEL W 3311 W YAKIMA AVE YAKIMA,WA 98902 AFFILIATION CERTIFICATE NOT TRANSFERABLE * * * THIS PERSON IS AUTHORIZED TO REPRESENT FISHER CONSULTING SULTING GROUP INC THIS AFFILIATION CERTIFICATE MUST BE ACCOMPANIED BY A CURREIT BROKER'S LICENSE. INSURANCE COMMISSIONER STATE (1F WA cumin -1-n., 1 h r • 1 *tote of a i ington OFFICE OF THE INSURANCE COMMISSIONER * • • AGENT'S LICENSE • • • PIC: FISHEDW379JQ EXPIRES: 04/18/98 FISHER,' DANI 3311 W Y YAKIMA, i.ilt• 010411'th. III THE LICENSEE IS AUTHORIZED TO SELL THE FOLLOWING LILIES OF INSURANCES LIFE, DISABILITY TML: LICENSE NWT SE ACCOMPANIED DY A CURRENT INTIENT OR AFFILIATION CERTIFICATE Fat TION REPRE Otate of Ili noilington OFFKE* OF TH ► NLfGERVM IDA CIC: FISHBCG021B1 EXPIRES: 01/21/2000 FISHER CONSULTING GRO'INC TIE LICENSEE 1S AUTHORIZED TO SELL THE FOLLOWING LINES OF INSURANCE: LIFE, DISABILITY, PROPERTY, CASUALTY TNIS LICENSE NWT BE ACCOMPANIED BY A =REV APPOINTMENT OR AFFILIATION CERTIFICATE FOR INSURER OR CORPORATION REPRESENTED. 3 311 W YAK, : = YAKIMA, W Ori L1[1. l N RANCE COMMISSIONER * * * PIC: FISHEDW379JQ EFFECTIVE: 01/21/1998 EXPIRES: 01/21/2000 INS. LINES: LIFE, DISABILITY FISHER, DANIEL W 3311 W YAKIMA AVE YAKIMA,WA 98902 AFFILIATION CERTIFICATE * * * THIS PERSON I8 ALTTHORIZED TO REPRESENT FISHER comuurnio GROUP INC THIS AFFILIATION CERTIFICATE MUST BE ACCOMPANIED BY A CURRENT ACT'S LICENSE. INSURANCE COMMISSIONER NOT TRANSFERABLE STATE OF WASHINGTON • turA 1 IVIYHL L.hiJUNL 1 I L.VIVII'F1111r Property/Casualty Division 8877 North Gainey Center Drive - Scottsdale, Arizona 85258 A Stock Company (800) 423-7675 Insurance Professionals Errors and Omissions Liability Claims Made Policy THIS IS A CLAIMS MADE POLICY. PLEASE READ THE ENTIRE POLICY CAREFULLY. Those words or phrases that are bold-faced have special meaning, refer to PART 8. PART 1. INFORMATION PAGE Policy No. AN 005064 IN RETURN FOR THE PAYMENT OF THE PREMIUM, WE AGREE TO PROVIDE INSURANCE TO YOU UNDER THE PROVISIONS IN THIS POLICY. ( Renewal of No. New Item 1. First Named Insured and Mailing Address: Fisher Consulting Group, Inc. P. 0. Box 67 Yakima, Washington 98907 c Item 2. Named Insured(s): See First Named Insured as stated above. Item 3. Policy Period: Inception Date January 1, 1998 Expiration Date January 1, 1999 Effective 12:01 A.M., Standard Time at the Mailing Address stated in Item 1. Item 4. Limit of Insurance: Item 5. Deductible: a. $ 1,000,000 b. $ 1,000,000 a. $ 2,500 b. $ 5,000 Deductible applies to Damages and Claim Expenses. Item 6. Premium: $ 1,785.00 State Surcharge/Tax: $ Not Applicable AN -D-1 (6-94) (Continued on next page) Per Claim Aggregate Each Claim Aggregate 24500 ivr, +rr1L I.NJUNL I 1 '..UIVIrN14I Property/Casualty Division 8877 North Gainey Center Drive - Scottsdale, Arizona 85258 A Stock Company (800) 423-7675 Insurance Professionals Errors and Omissions Liability Claims Made Policy PART 1. INFORMATION PAGE (Continued) First Named Insured: Fisher Consulting Group, Inc. Policy No: AN 005064 Item 7. Form(s) and Endorsement(s) made a part of this policy at time of issue: Insurance Professionals E & 0 Policy (Simple English) - AN 00 01 (6-94) 1. Prior Acts Change Endorsement - AN 20 08 (6-94) 2. Washington Cancellation & Nonrenewal Change Endorsement - AN 30 52 (6-94) 3. Washington Change Endorsement - AN 30 53 (6-94) THIS INFORMATION PAGE, ALONG WITH THE SIGNED APPLICATION OR RENEWAL APPUCATION AND ALL OF THE PARTS OF THE POLICY LISTED IN ITEM 7. ABOVE COMPLETE THE POLICY. Countersigned at Kansas City, Missouri Date January 8. 1998 AN -D-1 (6-94) By Auth6ite d present ive E & 0 Professionals Agency Producer 24506 Exhibit B SCOPE OF SERVICES •The Broker shall provide: •Market, analyze and recommend to the City all vendor services directly related to the self-insured Health Care Plan. • Daily servicing, to include but not limited to, answering questions concerning covered benefits, contract provisions, and plan administration. Assist in the resolution of problems relating to the benefit plan such as eligibility problems, incorrect billings, service problems with claim administrators, and denied claims that are either in dispute or are being appealed. •Research and recommend solution(s) for claims which are being appealed. •Attend regular or special Board meetings and other meetings upon request. Attend and conduct employee orientation meetings that provide and overview of the Plan and its operation, funding arrangements and benefits. •Conduct employee meetings to explain Plan changes and plan choices. Assist in the implementation of Plan changes such as employee communications and enrollment process. •Participate in or initiate meetings with claims administrator and City staff as necessary or requested. •Assist City staff and Board representatives in developing health care education information programs for delivery to individual users of the health program. • Market the City's individual and aggregate stop loss and group life insurance coverage and evaluate the underwriter's financial stability. Negotiate with carrier(s) on the City's behalf. Prepare and submit a renewal report to the Board/City that provides the renewal action, renewal and benefit options and recommendation(s). • Facilitate the City's claims administration services (inclusive of utilization review and case management services) and assist the City in securing claims administration services. Claims administrative services shall also include claims investigation review and payment of claims for the City's medical, vision, dental and prescription drug programs. •Assist the Board/City in developing medical, vision and dental benefit programs while limiting City and participants exposure to large losses. Provide analysis and recommendation(s) on plan design modifications and implementation. • Prepare, submit and present a detailed accounting report annually describing each area of cost, and an Executive Summary that goes directly to the Board and Council. •Develop bid strategies and specifications to be sent to insurance or administrative markets for existing or proposed benefits. Prepare an analysis and comparison of bids and make recommendation(s) for the Board/City's review. Actively participate in the negotiation for services. • Provide monthly claims analysis reports for medical, vision, dental and prescription drug plans as well as large claim analysis and reports. • Review all Plan policies, agreements, booklets and amendments to confirm compliance with policy -order specifications. Mail documents to Plan participants as requested. •Answer questions or research questions pertaining to specific employee benefit plans as well as questions pertaining to legislation or regulation affect benefit plans. Provide information bulletins on time -sensitive issues and employee benefit trends. When legislation is proposed or enacted, provide information on the potential impact to the City's benefit plans. •Provide excess insurers such reports as they may reasonably require. • Provide information and assistance as may be reasonably required for preparation and filing of all reports required by any government agency in connection with the City's approved self-insured status. BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT Item No. For Meeting Of 4/7/98 11 EM TITLE: Resolution Authorizing the Execution of a Professional Services Agreements for Broker Services for the Health and Welfare Benefit Program SUBMITTED BY: Greg Ahmann, Chair, Employee's Welfare Benefit Program Board Sheryl M. Smith, Deputy Personnel Officer John Hanson, Director of Finance and Budget CONTACT PERSON/TELEPHONE: Sheryl M. Smith, 575-6090 SUMMARY EXPLANATION: On February 2, 1998 the City issued a request for qualifications for broker services for our self insured health and welfare benefit program. The Employee's Welfare Benefit Board reviewed the responses and subsequently interviewed the three finalist firms. The Board recommended to City Manager that the contract be awarded to Fisher Consulting Group. The City has received these services from Dan Fisher, Fisher Consulting Group, Inc., since 1990 under the City's contract with Direct Administrators which was purchased by the Sedgwick firm in 1996. The costs associated with the Broker contract remain the same, $8,500 annually plus commissions. This cost has been included in the 1998 Health Benefit Reserve Fund Budget. Additionally,. the City is in the process of finalizing a third party administrators contract for medical/vision/dental claims processing and administration, which is anticipated to be forwarded to Council for adoption at its' April 21, 1998 meeting. A copy of the Request for Qualifications is available in the City Clerk's office. Resolution X Ordinance Contract X Other (Specify) Funding Source Health Benefit Re erv- Fund' /(A___ ad.,,,,-___ ity Manager V STAFF RECOMMENDATION: Adopt resolution authorizing execution of agreement. BOARD/COMMISSION RECOMMENDATION: COUNCIL ACTION: