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HomeMy WebLinkAboutBlue Cross Agreement 2016-2017IDAHO SCHOOL DISTRICT COUNCIL SELF - FUNDED BENEFIT TRUST EMPLOYER PARTICIPATION AGREEMENT Plan Year: September 1, 2016 — August 31, 2017 The Idaho School District Council Self- Funded Benefit Trust (the "Trust ") provides certain medical, dental, and vision benefits to active employees and pre -65 retirees of participating Employers. These medical, dental and vision benefits are not fully- insured coverage. The Trust does not participate in the state guaranty association. Rather, the Trust funds the payment of claims through Employer and employee contributions up to a certain limit and then has an agreement for stop -loss coverage that pays for all claims that exceed that limit. The Idaho Department of Insurance requires the Trust to provide an annual audit and to have an independent accredited actuary provide annual certification of the funding amounts and the contributions. Participating School District (the "Employer ") School District Name: Bonneville Joint School District #93 Mailing Address: 3497 N. Ammon Road City: Idaho Falls zip:83401 District Superintendent: Dr. Charles Shackett E -mail: cshackett @d93.k12.id.us Phone: 208 - 525 -4400 Fax: 2. 1 Benefit Programs Selected for the Upcoming Plan Year. The Employer will offer the benefit options selected in the accompanying Statewide Schools Benefit Selection Agreement(s), which show the plan type, deductible, coinsurance, copayment, and rates selected by the Employer for the upcoming Plan Year. The Employer's superintendent or official designee must sign the Statewide Schools Benefit Selection Agreement(s). 3. Trust Contributions and Trustees. The Employer understands and agrees that continued participation in the Trust and the continued coverage of employees and dependents is conditioned on the Employer making timely contributions to the Trust (or its designee). Failure to make timely contribution payments will result in termination of the Employer's participation in the Trust. In addition, the Trustees may terminate an Employer's participation in the Trust for a material failure to comply with the terms of this Agreement. The ISDC has the authority to appoint the Trustees of the Trust, and by entering into this Agreement you accept the appointment of the current Trustees of the Trust. 4. Additional Required Information. The Trust (or its designee) may request additional information from the Employer to satisfy certain compliance requirements. The Employer agrees to cooperate in a timely manner to provide such requested information. 5. Additional Terms & Conditions. By entering into this Agreement, you agree to abide by the additional terms and conditions in Appendix A, which is attached hereto. The Trust's delay in exercising or failure to exercise any right, power or privilege under this Agreement on any occasion shall not operate as a waiver; nor shall any single or partial exercise of any right, power or privilege preclude any other or further exercise thereof. 6. Broker Commissions and Disclosure. The Trust (or its designee) will honor an Employer's request to pay compensation in the form of a commission to the Employer's broker pursuant to a written agreement that clearly shows the commission as a percentage of the total contributions for each benefit program (i.e. medical, dental and /or vision). Such commissions will be added to and included in the Employer's rates. On a periodic basis (at least annually), the Trust (or its designee) may provide a report to the Employer's superintendent disclosing the total contributions paid to the Trust and the actual commissions paid by the Trust to the Employer's broker. 7. Acknowledgement. I have reviewed this Agreement, including the Statewide Schools Benefit Selection Agreement (s) and the Additional Terms & Conditions, which are incorporated herein and made part of this Agreement. On behalf of my District, I agree to the terms herein for the September 1, 2017 through August 31, 2017 Plan Year. Signature of E,"Ioyer Represen a ive (as authorized by the Superintendant): Date: �� APPENDIX A TO THE IDAHO SCHOOL DISTRICT COUNCIL SELF - FUNDED BENEFIT TRUST EMPLOYER PARTICIPATION AGREEMENT Plan Year: September 1, 2016 — August 31, 2017 This Appendix is incorporated into and part of the Employer Participation Agreement. Defined terms (i.e. capitalized terms such as Trust, and Employer) in this Appendix have the same meanings as in the Employer Participation Agreement. Employee Participation Requirements You must offer participation in the Trust to your eligible employees. An eligible employee is one who works the required number of hours (on average) per week and who has completed the Employer's required probationary period (not to exceed 90 calendar days). COBRA An Employer is subject to COBRA during the current calendar year if the Employer employed 20 or more employees on more than 50% of its typical business days in the preceding calendar year. This number is based on the total number of employees, not the number of employees covered. Part -time employees are included in the total employee count expressed as a fraction. The Trust's third -party administrator will send the required COBRA election notice and collect COBRA payments. However, the Employer will be required to comply with COBRA by, for example, properly providing the applicable COBRA general notice, timely notifying the Trust or its designee of COBRA qualifying events, and satisfying other COBRA compliance requirements. Changes to Benefit Options The Trustees have the right to make changes to the benefits from time to time, as they deem necessary in the operation and administration of the Trust. You will be notified of such changes and you agree to notify your covered employees and their dependents within 30 days of receipt of such notice of changes to the benefits. Plan Summaries, Policies and Procedures The Trustees have the authority and right to establish plan documents (including summary plan descriptions and benefit outlines), policies and procedures, as they deem necessary, for the operation and administration of the Trust. Such policies and /or procedures may include rules for minimum waiting periods applied to employers that leave the Trust and for reserve contributions from employers that were not recently participating in the Trust. By entering into this Agreement, you agree to abide by the terms and conditions of these documents, policies and procedures. Employer Benefit Selections Group enrollment in the benefit options are available annually for a September 1 effective date of coverage. Employer changes between benefit options are not available during the Plan Year, unless allowed by law and approved by the Trustees. Employer Changes You will notify the Trust office in writing within 30 days of any changes to your waiting periods, eligibility requirements, or other information described in this Agreement. These changes, if approved by the Trustees (or their designee), will be effective the first of the month following receipt of the notice to the Trust office. Employees hired before the effective date of the change will remain subject to the previous rules set by the Employer for the remainder of the Plan Year. Eligibility Requirements Should the total enrollment of Eligible Employees fall below the required 85 %, the Plan will be subject to surcharge or discontinued at the next renewal date. Existing districts that do not meet this criterion must submit to the Plan Administrator a written plan showing how and when compliance will be accomplished. Changes in Employee Information, Eligibility or Enrollment Within 30 days following the event, you must notify the Trust office (or its designee) of any of the following changes: • Change to an employee's or dependent's address • Change in enrollment or eligibility, including but not limited to — o termination of employment or reduction in hours • employee's death or entitlement to Medicare • ineligible dependents, if participating Employer is notified • newly eligible dependents due to marriage, birth or adoption • Leave of absence, including when an employee takes an FMLA leave or a USERRA leave, or fails to return to covered employment from an FMLA leave or a USERRA leave. • Receipt of Qualified Medical Child Support Orders. The Employer will be responsible to reimburse the Trust for any claims paid on behalf of ineligible employees and /or their dependents that result from a failure of the Employer to notify the Trust in a timely manner of changes or terminations. In addition, the Employer will be responsible to reimburse the Trust for any claims paid on behalf of ineligible employees and /or their dependents that are covered as a result of incorrect information. Open Enrollment The Employer agrees to provide an open enrollment each year to all eligible employees prior to a September 1 effective date. During open enrollment, an employee or dependent who was not enrolled when he or she first became eligible, or as allowed under special enrollment conditions, may be enrolled, and enrollees may change plans if the Employer offers a dual choice. Contributions The Trustees establish the annual amount of the contributions payable by participating Employers. The Trustees have the right to change the contribution amounts and how the amount is determined. By entering into this Agreement, you agree to the amounts that the Trustees have established for your group. Payment of Contributions You agree to pay all contributions by the due date and to abide by the Trust's delinquent contributions policy. You agree that the coverage and benefits provided through this Agreement under the Trust will be cancelled if your contribution payment is not received by the due date described in the delinquent contribution policy. Summary of Benefits and Coverage (SBC) Employers must complete and return all enrollment/renewal materials, including an SBC attestation of delivery, in a prompt and timely manner to the Trust office (or its designee). Incomplete or delayed enrollment/renewal materials may cause delays in processing and affect the Employer's ability to view SBCs. The Employer must register for access to the Blue Cross of Idaho Employer portal if you are new to the Trust or don't currently have a login. Employers must deliver the SBCs to all eligible employees (even those not enrolled) and dependents for all selected plan options 30 days prior to the start of the new Plan Year. The Employer must promptly notify the Trust office of any changes to coverage or issues regarding SBCs. Legal Compliance You understand and agree that as an Employer sponsoring an employee benefit plan for your employees you have certain legal obligations under state and federal law. By entering into this Agreement, you agree that you or your staff employees are familiar with or will become familiar with your compliance requirements under COBRA, FMLA, HIPAA, USERRA, PPACA and other applicable laws and regulations. Also, you agree that you will take the necessary steps and actions to comply with these laws and regulations and to cooperate with the Trust (or its designee) in satisfying its obligations to comply with applicable laws and regulations. Leave of Absence The Trust office must receive notified, in writing, containing the employee's name, the date the leave was granted, and the length of the leave within 30 days of the date of the leave event. A leave of absence can only be allowed when an employee is experiencing a personal or medical situation that is requiring the employee to be off the job for an extended period of time or for an employee that is working reduced hours, but not separated from the employer. The Employer group is responsible for contribution payment for the entire length of the leave of absence. Delinquent Contribution Policy Employer and employee contributions are due from the Employer in a timely manner each month. The Employer's account will be considered delinquent if payment is not received, in full, by the due date on the invoice. If payment is 30 days late, benefit coverage for the entire Employer group may be terminated back to the last day of the month in which a full contribution was paid. Contributions are due in full; partial payments will not be accepted. If an Employer leaves the Trust and has outstanding payments, the Trust will attempt to collect the outstanding payments. If the Employer does not bring the account current within 90 -days of termination, the Trust may take legal action to collect the outstanding payments. If an Employer is terminated due to non - payment of all or a portion of its contribution, employees and former employees may lose their coverage rights, and such liability will be the responsibility of the Employer. Trustees and Trust Agreement You understand that the Idaho School District Council has the authority to appoint the Trustees of the Idaho School District Council Self- Funded Benefit Trust, and by entering into this Agreement you accept the appointment of the current Trustees of the Trust. By entering into this Agreement, you agree to abide by the terms and conditions of the Trust Agreement and the terms and conditions of the benefit options offered under the Trust, including the information described in this Agreement. Miscellaneous This Agreement supersedes any previous Employer participation or similar agreement. The laws of the State of Idaho shall govern this Agreement. IN Summary of Benefits and Coverage Attestation `�� ® Cross of Idaho PLAN SPONSOR INFORMATION Please complete the information below. Employer/Plan Sponsor Group Number Address City, State Zip Code Zoe 370 S' - 4A'1'00 Email Address Phone If applicable, please complete the information below. The prescription drug coverage for this plan is administered by: The mental health and substance abuse benefits for this plan are administered by: ,Klr/,v_- 1:12055 Note: Blue Cross of Idaho will work with the employer /plan sponsor to develop compliant Summary of Benefits and Coverage (SBC) and provide the employer /plan sponsor, in a timely manner, an electronic copy or copies of the SBC(s) for distribution to employees (paper copy provided upon request). PLAN SPONSOR ATTESTATION I attest that the employer /plan Sponsor will distribute to all its employees, dependents, retirees and COBRA eligible (Variable — Insureds OR Members) if applicable or otherwise provide access, to the applicable Summary of Benefits and Coverage(s) (SBC) in a timely manner and in accordance with the requirements of the Patient Protection and Affordable Care Act (PPACA) and its implementing regulations. I attest that I am authorized to submit this documentation on behalf of the plan sponsor /employer listed above for the purpose of illustrating compliance with PPACA standards. c1h d L I e 5 Jig (J- _ First Name (Print) Middle Initial Last Name Title g[o/ Form No. 3 -325 (08 -12) © 2012 Blue Cross of Idaho is an Independent Licensee o1 the Blue Cross Blue Shield Association HEM