Ordinance No. 6,457921123 -10
ORDINANCE N0. 6457
AN ORDINANCE RENEWING THE CONTRACT FOR THE ADMINISTRATION OF THE
MEDICAL AND DENTAL BENEFITS PROGRAM FOR THE CITY OF BAYTOWN;
AUTHORIZING AND DIRECTING THE MAYOR TO EXECUTE AND THE CITY CLERK
TO ATTEST TO SAID CONTRACT; AUTHORIZING PAYMENT OF TWO HUNDRED
SEVENTEEN THOUSAND FIVE HUNDRED FIFTY NINE AND 88/100 DOLLARS
($217,559.88) PURSUANT TO THE TERMS OF SAID CONTRACT; AND PROVIDING
FOR THE EFFECTIVE DATE THEREOF.
WHEREAS, the City Council of the City of Baytown, Texas, did
authorize the administration to request proposals for
administration of the self - funded medical and dental benefits
program the City of Baytown provides for its employees; and
WHEREAS, a review of various proposals submitted indicates
that the proposal of Alta Health Strategies, Inc. for claims
administration and utilization review and Cox Insurance Services,
paid through J. E. Stone, for Aggregate and Individual Stop Loss
coverages through Lloyd's of London would be the most beneficial to
the City of Baytown; NOW THEREFORE,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF BAYTOWN,
TEXAS:
Section 1: That the City Council of the City of Baytown,
Texas, hereby accepts as their third party administrator, Alta
Health Strategies, Inc., for claims administration and utilization
review for the City of Baytown's medical and dental benefits
program and payment of administration service charges in the amount
of EIGHTY NINE THOUSAND TWO HUNDRED TWENTY NINE AND 60/100 DOLLARS
and ($89,229.60) and authorizes payment thereof.
Section 2: That the City Council of the City of Baytown,
Texas, hereby accepts the proposal of J. E. Stone and Associates,
Inc. for individual and aggregate stop --loss coverage for the health
and dental benefits program underwritten by Lloyd's of London
through Cox Insurance in the amount of ONE HUNDRED TWENTY EIGHT
THOUSAND THREE HUNDRED THIRTY AND 28/100 DOLLARS ($128,330.28) and
authorizes payment thereof.
Section 3: That the Mayor and City Clerk are hereby
authorized and directed to execute and attest to the contract with
First Health and Cox Insurance services through J. E. Stone and
Assoc., Inc., a copy of which is attached hereto as Exhibit "A ".
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921123 -10a
Section 4: This ordinance shall take effect immediately from
and after its passage by the City Council of the City of Baytown.
INTRODUCED, READ AND PASSED by the affirmative vote of the
City Council of the City of Baytown, this the 23rd day of November,
1992.
Attest
City Clerk
.:v Attornev
`iU -NIM pEZURCES
ADMINISTRATIVE SERVICES AGREEMENT NOV 2 0 ;
• This Administrative Services Agreement (this "Agreement ") is among ALTA Health Strategies (TPA), Inc., a
Delaware corporation ( "ALTA'), the City of Baytown _
a Texas ____ corporation (the "Plan Sponsor'), and Cif other than the Plan
Sponsor), (the "Plan Administrator ") and is for the provision of
certain administrative services to or respecting the City of Baytown Groun Benefits Plan (the "Plan").
1. SERVICES ID BE PERFORMED.
ALTA shall perform the administrative services described in the attached Services Exhibit in accordance with the
terms and conditions of the Plan and within the framework of policies, interpretations, rules, practices, and
procedures made by the Plan Sponsor or Plan Administrator, to the extent that such are consistent with the Services
Exhibit and all applicable law and regulations.
2. FEES.
The Plan Sponsor shall pay or cause to be paid to ALTA, for the services provided under this Agreement, the fees
described in the attached Fee Exhibit.
3. TERM.
The initial term of this Agreement shall begin on netnher 1 ..199-2-, (the "Effective Date') and end on
Re tpmhpr In . 199---1—. Thereafter, this Agreement shall be automatically renewed for successive one -year
periods unless terminated as provided in the attached Standard Terms and Conditions.
4. No FlDucmRY Aur omy.
The parties intend that ALTA shall not be deemed a Plan "fiduciary" under the Employee Retirement Income
Security Act of 1974, as amended ( "ERISA'). Accordingly, ALTA"s services shall not include the power to make any
decisions as to Plan policy, interpretations, practices or procedures, but shall limited to the performance of only
those ministerial functions such as the types described in Department of Labor Regulation § 2509.75 -8, D -2 (relating
to claims processing, calculation of benefits, report preparation, employee communications, recommendations
regarding Plan administration, etc.) within a framework of policies, interpretations, rules, practices, and procedures
made by the Plan Sponsor or Plan Administrator. Notwithstanding any other provision of this Agreement, ALTNs
services with respect to the Plan shall be subject to review, modification, or reversal by the Plan Sponsor or Plan
Administrator and ALTA shall have no final discretionary authority or control over Plan management, no final
authority or control over the management or disposition of any Plan assets, and no final discretionary authority or
responsibility over Plan administration. Nor shall ALTA render any investment advice with respect to Plan assets or
have any authority or responsibility to do so.
5. UmrrAnoN OF LuBII.riY.
ALTA shall have no responsibility, risk, or liability for funding the Plan, for the payment of Plan benefits or liabilities,
or for the failure of the Plan or the Plan Sponsor to obtain or continue insurance coverage or payment of insured
benefits. Benefits under the Plan, whether or not fully or partially funded or insured, shall be provided solely by the
Plan Sponsor or those persons named in the Plan. ALTA shall use its best efforts to render the agreed -upon services
in a timely and accurate manner, but shall not be liable for any damages resulting from occasional errors or delays
(within the range of accepted industry standards) in the provision of its services; from its good faith application of
Plan provisions, including those concerning eligibility, coverage, medical necessity, or benefits; or from the failure of
Plan participants or beneficiaries to obtain any particular health rare as a result of ALTA"s services. Nor shall ALTA
be liable for any recommendations concerning stop loss insurance carriers or for the quality or nature of health care
provided through health maintenance or preferred provider organizations, whether or not sponsored, arranged for,
or recommended by ALTA.
• ®CapyripM 1990 ALTA Health Strategies. Inc. ADMCONTRACT.1
EXHIBIT A
•- dvvnt,ir�
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6. INDEMNIFICATION. . 1 � 11
The Plan Sponsor shall indemnify ALTA against expense, loss, claim, or liability, including reasonable attorneys'
•fees, arising out of or based on (a) claims for the payment of benefits or other amounts under the Plan; (b) acts or
omissions of the Plan Sponsor or Plan Administrator, as Plan fiduciaries or otherwise; (c) ALTA's alleged status as a
Plan fiduciary; (d) the Plan's or ALTA's alleged status as an insurer, insurance company, or multiple employer
welfare trust or arrangement; or (e) acts or omissions of ALTA in providing services under this Agreement if made
in good faith or in accordance with the directions of the Plan Sponsor or Plan Administrator. ALTA shall indemnify
the Plan Sponsor against expense, loss, claim, or liability, including reasonable attorneys' fees, arising out of or
based on acts or omissions of ALTA, but only those acts or omissions for which ALTA is not entitled to
indemnification under the preceding sentence; provided that ALTA shall not be required to indemnify the Plan
Sponsor if the Plan Sponsor's acts or omissions contributed to its loss. Rights to indemnification shall survive the
termination of this Agreement.
%. STANDARD T1ERms AND CONDITIONS AND DXHIBTTS.
This Agreement includes the attached Exhibits and Standard Terms and Conditions.
City of Baytown
(Plan Sponsor)
2401 Market Street
(address)
Baytown, Texas 77522
By: 4
Print Name:
Title:
Date:
IF OTHER THAN THE PLAN SPONSOR:
(Plan Administrator)
(address)
By:
Print Name:
Title:
Date:
• 0 Copyright 1991 ALTA Heahh Sirategin. Inc.
ALTA HEALTH STRATEGIES (TPA), INC.
363 N. Sam Houston Pkwy. E., Suite 1500
(address)
Houston Texas 770M2496
By:
Print Name: C1 G. Naylor
Title:
Senior Vice President
Date: November 19, 1992
ADMCONTRACT.2
L`
STANDARD `RRMS AND CONDITIONS ou
1. PROVISION OF SERVICES TO OnIERS.
ALTA and its affiliates may provide identical or similar services to others, directly or indirectly, under ALTA's name or mark or otherwise.
1 0 �, ?
2. PIAN AND F�E CHANGES.
ALTA shall not be required to implement any changes in Plan provisions made after the Effective Date without its advance written agreement as to
their effective date and the amount of any additional fee required to cover ALTXs implementation costs. ALTA may adjust its fees for any reason
effective as of any renewal date of this Agreement, and, after the first renewal date, effective as of the first day of any month upon at least 30 days
advance written notice of the amount and effective date of the proposed adjustment The Plan Sponsor or Plan Administrator may terminate this
Agreement, as provided under TERMINATION below, 9 it does not accept such adjustment
3. IMAL AND Accotk IlNG SERVICES.
ALTA services shall not include the provision of legal services or the services of independent certified public accountants. ALTA may suggest the
use of such professional advisors, but shall have no liability for the quality or cost of any services so provided.
4. TAx, ERISA, AND COBRA Comma.
ALTA shall not be responsible for establishing or maintaining the Plan or the Plan Sponsor in compliance with federal or state taxing statutes, ERISA,
health care continuation obligations ( "COBRA obliigationsl, or other applicable state or federal laws or regulations, or for obtaining any tax benefits
that may be available to the Plan Sponsor, the Plan, or Plan participants. If so provided in the Services Exhibit, ALTA shall provide sample Plan
documents and administrative forms, but makes no representations or warranties as to their legal sufficiency. The Plan Sponsor or Plan Administrator
shall have the final authority and responsibility for approving the form and content of all Plan documents and forms.
5. ENFORCEmE NT.
Except as may be separately agreed upon, ALTA shall have neither the right nor the responsibility to take any legal action against any person,
including the Plan Sponsor or Administrator, to enforce the provisions of the Plan, or to recover overpayments of Plan benefits.
6. Coss AND EXPENSES; TAxEs.
ALTA shall, at its own cost and expense, maintain and operate the fatalities and personnel necessary to provide its services under this Agreement The
Plan or the Plan Sponsor shall be responsible for all other costs and expenses of Plan establishment and administration including legal, accounting, and
other professional fees. The Plan or the Plan Sponsor shall also be responsible for the payment or reimbursement to ALTA of any and all taxes relating
to the Plan, including any sales or use taxes or taxes in lieu thereof, and any related penalties, interest, or expenses of ALTA, imposed upon or incurred
by ALTA, or required to be ooilected by ALTA
7. Platy BENEw PAYmem.
If ALT& services include the payment of benefits or other amounts on behalf of the Plan or the Plan Sponsor, the payments shall be made by checks
drawn on demand deposit accounts designated by the Plan Sponsor or Administrator. ALTA may require, as a condition of its continued provision of
services under this Agreement, the maintenance of such account balances as it reasonably determines will be necessary for the continuous and timely
payment of Plan benefits. If ALTA determines that account balances may be insufficient to pay allowed benefit claims, it shall promptly so advise the
Plan Sponsor or Administrator, it shall not be obligated to mail benefit payment checks; and it may, without any liability, but shall not be required to,
advise claimants as to the insufficiency of funds.
A The Plan Administrator shall maintain and provide to ALTA all information sufficient to establish the identity and eligibility of all
Plan participants and beneficiaries and to enable ALTA to properly render its services ALTA shall not be required to begin processing
claims or providing eligibility or coverage information until 30 days after ALTA has initially received all required Plan data
B. ALTA shall maintain all Plan records generated or received by it and shall make such records available for inspection or copying,
at the Plan Sponsor's or Administrator's sole expense, at ALTA offices during normal business hours and upon not less than n hours
advance written notice, which right of inspection shall continue for six months following termination of this Agreement
• 0 Copyright 1991 ALTA Health StratSOM Inc. ADMCONTRACT.3
�u�7a *a c;c:,vil ACES
C. Within ten days after receipt of the Plan Administrators written request following the termination of this Agreement, AL ;AgbJ '
deliver to the Plan Administrator, or its designee, those Plan records in its possession that are described in such request The Plan records
may be delivered in the format in which they are maintained by ALTA, but shall include sufficient format explanations and documentation to
enable the recipient to have immediate use of the record information. The Plan Sponsor shall reimburse ALTA for all costs incurred in
providing such records, including the costs of programming and computer changes, and shall pay an additional mutually agreed -upon fee
for any services requested or required of ALTA for supplying additional information not contained in the Plan records. To the extent the
records documentation includes systems or programs developed or owned by, or licensed to, ALTA, ALTA shall have the right to safeguard
their secrecy and use by requiring the transfer to occur in such a manner that will not permit the recipient to have continuing use of the
protected information. The recipient shall not copy or otherwise take advantage of the protected information. ALTA shall be entided to
retain copies of Plan records at its own expense.
D. ALTA shall maintain all Plan records in its possession for seven years or, if earlier, until they have been transferred to the Plan
Sponsor or Administrator or its or their designee upon termination of this Agreement
9. CONFIDEMiAIIIY.
A ALTA may withhold participant or beneficiary medical records or other information from any person where ALTA reasonably
determines that it is obligated to do so under federal or state confidentiality statutes or regulations.
B. ALTA shall keep confidential all records relating to the Plan, its participants, and beneficiaries and shall disclose the information
in such records (if permitted pursuant to the preceding paragraph) only to the Plan Administrator, the Plan Sponsor, their designees, or by
order of a court of competent jurisdiction requiring disclosure. ALTA may, however, use Plan data for statistical or reporting purposes in a
manner that it reasonably expects will not disclose confidential information identifiable with specific Plan participants or beneficiaries.
14. LEGAL ALMON.
If legal action is brought against the Plan or ALTA to obtain Plan benefits for denied claims, at the written request and at the sole cost of the Plan or the
Plan Sponsor, ALTA shall, to the extent such is within its control, make available to testify directly as to such matter, the appropriate physician
reviewers or any other employees directly involved in such matter. If a party to this Agreement is validly served with a subpoena, discovery request
for production of documents, or other legal process C'Legal Process', the party served shall immediately notify the other party so that it may
determine whether any of its confidential or proprietary data, reports, or other printed materials may be included in the request The other party, may
at its own expense, preserve the confidentiality of its data. No party shall have an obligation to contest any Legal Process.
11. PROPRIEf'ARY INFORMATION.
Each party to this Agreement acknowledges the validity of the other parties servicemarks, trademarks, tradenames, patents, or copyrights and shall
not in any way infringe upon or otherwise harm their interests in such property. During the term of this Agreement, the Plan Sponsor and
Administrator may have access to information of a proprietary nature owned or developed by, or licensed to, ALTA, including but not limited to,
information concerning systems, programs, processes and methods used by ALTA, and other information marked "confidential," "proprietary," or "not
for public disclosure" (collectively the "Information', all of which have great value to ALTA The Plan Sponsor and Administrator shall not in any way
disclose, disseminate, publish, or reveal to any person or use for their own benefit, any of the Information which they may obtain, except as
contemplated by this Agreement, to government agencies as may be required for reporting purposes, or to a person who has obtained an order of a
court of competent jurisdiction requiring such disclosure. ALTA, during or after the term of this Agreement, may take all actions that it reasonably
deems necessary to preserve the confidentiality of the Information, including its intervention in any legal proceeding concerning the Information's use
or disclosure. Each party hereto acknowledges that the remedy at law for any infringement on or unauthorized use or disclosure of the Information
may be inadequate and that agrees that the harmed party shall be entitled to injunctive or other equitable relief in addition to any other available
remedies. Any injunctive relief may be granted without bond, which each party does hereby waive.
12. TERMAnON.
A Any party shall have the right to terminate this Agreement by written notice to the other parties:
(1) Effective as of the failure of any other party to cure any monetary default (including failure to pay AUKS fees and
charges or to properly provide for or pay allowed claims) within five calendar days after written notice thereof, or the failure to
commence to cure any other default within ten calendar days after written notice thereof,
• 0 Copyright 1991 ALTA Health Strategies. Inc. ADMCONTRACT.4
Ht:. ".9:a "f r EZURCES
(2) Effective as of the date any other party becomes insolvent, is adjudicated as a bankrupt, its b apes co s i*
possession or control, even temporarily, of any trustee in bankruptcy, has a receiver appointed for it, o "fnal�s Zgeneral
assignment for the benefit of creditors;
(3) Effective as of the expiration of the initial term of this Agreement or as of the fast day of any month during any
renewal term thereof, provided the party gives the other parties not loss than 60 days advance written notice prior to such
expiration date; or
(4) Effective as of the effective date of any proposed adjustment by ALTA to the monthly fees pursuant to the attached Fee
Exhibit if the Plan Sponsor does not concur with such adjustment
B. Upon the effective date of the termination of this Agreement for any reason:
(1) Each party will pay to the other parties all monies due to them under this Agreement within thirty days after the
effective date of the termination.
(2) The Plan Sponsor and Administrator shall immediately cease to represent that ALTA is a third party service provider
for the Plan and shall cease to use ALTA's documents, employee communications materials, systems, logo- types, service marks,
trademarks, tradenames, methods and techniques in any form, and the Plan Administrator shag immediately advise the Plan
participants and beneficiaries of the termination of this Agreement
(3) ALTA shag deliver the Plan's records to the Plan as provided for under "Books and Records" above. Except for the
transfer of the records as so required, ALTA shall have no further obligation to perform any services under the Agreement If,
however, ALTA is requested to continue processing claims or to perform other services for or with respect to the Plan after the
effective date of the termination, but prior to the transfer of records, ALTA shall be paid the fees provided for such post -
terrnination services in the attached Fee Exhibit
13. DEMA9ION.
ALTA shall not delegate its obligations under this Agreement without the specific prior written consent of the Plan Sponsor except to a subsidiary or
affiliate of ALTA.
14. BwDiNG EFFECT; No THmD PAmx BENEmc1Am.
This Agreement shag be binding upon and inure to the benefit of the parties hereto and their respective successors and permitted assigns. Nothing in
this Agreement, express or implied, is intended to confer upon any other person any rights, remedies, or obligations under or by reason of this
Agreement
15. Pi AN SpoNsolz; PLAN ADm MSMATOL
Unless the context requires otherwise, the term "Plan Sponsor" or "Plan Administrator" as used in this Agreement shag include any corporation,
partnership, committee, trustees of a trust, or other entity or individual sponsoring or administering the Plan at the time of execution of this
Agreement and shall also include such additional or successor individuals or entities serving from time to time during the term of this Agreement;
provided, however, that when this Agreement calls for direction or notice to be given to ALTA by the Plan Sponsor or Plan Administrator, ALTA shad
be absolutely protected in relying upon any direction or notice received from the persons executing this Agreement as Plan Sponsor or Plan
Administrator.
16. INDEPENDENT COMBACDOR.
ALTA is engaged to perform the services under this Agreement as an independent contractor and not as the Plan Administrator or other named
fiduciary. ALTA shall not be designated or deemed to be an "administrator" of the Plan as that term is defined under ER1SA section 3 (16) (A) or any
other applicable federal or state law.
17. ENM AGREEt tem,, Att+fENDMENIS.
This Agreement, including all schedules, exhibits and amendments hereto, constitutes the entire Agreement among the parties and supersedes all
prior proposals, discussions, and writings by and between the parties and related to the subject matter of this Agreement This Agreement may be
modified, amended, or supplemented, but only by a written instrument executed by all parties, except that fee adjustments proposed by ALTA and not
objected to by either the Plan Administrator or Plan Sponsor shall also constitute a binding amendment The parties acknowledge that the Plan or the
• O Copyright 1991 ALTA H$Wh S1rategkx. Inc. ADMCONTRACT.5
-URCEJ
NOV 1 0
Plan Sponsor may have entered into separate agreements with affiliates of ALTA for other types of services, but such agreements shall be construed
and enforced separately from this Agreement
• 18. SEPARABBM.
If any provision of this Agreement is held to be illegal or unenforceable„ the remaining provisions shall nevertheless remain in full force and effect In
addition, the illegal or unenforceable provision shall be modified so as to conform to the greatest extent legally permissible, to the original intent of
such provision.
19. FORCE MAMJRE.
The term "force majeure" shall mean an act of God, sHm walk -out, or other industrial disturbance, war, riot, lightning, fire, storm, flood, explosion,
governmental action or delay, unavailability or breakdown of equipment, and any other cause not reasonably within the control of the party claiming
suspension. The obligations of any party under this Agreement, other than the obligation to make money payments, shall be suspended during the
continuance of a force majeure applicable to that party. The affected party shall use all reasonable diligence to remove, to the extent reasonably
practicable, the force majeure situation as quickly as possible without incurring excessive costs, but shall not be required to settle strikes, walk -0uts, or
other labor difficulties contrary to its wishes.
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21. Nmcts.
All notices shall be in writing and shall be hand - delivered, transmitted by telecopy, or sent by registered or certified mad, return receipt requested, to
the address set forth on the signature page of this Agreement or to such other address furnished by the addressee. A band- delivered or telecopied
notice shall be deemed given only when actually received. A notice sent by registered or certified mail shall be deemed given on the first to occur of its
actual receipt or the fifth day after the date mailed as evidenced by the sendees certified or registered mail receipt
• m Copyright 1991 ALTA HeaM Strategies, Inc. ADMOONTRACT.6
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SERVICES EuM To
Anivmvlsrmnw SERVmEs AGREEMENT
h'U?,lAfl PF 3 "-, ES
NOV 1 0 ire?
ALTA shall provide the following services to or respecting the Plan, which services need not commence until 30 days after AUKs initial receipt of
all necessary Plan data:
1. Provide information, based on records provided by the Plan, concerning Plan eligibility and benefits to all participants, beneficiaries, and health
care providers by telephone during normal business hours, including toll -free access 9 separately agreed upon, and by mail in response to written
inquiries.
2. Administer claims in accordance with the terms of the Plan, including any summaries or "write- ups" as may be approved by the Plan Sponsor or
Plan Administrator as the correct interpretation of Plan provisions.
3. Claims administration services shall include:
a. The receipt and review of claims and claims documents.
b. Verification of eligibility and determination of medical necessity and amounts payable under the Plan in light of Plan provisions
concerning reasonableness of charges and preferred provider or other service arrangements.
C. Correspondence with claimants to obtain any required additional information and to determine whether other coverage for the
claim exists under subrogation rights or other benefit plans, insurance contracts, health maintenance organizations, or
government-sponsored benefit programs.
d. Preparation and mailing of explanations of benefits (or denial of benefits), and benefit payment checks drawn on designated
demand deposit ac counts.
e. Reasonable steps, in accordance with Plan provisions, to recover or offset erroneous payments of Plan benefits.
Administration of the claims review and appeals procedure in accordance with Plan provisions. Consistent with ALTA's lack of
discretionary authority or control over Plan administration, ALTA shall advise the Plan Administrator of all appeals of denied
claims and the Plan Administrator shall make all final benefit determinations in such cases.
4. Provide one copy of ALTNs current form of Plan document and /or summary plan description and ail related standard administrative forms and
assist with the design and printing of claim forms, ID cards, and other supplies designed specifically for the Plan.
5. Provide all reports included, from time to time, in ALTKs standard reporting package.
6. Provide the Plan Sponsor with any data maintained by ALTA that is required by the Plan in the preparation of required reports and filings
7. Attend meetings with the Plan Sponsor as reasonably requested and necessary for the provision of services under this Agreement
8. Other optional services:
a Processing of claims incurred prior to the Effective Date.
b. Processing of claims after the termination date Crun -off claims', but only if separately agreed to by the Plan Sponsor upon
termination.
C. Assist in the preparation and printing of multiple copies of forms, identification cards, plan documents, and other documents.
d. Provision of ALTA Intact Service, consisting of standard report package, executive summary, and various analytical services,
such as benefit modeling.
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g Copyright 1981 ALTA Health Strategies, Inc. ADMCONTRACT.7
e. Coordinating, transferring, and matching certifications from other third party service providers. N 01 2 0
• f. Arrange for and coordinate participation in preferred provider organizations.
g. PRESCEMMON DRUG PFMRAX
Alta may provide the following additional services in connection with the Plan's prescription drug benefits:
(1) Verification of eligibility, review and payment of claims, and provision of standard fops, in the manner provided under
claims administration services, with respect to the Plan's prescription drug benefits.
(2) Preparation of AUNs prescription drug program standard reporting package.
(3) Electronic transmission of participant eligibility information to, and the capture of prescription drug claims on
magnetic tape from, contracting pharmacies, using the proprietary data processing services and applications of
National Data Corporation, a Delaware corporation specializing in such data processing applications.
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h. Other services, such as consulting or troubleshooting services.
C Copyright 1991 ALTA Health Strategies, Inc. AOMCONTRACTS
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1 UII,II lo "k. M1! Vii' M ' M 10
The fees payable to ALTA for the services rendered under the Agreement to which this Fee Exhibit is attached shall be as follows:
I. Mom OF FEE.
A. LNMI& FEE.
An initial one -time fee of $ N/A payable on or before
B. BAsE Moantnx FEE.
The following monthly fee equal to $9.50 per number of Covered Employees as of the
_first day of the month. which includes $.50 to be paid to Stone & Assogiates
by ALTA.
C. FEE FOR PROcEssiNG of Rm -OFF ifs.
For processing claims after the Agreement's termination date (but only if requested or provided in the Services Exhibitl, the
following monthly fee:
subject to a minimum
monthly fee of $
D. ADDmo.,,,,SL FEES.
E. LNcmAg r\ NoN- comrwun» Cosm
Increases in the rate of any noncontrollable cost (as hereafter defined) beyond that in effect as of the date of this Agreement or
its most recent renewal shall be borne by the Plan. "Noncontrollable cost" means any expense ALTA incurs which is directly
attributable to ALTA's performance under this Agreement and which is beyond the reasonable control of ALTA, a g., postage rates.
H. PAYMENT OF FEES.
ALTA shall provide a monthly statement of its fees each month and the
Flan Sponsor shall pay such fees on or before the fifth business day
• after receipt of the monthly statement.
C Copyright 1991 ALTA Health Strategies, Inc. ADMCONTRAC111
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NOV 1 O
ALTA HEALTH STRATEGIES, INC.
ERISA PTE 77 -9 DISCLOSURE OF INSURANCE COMMISSIONS
Name of Plan: the City of Baytown Group Benefits Plan
Insurer: Lloyd's of London
The products recommended for purchase by the above Plan include the following:
Life AD &D Dependent Life X Stop Loss Other:
Broker markets products.
INITIAL AND RENEWAL COMMISSIONS
ALTA will receive the following initial and renewal sales commissions expressed as a percentage of the gross annual
premium payments (i.e. ):
Life:
Stop Loss:
Initial: 0 % Each Renewal: 0 96
Initial: 0 % Each Renewal: 0 96
OVERRIDE COMMISSIONS (OR PRODUCTION BONUS)
ALTA may receive so- called override commissions or a production bonus ("override commissions") from the
Insurer based upon its volume of business or potential volume of business with the Insurer or other similar factors.
The amount of such override commissions, if any, will not be known until the end of the contract with the Insurer.
Information regarding override commissions by ALTA insofar as they relate to the Plan will be available for the Plan
fiduciaries' review after such override commissions have been determined. Under the current commission policies
and practices of the Insurer, the override commissions, if any, to which ALTA may be entitled will be calculated in
the following manner:
OTHER COSTS OR FEES
Other costs or fees (in addition to sales commissions disclosed above) that may be charged to the Plan by the
Insurer include policy change fees and costs, early contract termination charges or certain other fees, discounts,
penalties, or adjustments which may be imposed under the terms of the recommended contract. These additional
costs or fees may be summarized as follows:
a Copyright 1991 ALTA Health Strategies, Inc. AOMCONTHAC712
RELATIONSHIP TO INSURER
i:Lj:Yl:w�•
NON Z 0 1992
ALTA is X is not an affiliate of the Insurer. ALTA is X is not limited
4Dby any agreement with the Insurer in its ability to recommend the purchase of insurance products from
other insurers or funding organizations.
Explanation if applicable:
RELATIONSHIP TO PLAN
To avoid a possible prohibited transaction under the Employee Retirement Income Security Act of 1974 ( "ERISA "),
ALTA may not be:
1. Affiliated with the Plan Sponsor or any other employer who has employees covered by the Plan;
2. A Plan Trustee (other than a nondiscretionary trustee who does not render investment advice
concerning Plan assets);
3. A named Plan Administrator; or
4. A named Plan Fiduciary or other fiduciary who is expressly authorized in writing to manage, acquire or
dispose of Plan assets on a discretionary basis.
ACKNOWLEDGEMENT
The undersigned acknowledges receipt of the information contained in this statement prior to any purchase and
approves the proposed transaction on behalf of the Plan without receiving, either directly or indirectly, any
compensation or other consideration for his own personal account from any party dealing with the plan in
connection with the transaction. The undersigned certifies that, to the best of his knowledge and belief, ALTA is not
related to the Plan in any capacity described above.
(Plan Administrator or other
named Fiduciary)
Date
O Copyright 1981 ALTA Fiaahh Stralagias. Inc. ADMCONTRACT.13