Ordinance No. 9,220ORDINANCE NO. 9220
® AN ORDINANCE AUTHORIZING AND DIRECTING THE CITY MANAGER TO
EXECUTE AND THE CITY CLERK TO ATTEST TO A RENEWAL OF THE
AGREEMENT WITH INTERCARE HEALTH PLANS AS A THIRD PARTY
ADMINISTRATOR FOR THE ADMINISTRATION OF MEDICAL AND DENTAL
CLAIMS AND FOR NETWORK SERVICES ON BEHALF OF THE CITY OF
BAYTOWN; AUTHORIZING PAYMENT OF ONE HUNDRED NINETY -ONE
THOUSAND THREE HUNDRED NINETY -FIVE AND NO /100 DOLLARS
($191,395.00); AND PROVIDING FOR THE EFFECTIVE DATE THEREOF.
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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 authorizes and directs the
City Manager and the City Clerk of the City of Baytown to execute and attest to a renewal of the agreement
with InterCare Health Plans as the third party administrator for the administration of medical and dental claims
and for network services on behalf of the City of Baytown. A copy of said Agreement is attached hereto,
marked Exhibit "A," and made a part hereof for all intents and purposes.
Section 2: That the City Council of the City of Baytown authorizes payment to InterCare Health
Plans of the sum of ONE HUNDRED NINETY -ONE THOUSAND THREE HUNDRED NINETY -FIVE
AND NO /100 DOLLARS ($191,395.00), pursuant to the Agreement.
Section 3: That the City Manager is hereby granted general authority to approve any change
order involving a decrease or an increase in costs of TWENTY -FIVE THOUSAND AND NO 1100 DOLLARS
($25,000.00) or less; however, the original contract price may not be increased by more than twenty-five
percent (25 %) or decreased by more than twenty-five percent (25 %) without the consent of the contractor to
such decrease.
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 13'h day of September, 2001.
/1"a-, e,
PETE C. ALFARO, ayor
ATTEST:
0AvW
GAR . S ITIJ, City Clerk
APPROVED AS TO FORM:
ACID RAMIREZ, SR., ka Attorney
dAMyDocuments \Counci1\00 -01 \September\RenewTPAlnterCare
C
City of Baytown
Renewal Services
InterCare Health Plans will assume the total responsibility for the administration of the
medical fund. These services include:
Monthly list billings (departmentalized if desired).
Payment of override premiums.
Payment of medical claims.
Monthly report of fund transactions and claims recap.
Assistance in filing of governmental reports and fonns.
Statistical and actuarial information.
Fees for these services:
Monthly Administrative Fee - Medical - $12.65 per employee per month.
Dental - $2.15 per employee per month
Precertiftcation /Utilization Review Fees - $2.25 per employee per month.
General Services Fee - $300 (one -time) - Through the course of the year,
InterCare is called upon to assist in a variety, of additional services outside the
realm of typical TPA claims processiig and reporting. These services often
include negotiations with blind (retro) networks, filing and preparing multiple
aggregate claims submissions, filing and preparing advances (aggregate_ and
specific), negotiating and renegotiating with PPOs, reconciling of bank accounts,
special reporting, broker support, advice, consulting, rate setting, auditor support,
and other miscellaneous, unforeseen services. This fee will be charged at the
beginning of the seventh month of the contract year.
Fees for optional services:
• COBRA Administration - S.75 per employee per month + S 10 per participant.
Notification
Record Keeping
Premium Collection
• H1PAA Administration - Sbb&@ per certificate.
• PPO Fees - $5.85 per employee per month (PHCS)
• Preparation of Form 5500 - $450.00 per form (optional)_
FMIT A
INVOWtUARE
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Renewal Services Continued Pase 2
■ RX Card (PTI /NPS) Administration - S2.00 per employee per month_
• InterCare On -Line Services - 11.25 per employee per month.
Other miscellaneous service fees are as performed:
r
• Aggregate Claim Filing, a charge of 51,100.00 will be made.
• Subrogation Services are charged at 10% of recovery, up to a maximum fee of
52,000.00 per case_
• Transplant Coordination charges amount to a flat fee of $849.00.
• Negotiation Services for out -of= network claims arc charged at 23% of negotiated
savings per case.
• In -House Case Management services are $85.00 per hour.
• Preparation for Outside Audits, including file retrieval, computer supports,
interview time, etc., is charged to the Plan at 5900.00 per audit or $150.00 per
hour.
1161,194:ZCARE