Administrative Services Agreement with SisCo Copyrighted
June 19, 2017
City of Dubuque Consent Items # 4.
ITEM TITLE: Administrative Services Agreement with SisCo
SUMMARY: City Manager recommending approval of an Administrative
Services Agreement with Self Insured Services Company
(SisCo)for COBRA Administration of the Medical and
Dental Plans and Administration of the Short-Term
Disability Plan effective July 1, 2017.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
SisCo Administrative Services Agreement-MVM Memo City Manager Memo
Staff Memo Staff Memo
SisCo Service Agreement Supporting Documentation
SisCo Service Agreement Addendum Supporting Documentation
THE CITY OF Dubuque
fta B E I 11p y
Masterpiece 012 the Mississippi 2007.2012«2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Administrative Services Agreement with Self Insured Services Company
(SisCO) for COBRA Administration of the Medical and Dental Plans and
Administration of the Short-Term Disability Plan
DATE: June 12, 2017
Personnel Manager Randy Peck recommends City Council approval of an
Administrative Services Agreement with Self Insured Services Company (SisCo) for
COBRA Administration of the Medical and Dental Plans and Administration of the Short-
Term Disability Plan effective July 1, 2017.
1 concur with the recommendation and respectfully request Mayor and City Council
approval.
vwu
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
THE CITY OF Dubu111Mque
DuB E 111111 .
Masterpiece on the Mississippi 2
2001•2012•20]3
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager q
SUBJECT: Administrative Services Agreement with Self Insured Services Company
(SisCo) for COBRA Administration of the Medical and Dental Plans and
Administration of the Short-term Disability Plan
DATE: May 26, 2017
Self Insured Services Company (SisCo) of Dubuque, Iowa has presented a proposal for
COBRA administration of the medical and dental plans and the Short-term disability
plan. The fee for COBRA administration of the medical and dental plans is $250 per
month and the fee for administering short-term disability plan is $100 per month per
active short-term disability case. There are currently thirteen people taking COBRA
insurance. There are no employees currently receiving disability payments. The
effective date of the agreement is July 1, 2017.
The agreement has been reviewed by City Attorney Crenna Brumwell and she finds the
terms acceptable. I request that the City Council pass a motion approving the
agreement and authorize you to sign the agreement.
RP:alk
I
I
experience the benefits
SISCO
SERVICE AGREEMENT
ADMINISTRATIVE SERVICES
THIS.AGREEM1?NT, made this lst day of July; 2017 between City-of'Dubutlite ("E rtployer.")
and Self Insured. Services Company ("SISCO".).
WHEREAS, 4mployer,. as Plan. Administrator, Ma ntains the City of Iaubuqu i Etnployee Benefit.
Plan (the "'Plan") for the benefit of eligible euiployees;.and
WHEREAS, Platt benefits will be finahced by contributions made by the Employer and/or
employees dining the'termof this Agreeritent; and
WHEREAS, Employer desires that-SISCO provide the services sat forth herein to the Plan and
SISCO has. agreed that it will provide such services to the. Etnployer.in accordance with the terms and
Conditions of this .Agreement.
THEREFORE, Employer and SISCO agree as follows:
1.. Term of Agreement. This Agreement shall commence on July 1, 2017 and s[hall.remain
in full force and effect until canceled. Either party inay cancel this Agreement effective on the last.:day of
any calendar month by giving at least sixty (60) days written notice to the other. SISCO shall have the
right to cancel this Agreement upon twenty one. (21) days written notice if Employer fails to provide
adequate- funds to pay claims or fails to pay SISCO's fees when due.
2. SISCO Duties. SISCO shall provide the following non -discretionary services to the
Employer during the term of this Agreement:
a. Records, forms and information.
1. Maintain employee benefit records in accordance with SISCO's records
retention policy, which SISCO mayreasonahly amend from time to time,
2. Provide claimants with Employer -approved claims forms and forms of written
explanations of benefits,
3. Provide Employer with monthly reports of benefit payments.
4. Prepare required regulatory reporting including Wage & Tax Statements (IRS
Form W-2),
b. Claims adjudication,
1. Receive claims.
2. Adjudicate claims which appear clearly covered or clearly not covered under the
terms of the Plan documents and the policies,, practices, procedures and
precedents established by Employer.
3. Refer to Employer, or to an expert selected by the Employer, any fact question
which may affect the benefits payable under the Plan and recommend a .decision
if requested by the Employer, and adjudicate Such claim based upon Employer's
decision.
4. Refer to the Employer, with. recommendations, any unresolved question
regarding interpretation of Employee docatnents` or summary plan descriptions
of of apolicy., practice or pr:ocedtireestablished by Employer.
5. Reconsider claims in accordance with the Pian as requested by a clairnantwhen
there is additional evidence,, or as directed by Employer.
c, COBRA Administration —Medical & Dental
l . Employer provides all required information for participants with COBRA
eligible termed coverages on a weekly basis.
2, SISCO mails COBRA notification letter to participant.
3. For participants who elect COBRA coverage, SISCO reoeives COBRA
premiums, updates. spreadsheet manually and;forwards premium to Einployer.
4, Issue checks. in payment of claims with funds provided byEmployer.
5. SISCO provides weekly spreadsheet of active participants .and paid through
dates to Employer.
6. Employer contacts carriers to update coverage for active participants,
7. SISCO provides initial required notices but excludes state continuation coverage
administration.
d. Payments.
1. Report to Employer the speoifio amount and timing of benefits to be paid under
the terms of the Plan in accordance with the adjudications of the claims.
Issue cheeks in payment of claims with funds provided by Employer,
3. EMPLOYER DUTIES. Employer agrees to:
a. Records, forms and information.
1. Approve Plan documents, Plan Amendments, and Summary Plan Descriptions,
2. Provide SISCO with accurate information necessary for the administration and
payment of claims. Misinformation will he promptly reported to SISCO upon
discovery,
3. Notify SISCO of additional participants eligible to participate in the Plan or of
participants no longer eligible to participate in the Plan within 30(thirty) days of
the date of eligibility or non -eligibility. Failure to timely report the addition, of
eligible participants may jeopardize Employer's stop loss insurance.
b. Payments,
1. Provide funds for payment of claims within fourteen (14) days .of request by
SISCO or sooner if necessary to provide funds for payment of claims prior to the
expiration of the stop loss insurance.
2. Remit payment for monthly administrative fees upon receipt of invoice,
4. Services Fee. SISCO shall be compensated for all services based upon the terms and
conditions set forth in Schedule A of the Addendum attached hereto which is part of this Agreement.
SISCO reserves the right on or after each anniversary date of this Agreement' to modify the fee upon
written notice to Employer.
5. Optional Services, If requested by the Employer, SISCO will provide assistance in the
preparation of Plan Documents, Plan Amendments,, Summary Plan Description, and forms provided to
claimants. The Employer will review such documents; as appropriate, with legal counsel.
6. Limitation of Liability. The Employer agrees to defend, indemnify, and save harmless
SISCO, and its employees, froin any and all loss, damage; lirtbility, judgments, claims rind expenses
:arising alit of:
a. The Employer's negligent performance, or lack thereof, of its duties and obligations
under thePlan or this Agreement.
b. The good faith performance by SISCO of its duties to the Employer under this
Agreement.
c, Actions taken by srsco at the direction of the Employer.
SISCO shall be responsible to the -Employer for loss of money resulting directly from the fraudulent or
dishonest act's by its employees. The remedy for payments madein error will be to seek recovery from the
employee or the provider of services,
7. Integration. This Agreement including the Addendum attached hereto and future
Addendums sets forth all of the terms, conditions, and agreements dine parties, and supersedes former
agreements, There are no terms, conditions, or agreements except as herein provided and no amendment
or modification of this Agreement shall be effective unless reduced to writing and executed by the parties,
8. Other.
R. It is the intent of the parties that SISCO act solely as a non -fiduciary Third Party
Administrator.
b. The terms and conditions of this Service Agreement shall apply to any other services
furnished by SISCO to the Employer,
c. The law of .Iowa will be controlling in all matters relating to the interpretation and
validity of this Agreement unless preempted by federal law.
d. This Service Agreement shalt be construed as creating rights and duties solely between
SISCO and the Plan, enforceable exclusively by SISCO or the Plan, There are no third
party beneficiaries either in respectto the services enumerated herein or in respect to any
other services performed for. the Plan,
No 'failore to ptirae a right or remecly.Bhall be deemed a Waiver oe that or any .other right
or rOtheely,
above wrItte,
al'Y Q1n)ippU13 SEIX INSURED SERYICES COMPANY
. By: By;
Aut lotizeci SignAture of Employer Richat'cl 4.. S[gwarth
Michael C. Van Milligan
Nitate
City Mane
title
Vlc PresIden't an( COO
experience the benefits
SISCO SERVICE AGREEMENT ADDEND um
ADMINISTRATIVE SERVICES
1, Schedule A. Service Fees areas follows:
Service
Short Term Disabitity.Admini8trittion.
COBRA AdmiriistratiOn, —Medical & Dental
.Fec/Cost
$ 100 Pep MOnth.Per Active STD Case
$ 250 Per Month
2; This Addendum shall take -effect on the let clay of Juty, 2017, Au: other p0v4lons of the Service
Agreernent, including the Integration provision are reaffirmed.
cr ry, OP DUE UE
13y:
,Autlirized Signature of Employer
Michael C. Van Milligen
Name
Clty Manger
Title
SELF INSURED SERVICES COMPANY
Richard A, Sigcyarth
Vice, •Peasklqnt and COO
City of Dubuque Insurance Requirements for Professionei Services
3.,
Insurance Schedule C
SisCo :shall furnish a signed Certificate of Insurance to the city of Dubtique, Iowa for the
coverage required In Exhibit I prior to commencing work and at the end of the project If the term of work
Is longer then 60 days, Providers presenting annual certificates shall present a Certificate at the end of
each project with the final billing, Bach Certificate shall be. prepared on the most current ACORD form
approved by. the Iowa Department of Insurance or an equivalent. 'Each certificate shall Include a
staternentunder Description of Operations -as to why Issued. Eg; Project A. or Project Location at
or.construction of
2. Ail policies of -Insurance regUlred hereunder•shall be with a carrier authorized to do business In Iowa and
all carriers shill have'e rating ofA or better In the currentA.M, Best's -Rating Guide. •
3, Each'Certificate:shall be furnished to the contracting department of.the City of Dubuque,
4, Failure:to provlde minimum coverage shall notbe deemed;,
Dubuque. 'Failure to obtain or maintain the required Insura
this agreement.
elver of these requirements by the City of
Shall be cansfdered a material breach of
5, Consultants shall require all subconsultants and sub subconsultants to obtain and maintain during the
performance of work Insurance for the coverages described In this. insurance Schedule and shall obtain
certificates of Insurances from all suchsubconsultahts and sub-subconsultants. Consultants agree that It
shall be liable for the failure of a subconsultants and sub-subconsultants to obtaln-and maintain such
coverages. The City may request a copy of such certificates from the Consultants.
6, All required endorsements to various policies shall be attached to Certificate of Insurance.
7. Whenever a specific IS form isllsted, an equivalent form may be substituted subject to the provider
identifying and fisting In wilting all deviations and exclusions that differ from the ISO form. "
8. Provider shall be required to carry the minimum coverage/Ilmits, or greater If required by law or other
legal agreement, In Exhibit I. If provider's limits of liability are higher than the required minimum limits
then the provider's limits shall be this agreement's required limits
9, Whenever an ISO form Is referenced the current edition of the form must be used,
Page 1 of 3 Schedule C Professional Services
_.af aub_u.q..u.e ln. s_ut nGe_..0 .eq:ia_ r tne.n..afc.r_R_raes.s..i.o. al S ,rices
insurance Schedule -C (continued)
Exhibit
A) COMMERCIAL GENERAL LIABILITY
General Aggregate limit $2,000,000
Products -Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written on an occurrence, not claims made, form. The general liability
coverage shall be written in.ac'eord with' (Sq forrn CG0001 or business owners form BP0002,
All deviations from the standard 150 commercial general llability form CG 0001, or Business
owners form BP 0002, shall be Clearly identified.
b) Include ISO endorsement form CG 25 04 "Designated Location(s) General Aggregate limit"
or CG 25 03 "Designated Construction Protect (s) General Aggregate Limit" as .appropria te.
c) Include endorsement indicating that coverage its primary and non-contributory,
d) Include" endorsemeht to preserve Governmental Immunity, (Sample attached),
e) Include an endorsement that deletes any fellow employee exclusion,
f) Include additional insured• endorsement for:
The City of Dubuque, Including all its elected and appointed officials,, all Its employees
and volunteers, all Its boards, commissions and/or authorities and their board members,
employees and volunteers. Use ISO form CG 2026.
B) AUTOMOBILE LIABILITY $1,000;000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the Job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended,
Coverage A Statutory --State of Iowa
Coverage 13 Employerstiabllity
Each Accident $100,000
Each Employee -Disease $100,000
Policy Limit -Disease . $500,000
Policy shall Include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage 13 limits shall be greater if required by Umbrella Carrier,
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein,
E) PROFESSIONAL LIABILITY $1,000,000
a) Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of Income and cyber breach of information.
Yes X No
Page 2 of 3 Schedule C Professional Services May 2016
City of Dubuque lU3UyaOCeReq Uif8D1eOts for Professional Services
Preservation of Governmental )mmunities Endorsernent
1. Nonwaiver of Governmental Immunity, The ihsurance carrier expressly agrees and states. that the
purchase of this 'pollcy and the Including of the City of Dubuqua, Iowa as an Additional Insured does
not waive any of the defenses of goVernmental Immunity available to the City of Dubuque, JoWe
underCodeof|owaSocHon67O.4us|t1snowc;|sts$ndat|tmaybnomended[mmt}metntime.
2. Claims Coverage, The Insurance carrier further agrees that thls policy of nsurarlce shall cover only
those daims hot subjeCt to the defense.of governmental Immunity under the'COde of Iowa Section
670.4 as It now exlsts and as rny be arnended ftom time to. time. Those claims not subject to
Code of Iowa SectIon,670.4 shall be covered by the term.s and conditions Of this InsUranCe policy;
3, Assertion of GovernrnentImmunli The dty of DubuqLr, Iow shall be responsible for assertlng any
detente of goVernMental Iromuhlty, and may do so at anytime and shall do so upon the thely
written request of the |noVranounorr|8r.
4. Non -Denial of Coverage, The Insurance carder shall not deny coverage under this policy-andthe
insurance carder shall not deny any ofthe rights and benefits accruing to the City of Dubuque, Iowa
under this policy for reasons of governmental linmurilty unless and until a court of competent
]ur|SdictionhasYn\edDn'favvrofthmdcfenoo(s)ofgoverqmantal|mmuohyooertedbythoCityof
Dubuque, Iowa,
No OtarChangeinPoUcv The above prespreservation of governmental lmmunities shall not otherwise
change er alter the coverage avallable under the.policy.
Page 3 of 3 Schedule C Professional Services May 2.010