2023/11/29 Council Agenda Packet

© Peak One Administration 2016 30 RETIREE ALTERNATIVE COVERAGE IN LIEU OF COBRA BILLING APPENDIX The Client has independently concluded that the Plan (“Health Plan”) is subject to the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) and applicable state law, as subsequently amended. Consequently, Client is required to perform certain acts in order to comply with COBRA and state continuation of coverage laws. Client has determined that under the terms of the Health Plan certain retirees and their qualified beneficiaries may waive COBRA and elect alternative coverage in the form of self- paid retiree coverage under the Health Plan. Client has engaged PSP to perform services to assist with billing for retires alternative coverage in lieu of COBRA coverage. The effective date of this Service Appendix is the effective date of the Agreement or if later, the date that both parties have signed this Service Appendix as set forth below. The responsibilities of the parties set forth in this Service Appendix are in addition to any responsibilities set forth in the Agreement. If there is a conflict between this Service Appendix and the Agreement, the Agreement controls. PSP and Client Responsibilities Client has asked PSP to provide the retiree self-pay coverage billing services indicated below for retirees and their qualified beneficiaries who have waived COBRA and elected alternative coverage in the form of self-paid retiree coverage under the Health Plan. 1. Premium Billing and Collection. (a) PSP will notify the retiree and/or respective Qualified Beneficiary of the amount due for the initial premium, which will be considered due days after the date the election is made. PSP will provide the retiree and each Qualified Beneficiary with coupons (i.e. payment booklet) stating the initial premium amount due and the due date. All subsequent monthly premiums will be due thirty (30) days after the due date, which is the first day of each month of the retiree coverage period, unless instructed otherwise in writing by the Client. Premiums will be considered timely paid if received in the offices of PSP or postmarked by the applicable due date (including any grace period). Premiums collected by PSP will be deposited into a PSP bank account but will be accurately accounted for in the accounting records of PSP. PSP will send all premiums collected the previous month to Client by the tenth (10th) day of the succeeding month. Premiums collected by PSP will be deposited into a PSP bank account but will be accurately accounted for in the books. PSP will send all premiums collected the previous month to Client by the tenth (10th) day after the end of the month, minus the administrative fee permitted under applicable law which PSP will retain as part of its administration. PSP will submit the premiums collected to third parties upon written instruction from the Client. In addition, PSP will retain any interest earned on such funds while held in a PSP account as an administrative fee. Notwithstanding the previous two sentences, PSP will not comingle the collected premiums with PSP’s own funds. (b) Client is responsible for notifying PSP of the applicable retiree coverage premium and any changes to the applicable premiums at least thirty (30) days prior to the effective date of any such change. 2. Notice of Termination Due to Retiree’s Medicare Eligibility: PSP will send to the last known address of the retiree and each covered Qualified Beneficiary recorded in its records written notification that retiree coverage is ending at least sixty (60) days prior to the date a retiree and each Qualified Beneficiary becomes eligible for Medicare as communicated by Client to PSP.