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HomeMy WebLinkAboutContract 1532MEDICA SENIORCARE SECURE MASTER GROUP CONTRACT Employer: City of Columbia Heights Employer Group #: 71113 Effective Date: September 1, 2000 Contract #: 03540 INTRODUCTION This Master Group Contract ("Contract") is entered into by and between Medica and the employer group named above ("Employer"), and includes Appendix A and the Certificate of Coverage which are part of this Contract and incorporated by reference. This Contract is delivered in and governed by the laws of the State of Minnesota. In consideration of the premiums the member has agreed to pay, and the payment of copayments to be paid by or for members, Medica agrees to arrange to provide coverage for benefits as set out in the Certificate of Coverage. This agreement is subject to all terms and conditions, including limitations and exclusions, set forth in this Contract. TERM OF CONTRACT This Contract will be effective from September 1, 2000 ("Effective Date") to August 31, 2001 ("Termination Date"). All coverage under this Contract begins and ends at 12:01 a.m. Central Time. Medica or the Employer may cancel this Contract with or without cause after at least 30 calendar days' written notice. If Medica terminates this Contract during its term, and termination is due to the Employer ceasing to do business, Medica will notify the Employer in writing of such cancellation. PREMIUMS The premiums under this Contract are as follows: Retiree or spouse Monthly Premium Rate $242.20 SeniorCare Secure The member will be responsible for payment of premium to Medica. The member will have one of the following payment options: The Automated Cleating House ("ACH") option. If the member has selected the ACH option, he or she will need to contact Member Service to obtain the necessary paperwork to automatically have their monthly premium deducted from their checking or savings account. Once this information is processed by Medica, the member will receive written notification of the effective date of their automatic premium deductions; Direct billing option. If the member chooses the direct billing option, Medica will send the member a monthly invoice stating the monthly premium amount due and payable to Medica by member. When premiums are due: o For the ACH option, premium deductions occur the fifth working day of every month. For the direct billing option, the monthly premium payment is due on the first day of every month. The member has a grace period of 31 calendar days from the due date to pay each premium. Failure to pay the premium within the grace period will result in premium collection by Medica and if premium is not collected, Medica will formally notify the Employer and the member of the termination of coverage. Non-payment of premium only, does not constitute a temfination notice. The member must notify the Employer, who in turn will notify Medica in writing to terminate coverage. See Section XXVII. To be eligible for coverage, the member must continue to seek care from Medica participating providers until the member receives notice of termination form Medica. The member must continue to pay the Medicare Part B premiums. How to pay premiums: o For the ACH option, once the appropriate paperwork has been processed, the member's premium deductions will occur automatically. o The member will send thepremium and the appropriate payment form to Medica at P.O. Box 9310, Minneapolis, Minnesota 55440-9310; or o Deliver your premium to Medica at 5601 Smetana Drive, Minnetonka, Minnesota. Responsibilities of Medica: In exchange for the premiums paid by the member, Medica shall arrange for the provision of benefits. In so doing, Medica may enter into agreements with providers of health care, one or more insurers and such other individuals and entities as may be necessary to enable Medica to fulfill its obligations under the Contract. O The Contract, its benefits and premiums may be changed from time to time. When this happens, the member will receive a revised Certificate of Coverage at their monthly renewal date, 31 calendar days in advance of any changes in benefits or premiums. Medica may change the premiums on any monthly due date or on any date this Contract is amended. Medica will provide 30 calendar days' written notice of premiums and coverage changes, including renewal of this Contract. Medica will give 30 calendar days' written notice for amendments to this Contract. All changes to enrollment will be made as specified in Appendix A. In no event will a refund of premiums for more than 60 calendar days be made to the Employer for termination of a member's coverage when the Employer has failed to notify Medica of such change. GRACE PERIOD If all or a portion of the premiums due remain unpaid at the end of the grace period, Medica may assess a finance charge for the unpaid amount and terminate this Contract upon 30 calendar days written notice to an authorized representative of the Employer and each subscriber. In the event of cancellation, Medica will not be responsible for any claims for health services incurred by members 30 calendar days after the notice date. ALTERATIONS This Contract may not be changed and no provisions may be waived unless approved in writing by an executive officer of Medica. ASSIGNMENT Medica will have the right to assign any and all of its rights and responsibilities under this Contract to any subsidiary or affiliate of Medica or to any other appropriate organization or entity. CLERICAL ERROR You will not be deprived of coverage under this Contract because of a clerical error. On the other hand, you will not be eligible for coverage beyond the scheduled termination of your coverage because of a failure to record the termination. CONFORMITY WITH STATUTES If a provision of this Contract conflicts with the terms of the laws of Minnesota, it is amended to conform to the minimum requirements of such laws. NOTICE Notice given by Medica to an authorized representative of the Employer will be deemed notice to all affected in the administration of this Contract in the event of termination or non-renewal of this Contract. ACCEPTANCE OF CONTRACT The Employer may accept this Contract either by having its duly authorized representative execute this Contract or by remitting the first premiums due on behalf of enrolling members to Medica, and such acceptance renders all terms and provisions herein binding on Medica and the Employer. IN WITNESS WHEREOF, Medica has caused this Contract to be executed on this August 17, 2000, to take effect on the Effective Date stated above. Medica 5601 Smetana Drive Minnetonka, Minnesota 55343 (612) 936-1200 Mailing Address: P.O. Box 1587 Minne/~zjpli. s, Minnesota 5~440 Title: Manager, Medicare Sales and Marketing EMPLOYER: City of Columbia Heights Address: 590 - 40th Avenue Northeast Columbia Heights, MN 55421 By: ~ 'Walt Fehst Title: City Manager Employer Representative: Linda Magee Assistant to the City Manager APPENDIX A Employer Name: City of Columbia Heights ELIGIBILITY To enroll for coverage, the retiree must reside in the Medica Plan- service area, be enrolled in both Parts A and Part B of Medicare and meet the eligibility requirements described below and in the Contract. If there is a conflict between the Contract and this Appendix A, Appendix A will prevail. Any person who does not satisfy the terms listed above will not be eligible for coverage under the Contract. INITIAL ENROLLMENT "Initial Enrollment Period" is a 31 day time period starting with the date the retiree is first eligible to enroll for Medica SeniorCare coverage. The retiree must apply within this period for coverage to begin the date he or she was first eligible to enroll. The retiree who enrolls during his or her Initial Enrollment Period is accepted without application of health screening or waiting periods. However, a retiree who becomes enrolled under Medicare Part B for the first time will be allowed to enroll in Medica SeniorCare without application of health screening or waiting periods for up to 6 months, beginning with the first month in which the retiree first enrolled for coverage under Medicare Part B. OPEN ENROLLMENT "Open Enrollment" is a minimum 14 day period set by the Employer and Medica each year during which eligible persons may enroll for coverage without application of health screening or waiting periods. NOTIFICATION Subscribers must notify the Employer within 30 calendar days of the effective date of any change of address or name, or other facts identifying the subscriber. The Employer must notify Medica within 31 calendar days of the effective date of the retiree's initial enrollment application, changes to the retiree's name or address, or changes to enrollment, including if a retiree is no longer eligible for coverage. TERMINATION Unless otherwise specified in this Contract, coverage will end the earliest 1. 11. of the following: The date the Contract is cancelled by Medica, upon 30 calendar days written notice to the employer. The date the Contract is cancelled by the Employer. The first day of the month after a member is no longer eligible for Medicare Parts A and B. The end of the month following Medica's receipt of written notice from the member requesting that coverage end. Non-payment of premium only does not constitute a termination notice by the member. The last day of the month following a 31 calendar day notice after Medica notifies a member that coverage will end because the member did not pay a copayment or premium. The date 31 calendar days after Medica notifies a member that coverage will end because the member no longer lives in the service area. January 1 of the year following the year in which Medica provides the member with 90 calendar days written notice that coverage will end because Medica has ceased to conduct business in the service area. Members will receive an opportunity to purchase replacement coverage without pre-existing condition limitations or interruption of coverage. The date of termination of Medica's contract with HCFA. Members will receive 90 calendar days notice of termination and an opportunity to purchase replacement coverage without pre-existing condition limitations or interruption of coverage. The end of the month in which the member dies. The date the Contract is cancelled due to a materially false statement or misrepresentation by or on behalf of the member on the application form. The date specified by Medica in written notice to the Employer because the Employer knowingly provided Medica with false information material to the execution of this Contract or to the provision of coverage under this Contract.