HomeMy WebLinkAboutAGMT - Holman Family Counseling (Amended Group Plan for EAP) Holman Family Counseling, Inc.
�.® Managed Behavioral Health Care Services
May 8, 2013
Emile Bayle
TRC Financial
2450 Mission Street,Suite 21
San Marino,CA 91108
Dear Emile:
We are pleased to renew our contract with City of Seal Beach at the current rate of $1.11
per employee,per month, for one year, for the period of September 1, 2013 through
August 31, 2014 for Employee Assistance Program Services. Please pass the great news
along to our mutual client.
3 Sessions Renewal Rate- $1.11
All renewal rates are guaranteed until August 31, 2014 (12 Months)
We have enjoyed working with you and City of Seal Beach and look forward to another
successful contract year as their behavioral health care provider.
Thank you for your continued support of The Holman Group. I look forward to hearing
from you soon.
Sincerely,
Elizabeth Holman
Vice President Sales&Marketing
EH/es
9451 Corbin Avenue Suite 100 Northridge, CA 91324 tel: 800321.2843 tel: 818.704.1444 fax: 818.704.9339
PROFESSIONAL SERVICES AGREEMENT
AMENDED GROUP PLAN CONTRACT
EMPLOYEE ASSISTANCE PROGRAM PLAN
0/
between
• 6 o3q
City of Seal Beach
211 - 8th Street
Seal Beach, CA 90740
Holman Family Counseling, Inc.
9451 Corbin Avenue
Northridge, CA 91324
(800) 321 -2843
This Professional Service Agreement ( "the Agreement ") is made as of the 9th day of
August, 2010 (the "Effective Date "), by and between Holman Family Counseling, Inc.
( "Consultant "), a California corporation, and the City of Seal Beach ( "City "), a California
charter city, (collectively, "the Parties ").
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RECITALS
WHEREAS, it is the purpose of HFC to provide Employee Assistance Program (EAP)
services ( "Services ") to employer groups while maintaining the requisites of an
independent and responsible profession;
WHEREAS, HFC has provided the Services to Employer since September 2000; and
WHEREAS, HFC wants to reduce its monthly rate to $1.11 per employee, effective July
1, 2010.
NOW THEREFORE, HFC and Employer, in consideration of the mutual promises and
covenants contained herein, do hereby agree as follows:
AGREEMENT
I. DEFINITIONS
A. Benefits Schedule: The "Benefits Schedule" is attached hereto as Exhibit
A, which is hereby incorporated herein by this reference. The Benefits
Schedule describes the number of sessions available to Enrollees if such
sessions are approved by the CMC. To the extent that there is any
conflict between Exhibit A and this Agreement, this Agreement shall
control.
B. CMC: The Clinical Management Committee ( "CMC ") functions to assure
quality control of treatment. All EAP services are authorized by the CMC.
C. EAP Services,: Employee Assistance Program (hereinafter "EAP ")
services are a program of comprehensive assessment and referral
services designed to identify and make appropriate referrals for treatment
of physical, mental or emotional conditions which may result in impaired
employee performance. Drug or alcohol abuse and marital difficulties are
the most common sources of impaired employee performance which fall
within the scope of the EAP. However, the EAP is concerned with the
entire range of problems which may prevent employees from realizing
their full performance potentials.
Although the EAP is ultimately concerned with employment performance,
it must necessarily also concern itself directly with an employee's
concerns outside of the work place, including the employee's family.
When appropriate, family members are involved to the extent necessary to
fully assess an employee's problems or concerns. Assessment and
referral services are also available to an employee's family members.
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The function of the EAP is mainly to provide an assessment and referral, if
appropriate, rather than actual professional treatment. However, to the
extent that treatment can effectively take place during the limited number
of professional sessions provided for by this Group Plan Contract,
professional treatment is provided by the Provider by whom an Enrollee is
assessed as a part of the EAP. Referrals are made as necessary for
purposes of treatment covered by HFC from the Provider who has initially
been assigned the Enrollee for purposes of assessment and referral, in
accordance with individual Enrollee needs. At Enrollee's discretion,
ongoing treatment may be furnished by Provider rather than selecting a
new Provider or receiving a referral.
EAP Services utilize all psychological principles and methods for the
understanding, diagnosis, referral, prevention, and treatment of
psychological or personal problems in adults, children, couples, and
families. Procedures utilized may include, but are not limited to, individual
counseling, marital counseling, psychotherapy, behavior modification,
chemical and alcohol abuse counseling, and hypnosis, used in a
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professional relationship to assist a person or persons to acquire greater
human effectiveness, or to modify feelings, work situations, conditions,
attitudes, and behavior patterns which are emotionally, intellectually, or
socially ineffectual or maladjustive.
D. Eligible Dependents: The Eligible Dependents of an Eligible Employee's
are such Eligible Employee's lawful spouse and unmarried dependent
children to age 19 or to age 23 if the child is a full -time student. Children
include step - children, adopted children, and foster children, provided such
children are dependent upon the employee for support and maintenance.
Attainment of the limiting age of 19 by unmarried dependent children, or
the limiting age of 23 by full -time students, shall not operate to terminate
the coverage of a child while the child is and continues to be incapable of
self- sustaining employment by reason of mental retardation (although no
payment will be made by HFC for treatment of the mental retardation,
other than primary diagnosis) or physical handicap and their child is chiefly
dependent upon an Eligible Employee for support and maintenance. If
requested, proof of such incapacity and dependency may be required by
HFC from the Eligible Employee. If requested, such proof must be
furnished within 31 days of the request for such information by HFC, but
not more frequently than annually.
Eligible Dependents are further defined as including all dependents in
those categories stated above, regardless of enrollment in the Employer's
group health plan. The effective date shall be the same as for the Eligible
Employee.
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E. Eligible Employee: The term "Eligible Employee" shall mean a full time
regular employee of Employer. The effective date of coverage shall be
thirty (30) days after date of hire and ends on the last day of the month for
which a premium was paid. Continuation will be allowed under COBRA
provisions.
F. Enrollee: The term "Enrollee" shall mean an Eligible Employee and /or
such Eligible Employee's Eligible Dependents as defined herein.
G. Non - Contracting Provider: The term "Non- Contracting Provider" shall
include any Provider who has not contracted with HFC to deliver services
to Enrollees.
H. Provider: The term "Provider," for purposes of this Agreement, shall mean
and include any licensed psychologist, psychiatrist, clinical social worker,
marriage, family and child counselor, or mental health nurse working
individually, or within a corporation, clinic, or group practice, who delivers
mental health services to Enrollees. The term "Provider" includes the duly
licensed professional employees of a provider who has been approved in
advance in writing by HFC to provide services to Enrollees.
II. COVENANTS OF EMPLOYER
A. Employer agrees to pay HFC monthly, commencing July 1, 2010, and on
or before the first day of each succeeding month, a fee of $1.11 per each
Eligible Employee. (See Exhibit A) HFC guarantees such fee until August
1, 2011. Fee increases after August 1, 2011 for any renewal term shall be
effective on the first date of such renewal term date and only if HFC has
given thirty (30) days written notice prior to such first date of such renewal
term.
B. This Agreement shall be deemed to be renewed for additional terms of
one year each unless a party gives the other party written notice of its
intent to terminate this Agreement at least 30 days prior to the expiration
of the term hereof or the expiration of any renewal term.
C. Employer shall direct Enrollees who wish to receive EAP services to
telephone HFC at (800) 321 -2843 Nationwide, to make arrangements for
such services to be rendered.
111. COVENANTS OF HFC
A. HFC shall provide EAP services pursuant to the Schedule of Benefits. In
order to receive EAP Services, Enrollees shall telephone HFC at 800 -321-
2843 Natioriwide. HFC will assign to Enrollee an appropriate Provider
based upon intake information which HFC will request in its telephone
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conversation with the Enrollee. In most instances, treatment
recommendations and referrals will be discussed with Enrollee by
Provider. If the Enrollee wishes to use a Non - contracting Provider,
Enrollee would do so at his /her own expense and it shall be the
responsibility of the Enrollee to arrange for services with the Non -
contracting Provider.
B. Services shall be provided by HFC in HFC's offices, or offices of
Providers. Normally services shall be delivered within five (5) business
days of a request by an Enrollee. Emergency services will be available on
a 24 -hour per day, 7 -day per week basis. Emergencies will be handled on
an immediate basis.
C. HFC shall be available to assist Employer in developing an internal policy
and procedures for referring Enrollees to HFC. A HFC Account Manager
will provide necessary consultation with Employer's supervisors in
connection with job performance related formal Enrollee referrals.
Additionally, in the first year of this Group Plan Contract, HFC will provide
management training for Employer's supervisors.
D. HFC shall provide Employee Assistance Program brochure, or copy, and .
consult with Employer and Employer's representatives about same.
E. HFC shall make available to Enrollees the telephone number of HFC for
making appointments and obtaining information with respect to services
provided by HFC pursuant to this Group Plan Contract.
F. HFC shall establish and maintain a quality control procedure, under the
supervision of the CMC, in order to assure delivery of effective health care
services to Enrollees.
G. HFC shall require all Contracting Providers and their authorized
professional employees to agree with HFC that they shall abide by ethical
principles of their respective professions, including, as appropriate, the
Ethical Standards of the American Psychological Association, the
standards of the Ethics Committee of the American Psychiatric
Association, the ethical standards of the National Association of Social
Workers, and or ethical standards of the California Association of
Marriage, Family and Child Counselors, and /or ethical standards of the
Board of Registered Nurses.
H. HFC shall provide written notice to Employer within thirty (30) days in the
event that any Provider terminates or breaches their contract with HFC or
becomes unable to perform under such contract if, in the reasonable
estimation of HFC, Employer or Enrollees may be materially or adversely
affected thereby.
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HFC shall not increase the amount of the fee to be paid by Employer or
otherwise increase the compensation to be paid to HFC by Employer for
services provided pursuant to this Group Plan Contract except as provided
in Section IIA.
J. HFC shall not decrease the amount of benefits to be provided pursuant to
this Group Plan Contract except after a period of at least thirty (30) days
from either the postage paid mailing to the Employer of written notice of
such decrease, at the Employer's address of mailing as reflected by the
records of HFC, or the actual hand delivery to Employer by HFC of written
notice of such decrease. Decrease of benefits will be contingent upon
Employer's agreement with HFC's proposed benefit reduction and rate will
be renegotiated.
K. HFC shall keep confidential all files, records, documents and any other
information pertaining to Enrollees, which identifies individuals who
receive professional services from HFC. HFC further agrees to restrict
internal distribution of all such information and release such information
internally only when necessary to the provision of services to Enrollees.
Except for use reasonably necessary to the provision of services under
this Group Plan Contract, or reasonably necessary to evaluate the quality
of care delivered, such information shall not be disclosed without the
written consent of the Enrollees. Notwithstanding the foregoing,
confidential information maybe disclosed if required or permitted by
applicable law.
L. HFC shall require that all Providers have malpractice liability insurance
coverage for $1,000,000 each occurrence and $1,000,000 in the
aggregate.
M. HFC shall carry:
1. Comprehensive general liability insurance: $2,000,000 each
occurrence (bodily injury, personal injury and property damage);
and Business personal property insurance on all HFC facilities in
the amount of $65,000.
2. Statutory Workers' Compensation for all HFC employees.
3. Fidelity Bond.
HFC shall not commence work under this Agreement until it has provided
evidence satisfactory to the City that HFC has secured all insurance
required under this Section. HFC shall furnish City with original
certificates of insurance and endorsements effecting coverage required by
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this Agreement on forms satisfactory to the City. The certificates and
endorsements for each insurance policy shall be signed by a person
authorized by that insurer to bind coverage on its behalf, and shall be on
forms provided by the City if requested. All certificates and endorsements
shall be received and approved by the City before work commences. The
City reserves the right to require complete, certified copies of all required
insurance policies, at any time.
The insurance policies shall contain the following provisions, or HFC shall
provide endorsements on forms supplied or approved by the City to state:
(1) coverage shall not be suspended, voided, reduced or canceled except
after thirty (30) days prior written notice by certified mail, return receipt
requested, has been given to the City; (2) any failure to comply with
reporting or other provisions of the policies, including breaches of
warranties, shall not affect coverage provided to the City, its directors,
officials, officers, (3) coverage shall be primary insurance as respects the
City, its directors, officials, officers, employees, agents and volunteers, or
if excess, shall stand in an unbroken chain of coverage excess of the
HFC's scheduled underlying coverage and that any insurance or self -
insurance maintained by the City, its directors, officials, officers,
employees, agents and volunteers shall be excess of the HFC's insurance
and shall not be called upon to contribute with it; (4) for general liability
insurance, that the City, its directors, officials, officers, employees, agents
and volunteers shall be covered as additional insureds with respect to the
services or operations performed by or on behalf of the HFC, including
materials, parts or equipment furnished in connection with such work.
All insurance required by this Section shall contain standard separation of
insureds provisions and shall not contain any special limitations on the
scope of protection afforded to the City, its directors, officials, officers,
employees, agents, and volunteers.
Any deductibles or self- insured retentions shall be declared to and
approved by the City. HFC guarantees that, at the option of the City,
either: (1) the insurer shall reduce or eliminate such deductibles or self -
insured retentions as respects the City, its directors, officials, officers,
employees, agents, and volunteers; or (2) the HFC shall procure a bond
guaranteeing payment of losses and related investigation costs, claims
and administrative and defense expenses.
N. Upon termination of a Provider Agreement by a Contracting Provider
( "Provider ") HFC shall be liable for covered services rendered by such
Provider to Enrollees who are under the care of such Provider at the time
of such termination until services being rendered by the Provider are
completed unless HFC makes appropriate provision-for the assumption of
such services by another contracting Provider.
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O. Every contract between HFC and its Contracting Providers will, as
required by law, contain a provision to the effect that Enrollees shall not be
responsible for payment to any Provider who has contracted to provide
services to HFC in the event that HFC should fail to pay the Provider for
services rendered.
P. Holman shall provide as part of this contract unlimited hours of
supervisory training and /or employee orientations per year on a use it or
lose it basis. Additional training will be at $150.00 per hour. Required
travel will be at cost plus $75.00 per hour for time.
IV. CHARGE FOR BROKEN APPOINTMENTS
An Enrollee will forfeit one (1) EAP session for any appointment made with such
Contracting Provider and not. kept, except in those cases where the Contracting
Provider is notified at least 24 hours in advance of the appointment that it will not
be kept.
V. GRIEVANCE PROCEDURE
The Grievance Committee will be responsible for hearing and resolving
grievances between HFC and its Enrollees and Providers. The Grievance
Committee will also monitor patterns of grievances in order to formulate policy
changes and procedural improvements.
The Grievance Committee shall be composed of one member of HFC's Board of
Directors, one Provider appointed by HFC's Board of Directors, and one Enrollee
appointed by HFC's Board of Directors.
The primary input to the grievance Committee shall be HFC's complaint forms
and other complaints which are telephoned into HFC or are received in writing by
HFC. As to each complaint received in person or by telephone, a written record
shall be made, including the date, identification of the individual recording the
grievance and its disposition. A written record of tabulated grievances shall be
periodically reviewed by HFC's Board of Directors and the President of HFC.
The review procedure shall be documented, including the procedure used in
consideration of tabulating grievances periodically in relation to policy and
procedure review.
HFC's President shall be primarily responsible for maintenance of the Grievance
Committee's procedures and for conducting monthly review of the operations of
the Grievance Committee and for monitoring any emergent patterns of
grievances in order to formulate policy changes and procedural improvements in
HFC's administration.
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The President will assure that complaints are promptly reviewed by the
management or supervisory staff responsible for the services or operations which
are the subject of one or more complaints.
Complaint forms and a copy of this grievance procedure shall be made readily
available at each facility of HFC and at each Provider's office. Such forms shall
be promptly made available upon receipt of a request therefore by mail, by
telephone, or in person. Each Provider shall provide reasonable assistance as
requested by Enrollees in filing grievances with HFC. Assistance will also be
available in filing grievances by telephone at (818) 704 -1444.
The Grievance Committee shall acknowledge in writing by mail the receipt of
each complaint and provide the complainant with the name of a representative of
HFC who may be further contacted regarding the complaint within twenty (20)
days of the receipt of the complaint by HFC. Notice of the disposition of the
complaint will be provided to the complainant as expeditiously as is reasonable
and normally within thirty (30) days of the date upon which the complaint is
received by HFC. Where HFC is unable to distinguish between a complaint and
an inquiry, the communication shall be treated as a complaint.
HFC and its Providers shall not discriminate against any Enrollee (including
cancellation of any Group Plan Contract) in whole or in part on the ground that
such Enrollee has filed one or more complaints with HFC.
Any grievances from Providers, if an amicable solution cannot be reached by
Provider and the Clinical Management Committee, shall be referred to the
Grievance Committee and if no resolution is reached through the Grievance
Committee, such grievances shall be referred to arbitration. Grievances from
Enrollees may be appealed from the Grievance Committee by either the relevant
Provider or by the Enrollee.
HFC shall inform its Enrollees upon enrollment and annually thereafter of HFC's
procedures for processing and resolving grievances, including the location and
telephone number where grievances may be submitted. HFC shall keep in its
files for a period of five years copies of all complaints and the response of HFC.
VI. INDIVIDUAL CONTINUATION OF SERVICES
HFC offers its professional services only to employer or similarly constituted
groups. Accordingly, if an Eligible Employee's group ceases to exist, the Group
Subscriber Contract is terminated, the Eligible Employee leaves the group or
otherwise becomes ineligible, the Eligible Employee and such Eligible
Employee's Eligible Dependents will not be able to remain eligible to receive
services from HFC unless the Eligible Enrollee becomes covered by another
Group Plan Contract.
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VII. CHOICE OF PROVIDERS
Although an Enrollee does not choose a Provider with respect to EAP services
provided by HFC under this Group Plan Contract, HFC's staff will work with an
Enrollee to refer the Enrollee to a Provider who is geographically close to the
Enrollee and who is appropriately suited to the Enrollee's needs and preferences.
VIII. PERIOD OF COVERAGE
Coverage of Enrollees became effective September 2000 and shall terminate at
such time as this Group Plan Contract shall be terminated pursuant to the
provisions hereof.
IX. GENERAL PROVISIONS
A. - Cancellations, Terminations, and Non - renewal: Pursuant to Section IIB,
either party may terminate this agreement, with or without cause, by
providing notice of termination in accordance with the provisions of
Section IIB. In addition to termination by non - renewal pursuant to Section
IIB, this Agreement may be cancelled or terminated as follows:
1. If HFC materially breaches this Agreement and fails to cure such
breach within sixty (60) days following receipt of a written notice to
cure, Employer may cancel this Agreement upon thirty (30) days
further written notice to HFC.
2. HFC may cancel or terminate this Agreement for the following
reasons:
(a) If any payment owed to HFC by Employer is delinquent for
more than thirty -one (31) days, HFC shall give City a written
demand to make such payment within thirty (30) days. If
City fails to pay the delinquent amount within thirty (30) days,
HFC may, at its sole option, cancel the Agreement. Fraud or
material misrepresentation by Employer in the use of the
services or facilities of HFC or Employer knowingly permits
such fraud or material misrepresentation by another. In this
event, cancellation shall occur thirty (30) days from the date
HFC issues written notice of cancellation.
(b) Employer fails to maintain the minimum employee population
of twenty -five (25) employees. In this event, termination
shall occur thirty (30) days from the date HFC issues written
notice of termination.
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(c) HFC and Employer are unable to agree on any fee
adjustment provided for hereunder. In this event,
termination will occur thirty (30) days from the date HFC
issues written notice of termination.
All benefits under this Agreement shall cease as of the date of
cancellation, termination, or nonrenewal with HFC and Employer being
released from all further obligations.
3. In the event of cancellation by HFC (except in the case of fraud or
deception in the use of services or facilities of HFC or knowingly
permitting such fraud or deception by another) or by Employer,
HFC shall, within thirty (30) days, return to Employer the prorated
portion, if any, of the money paid to HFC which corresponds to any
unexpired period of which payment has been received, less any
amounts due HFC.
4. Acceptance by HFC of the proper prepaid or periodic payment,
after termination of this Agreement and without requiring new
application, shall reinstate the Agreement as though it had never
terminated or been canceled unless HFC, within five (5) business
days of receipt of such payment, either refunds such payment or
delivers to the other party a new contract accompanied by written
notice stating dearly those respects in which the new contract
differs from the terminated contract in benefits, coverage, or
otherwise.
B. Arbitration: Except as otherwise provided herein, any controversy or claim
arising out of or relating to this Agreement, including any claims for tort
liability, bad faith liability, breach of contract, punitive damages or any .
other claim shall be submitted to binding arbitration before the American
Arbitration Association.
C. Liability of HFC upon Provider Termination: Upon termination of a Provider
Agreement, HFC shall be liable for covered services rendered by such
Provider to an Enrollee who retains eligibility under the Group Plan
Contract and who is under the care of such Provider at the time of such
termination until the services being rendered by such Provider are
completed, unless HFC makes appropriate provision for the assumption of
such services by another Contracting Provider.
D. Enrollees Held Harmless: As required by California law, every contract
between HFC and a Provider shall provide that in the event HFC fails to
pay the Provider, the Enrollees of HFC shall not be liable to the Provider
for any sums owed to the Provider by HFC.
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E. All material published or distributed by Employer concerning this Group
Plan Contract shall be approved by HFC prior to use.
F. Both parties to this Group Plan Contract agree to permit and encourage
the professional relationship between Providers and Enrollees to be
maintained without interference and in a manner which would enhance the
confidentiality of services.
G. All notices provided hereunder shall be deemed as having been properly
made upon depositing the same in the United States mail, postage
prepaid, and addressing such notices to HFC at its administrative office, or
to Employer at the address appearing last on the books of HFC.
H. This Group Plan Contract contains all of the provisions of the agreement
between parties hereto, and no promise or agreement not contained
herein shall be binding on the parties unless the same is in writing, signed
by the parties hereto and attached to this Group Plan Contract. Only an
officer or director of HFC has the power to change, modify or waive the
provisions of this Group Plan Contract, and then only in writing. Consent
of Enrollees is not required to effect any such change.
Neither this Group Plan Contract nor any benefits hereunder, including the
payment of money, is assignable, except with the prior consent of HFC.
J. If any provision of this Group Plan Contract is declared invalid or
unenforceable by any arbitrator, court or other competent authority, the
remaining provisions hereof shall remain in full force and effect. The
failure of either party to protest any default or breach shall not constitute a
waiver of such party's rights under this Group Plan Contract, or such
party's rights upon any subsequent default or breach.
K. This Group Plan Contract shall be governed by and construed under the
laws of the State of California.
L. Indemnification: HFC hereby agrees to indemnify and hold employer, its
elective and appointive boards, officers, agents and employees, harmless
from any liability for damages or claims for damages for personal injury,
including death, as well as claims for property damage which may arise
from HFC's negligent acts, errors, or omissions, under this Agreement.
HFC agrees to and shall defend employer and its elective and appointive
boards, officers, agents and employees from any suits or actions at law or
in equity for damages caused, or alleged to have been caused, by reason
of any of the aforesaid negligent acts, errors, or omissions.
Employer hereby agrees to indemnify and hold HFC, its elective and
appointive boards, officers, agents and employees, harmless from any
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•
liability for damages or claims for damages for personal injury, including
death, as well as from claims for property damage which may arise from
negligent acts, errors, or omissions under this Agreement. Employer
agrees to and shall defend HFC and its elective and appointive boards,
officers, agents and employees from any suits or actions at law or in
equity for damages caused, or alleged to have been caused, by reason of
any of the aforesaid negligent acts, errors or omissions.
M. Claims incurred by HFC prior to or on the date of termination of either an
individual Enrollee or the Group Plan Contract itself, will be paid by HFC.
N. Term: The term of this Agreement is July 1, 2010 to and including June
30, 2011.
IN WITNESS WHEREOF, the Parties hereto, through their respective authorized
representatives have executed this Agreement as of the date and year first above
written.
CITY OF SEAL BEACH HOLMAN FAMILY COUNSELING, INC.
( "HFC') A California Corporation
By:
David Carma y, City Manager By: o►ti_
(Signature)
Attest: Ron Holman
(Name)
By: 07/i
Lin.a Devine, City C lerk President
(Title)
Approved as to Form: - a. 4 a- Q t (7
(Date)
By: . X4
Quinn Barrow, City Attorney
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•
EXHIBIT A
EAP BENEFIT SCHEDULE
PRODUCT SOLD (CATEGORIES): V ONLY- 3 Session EAP
ACCOUNT NAME: Citv of Seal Beach
Category V
V. Employee Assistance Program.
N/A Sessions per individual per year
N/A Sessions per family unit per year
3 Sessions per family unit per problem per year
N/A Sessions per individual per problem per year
Reimbursement of Non - Contracted Providers. Not allowed.
Assumption of Risk /Liability. The Enrollee will be liable to the Non - Contracted
Provider for the cost of services by the Non - Contracted Providers.
Out of Area. EAP coverage is provided outside of California. Please call 1 -800-
321 -2843 for more information.
I BENEFIT RENEWAL
9/01/01
NOTES
• WHEN APPLICABLE:
1. Late Cancel /No Show Penalty: An enrollee will be charged the
applicable copay or the sum of twenty -five ($25.00) directly to the
contracted provider for any appointment made with contracted provider
• and not kept, except in the case where the contracted provider is notified
at least twenty -four (24) hours in advance of the appointment that it will
not be kept.
2. CISD Services /Seminars Available (indicate rate): This fee varies
Available at $150.00 per hour, per therapist. Health fair coverage included
for all groups in CA. All C.I.S.D. and Seminars must go through the City's
Human Resources.
3. Unique Implementation Requirements: Employees become eligible for
benefits 30 days after hire on the fi rst of the month and must be full -time.
4. Dependent eligibility age limits and /or if the dependent is a student:
19/23
5. Are benefits contingent on medical insurance? No.
6. Medical Insurance Renewal Date: January 1, 2010
7. Medical Carrier(s) /TPA (list all):
CarrierITPA
Name & Address / Phone # / Email
(1) CaIPERS / (800) 237 -3345 / N/A
f �\, Holman Professiorral RECEIVED
Al e : " Counseling Centers
O Managed Behavioral Health Care Services JUN ®7 2010
May 25, 2010 City Manager's Office
Nancy Ralsten
City of Seal Beach
211 8th Street
Seal Beach, CA 90740
Dear Nancy:
Please accept this letter as a formal amendment to the renewal letter for City of Seal Beach, which was
dated June 3, 2009. We are decreasing the current rate of $1.85 to $1.11 per employee, per month,
effective June 1, 2010. In addition, we would like to extend 4 hours of FREE seminars as a means of
providing higher visibility and service to you and your employees.
5 EAP Sessions Renewal Rate - $1.11
4 FREE hours of seminar training
All renewal rates are guaranteed until August 1, 2011
We have enjoyed working with the City of Seal Beach and look forward to a mutually satisfying relationship
in the coming contract period.
Please sign and return both copies of the agreement. A fully executed copy will be forwarded to your
attention.
Sincerely,
Zer01-4
Elizabeth Holman, M.B.A.
Vice President of Sales and Marketing
Understood and agreed to:
City of Seal Beach HOLMAN FAMILY COUNSELING, INC.
( "HPCC "), A CALIFORNIA CORPORATION
By: (S"-.0 By:
David Carmany Elizabeth Holman, M.B.A.
Name Name
City Manager Vice President Sales & Marketing
Title Title
08/10/10 f�o 3/
Date Date
9451 Corbin Avenue Suite 100 Northridge, CA 91324 tel: 800.321.2843 tel: 818.704.1444 fax: 818.704.9339