HomeMy WebLinkAboutAgreement A-19-731 with UnitedHealthcare.pdfAgreement No . 19-731
.MEDICA.R~ PRESCRIPTION D~UG PLAN
GROUP AGREEMENT
This Medicare Prescription Dn,1$ Plan Group Agreement ('.'Agreemene•), Group Number 25 J 83; is entered into
effective as . of Ja1mary I, 2,0~0. (the "Efft:ctive Date") between United.Healthcare Insurance Compan_y on behalf.of
itself and . its affiliates (collectively ''United"), and County of Fre!lno (:!Group"). All defined tenns . shall be .as
described in this Agreement unless stated otherwise. . . . . . . .
RECITALOF FACTS
United is a prescription dr'ug plan sponsor. certified by 'the Centers for Medicare & Medicaid Services ("CMS;') to
offer prescription drtJg benefit plans. . .
Group is an . employer pr other entity which sponsors an employee welfare benefit plan and desires to provide a
United Medicare Adva:11tage Plan for its Eligible Retirees and _ their Eligible Dependents,
AGREEMENT
NOW THEREfORE, in consideration of the application of Group for the benefits provided under this Agreement
and in consid_eriition oflhe periodic payment of the Plan Beneficiary Premium on behalfofMeinbers in advance as
they become. cl1.1e, United agrees to provide Coveted Services to Members subject to aU terms and conditions of this
Agreement .
SECTION J -DEFINITIONS
Centers for Medicare & Medicaid Services ("CMS") is a Federal agency within the United States Department of
Heahh and Huma_n Services and · is resporisible for administering various Medicare . programs .
. Coinsurance is the portion of medical expenses for a service the _Member mu~t .pay out-of-poc)<et, usually a fixed
percentage. Coinsurance is u~ually appl(ed after a dedu_ctible or Copayment requirement is met. Coinsurance is in
addition to the -Plim Beneficiary Premiurrt .
Copayment(s) i~ a fixed dolla_r amount payable to a health care provider or phannacy by the Member when the
Member receive$ a health care service or prodli~t that is ¢overed by the Plan . Copayments are · in addition to the Plan
Beneficiary Premium . . . .
Coveted . Services inciude Medicare Part D eligiQ)e: prescription drug~ a11d drug prodµi;ts covered pursuant tQ .the
current terms oi'the Plan, in compliance with Medicare Laws iind Regulations .
Eligible Dependentcs) is any person •defined . as a qualified dependent by Group , who meets all t)le eligibility
requirements of Group and the Plan, and who js eligible .to enroll fo a plan under the Medicare Laws and
Regulations and who peonanently resides within the Service Area ;
Eligible Retiree(s) is a. fotmet Group employee who has met the minimum required retiree participation condition$
as determined by Group, who is elig1ble to eilroli in a plan . under the .Medicare Laws and Regulations, who meets the
. eligibility and enrollment teqµirements of the Plan , arid who permanently reside~ in the $ervic:e Area.
Enrollment . is tile .enrollment of Group's Eligible Retirees and Eligible Dependents into the Plan by Group.
Enrollment.is cqnditioned upon acceptance of the Eligible Retiree or Eligible Dependeritby United and by CMS, the
exe<;:ution ofthis Agreement by United and by Group; and the receipt of Plan Beneficiary Premium b:yUnited .
Evidence of Covetage .("EOC"} 1s the docum¢nt supplied by United and issue.ct to Members disclosing and setting
forth the health care benefits and terms ~nd condition$ ofccive~ge of the Plan to Which . Me _mbers are entitled. The
EOC is.incorporated fully into. thJs Agreewent by reference : ·
Group.is the s'ingle employer or other entity identified above ..
Group Contribution is the ,amount of the . Plan Beneficiary Premium applicable to .e.ach Member which is paid by
Group .
C;qnlidcntial _lnfonnation :of U111icdl-lcalthcarc Jnsunmcc Company
GA2Q 20 l5
164.504(t)(2) and that the plan sponsor will safeguard and limit the use and disclosure of protected health
information that the plan sponsor may receive from United to perform the plan administration functions .
Specifically, the plan sponsor will:
a. Not use or further disclose the information other than as permitted or required by the plan documents or as
required by law;
b . Ensure that any agents, including a subcontractor, to whom it provides protected health information received
from United, agree to the same restrictions and conditions that apply to the plan sponsor with respect to such
information;
c. Not use or disclose the information for employment-related actions and decisions or in connection with any
other benefit or employee benefit plan of the plan sponsor;
d . Report to United any use or disclosure of the information that is inconsistent with the uses or disclosures
provided for of which it becomes aware ;
e . Make available protected health information in accordance with 45 CFR § 164 .524 ;
f. Make available protected health information for amendment and incorporate any amendments to protected
health information in accordance with 45 CFR § 164 .526;
g. Make available the information required to provide an accounting of disclosures in accordance with 45 CFR
§164.528;
h. Make its internal practices, books and records relating to the use and disclosure of protected health
information received from United available in response to an inquiry from United or an appropriate regulatory
entity for purposes of determining compliance with federal privacy requirements;
i. If feasible, return or destroy all protected health information received from the United that the plan sponsor
still maintains in any form and retain no copies of such information when no longer needed for the purpose of
which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and
disclosures to those purposes that make the return or destruction of the information infeasible .
IN WITNESS WHEREOF, the parties hereto have executed this Agreement.
County of Fresno
2220 Tulare Street, 14th Floor
Fresno, CA 93721
By: --ZL----.~ ::>
Authorized Signature
Print Name: Nathan Magsig Print Name: Greta Redmond
Print Title: Chairman of the Board of Supervisors of Print Title: Vice President, Finance
the County of Fresno
Date: ___./_..a"-"--... .......,\ 0"""------'\c..-9.,___ __ _
ATTEST :
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
County of Fresno , State of California
By Su Mc<\ hs.ho,p
Deputy
10
Confidential lnfonnation of UnitcdHealthcare Insurance Compan y