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HomeMy WebLinkAboutIntercare Holdings Insurance Services - 2023-08-01 OING o 2000 Main Street, " ti Huntington Beach,CA c 92648 City of Huntington Beach APPROVED 7-0 �CF• B.1.1"' ,UUNTV File #: 23-660 MEETING DATE: 8/1/2023 REQUEST FOR CITY COUNCIL ACTION SUBMITTED TO: Honorable Mayor and City Council Members SUBMITTED BY: Al Zelinka, City Manager VIA: Travis K. Hopkins, Assistant City Manager PREPARED BY: Theresa St. Peter, Interim Human Resources Director Subject: Approval of Professional Services Contract between the City of Huntington Beach and INTERCARE for Workers' Compensation Third Party Administration of Claims Statement of Issue: Following the issuance and evaluation of a Request for Proposals (RFP) for Third Party Administration of the City's Workers' Compensation Program, staff recommends awarding a three- year fixed fee contract for claims administration services to INTERCARE, the highest rated firm. Financial Impact: The funds for this contract will be from the Self Insurance Workers' Compensation Fund. The annual fiscal impact during the term of the contract is: Yr. 1) $740,528.00; Yr. 2) $698,649.00; Yr. 3) $719,576.00. Total compensation over three years is $2,158,753.00. The annual contract cost is fixed and contains no auto-adjusting cost escalator or COLA. Funds for Year 1 are included in the FY 2023-24 budget. Funding for Years 2 and 3 will be included in future budgeting cycles. Recommended Action: Approve the Professional Services Contract between the City of Huntington Beach and INTERCARE for Workers' Compensation Third Party Administration of Claims for a three-year term. Alternative Action(s): Do not approve the Professional Services Contract between the City of Huntington Beach and INTERCARE for Workers' Compensation Third Party Administration of Claims for a three-year term. Analysis: The City's current agreement with Acclamation Insurance Management Services (AIMS) to provide third-party claims administration is set to expire on October 31, 2023. Following the City's best practices to routinely search the open market for cost competitive and superior quality services, , the City of Huntington Beach issued an RFP from qualified firms to provide Workers' Compensation Third City of Huntington Beach Page 1 of 2 Printed on 7/26/2023 powered by LegistarTM File #: 23-660 MEETING DATE: 8/1/2023 Party Administration Services for the City. The City's intent via the RFP process was to evaluate and select the best qualified respondent. The City issued the RFP via Planet Bids and received proposals from three (3) qualified firms. Following a three-phase evaluation process by a panel of industry professionals, including two rounds of interviews, INTERCARE was identified as the highest ranking and most qualified proposer. the Professional Service Award Analysis is attached. Based on the analysis and rankings, staff recommends awarding a three-year agreement for Workers' Compensation Third Party Administration of Claims to INTERCARE. Environmental Status: Pursuant to CEQA Guidelines Section 15378(b)(5), administrative activities of governments that will not result in direct or indirect physical changes in the environment do not constitute a project. Strategic Plan Goal: Non Applicable -Administrative Item Attachment(s): 1. Professional Services Contract 2. Professional Service Award Analysis City of Huntington Beach Page 2 of 2 Printed on 7/26/2023 powered by Legistarmt PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND INTERCARE HOLDINGS INSURANCE SERVICES FOR WORKERS' COMPENSATION THIRD PARTY ADMINISTRATION THIS AGREEMENT ("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and, INTERCARE HOLDINGS INSURANCE SERVICES., a hereinafter refereed to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to perform workers compensation claim administration services; and Pursuant to documentation on file in the office of the City Clerk, the provisions of the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service contracts have been complied with; and CONSULTANT has been selected to perform these services, NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows: 1. SCOPE OF SERVICES CONSULTANT shall provide all services as described in Exhibit "A," which is attached hereto and incorporated into this Agreement by this reference. These services shall sometimes hereinafter be referred to as the "PROJECT." CONSULTANT hereby designates Agnes Hoeberling, who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. 23-13181/315103 1 of 12 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with CONSULTANT in the performance of this Agreement. 3. TERM; TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on November 1, 2023 (the "Commencement Date"). This Agreement shall automatically terminate three (3) years from the Commencement Date, unless extended or sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be completed no later than two (2) years from the Commencement Date. The time for performance of the tasks identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and CONSULTANT. In the event the Commencement Date precedes the Effective Date, CONSULTANT shall be bound by all terms and conditions as provided herein. 4. COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified in Exhibit "B," which is attached hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to exceed Two Million One Hundred Fifty Eight Thousand Seven Hundred and Fifty Three Dollars ($2,158,753.00). 5. EXTRA WORK In the event CITY requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such work only after receiving written authorization from CITY. Additional 23-13181/315103 2 of 12 compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 6. METHOD OF PAYMENT CONSULTANT shall be paid pursuant to the terms of Exhibit "B." 7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS CONSULTANT agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations, computer code, language, data or programs, maps, memoranda, letters and other documents, shall belong to CITY, and CONSULTANT shall turn these materials over to CITY upon expiration or termination of this Agreement or upon PROJECT completion, whichever shall occur first. These materials may be used by CITY as it sees fit. 8. HOLD HARMLESS A. CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims, damages, losses, expenses, judgments, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by CONSULTANT, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. CONSULTANT will conduct all defense at its sole cost and expense and CITY shall approve selection of CONSULTANT's counsel. This indemnity shall 23-13181/315103 3 of 12 apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as limitation upon the amount of indemnification to be provided by CONSULTANT. B. To the extent that CONSULTANT performs "Design Professional Services" within the meaning of Civil Code Section 2782.8, then the following Hold Harmless provision applies in place of subsection A above: "CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless CITY and its officers, elected or appointed officials, employees, agents and volunteers, from and against any and all claims, damages, losses, expenses, demands and defense costs (including, without limitation, costs and fees of litigation of every nature or liability of any kind or nature) to the extent that the claims against CONSULTANT arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONSULTANT. In no event shall the cost to defend charged to CONSULTANT exceed CONSULTANT's proportionate percentage of fault. However, notwithstanding the previous sentence, in the event one or more other defendants to the claims and/or litigation is unable to pay its share of defense costs due to bankruptcy or dissolution of the business, CONSULTANT shall meet and confer with CITY and other defendants regarding unpaid defense costs. The duty to indemnify, including the duty and the cost to defend, is limited as provided in California Civil Code Section 2782.8. C. Regardless of whether subparagraph A or B applies, CITY shall be reimbursed by CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by CONSULTANT. 23-13181/315103 4 of 12 9. PROFESSIONAL LIABILITY INSURANCE CONSULTANT shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for CONSULTANT's professional liability in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above- mentioned insurance shall not contain a self-insured retention without the express written consent of CITY; however an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims-made policy shall be acceptable if the policy further provides that: A. The policy retroactive date coincides with or precedes the initiation of the scope of work (including subsequent policies purchased as renewals or replacements). B. CONSULTANT shall notify CITY of circumstances or incidents that might give rise to future claims. CONSULTANT will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated for any reason, CONSULTANT agrees to purchase an extended reporting provision of at least two (2) years to report claims arising from work performed in connection with this Agreement. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not 23-13181/315103 5 of 12 effect Consultant's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 10. CERTIFICATE OF INSURANCE Prior to commencing performance of the work hereunder, CONSULTANT shall furnish to CITY a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: A. provide the name and policy number of each carrier and policy; B. state that the policy is currently in force; and C. shall promise that such policy shall not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice; however, ten (10) days' prior written notice in the event of cancellation for nonpayment of premium. CONSULTANT shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from CONSULTANT's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 23-13181/315103 6 of 12 11. INDEPENDENT CONTRACTOR CONSULTANT is, and shall be, acting at all times in the performance of this Agreement as an independent contractor herein and not as an employee of CITY. CONSULTANT shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for CONSULTANT and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 12. TERMINATION OF AGREEMENT All work required hereunder shall be performed in a good and workmanlike manner. CITY may terminate CONSULTANT's services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall be made in writing, notice of which shall be delivered to CONSULTANT as provided herein. In the event of termination, all finished and unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become its property and shall be promptly delivered to it by CONSULTANT. 13. ASSIGNMENT AND DELEGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by CONSULTANT to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subconsultants must satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 23-13181/315103 7 of 12 14. COPYRIGHTS/PATENTS CITY shall own all rights to any patent or copyright on any work, item or material produced as a result of this Agreement. 15. CITY EMPLOYEES AND OFFICIALS CONSULTANT shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 16. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to CONSULTANT's agent (as designated in Section 1 hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, to the addresses specified below. CITY and CONSULTANT may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U. S. certified mail-return receipt requested: TO CITY: TO CONSULTANT: City of Huntington Beach Intercare Holding Insurance Services ATTN: Dir. of Community Development ATTN: Agnes Hoeberling, President 2000 Main Street 999 Town and Country Road Huntington Beach, CA 92648 Orange, CA 92868 23-13181/315103 8 of 12 17. CONSENT When CITY's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transaction or event. 18. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 19. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement are merely descriptive and are included solely for convenience of reference only and are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the construction or interpretation of any provision of this Agreement. 20. INTERPRETATION OF THIS AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act 23-13181/315103 9 of 12 contrary to law, and wherever there is any conflict between any provision contained herein and any present or future statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 21. DUPLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 22. IMMIGRATION CONSULTANT shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 23. LEGAL SERVICES SUBCONTRACTING PROHIBITED CONSULTANT and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services contemplated hereunder. CONSULTANT understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for CITY; and CITY shall not be liable for payment of any legal services expenses incurred by CONSULTANT. 23-13181/315103 10 of 12 24. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the nonprevailing party. 25. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 27. SIGNATORIES Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 28. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation, and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations, inducements, promises, agreements or warranties, oral or otherwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agreement in reliance on any representation, inducement, 23-13181/315103 11 of 12 promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement, and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when terminated as provided herein. IN WITNESS WI-IEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CITY OF HUNTINGTON BEACH, INTERCARE HOLDINGS INSURANCE a municipal corporation of the State of SERVICES California a. HiRsok21; By: City Manager Agnes Hoeberling print name INITIATED AND APPROVED: ITS: (circle one)Chairman/PresidentNiee President AND Acting Director of Human Resources By: 41APPROVED AS TO FORM: odi Ellington print name City Attorney ITS: (circle one)Secretor ' 4ii ancial Officer/ sst. Secretary—Treasurer Date RECEIVE AND FILE: U NTERPART City Clerk Date 23-13181/315103 12 of 12 promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement, and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof 29. EFFECTIVE DATE This Agreement shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when terminated as provided herein. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. CONSULTANT, CITY OF HUNTINGTON BEACH, INTERCARE HOLDINGS INSURANCE a muni ': corporation •,'the State of SERVICES Calif•- By: \_ A City Tilajr\ print name INITIATED AND APPROVED: ITS: (circle one)Chairman/PresidentNice President CL* AND � . . Interim Director of Human Resources By: APPROVED AS • print name C A rney ITS: (circle one)Secretary/Chief Financial Officer/Asst. Secretary—Treasurer Da COUNTERPART RECEIVE ND FILE:/ 14L. 9,6ianiattd City Clerk Date ;/ 7/23 23-13181/315103 12 of 12 EXHIBIT "A" A. STATEMENT OF WORK: (Narrative of work to be performed) Administer the City's claims for Workers' Compensation benefits in accordance with the requirements of the Workers' Compensation laws of the State of California; provide the City with cost effective claims administration while delivering value added services with measurable results and better outcomes. B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: CONSULTANT'S duties and responsibilities shall follow provisions specified in the City of Huntington Beach Scope of Work shown in Exhibit Al. Detailed services shall include but is not limited to the Scope of Work in Exhibit Al. C. CITY'S DUTIES AND RESPONSIBILITIES: City shall collaborate with CONSULTANT to promote compliance with Scope of Work requirements; foster a high level of communication, trust, transparency, and commitment which is imperative to the success of the program. D. WORK PROGRAM/PROJECT SCHEDULE: Work program is required per the Scope of Services requested by the CITY. EXHIBIT A EXHIBIT A.1 ACCLAMATION INSURANCE MANAGEMENT SERVICES SCOPE OF SERVICES Program Administration • The selected Consultant(TPA) firm will interface directly with the City's injured employees in close coordination with Risk Management. • Inform the City of proposed changes in statues, rules and regulations, and case law affecting the workers' compensation program. Dedicated/Designated Assigned Personnel • The Consultant/TPA shall provide at least two and '/z dedicated claims examiners to the City's account. • The Consultant/TPA shall provide a designated claims unit supervisor that will regularly review the work product of the claims examiner(s). • Claims examiner(s) must be certified with the State of California and be experienced dealing with public safety officers. • Consultant/TPA shall provide sufficient team of claims examiner(s)that are dedicated to the City's account and maintain a caseload of approximately 150 claims. • Consultant/TPA will continue to staff the City's account with a blend of current experienced personnel and new hires if needed. Claims Management Services • Administer Workers' Compensation benefits in accordance with the Labor Code. • Make initial contact with the employee and establish a claims file within 24 hours of receipt of the Employer's First Report of Injury for the City. Claim files will be available for review by the City at any time during the TPA's regular business hours. • The Consultant/TPA must resolve City issues immediately to the City's satisfaction. This may include reassignment of claims examiner(s) staff. • The compensability determination(accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination • Provide guidance and information regarding Workers' Compensation benefits to City employees. • Respond to City staff inquiries within twenty four (24)hours and critical issues on the same day. • Monitor treatment programs for injured employees to ensure that they receive proper care and to avoid over treatment situations. • Establish claim reserves and provide a continual review and update of reserves to reflect changes during the life of the claim. • All reserves initial or changes are to be documented by the completion of a Reserve Worksheet contained within the Claims Information Management System. The reserve rationale must be completed for each entry into the Claims Information Management System. The basis for establishing reserves shall be clearly documented in every reserve worksheet and case notes as applicable. EXHIBIT A • Reserve worksheets are prepared to support any changes made in reserving amounts and can be provided to the City in support of a reserve increase or other change. This information is made available to the City through online viewing of the Claims Examiner's electronic file notepad. If the City desires, prior to any reserve change of a pre-agreed amount or level, the Claims Examiner will confer with appropriate City personnel to discuss the merits of the proposed change. • Claims Examiner will review and evaluate the reserve adequacy and possible closure at 30 to 90 day intervals or as designated by the City. • The Consultant/TPA should pursue actions of abuse of the Workers' Compensation system or suspected fraud. • Investigate and recommend special, outside independent investigations for questionable claims with the consent, coordination and assistance of the City of Huntington Beach. • City authorization shall first be obtained before initiating any field investigation. The authorization will be documented in the notepad section of the claims file. • The claims examiner shall obtain the City's authorization on all claim settlements. • All penalties incurred because of failure of the Consultant to comply with statutory laws and/or reimbursement should be brought to the City's attention, and shall be the sole responsibility of the third party administrator and reimbursement shall be made on a quarterly basis. • The Consultant/TPA will be responsible to identify subrogation opportunities and in consultation with Risk Management, will be called upon to pursue subrogation. • The Consultant/TPA will be required to conduct file/claims reviews at the discretion of the City of Huntington Beach. • Assist with the ongoing development and maintenance of the Alternative Dispute Resolution (ADR) carve-out program. • Consultant/claims examiner will seek approval from the City/Risk Management when assigning a specific nurse case manager to individual claim files. • Claims examiner will seek approval from the City's Risk Management Department when assigning specific vendors to provide durable medical equipment for specific claim files. • Claims examiner shall obtain the City/Risk Management authorization to assign legal counsel to specific claim files. • Claims examiner will seek approval from the City/Risk Management when assigning sub rosa/surveillance and/or social media for specific claim files. Claims Management Software • The claim's management software should provide a claim description, financial data, and ad hoc reports on claims using criteria such as reserves,paid, indemnity, etc. • The claims management system must be read-only accessible to City of Huntington Beach Risk Management with licensing allowing a minimum of three (3) individual computers to access claim information simultaneously. • The selected firm will be required to provide training to Risk Management staff on report generation and the use of software. EXHIBIT A Reporting • Reports generated by the TPA should be furnished to the City in paper or electronic form as requested. • Provide customized reports as needed upon reasonable request. • Provide a monthly administrative report in Excel format, including information such as: o Number of claims, medical only, indemnity and reporting only o Number of closed claims o Number of active files assigned to each claims adjuster o Indemnity paid in 4850 benefits, TD, PD, Death and Rehabilitation Benefits o Expenses paid o Cases assigned to counsel, investigators and nurse advocate o Amounts recovered in apportionment or subrogation o Number of litigated cases o List of cases settled during the month, indicating the amount of the settlement and method/type of settlement o Legal report reflecting defense attorneys with monthly billing/expense and year-to- date current total spend. o Report reflecting detailed durable medical equipment spend. • Provide the following annual report to Risk Management: o Assemble and submit workers' compensation claims data as required for State reports, including the self-insurance report to Industrial Relations. State reporting shall be only for the Claims Management Services and shall not include reporting for the Managed Care Program Consultants. Assemble and submit data needed for actuarial studies performed on the City's Workers' Compensation Program o OSHA 300 log of Work-Related Injuries and Illnesses; and OSHA 300A Summary of Work-Related Injuries and Illnesses o The annual carve out report for the ADR program as required by the State of California o Annual Stewardship Report with pertinent statistics for benchmarking and ADR program, measuring the City of Huntington Beach's workers' compensation program Banking, Tax Reporting & Financial Needs • City of Huntington Beach will establish and maintain a bank account from which TPA will issue checks for payment of services and benefits. • The TPA will provide weekly to City of Huntington Beach's Risk Management and Finance Department a check register, indicating date, check number,payee, reason for payment and amount paid, in Excel/spreadsheet format. • The City of Huntington Beach Finance Department will reconcile bank account statements against check registers provided by the TPA. • Invoices for replenishment of the City's Trust Account shall be submitted to City weekly on Thursday. The invoices submitted will replenish the fund expenditures from the previous week. EXHIBIT A • Monthly reconciliation invoices will be submitted at the end of any given month. These invoices will replenish any other funds in the account not covered under the weekly invoices. • Provide any other written documentation to support any changes to the trust account balance. Future Medical Claims • Reviews shall be documented in the claims notes to include settlement information, outline future medical care, last date and type of treatment, name of excess carrier, excess carrier reporting history. • The claim examiner shall regularly evaluate the claim to determine a reasonable amount for settlement of future medical payments and any remaining benefits due. The reason(s) and calculation(s) for the recommended settlement amount shall be clearly documented. Coordination with Managed Care Program (MCP) Consultants • Consultant/TPA shall be prepared to interface with all MCP/Ancillary service providers in a professional and efficient manner. EXHIBIT A EXHIBIT "B" Payment Schedule (Hourly Payment) A. Hourly Rate CONSULTANT'S fees for such services shall be based upon the following hourly rate and cost schedule: SEE ATTACHED EXHIBIT B.1 —FIXED FEE PAYMENT SCHEDULE B. Travel. Charges for time during travel are not reimbursable C. Billing 1. All billing shall be done monthly in fifteen (15) minute increments and matched to an appropriate breakdown of the time that was taken to perform that work and who performed it. 2. Each month's bill should include a total to date. That total should provide, at a glance, the total fees and costs incurred to date for the project. 3. A copy of memoranda, letters, reports, calculations and other documentation prepared by CONSULTANT may be required to be submitted to CITY to demonstrate progress toward completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify specific requirements for satisfactory completion. 4. CONSULTANT shall submit to CITY an invoice for each monthly payment due. Such invoice shall: A) Reference this Agreement; B) Describe the services performed; C) Show the total amount of the payment due; D) Include a certification by a principal member of CONSULTANT's firm that the work has been performed in accordance with the provisions of this Agreement; and E) For all payments include an estimate of the percentage of work completed. Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory progress toward completion of tasks in accordance with this Agreement, CITY shall approve the invoice, in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. Such approval shall not be unreasonably withheld. If CITY does not approve an invoice, CITY shall notify CONSULTANT in writing of the reasons for non-approval and the schedule of performance set forth in Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is terminated as provided herein. EXHIBIT A 5. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be invoiced separately to CITY. Such invoice shall contain all of the information required above, and in addition shall list the hours expended and hourly rate charged for such time. Such invoices shall be approved by CITY if the work performed is in accordance with the extra work or additional services requested, and if CITY is satisfied that the statement of hours worked and costs incurred is accurate. Such approval shall not be unreasonably withheld. Any dispute between the parties concerning payment of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder of this Agreement. EXHIBIT A EXHIBIT B.1 FIXED FEE PAYMENT SCHEDULE a THr. l lW PART Yi>7 q y �,un!a �r v n ADMINISTRATION 1114 0iGil0\ , Contract Years FY 23-24 FY 24-25 FY 25-26 Claims Administration'- $728 528.002 $694 561.Q0- ! $715 397.8: ADR Administration4 $2,500.00 Account Management $2,500.00 $2,587.50 $2,678.06 EXTENSION YEARS FY 26-27 i FY 27-28 Claims Administration $73 6,859.76 ( $758,965.56 ADR Administration Account Management $2,771.79 $2,868.81 List extra fees for Claims Transition from $7,000.005 current TPA to newly contracted TPA, if any, for FY 23/24 ' The claims administration fee is a fixed flat annual fee which represents 3% of the City's $23,417,160 in outstanding claim liabilities. As we discussed in the cover letter, we feel there is an opportunity to reduce some of the City's pending inventory and associated claim liabilities. As a result, we will be able to reduce our fee in year 2 to reflect these expected results. The staffing model is based on the following assumptions: • Claim Volume: approximately 150 new claims per year and 526 pending (open) claims including 16 Medical Only (MO), 290 Future Medical (FM) and 220 Indemnity (IN) claims. • Average Caseload not to exceed 150 indemnity claims per examiner. In calculating the staffingmodel, MO and FM claims were given a 2:1 ratio per IN claim. • The staffing model includes a designated Supervisor and 1 dedicated claims assistant to supportthe examiners; a designated Account Manager will also be assigned to the program and a Project Manager familiar with the program will provide assistance and training in Year 1 to ensure a smooth and seamless transition. 2 The Year 1 fee assumes 2.5 examiners will be assigned to the program initially. Our approach to onboarding new programs include a triage of all new claims in year 1. 2.5 adjusters is needed in order to reduce the pending inventory. 3 Intercare's SWORT program has been proven to reduce pending inventory by 12-20% by the end of the first contract year.Year 2 fees shows the reduction in the pending inventory plus a 3% increase. Subsequent contract years also shows 3% increase. The reduced fee in Year 2 assumes the average number of new claims reported will not exceed 150 per year. EXHIBIT A ^ This is the estimate to program the annual report and letters for the administration of the City's ADR program. If the ADR correspondence and workflow we are currently using for our other programs is sufficient to the City and no additional programming and maintenance needs to be developed and implemented,this fee could be lower. 5 The data conversion fee is a one-time fee payable in year 1 to migrate historical data including closedclaims from the incumbent's system to our claim system. Intercare will provide 4 RMIS user licenses at no charge for the 1st year of the program. Beginning year 2and 3,we will provide 3 user licenses at no charge and all others will be billed at$1,500.00 per user, per year. 1 Exhibit B - ) INTEHOL-06 JBAXTERI ACUR/fl" DATE(MMIDDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 7r25/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Vance Morris HUB International Insurance Services Inc. PONE,Ext):(85B)373-6979 I FAX (NC,No): 9855 Scranton Road tA�}c,No Suite 100 a�"ass:Vance,Morris@hubinternational.com San Diego,CA 92121 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hartford Accident and Indemnity Company 22357 INSURED INSURER B:Trumbull Insurance Company 27120 Intercare Holdings,LLC INSURER c:Hartford Casualty Insurance Company 29424 6020 W.Oaks Blvd Ste.100 INSURER o:Hartford Insurance Group 914 Rocklin,CA 95765 INSURER E:Ironshore Specialty Company 25445 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE MD WWI, POLICY NUMBER (MM/DD/YYYY1 IMM/DOIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 72 UUN DQ7629 6/1/2023 6/1/2024 PREMISES(Ea occU ence) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jP I L1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 B OTHER: $ COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY (Ea accldentl $ ANY AUTO 72 LIEN DQ7825 6/1/2023 6/1/2024 BODILY INJURY(Per person) $ — OWNED —SCHEDULED AUTOSpE� ONLY AUTOS yyN p pBODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONoY (Perr acciidentDAMAGE $ $ C X UMBRELLAUAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE 72 XHU D09790 6/112023 6/1/2024 AGGREGATE $ 10,000,000 DED X RETENTIONS 10,000 ( $ D WORKERS OYERS LISABIIIOITNY X STATUTE (ERH Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE 72WEAX8XS4 6/112023 611/2024 EL EACH ACCIDENT $ 1,000,000 FFICERR/MEMBER EXCLUDED? N I A 1,000,000 (Mandatary In NH) E.L.DISEASE-£A EMPLOYEE $ If es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Errors&Ommissions HC7GAB807Z003 1/28/2023 1/2812024 Each Claim 10,000,000 E Errors&Ommissions HC7GAB607Z003 1/28/2023 1/28/2024AGEach Claim 10,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IIIPM AZIf;E7el{�nr FORM Byt --------- C Mi,,E{A ICH EL E.OATES CITY ATTORNEY WI Of HUNTINGTON BEACH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN .City:of-Huntington Beach - ACCORDANCE WITH THE POLICY PROVISIONS. 2000 Main.Street Huntington.Beach,CA 92648 AUTHORIZED REPRESENTATIVE 014.4d-a.01--. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Workers' Compensation Third Party Administrator SERVICE DESCRIPTION: Provide Workers' Compensation claims administration VENDOR: INTERCARE Insurance Services OVERALL RANKING: 1 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Interim Human Resources Director, 2. City of H.B. Risk Manager 3. City of H.B. Assistant City Manager 4. City of H.B. Human Resources Manager 5. City of Long Beach Workers' Compensation Program Mgr. 6. City of San Diego Workers' Compensation Program Manager 7. County of Orange Workers' Compensation Program Manager MINIMUM QUALIFICATIONS REVIEW • Written Proposal Score: 1146 INTERCARE =¢Minimum Qualifications Review'. Total Weighted Maximum Criteria Score Score Compliance with RFP 142 150 Technical Approach 275 375 Qualifications 295 375 Partnership Strength 224 300 Cost 210 300 Total 1.146 %1500 II. DUE DILIGENCE REVIEW • Interview Ranking: 1 INTERCARE :-Summary of Review • Highest score overall (Proposal and Interviews) • Excellent claims handling team • Alternative Dispute Resolution experience • 70% of business currently with public entities • Excellent reference checks INTERCARE=,Pricing • Most competitive pricing for claims handling with an opportunity to reduce some of the City's pending inventory/claim liabilities which enables a reduction of their fee in year 2 to reflect these expected results. PROFESSIONAL SERVICE AWARD ANALYSIS SERVICE: Workers' Compensation Third Party Administrator SERVICE DESCRIPTION: Provide Workers' Compensation claims administration VENDOR: Vendor#2 OVERALL RANKING: 2 SUBJECT MATTER EXPERTS/RATERS: 1. City of H.B. Interim Human Resources Director, 2. City of H.B. Risk Manager 3. City of H.B. Assistant City Manager 4. City of H.B. Human Resources Manager 5. City of Long Beach Workers' Compensation Program Mgr. 6. City of San Diego Workers' Compensation Program Manager 7. County of Orange Workers' Compensation Program Manager MINIMUM QUALIFICATIONS REVIEW • Written Proposal Score: 1054 VENDOR#2 —Minimum Qualifications Review Total Weighted Maximum Criteria Score Score Compliance with RFP 120 150 Technical Approach 250 375 Qualifications 280 375 Partnership Strength 244 300 Cost 160 300 Total 1054 1500 II. DUE DILIGENCE REVIEW • Interview Ranking: 2 VENDOR#2 Summary of Review • Methodology and approach is good • Good data analysis/reporting • Alternative Dispute Resolution experience • Public entity accounts experience • Nice reference checks VENDOR#2 Pricing • Pricing is above industry average standard. ®s,�®aaom®s \N�ING ° City of Huntington Beach 0� = �••�.`` ��� 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 • www.huntingtonbeachca.gov N�GF � ......•• P�� off Office of the City Clerk °LA T?fir; Robin Estanislau, City Clerk August 7, 2023 Intercare Holding Insurance Services Attn: Agnes Hoeberling, President 999 Town and Country Road Orange, CA 92868 Dear Ms. Hoeberling: Enclosed is a fully executed copy of the Professional Services Contract between the City of Huntington Beach and Intercare Holding Insurance Services, approved by City Council on August 1, 2023. Sincerely, 9-441zzaitu) Robin Estanislau, CMC City Clerk RE:ds Enclosure Sister City: Anjo, Japan