HomeMy WebLinkAboutContract 52689 � healthy CSC No. 52689
\= PROGRAM AGREEMENT
Wellness. Rewarded
Primary address: 200 Texas Street Address#2:
Primary Business Name(DBA). City of Fort Worth Primary Contact Number: 817.392.5726
Primary Business Name{Legal): City of Fort Worth City. Fort Worth State: TX Zip: 76102
This Agreement is made on Aug 22,2019 20 ("HC")g ___,by and between Healthy Contributions,LLC and
The City of Fort Worth (`Client")will confirm the arrangement under which HC is providing payment-processing services for Client's
facility and data transfer and disbursement services for the Optum Fitness Passport Program(Program Provider),all as set out below.
1. Appointment:Client hereby appoints HC to act as its reimbursement processor for the Optum Fitness Passport Program. The duties of HC
are as follows: (A)provide a platform for the entry of data; (B)collect and provide specific Program usage data to the Program Provider;
(C)return status of this data to Client via web reporting; and(D)if applicable,disburse any monies to the Client based upon instructions
from the Program Provider.
2. Service:HC agrees to facilitate the collection and transfer of data and funds for Client as this information is provided to HC. To that end,
by the 5th calendar day of each month for the prior month,Client shall provide HC with the member usage information for Client's facility
as requested,and in the format required,by HC. Disbursement of funds hereunder by HC to Client shall occur at the times agreed to by
HC and the Program Provider,but is contingent upon data and funds received from the associated Program Provider,and upon Client's
provision of member usage information in the formats required by HC.
3. Management: HC has agreed to manage the reimbursement portion of the Optum Fitness Passport Program. Management and
maintenance of Client shall include audits of usage data. Client's staff is subject to record and data review by HC.Instances where HC has
reasonable cause for audits or record and data reviews will be initiated with a written notice that specifies the purpose and scope of the
record and data review and will be sent to Client by certified mail.If improprieties are found or suspected,a review of participation will
be Initiated with due process and Program Provider in question and may result in a warning,probation,suspension or Client's permanent
removal from the program.
4. Fees:Program Provider agrees to pay all applicable HC fees on behalf of the Client,for services herein.HC will not be liable to Client or
be in breach of this Agreement for events directly related to the failure of Client to comply with its reporting obligations to HC or due to
the failure of the Program Provider to provide HC with the appropriate information so that HC can perform its obligations hereunder. In
the event that Program Provider fails to pay any HC fees on behalf of the Client as set forth herein,HC can immediately terminate this
Agreement upon written notice to Client,and Client will notify all participating members of the program that benefits will cease.
S. Termination @ Closing club(s):Unless otherwise terminated pursuant to Section 4,either party may terminate this Agreement by giving
the other party(30)days written notice. If Client Is discontinuing its involvement In a Program,it will immediately notify all participating
members of the Program that benefits will cease. It must also immediately notify HC to close out accounts and provide HC with current
member status. HC will notify the Program Provider,if necessary.
6. Sale:If Client sells the facility'to a new owner,client must agree to provide to Healthy Contributions the identity and contact information
of new ownership. This agreement will immediately terminate without further obligation from HC or Client. Fees that are owed for the
final processing period will be the responsibility of Program Provider. Any processing that is submitted past the date of sale is still
calculated by usage month and Program Provider Is responsible for paying these fees to HC.
7. Confidentiality:During the term of this Agreement and at any time after,Client will keep confidential and not disclose any Confidential
Information(as defined below)nor will Client use the Confidential Information listed below for a purpose causing harm or damage to HC.
Client will hold the Confidential Information In strict confidence and will protect(t with the same diligence that it protects its own
confidential Information. Confidential information shall include,but not be limited to,the terms of this Agreement,including any
financial terms,trade secrets,the identity of any Program providers,unique identifiers,Personal Information(as defined below),and
reimbursement amounts.
8. Privacy:During the term of this Agreement and at any time after,If Client obtains or has access to"Personal information",Client agrees
to comply with all applicable privacy laws and to hold and protect all"Personal Information"In strict confidence and maintain the
confidentiality of this Information except as required by law or a court order.
a. "Personal information"means any information about or concerning an Individual including,but not limited to:
1. An individual's first name or first initial and his or her last name,or any Information concerning a natural person
which,because of name,number,personal mark,or other identifier,can be used to identify such natural person
whether or not in combination with any one or more of the following data elements: (A)social security number, (B)
driver's license number or state identification card number; (C)checking account number,savings account number or
other account number alone if no other information is required to access such account or otherwise commit identity
theft or misuse such information;(D)credit or debit card number,(E)account passwords or personal Identification
numbers,other access codes,or any other accounts or resources;(F)electronic identification number,(G)digital
signatures; (H)blometric data,including fingerprints;(1)birth date;(J)parent's legal surname prior to marriage; (K)
Identification number assigned by an employer;(L)any individually identifiable information,in electronic or physical
form,regarding the individual's medical history or medical treatment or diagnosis by a health care professional;
9. Forms;Programs:HC shall advise Client that Client's facility has the option to either 1.)Maintain original documents related to the
participating member's Program Providers enrollment forms in a secure location consistent with existing record retention policies,2.)
Retum documents and forms back to the member after Inserting this information into the enrollment website,or 3.)Destroy forms in a
secure manner.All options stand unless state law record retention requirements state otherwise.Client is solely responsible for the
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TY SECRETARY
T. WORTH,TX
membership agreement that Client uses, HC will provide Client with a copy of the participating Program Provider's enrollment forms and
Client shall make copies for enrollment. Client will not be allowed to make changes to the enrollment forms.
10. Visits:All visits for this Program by Client's members must be performed at Client's facility.Events,programs,classes or other activities
hosted by Client outside of Client's physical facility will also be eligible for being counted in the cumulative total number of visits for
members if Client has a commercially reasonable method of tracking such activity.
11. Trademark Usage:All advertisements or other marketing materials referencing a Program Provider's name,trademark,service mark,logo
or other commercial symbol must be approved by that Program Provider's legal department prior to publication by Client. Requests can be
facilitated through HC.
12. Indemnification:Liability:The parties agree to defend,indemnify and hold each other,harmless,its owners and affiliates,and each of
them,and their respective officers,directors,employees,shareholders,agents,insurers,and representatives from and against any and all
demands,losses,actions,damages,claims,costs,expenses and liability(including attorneys'fees)("Damages")whether or not involving
any third party claim, that results from or arises out of directly or indirectly: (a)any act or omission;or(b)any injury or Damage caused
in connection with providing services hereunder.
13. Dispute Resolution:in the event that any dispute,claim,or controversy of any kind or nature relating to this Agreement arises between
the Parties,the Parties agree to meet and make a good faith effort to resolve the dispute. If the dispute is not resolved within thirty(30)
days after the Parties first met to discuss it,and either Party wishes to further pursue resolution of the dispute, that Party shall refer the
dispute to non-binding mediation under the Commercial Mediation Rules of the American Arbitration Association("AAA").in no event may
the mediation be initiated more than one(1)year after the date one Party first gave written notice of the dispute to the other Party.A
single mediator engaged in the practice of law,who is knowledgeable as to the subject matter relevant to the dispute,shall conduct the
mediation under the then current rules of the AAA.The mediation shall be held in a mutually agreeable site.Nothing herein is included to
prevent either Party from seeking any other remedy available at law including seeking redress in a court of competent jurisdiction.
14. Entire Agreement:This Agreement,including the documents referenced herein,is tt a only agreement between the parties concerning the
subject matter hereof and supersedes all prior agreements,whether written or oral,relating hereto. No purported amendment,
modification or waiver of any provision of this Agreement shall be binding unless set forth in a written document signed by all parties(in
the case of amendments or modifications)or by the party to be charged thereby(in the case of waivers);provided,however,HC may
amend the FPR&D and the Policy(at[as defined below)at any time. Copies of this Agreement with signatures transmitted by facsimile
shall be deemed to be original signed versions of this Agreement.
15. Additional Documents:Client acknowledges that it has read and understands this Agreement,the opium Fitness Passport Program
Information Packet document,and the Cancellation Policy(the"Policy"). in the evert of a conflict between the terms of this Agreement
and any of the foregoing documents,the terms of this Agreement shall control.
16. Facility Liability Insurance: Client wilt at its own cost and expense,maintain(and cause its subcontractors working on the facility,if any
to maintain)the following insurance coverage in full force:Workers'Compensation Insurance and Commercial Liability Insurance,with
limits of not less than$1,000,000. The insured must give Healthy Contributions thirty(30)days'written notice before the insurance is
cancelled or altered in a way that no longer satisfies the requirements Client will need to provide a copy of the current certificate of
liability insurance.
17. Benefits;Assignment:This Agreement shall inure to the benefit of and shall bind the successors and permitted times assigns of both
parties to this Agreement. Client may not assign or transfer its interest in this Agreement without the prior written consent of HC.
18. Acknowledgments:Client acknowledges: (A)that HC is not a payer of services,nor an insurer with respect to any services provided by
Client and its only obligation with respect to funds received from the Program Provider is to disburse the funds in accordance with the
instructions of the Program Provider; (B)that HC shall have no obligation to disburse funds hereunder if a Program Provider fails to provide
the funds for reimbursement to HC;and(C)that HC has not made any representation,warranty or guarantee as to any revenue that it may
derive from any program.
19. Assignment: Neither party shall assign this agreement,its rights or obligations under this agreement or grant a security interest in or
pledge as collateral any interest herein or therein without written consent of the non-assigning party.
20. Non-exclusivity:Each party understands and acknowledges that the relationship created hereby is of a non-exclusive nature,meaning that
either party may do business with any other party that provides the same or similar services.
21. Email:Healthy Contributions may from time to time send emaits to the addresses referenced in the Smart login forms to update of
program changes,enhancements and other pertinent information. These may include communications from health plans or promotional
advertisings in connection with our standard services.Notwithstanding,any formal notifications regarding this Agreement shall be sent to
the other party via certified mail for approval and verification that such mailings do not violate privacy laws or opt out notifications by the
intended recipient.
HFalthy Contributions,LLC C!;enr The City of Fort Worth
By: Brittany Schwandt Signee Name: Fernando Costa
Title: Network Specialist Title: Assistant City Manager
Signature: Signee Email:
Date: Signature: ,n, ;1.g,,.,o,9,
Date: Aug 22,2019
6
For internal use only
healthy
Wellness.Rewarded. Club Enrollment Form
Each location's profile will be setup with the Renew Active by UnitedHealthcare Program.
Primary Club Name: See attachment Facility Phone:
Address:
City: County: State: Zip:
Primary Contact Name: Tom:
Primary Contact Email: Primary Contact Phone:
Facility Website URL:
**If primary contact is different for each location,please indicate below.
Other Locations)/Branches: Other Locations)/Branches:
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County —zip: County: Zip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL Facility Website URL:
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: Slate: City: State:
County: Zip: County: Zip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL Facility Website URL
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State• City: State:
County: Zip: County: Zip-
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL Facility Website URL:
7
For internal use only
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County: Zip: County: Tip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL: Facility Website URL:
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County: Zip: County: Tip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL: Facility Website URL:
Facility Name(RBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County: Zlp• County: Zip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL, Facility Website URL:
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County Zip: County: Zip:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL: Facility Website URL:
Facility Name(DBA) Facility Name(DBA)
Address: Address:
City: State: City: State:
County: Zip: County, ZiP:
Facility Phone: Facility Phone:
Primary Contact Name: Primary Contact Name:
Primary Contact Email: Primary Contact Email:
Primary Contact Phone: Primary Contact Phone:
Facility Website URL: Facility Websl�e URL:
8
For internal use only
healthy
Wellness. Rewarded.
Smart Login Website Access Form
This setup will grant staff access to www.healthycontributions.com. For multiple facility groups,please complete one
Website Access form for each location.
Facility Name and State: See Attached
Note:Each login must have a unique email address which will be used as the username.Please record your entries for future reference.
Passwords must be at least 8 characters and contain at least 1 letter and 1 number.
User 1:
First and Last name:
Email address: Password:
User 2:
First and Last name:
Email address: Password:
User 3:
First and Last name:
Email address: Password:
User 4:
First and Last name:
Email address: Password:
If you would like additional users to have access to your Healthy Contributions portal,please complete a second
SmartLogin Form.
Healthy Contributions 1 111 Weir Drive l Woodbury,MN 55125 1 F:651.438.5196 (network@healthycontributions.com
10
For internal use only
r"+', healthy
Facility Profile Works ftet
In an effort to highlight the on-going amenities,classes,and personalized fitriess plan offerings at your facility,please
complete the profile below. For multiple facility groups, please complete one worksheet for each location.
Facility Name: See Attached
Amenities&Classes
1. Does your facility have a pool?❑Yes ❑ No
2.is your facility Co-Ed or Women Only?❑Co-Ed ❑Women Only
3.Does your facility offer complimentary Group Exercise Classes?❑Yes ONO
If yes,please complete the chart below.
Check the categories in which Optional:Optum would like to highlight a complimentary class in each category that you offer.Please list
you offer complimentary classes. an offered class that is older adult appropriate.
❑Cardio
❑Strength
❑Mind/Body
❑Aquatic
❑Specialty
'Please DO NOT list branded classes created from other third parry Medicare Programs.
Class Descriptions:
Cardio Focus on getting the heart rate up for the duration of the class.This category includes long-time favorites such as step and hl-
lo floor aerobics,and some more recent favorites such as kickboxing and indoor cycling.
Use equipment like light dumbbells,barbells,resistance bands,kettle bells or body weight to build muscular strength and
Strength endurance.These classes usually involve all the major muscle groups,but can be broken down into formats that focus on just
abdominal,upper body or lower body exercises.These classes are considered non-aerobic,but are a great way to incorporate
resistance training into a weekly routine without getting out on the weight room floor.
The most recognizable mind/body classes are yoga and Pilates,but these can include stretching or core strength classes.
Mind/Body These formats focus on flexibility,core strength and balance with an emphasis on connecting the mind to the physical work
of the body.These classes have become more common at mainstream fitness facilities,but can still be found at specialty
studios that offer no other formats. Meditation classes are also a form of mind/body classes.
Specialty Specialty classes tend to be nontraditional.Examples of specialty classes are several forms of dance(hip hop,salsa,line
dancing)or self-defense.
Water aerobics is a form of aerobic exercise that requires water-immersed participants.Most water aerobics is in a group
Aquatic fitness class setting. Focused on aerobic endurance,resistance training,and creating an enjoyable atmosphere with music.
Different forms of water aerobics may Include:aqua Zumba,water yoga,aqua aerobics,and aqua jog.
Personalized Fitness Plan
Is your location interested in offering a complimentary Personalized Fitness Plan session for eligible members once per
calendar year? ❑Yes G No
Personalized Fitness Plan reaulrements:
1.Complimentary session must be with a Personal Trainer for a minimum of 30 minutes once per calendar year.
2.Discuss and provide feedback on member's health and wellbeing goals
3.Connect and recommend services,programs and classes that will help the member meet their health and wellbeing goals
4.Present a customized action plan to include an exercise prescription plan
5.Offer an equipment orientation
Benefits to the facility for offering a Personalized Fitness Plan to Your O=rn Fitness AdvaaM members:
•Increase in member enrollment,retention,and utilization yielding more revenue
•Be highlighted on the Optum website as a location offering a personalized fitness plan for eligible members
•Conned our members with your services,programs,amenities,and classes which can drive increased engagement and sales opportunities for
your facility generating more revenue
Name Phone Number Email
ADDENDUM TO PROGRAM AGREEMENT
BETWEEN
THE CITY OF FORT WORTH
AND
HEALTHY CONTRIBUTIONS, LLC
This Addendum to Program Agreement("Addendum") is entered into by and between Healthy
Contributions, LLC, a part of UnitedHealth Group, ("HC") and the City of Fort Worth ("Facility"),
collectively the"parties,"for the purposes of providing payment-processing services for the City's Optum
Fitness Passport Program.
The Contract documents shall include the following:
1. The Program Agreement,and
2. This Addendum.
Notwithstanding any language to the contrary in the attached Program Agreement (the
"Agreement"), the Parties hereby stipulate by evidence of execution of this Addendum below by a
representative of each party duly authorized to bind the parties hereto,that the parties hereby agree that
the provisions in this Addendum below shall be applicable to the Agreement as follows:
1. Term. The Agreement shall become effective upon the signing of the Agreement
(the"Effective Date")and shall expire one(1)year after the Effective Date(the Expiration Date"),
unless terminated earlier in accordance with the provisions of the Agreement or otherwise
extended by the parties.The Agreement may be renewed for four(4)renewals at Facility's option,
each a"Renewal Term."Facility shall provide HC with written notice of its intent to renew at least
thirty(30)days prior to the end of each term.
2. Termination.
a. Convenience. Either Facility or HC may terminate the Agreement at any
time and for any reason by providing the other party with 30 days written notice of
termination.
Addendum Page 17 of 22
b. Breach.If either party commits a material breach of the Agreement,the non-
breaching Party must give written notice to the breaching party that describes the breach
in reasonable detail. The breaching party must cure the l reach ten(10)calendar days after
receipt of notice from the non-breaching party, or other time frame as agreed to by the
parties. If the breaching party fails to cure the breach within the stated period of time,the
non-breaching party may, in its sole discretion, and without prejudice to any other right
under the Agreement, law, or equity, immediately terminate this Agreement by giving
written notice to the breaching party.
C. Fiscal Funding Out. In the event no funds or insufficient funds are
appropriated by Facility in any fiscal period for any payments due hereunder,Facility will
notify HC of such occurrence and the Agreement shall terminate on the last day of the
fiscal period for which appropriations were received without penalty or expense to the
Facility of any kind whatsoever, except as to the portions of the payments herein agreed
upon for which funds have been appropriated.
d. Duties and Obligations of the Parties. In the event that the Agreement is
terminated prior to the Expiration Date,Facility shall pay HC for services actually rendered
up to the effective date of termination and HC shall continue to provide Facility with
services requested by Facility and in accordance with the Agreement up to the effective
date of termination. Upon termination of the Agreement for any reason,HC shall provide
Facility with copies of all completed or partially completed documents prepared under the
Agreement. In the event HC has received access to Facility information or data as a
requirement to perform services hereunder, HC shall return all Facility provided data to
Facility in a machine readable format or other format deemed acceptable to Facility.
3. Attorneys' Fees, Penalties, and Liquidated Damages. To the extent the attached
Agreement requires Facility to pay attorneys' fees for any action contemplated or taken, or
penalties or liquidated damages in any amount, Facility objects to these terms and any such terms
are hereby deleted from the Agreement and shall have no force or effect.
4. Law and Venue.The Agreement and the rights and obligations of the parties hereto
shall be governed by, and construed in accordance with the laws of the United States and state of
Texas,exclusive of conflicts of laws provisions. Venue for any suit brought under the Agreement
shall be in a court of competent jurisdiction in Tarrant County,Texas.To the extent the Agreement
is required to be governed by any state law other than Texas or venue in Tarrant County,Facility
objects to such terns and any such terms are hereby deleted from the Agreement and shall have
no force or effect.To the extent the Agreement requires arbitratiM Facility objects to such terms
and any such terms are hereby deleted from the Agreement and skull have no force or effect.
5. Linked Terms and Conditions. If the Agreement contains a website link to terms
and conditions,the linked terms and conditions located at that website link as of the effective date
of the Agreement shall be the linked terms and conditions referred to in the Agreement.To the
extent that the linked terms and conditions conflict with any provision of either this Addendum or
the Agreement,the provisions contained within this Addendum and the Agreement shall control.
If any changes are made to the linked terms and conditions afterie date of the Agreement, such
Addendum Page 18 of 22
changes are hereby deleted and void. Further, if HC cannot clearly and sufficiently demonstrate
the exact terms and conditions as of the effective date of the Agreement, all of the linked terms
and conditions are hereby deleted and void.
6. Insurance.The Facility is a governmental entity under the laws of the state of Texas
and pursuant to Chapter 2259 of the Texas Government Code, entitled "Self-Insurance by
Governmental Units," is self-insured and therefore is not required to purchase insurance. To the
extent the Agreement requires Facility to purchase insurance, Facility objects to any such
provision, the parties agree that any such requirement shall be null and void and is hereby deleted
from the Agreement and shall have no force or effect. Facility will provide a letter of self-insured
status as requested by HC.
7. Sovereign Immunity. Nothing herein constitutes a waiver of Facility's sovereign
immunity. To the extent the Agreement requires Facility to waive its rights or immunities as a
government entity; such provisions are hereby deleted and shall have no force or effect.
8. Limitation of Liability and Indemnity. To the extent the Agreement, in any way,
limits the liability of HC or requires Facility to indemnify or hold HC or any third party harmless
from damages of any kind or character, Facility objects to these terms and any such terms are
hereby deleted from the Agreement and shall have no force or effect.
9. No Debt. In compliance with Article 11 § 5 of the Texas Constitution, it is
understood and agreed that all obligations of Facility hereunder are subject to the availability of
funds. If such funds are not appropriated or become unavailable, Facility shall have the right to
terminate the Agreement except for those portions of funds which have been appropriated prior to
termination.
10. Confidential Information. Facility is a government entity under the laws of the
State of Texas and all documents held or maintained by Facility are subject to disclosure under the
Texas Public Information Act.To the extent the Agreement requires that Facility maintain records
in violation of the Act, Facility hereby objects to such provisions and such provisions are hereby
deleted from the Agreement and shall have no force or effect. In the event there is a request for
information marked Confidential or Proprietary, Facility shall promptly notify HC. It will be the
responsibility of HC to submit reasons objecting to disclosure. A determination on whether such
reasons are sufficient will not be decided by Facility, but by the Office of the Attorney General of
the State of Texas or by a court of competent jurisdiction.
11. Addendum Controlling. If any provisions of the attached Agreement,conflict with
the terms herein, are prohibited by applicable law, conflict with any applicable rule,regulation or
ordinance of Facility,the terms in this Addendum shall control.
12. Immigration Nationality Act. HC shall verify the identity and employment
eligibility of its employees who perform work under this Agreement, including completing the
Employment Eligibility Verification Form (I-9). Upon request by Facility, HC shall provide
Addendum Page 19 of 22
Facility with copies of all I-9 forms and supporting eligibility 4ocumentation for each employee
who performs work under this Agreement. HC shall adhere to all Federal and State laws as well
as establish appropriate procedures and controls so that no services will be performed by any HC
employee who is not legally eligible to perform such services. HC SHALL INDEMNIFY
FACILITY AND HOLD FACILITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY HC,
HC'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR LICENSEES. Facility, upon
written notice to HC, shall have the right to immediately terminate this Agreement for violations
of this provision by HC.
13. No Boycott of Israel. If HC has fewer than 10 employees or the Agreement is for
less than $100,000, this section 13 does not apply. HC acknowledges that in accordance with
Chapter 2270 of the Texas Government Code, Facility is prohibited from entering into a contract
with a company for goods or services unless the contract contains a written verification from the
company that it: (1)does not boycott Israel; and (2)will not boycott Israel during the term of the
contract. The terms "boycott Israel" and "company" shall have the meanings ascribed to those
terms in Section 808.001 of the Texas Government Code. By sip7ing this Addendum, HC certifies
that HC's signature provides written verification to Facility that HC: (1)does not boycott Israel,
and(2)will not boycott Israel during the term of the Agreement.
14. Right to Audit. HC agrees that Facility shall,unti I the expiration of three(3)years
after final payment under the Agreement, have access to and t�e right to examine any directly
pertinent books, documents, papers and records of HC involving transactions relating to the
Agreement.HC agrees that Facility shall have access during normal working hours to all necessary
HC facilities and shall be provided adequate and appropriate workspace in order to conduct audits
in compliance with the provisions of this section.Facility shall give HC reasonable advance notice
of intended audits.
(signature page follows)
Addendum Page 20 of 22
Executed this the Aug22,2019 day of Aug 22,2019 ,2019.
CITY:
City of Fort Worth Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract,including ensuring all performance
and reporting requirements.
By. Fernando Costa(Aug 22,2019)
Name: Fernando Costa
Title: Assistant City Manager
�r5 d[Loao�F�d+r�.�{L
By. Sheri Endsley(Aug 20,2015)
Date:
Aug 22, 2019 Name: Sheri Endsley
Title: District Superintendent
Approval Recommended:
Approved as to Form and legality:
By: David Creek(Aug 21,2019)
By:
Matt Murray(Aug 22,201
Name: David Creek
Name: Matthew A.Murray
Title: Acting Director
Title: Assistant City Attorney
Attest:
Contract Authorization:
M&C: No M&C reauired
OFFICIAL 111 C®RD
CITY SECRI TARY
FT. WORTH,TX
21
For internal use only
By: V
Name: Mary Kayser _
Title: City Secretary
�XF+�
HEALTHY CONTRIBUTIONS, LLC:
By:
Name:
Title:
Date: `�� 1(
�911*'I�;AL RECORD
gV SECRETARY 22
'� fatTiye my
Fitness Incentive Program Procedures
Facility Responsibilities
• Complete all Healthy Contributions set up forms and email or fax back to Healthy Contributions.
• Complete Optum agreement.
• Retain a copy of all program forms in a secure place.
• Make a copy of each member's confirmation letter for reference and store in secure location.
• Enter all member demographic and confirmation number into Healthy Contributions.
• Between the 1st through the 51h calendar day of each month, report monthly utilization records to
Healthy Contributions.
• Correct any false demographic or fitness incentive provider information based on monthly return
reports promptly to safeguard proper payments.
Resubmitting Past Usage Information
• You may resubmit a member's past usage at any time during the month. It will be submitted with
the next month's file submission. (Example: resubmit for December's usage on February 10, it will
be submitted with February's file submission through the 1st and the 51h calendar day of March.)
• The Renew Active by UnitedHealthcare Program will only accept resubmissions for up to 2 months.
Please know that it is always up to the program provider to approve or deny any resubmissions.
Viewing and confirming monthly Return Reports
• It is REQUIRED that on or after the 25th of EACH month, the facility logs in to
www.healthycontributions.com and views the return report.
• Verify information as necessary on the online return reports.
• Correct any incorrect information, paying special attention to all members the club was not paid
for if the member had visits, and make resubmissions as necessary.
Reimbursements
• Healthy Contributions will directly receive fitness plan funds and will disperse them directly to the
club's bank account on or after the 25th of each month.
Changes, Corrections and Deletions
• The facility is solely responsible for any changes, corrections and deletions made to member
demographic and fitness incentive insurance information.
Cancellation Policy
• Please see specific program information noted under Cancellation Policy Information in this
document.
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Typical Processing Timeline
Member Exercise Period 1 11t—end of month
• Members work-out periodically throughout the month.
• Clubs receive payments based on individual member's usage, as detailed in the Optum
Agreement.
Usage Submission 11 -5' calendar day of the month
• Member utilization records should be reported to www.healthycontributions.com before the 51
calendar day at mid-night.
• Also during this time, you may enter any resubmissions you might have following the
resubmission guidelines.
• Following submission, usage files are transferred by Healthy Contributions to the Renew Active by
UnitedHealthcare Program for processing.
Data Exchange 1 6"— End of month
• Healthy Contributions submits one completed usage file to program provider by the 6th of the
month or the next available business day.
• The Renew Active by United Healthcare Program team reviews the usage file.
• The usage file is returned to Healthy Contributions with status codes by the end of the month or
the next available business day.
Reimbursement I On or after the 251h of month
• Clubs receive payment based on the criteria and payment schedule outlined by the Optum
Agreement.
• Return reports are made available to your club for reconciliation.
Resubmissions 1.Can be entered any time throughout the month
• The Renew Active by United Healthcare Program will only accept resubmissions for up to 2 months.
For example, resubmissions for the month of April must be entered into the HC website by July's
submission (the 1st-5th calendar day) period. April resubmissions will not be accepted after July
and the club will not be paid for those visits.
Additional information, detailed instruction sheets, tutorials, and walk-thWghs are available upon request
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Cancellation Policy Information
Member Cancellations
• Each facility is required to have prearranged member cancellation policy in place.
• It is important that the facility knows that they can only expect to receive a payment for the
members' visits that were made on the last month of their membership.
• Please ensure that the members stay in the Healthy Contributions web portal until the last month's
payment has been received. Failure to adhere to this may result in non-payment
Facility Cancellations
• The Optum agreement requires Renew Active by UnitedHealthcare clubs to provide written
notice to Optum of cancellation per the details outlined in the Optum agreement.
• If you wish to cancel; please provide a cancellation notice to Healthy Contributions in writing by
emailing network@healthycontributions.com. Healthy Contributions will send you a confirmation
email once approved. Please note that cancellation is not accepted until email confirmation is sent
back to club. The facility is responsible for notifying participating members of program
cancellation.
Facility Closures
• It is the owner's responsibility to notify Healthy Contributions when the facility is closing. A 30-day
notice is required.
• The facility must email their closing notice to: network@healthycontributions.com, or fax to:
651-438-5196.
• Members can locate and re-enroll in the Renew Active by UnitedHealthcare Program at another
participating Iocatiori. Members can contact the Renew Active by UnitedHealthcare team for a list
of participating clubs in the area.
• It is the facility's responsibility to notify all members of the club closure.
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Club Marketing Guidelines
Marketing is an important part of operating a successful business, which is why we have included
some tips on marketing the Renew Active by UnitedHealthcare Program in your facility.
Use of logo information
• It is not advised to use the program provider's name, logo, or likeness, in circulars,
advertisements, web content, or other forms of solicitation without the expressed
consent of that particular program provider.
• If you have questions about the marketing this program, please contact Healthy Contributions
at network@healthycontributions.com or call your program representative.
Inquire with prospective members concerning which insurance provider they
currently have
• Prospective members maybe intrigued to learn that your facility participates in the Renew
Active by UnitedHealthcare Program.
Word of Mouth
• Be sure to thoroughly explain the program details to your members. The participating
members will be your biggest advocate and asset!
• Encourage your Renew Active by UnitedHealthcare members to refer their friends and family to
your club.
Offer promotional Senior Friendly days
• Post fliers around your facility offering a day for members to come and learn about your
facility.
• Offer small refreshments to those in attendance.
• Explain to those in attendance the importance of fitness and the benefits of choosing a healthy
lifestyle.
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