HomeMy WebLinkAboutContract 53026 Vr, 56T8�
CITY SECRETARY
: ! CONTRACT NO. 53oat�
AGREEMENT
C C: 15ECR�ARY�
BETWEENTHE CITY OF FORT WORTH
AND
£� EYEMED VISION CARE, LLC
This Agreement ("Agreement") is entered into by and between EyeMed Vision Care,
LLC ("Vendor").and the City of Fort Worth ("City"), collectively the "parties."
WHEREAS, City is an employer that provides vision benefits for its employees and their
qualified dependents and now intends to offer vision benefits to such individuals;
WHEREAS, City has obtained a Vision Insurance Group Policy (as defined herein)under
its ERISA plan(the "ERISA Plan") to make available an insured vision benefit to its members;
WHEREAS, the Vision Insurance Group Policy is issued by Fidelity Security Life
Insurance Company (the "Insurance Company");
WHEREAS, City wishes to engage the services of Vendor to provide vision network
administration and other services in conjunction with the Insurance Company related to the
Vision Insurance Group Policy;
WHEREAS, Vendor makes its vision network of participating providers available to the
City's members who have vision benefits under the Vision Insurance Group Policy; and
WHEREAS, First American Administrators, Inc. ("FAA") is a wholly owned subsidiary
of Vendor and a duly licensed third-party administrator in required states and has contracted with
the Insurance Company to provide certain claims administrative services under the Vision
Insurance Group Policy.
NOW, THEREFORE, in accordance with the terms and conditions contained herein,the
parties agree as follows:
1. Control. If there are any conflicts between the terms set forth in this Agreement
and the terms set forth in the Vision Insurance Group Policy,the terms of the Vision Insurance
Group Policy shall control.
1. Attorneys' Fees, Penalties, and Liquidated Damages. To the extent the Agreement
requires City to pay attorneys' fees for any action contemplated or taken, or penalties or
liquidated damages in any amount, City objects to these terms and any such terms are hereby
deleted from the Agreement and shall have no force or effect.
2. 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, Te
the Agreement is required to be governed by any state law other than Texas o
C3TV` Kpl
Addendum 4ee 1 of 4
County, City objects to such terms and any such terms are hereby deleted from the Agreement
and shall have no force or effect.
3. Insurance. The City 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 City to purchase insurance, City 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. City will provide; a letter of self-insured status as
requested by Vendor.
4. Sovereign Immunity. Nothing herein constitutes a waiver of City's sovereign
immunity. To the extent the Agreement requires City to waive its rights or immunities as a
government entity; such provisions are hereby deleted and shall have no force or effect.
5. Limitation of Liability and Indemnity. To the extent the Agreement, in any way,
limits the liability of Vendor or requires City to indemnify or hold Vendor or any third party
harmless from damages of any kind or character, City objects to these terms and any such terms
are hereby deleted from the Agreement and shall have no force or effect.
6. No Debt. In compliance with Article 11 § 5 of the Texas Constitution, it is
understood and agreed that all obligations of City hereunder are subject to the availability of
funds. If such funds are not appropriated or become unavailable, City shall have the right to
terminate the Agreement except for those portions of funds which have been appropriated prior
to termination.
7. Confidential Information. City is a government entity under the laws of the State
of Texas and all documents held or maintained by City are subject to disclosure under the Texas
Public Information Act. To the extent the Agreement requires that City maintain records in
violation of the Act, City 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, City shall promptly notify Vendor. It will be the
responsibility of Vendor to submit reasons objecting to disclosure. A determination on whether
such reasons are sufficient will not be decided by City, but by the Office of the Attorney General
of the State of Texas or by a court of competent jurisdiction.
8. Immigration Nationality Act. Vendor 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 City, Vendor shall provide
City with copies of all I-9 forms and supporting eligibility documentation for each employee
who performs work under this Agreement. Vendor 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 Vendor employee who is not legally eligible to perform such services. VENDOR SHALL
INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY
VENDOR, VENDOR'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR
Addendum Page 2 of 4
LICENSEES. City, upon written notice to Vendor, shall have the right to immediately terminate
this Agreement for violations of this provision by Vendor.
9. No Boycott of Israel. If Vendor has fewer than 10 employees or the Agreement is
for less than $100,000,this section does not apply. Vendor acknowledges that in accordance with
Chapter 2270 of the Texas Government Code, City 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 signing this Addendum, Vendor
certifies that Vendor's signature provides written verification to City that Vendor: (1) does not
boycott Israel; and(2) will not boycott Israel during the term of the Agreement.
(signature page follows)
Addendum Page 3 of 4
a
ACCEPTED AND AGREED:
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
By: �� and reporting requirements.
Name: eSus�,C �
Title: Assistant City Manager
Date: l /✓ By:
Name:
Approval Recommended: Title:
Approved as to Form and Legality:
By: -
Name:
Title: By:
Name: hn B. S rong
Attest: �f� Title: Assistant City orney
Contract Authorizat)ion•
M&C:P-12341 OU t5 1
9
By: }F'� La9S . aQ)ol- $46ig
Name: r
Title: City Secre ary
• sc
VENDOR:
j
EyeMed Vision Care,LLC rEX
By;
Name: Natasha D'Sa
Title: VP,Sales&Account Mgmt
Date: October 24,2019
Reviewed As to Form by EyeMed Legal: OFFICIAL RECORD
' CITY SECRETARY
FT. NORTH,TX
Addendum Page 4 o
Docu:,'ign Envelope ID:39CBF506-5D5C-4A80-BF94-9A1 B906950AE
Application for Vision Care Benefits
Underwritten by Fidelity Security Life Insurance Company
Kansas City, Missouri
I. GROUP INFORMATION
Group Name: City of Ft.worth-TX Tax ID#:
DBA Name (If other than above):
Business Address: 1000 Throckmorton St. City: State: TX ZIP: 76102
Mailing Address: \ = o { jC cS �' t City: f f State:Tf ZIP:
1 Z
Primary Contact: 41��lE;i F �a i !�z-v Title: S t. �1S►- I,,-
Phone Number: ( ` a ) 3`tZ- ` h `` Fax Number: ( i I ) _`j z 2 -.ZC:2-
E-mail Address: 1rc&)-e;i c1 i �4«p. �' Turf crJCt Cx�,� .Gc ;ir
Type of Business: Proprietorship Corporation Other (Specify): Iti1 ic.ill � 7Lr
PLEASE NOTE THE FOLLOWING TYPE BUSINESSES REQUIRE PRIOR CARRIER APPROVAL:
MEWA PEO Trust " Union
Service Area: - National (U.S.-does not include Puerto Rico) State Specific (List)
If any subsidiary or affiliated companies are to be insured or any Employees/Members are working at a location other
than the business address above, please explain and list states.
Billing Contact Name: 4�=�� .� f Gli1pr.r•__- Phone: J I ) 3 4_4 1
Billing Address: JCU T-CK 4o S4' City: P-cf) L; '2.c j- -- Statej X ZIP:-"fir t 02-
If you have subsidiaries, affiliated companies, or divisions who use another name and will be covered by this plan, AND
require separate billing invoices, please attach the following information on a separate sheet of paper signed by you:
• Name •Address • Billing Contact& Phone Number
Will this plan replace any existing coverage? „__ Yes--„ No
If "Yes," indicate name of existing insurer:
If "Yes," are any Employees/Members on COBRA continuation? Yes No How many?
Do you intend to offer Employees/Members COBRA continuation?' Yes No
11. PLAN SELECTION
Please refer to the attached proposal page. Services are provided by EyeMed Vision Care.
111. PREMIUMS
Group's Premium Contribution for*: Employees/Members: % Dependents: ` %
Employee's/Member's Premium Contribution for: Employees/Members: l Li� % Dependents: f C"; %
Are Employee/Member and Dependent premiums paid through a Section 125 Plan? - Yes 11No
Are Employee/Member and Dependent premiums collected via payroll deduction?_'-411; Yes ___,; No
Premiums shall be payable at the rates included on the attached proposal page.
*If the Groups contribution percentage is changed or the numberof eligible Employees/Members increases or decreases,
premium may be adjusted as allowed under the Policy. The premium may be adjusted at the end of the calendar month
in which the change occurred.
M-9083/M-9093
A-01053TX Rev 06/01/2017
DocuSign Envelope ID:39CBF506-5D5C-4A80-BF94-9A1B906950AE
IV. ELIGIBILITY
Number of Employees/Members: 6340 Number Applying:
Number of Dependents: Number of Retirees:
Are Domestic Partners covered under this Plan*? Yew No
Dependent Children Covered to Age*: 25 26** Other
Dependent Children Covered if Full-Time Student*? Yeses,.' No
If "Yes," Dependent Full-Time Students Covered to Age*: 26 27 Other
*Unless state law has different requirements.
**Dependent Children covered to age 26 regardless of financial dependency, resider; , student status or marital status.
Eligibility Reporting Contact (produces the eligibility file): E15
Address (if different from Group):
City: rr l State: — ZIP:
E-mail Address: Cric. . �9:c ni t� ri C,,4� ,
Phone: (11_1 - 35 1 Fax: ( ) ✓
Eligibility Authorization Contact (Benefits Administrator or Third Party Administrator responsible for verifying vision
election for Employees/MembersI ): -t
Name: �� r `� C-1t l► '� Phone: (� ! ) 73R� `'1-1,SS
Days/Hours of Availability: �^'` '�' 46 ^ E-mail Address:
PROBATIONARY PERIOD
For New Employees/Members:,', 30 days 60 days 90 days 180 days Other
Probationary Period is waived for present Employees/MembersF.�, Yes No
Number of Employees/Members who have not yet completed the probationary period:
V. EFFECTIVE DATE
This plan will become effective at 12:01 a.m. Local Time at the Group's address herein, on the first day of
January 1st , 20 20 , provided all of the following have been completed prior to this effective date:
A. This application has been received and accepted by the Company (roust be submitted 30 days in advance of the
effective date).
B. EyeMed has been furnished a working file of all eligible Employees/lMembers, according to the layout guidelines.
It is understood and agreed that EyeMed may rely on this information to provide services to individuals designated
as eligible.
2
Docu&gn Envelope ID:39CBF506-5D5C-4A80-BF94-9A1B906950AE
The Group hereby makes application to Fidelity Security Life Insurance Company for Vision Care Benefits. The Group
agrees to maintain and furnish any records necessary to administer this plan and to forward premiums monthly.
The Group certifies that all the information shown on this application and any attachments are correct and complete as
of the date this application is signed, The Group understands that the Company intends to rely on this information in
determining whether or not the enrolling Employees/Members and their Dependents may become insured. It is further
understood and agreed that NO INSURANCE WILL BECOME EFFECTIVE UNTIL APPROVED BY THE COMPANY; and
that no field representative of the Company has the authority to modify any conditions of the application or the Policy by
making any promise or representation. It is understood that the insurance as to any Employee/Member will not become
effective on the date insurance should otherwise become effective if he or she is not at work on such date performing
all duties of his or her occupation and otherwise meets the requirements of the Company.
Any person who with intent to defraud or knowing that he or she is facilitating a fraud against an insurer,
submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud:
ffA
Dated at: - P� '` this day of /Vona I 4-0,�6- 20 /17_
Signed for the Group: > �-�!/ 1�- Title: lf. c ►�/ /w<<tJ'l�� t'r
VI. COMPANY DISPLAY NAME (Your Grou name as it should appear to your employees)
Company Name i C t r ( - W0H
(Maximum of 30 characte , including punctuation and spacing.)
ATTENTION:THE DEPARTMENT OF INSURANCE REQUIRES THAT ONLY
THE BROKER AND/OR GENERAL AGENT WHO SOLD THE PRODUCT AND HOLDS A VALID
LIFE AND HEALTH LICENSE MAY COMPLETE THE CERTIFYING STATEMENT
WRITING BROKER'S CERTIFYING STATEMENT
I certify that I have accurately recorded on this application the information supplied by the applicant, if such information
has been provided directly to me for recording purposes, and I am properly licensed in the state in which the Group is
domiciled.
Firm Name (print): EyeMed Vision Care Tax ID No.: 31-1656473
Address: 4000 Luxottica Place City: Mason State: OH ZIP: 45040
Phone: ( 513 765 6127 Fax: ( )
Primary Contact: Robin Wynne Secondary Contact:
Title: Title:
E-mail Address: RWynne@eyemed.com E-mail Address:
Commission checks payable to: X.' Firm Broker
Broker's Name (print): Robin Wynne SS#:
Broker's Signature: > r66, hvgAt
3
DocuSign Envelope ID:39CBF506-5D5C-4A80-BF94-9A1B906950AE
WRITING GENERAL AGENT'S CERTIFYING STATEMENT
I certify that I have accurately recorded on this application the information supplied by the applicant, if such information
has been provided directly to me for recording purposes, and 1 am properly licensed in the state in which the Group is
domiciled.
Firm Name (print): Tax ID No.:
Address: City: State: ZIP:
Phone: ( ) Fax:
Primary Contact: Secondary Contact:
Title: Title:
E-mail Address: E-mail Address:
Commission checks payable to: Firm General Agent
General Agent's Name (print): SS#:
General Agent's Signature: >
4
11/7/2019 M&C Review
Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FORT ORTH
COUNCIL ACTION: Approved on 6/1 812 0 1 9
DATE: 6/18/2019 REFERENCE P-12341 LOG NAME: 13P19-0067 DENTAL VISION FSA HSA
NO.: COBRA HR JPB
CODE: P TYPE: NOW PUBLIC NO
CONSENT HEARING:
SUBJECT: Authorize Execution of Contracts with Delta Dental Insurance Company for the
Administration of Dental Insurance with Participants Paying All Premiums,EyeMed Vision
Care,LLC for the Administration of Vision Insurance with Participants Paying All
Premiums,with WageWorks,Inc.for the Administration of the City's Flexible Benefit Plan
(FSA),Health Savings Account(HSA)and COBRA in the Amount of Up to$300,000.00
Per Year with Three-Year Initial Terms and Authorize Two One-year Renewal Options for
the Human Resources Department(ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of contracts with Three-Year Initial
Terms for the Human Resources Department with:
i)Delta Dental Insurance Company for the administration of Dental insurance with participants paying
all premiums,and no financial impact to the City:
ii)EyeMed Vision Care,LLC for the administration of Vision insurance with participants paying all
premiums,and no financial impact to the City;
iii)WageWorks, Inc.for the administration of the City's Flexible Benefit Plan,Health Savings Account
and COBRA in the amount of up to$300,000.00 per year;
And authorize two one-year renewal options.
DISCUSSION:
The Human Resources Department(HRD)approached the Purchasing Division to secure
agreements for City employees and retirees with access to Dental Insurance Plan,Visual Insurance
Plan and administration of the City's Flexible Benefit Plan,Health Savings Account and COBRA.Staff
issued a Request for Proposals(RFP)that consisted of detailed scope of services.The RFP was
advertised in the Fort Worth Star-Telegram every Wednesday starting on February 12,2019 through
March 13,2019. Twenty eight vendors were solicited from the purchasing database;twenty two
responses were received.
The proposals were thoroughly reviewed by an evaluation team consisting of staff from the different
departments separately for vision,dental and FSA/HSA/COBRA administration.The evaluation team
was provided with resources and assistance by the City's benefits consultant,Holmes Murphy.The
evaluation team ranked the proposals based on pre-defined factors.Finalists were selected for
presentations. Following the presentations,the evaluation team determined the following vendors
provides the best overall solution to the each listed services:
i)Delta Dental Insurance Company for the administration of Dental insurance with participants paying
all premiums,and no financial impact to the City;
ii)EyeMed Vision Care,LLC for the administration of Vision insurance with participants paying all
premiums,and no financial impact to the City;
iii)WageWorks, Inc.for the administration of the City's Flexible Benefit Plan,Health Savings Account
and COBRA in an amount of up to$300,000.00 per year;
The proposed contracts will offer enhanced benefits at reduced costs to City employees and retirees.
An administrative change order or increase may be made by the City Manager up to the amount
allowed by relevant law and the Fort Worth City Code and does not require specific City Council
approval as long as sufficient funds have been appropriated
Upon City Council approval,the initial three-year term of these contracts shall begin on January 1,
2020 and expire on December 31,2022.Contracts may be renewed up to two one-year terms at the
City's sole discretion. This action does not require specific City Council approval provided that
sufficient funds are appropriated for the City to meet its obligations during the renewal period.
A waiver of the goal for MBE/SBE sub-contracting was requested by the Purchasing Division and
approved by the M/WBE Office,in accordance with the BIDE Ordinance,because the purchase of
goods or services is from sources where sub-contracting or supplier opportunities are negligible.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the Group Health and Life Insurance
Fund.Prior to expenditure being made,the Human Resources Department has the responsibility to
validate the availability of funds.Future year funding subject to MAyor and Council approval.
BQN\19-0067\JPB
TO
apps.cfwnet.org/council_packet/mc_review.asp?ID=27028&councildate=6/18/2019 1/2
11/7/2019 M&C Review
T Fund Department Account Project Program Activity Budget I Reference# Amount
ID I I ID I I Year Chartfield 2
F &Wd Department Account Project Program Activity Budget Reference# Amount
ID ID Year Chartfield 2
Submitted for City Manager's Office by_ Susan Alanis(8180)
Originating Department Head: Kevin Gunn(2015)
Additional Information Contact: Cynthia Garcia(8525)
John Padinjaravila Baby(2279)
ATTACHMENTS
19-0067 Form1295 Delta Dental Redacted.g_df
19-0067 Form1295 EyeMed Redacted.pdf
19-0067 Form1295 WageWorks Redacted R1.122f
apps.cfwnet.org/council_packet/mc_review.asp?ID=27028&councildate=6/18/2019 2/2