2010-06-07_(2).pdf - 19318.8K - BridgeportCT.gov

Customer Name Bridgeport City
BOE
Administrative Services Only Agreement
THISAGREEMENT effective July 1 2010 the Effective Date is by and between Bridgeport City
BOE Employer and Connecticut General Life Insurance Company Connecticut General
RECITALS
WHEREAS Employer as plan sponsor has adopted the benefit described in Exhibit A as may be
amended Plan for certain of its employees members and their eligible de pendents collectively
Members and
WHEREAS Employer has requested
Connecticut General to furnish certain administration services in
connection with the Plan described in Exhibit B Account No 3213172
NOW THEREFORE in consideration ofthe mutual promises and covenants contained herein it is
hereby agreed as follows
Section 1 Term and Termination of
A2reement
This Agreement is effective on the Effective
Date cited above The initial term ofthis
Agreement shall be for thirty
six 36 months
commencing on the Effective Date Thereafter
this Agreement shall renew on each anniversary
ofthe Effective Date the anniversary
for
successive terms oftwelve 12 month subject
to Connecticut General s
right to revise charges
as outlined in Section 8 unless at least ninety
90 days prior
to the end ofthe then current
term the or
Employer
at least one hundred
eighty
180 days prior to the end ofthe then
current term Connecticut General
gives written
notice to the other party that it will not renew the
Agreement unless the Agreement is otherwise
terminated as
provided
for in Section iv
The Agreement shall
immediately below
remain in effect until the earliest ofthe
following dates
i The end ofthe term in which delivery of
written notice ofnon renewal is made
pursuant to the paragraph above
ii The date which is at least ninety 90 days
from the date that Employer or the date
which is at least one hundred eighty 180
days form the date that Connecticut General
provides written notice to the other party of
termination of the Agreement
Hi The effective date of any applicable law or
governmental action which prohibits
iv
v
performance oflthe activities required by this
Agreement
Two 2 business days from The date upon
which Employer fails to fund the Bank
Account as
required by this Agreement
provided Connecticut General notifies
Employer of its election to terminate
Twenty 20 days
from the date on which
Employer fails to pay
Connecticut General
any charges identified in this Agreement
when due provided
Connecticut General
notifies Employer ofits election to
terminate
vi Any other date mutually agreed upon by the
Parties
Section 2
Additional Service
a
Claim Administration and
While this Agrel
ment is in effect
Connecticut General shall consistent with
the claim administration policies and
procedures then applicable to its own health
care insurance business and in accordance
with all applicable laws i
review claims for Plan Benefits
receive and
determine the Plan Benefits if any payable
applicable for such claims iii disburse
payments of Plan Benefits to claimants and
iv provide in the mannerand within the
time limits required by applicable law
notification to claimants of a the coverage
determination Olr b any anticipated delay in
ii
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