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00-0719_HOLMAN FAMILY COUSELING INC_Contracts GROUP PLAN CONTRACT HOLMAN FAMILY COUNSELING, INC. EAP PLAN HOLMAN FAMILY COUNSELING, INC. (hereinafter "HFC') a California corporation having its principal place of business at 21050 Vanowen Street, Canoga Park, California 91303, telephone number (800) 321-2843, which is duly licensed to operate a prepaid Employee Assistance Program, and CITY OF SAN JUAN CAPISTRANO (hereinafter 'Employer") hereby enter into this Group Plan Contract as of this first day of July 1, 2000. WHEREAS, it is the purpose of HFC to provide employee assistance program services to employer groups while maintaining the requisites of an independent and responsible profession; and WHEREAS, Employer desires to provide its employees with Employee Assistance Program services by contracting with HFC, NOW THEREFORE, HFC and Employer, in consideration of the mutual promises and covenants contained herein, do hereby agree as follows: I. The 'Benefits Schedule" is attached hereto as Exhibit A, which is hereby incorporated herein by this reference. The Benefits Schedule describes the number of sessions available to Enrollees if such sessions are approved by the CMC. B. CMC: The Clinical Management Committee ("CMC') functions to assure quality control of treatment. All EAP services are authorized by the CMC. Employee Assistance Program (hereinafter 'EAP") services are a program of comprehensive assessment and referral services designed to identify and make appropriate referrals for treatment of physical, mental or emotional conditions which may result in impaired employee performance. Drug or alcohol abuse and marital difficulties are the most common sources of impaired employee July 12, 2000 performance which fall within the scope of the EAP. However, the EAP is concerned with the entire range of problems which may prevent employees from realizing their full performance potentials. Although the EAP is ultimately concerned with employment performance, it must necessarily also concern itself directly with an employee's concerns outside of the work place, including the employee's family. When appropriate, family members are involved to the extent necessary to fully assess an employee's problems or concerns. Assessment and referral services are also available to an employee's family members. The function of the EAP is mainly to provide an assessment and referral, if appropriate, rather than actual professional treatment. However, to the extent that treatment can effectively take place during the limited number of professional sessions provided for by this Group Plan Contract, professional treatment is provided by the Provider by whom an Enrollee is assessed as a part of the EAP. Referrals are made as necessary for purposes of treatment covered by HFC from the Provider who has initially been assigned the Enrollee for purposes of assessment and referral, in accordance with individual Enrollee needs. At Enrollee's discretion, ongoing treatment may be furnished by Provider rather than selecting a new Provider or receiving a referral. EAP Services utilize all psychological principles and methods for the understanding, diagnosis, referral, prevention, and treatment of psychological or personal problems in adults, children, couples, and families. Procedures utilized may include, but are not limited to, individual counseling, marital counseling, psychotherapy, behavior modification, chemical and alcohol abuse counseling, and hypnosis, used in a professional relationship to assist a person or persons to acquire greater human effectiveness, or to modify feelings, work situations, conditions, attitudes, and behavior patterns which are emotionally, intellectually, or socially ineffectual or maladjustive. The Eligible Dependents of an Eligible Employee's are such Eligible Employee's lawful spouse and unmarried dependent children to age 19, or to age 23 if the child is a full-time student. Children include step -children, adopted children, and foster children, provided such children are dependent upon the employee for support and maintenance. Attainment of the limiting age of 19 by unmarried dependent children, or the limiting age of 23 by full-time students, shall not operate to terminate the coverage of a child while the child is and continues to be incapable of self-sustaining employment by reason of mental retardation (although no payment will be made by HFC for treatment of the mental retardation, other than primary diagnosis) or physical handicap and their child is chiefly dependent upon an Eligible Employee for support and maintenance. If requested, proof of such incapacity and dependency may be required by HFC from the Eligible Employee. If requested, such proof must be famished within 31 days of the request for such information by HFC, but not more frequently than annually. July 12, 2000 0 0 Eligible Dependents are further defined as including all dependents in those categories stated above, regardless of enrollment in the Employer's group health plan. The effective date shall be the same as for the Eligible Employee. .-� The term "Eligible Employee" shall mean a full time, regular employee of Employer. The effective date of coverage shall be the first day of the month following first day of employment and ends on the last day of the month for which a premium was paid. Continuation will be allowed under COBRA provisions. F. Enrollee: The term "Enrollee" shall mean an Eligible Employee and/or such Eligible Employee's Eligible Dependents as defined herein. ►1I 111. I• ' 1 .- The term "Non -Contracting Provider" shall include any Provider who has not contracted with HFC to deliver services to Enrollees. The term "Provider," for purposes of this Agreement, shall mean and include any licensed psychologist, psychiatrist, clinical social worker, marriage, family and child counselor, or mental health nurse working individually, or within a corporation, clinic, or group practice, who delivers mental health services to Enrollees. The term "Provider" includes the duly licensed professional employees of a provider who has been approved in advance in writing by HFC to provide services to Enrollees. "WI �►`/4Y I��Y7171115`�� i A. Employer agrees to pay HFC monthly, commencing with the effective date of this Group Plan Contract, and on or before the first day of each succeeding month, the sum of $1.57 per employee, per month to be covered as an Eligible Employee by this Group Plan Contract. (See Exhibit A). Such rates are guaranteed for one year from the effective date of this contract. This Agreement shall be deemed to be renewed for additional terms of one year each if neither party gives the other thirty days' written notice of its intent that this Agreement not be so renewed prior to the expiration of the term hereof or the expiration of any renewal term. Fee changes for any renewal term shall be effective only as of any renewal date and only if HFC has given thirty (30) days written notice prior to such date of such fee increase. July 12,20M B. Employer shall direct Enrollees who wish to receive EAP services to telephone HFC at (800) 321-2843 Nationwide, to make arrangements for such services to be rendered. ►:► A. HFC shall provide EAP services pursuant to the Schedule of Benefits. In order to receive EAP Services, Enrollees shall telephone HFC at 800-321-2843 Nationwide. HFC will assign to Enrollee an appropriate Provider based upon intake information which HFC will request in its telephone conversation with the Enrollee. In most instances, treatment recommendations and referrals will be discussed with Enrollee by Provider. If the Enrollee wishes to use a Non - contracting Provider, Enrollee would do so at his/her own expense and it shall be the responsibility of the Enrollee to arrange for services with the Non -contracting Provider. B. Services shall be provided by HFC in RFC's offices, or offices of Providers. Normally services shall be delivered within five business days of a request by an Enrollee. Emergency services will be available on a 24-hour per day, 7 -day per week basis. Emergencies will be handled on an immediate basis. C. HFC shall be available to assist Employer in developing an internal policy and procedures for referring Enrollees to HFC. A HFC Account Manager will provide necessary consultation with Employer's supervisors in connection with job performance related formal Enrollee referrals. Additionally, in the first year of this Group Plan Contract, HFC will provide management training for Employer's supervisors. (See Exhibit A.) D. HFC shall provide Employee Assistance Program brochure, or copy, and consult with Employer and Employer's representatives about same. E. HFC shall make available to Enrollees the telephone number of HFC for making appointments and obtaining information with respect to services provided by HFC pursuant to this Group Plan Contract. F. HFC shall establish and maintain a quality control procedure, under the supervision of the CMC, in order to assure delivery of effective health care services to Enrollees. G. HFC shall require all Contracting Providers and their authorized professional employees to agree with HFC that they shall abide by ethical principles of their respective professions, including, as appropriate, the Ethical Standards of the American Psychological Association, the standards of the Ethics Committee of the American Psychiatric Association, the ethical standards of the National Association of Social Workers, and or ethical standards of the California Association of Marriage, Family and Child Counselors, and/or ethical standards of the Board of Registered Nurses. July 12, 2000 s H. HFC shall provide written notice to Employer within thirty (30) days in the event that any Provider terminates or breaches their contract with HFC or becomes unable to perform under such contract if, in the reasonable estimation of HFC, Employer or Enrollees may be materially or adversely affected thereby. 1. HFC shall not increase the amount of the premium to be paid by Employer or otherwise increase the compensation to be paid to HFC by Employer for services provided pursuant to this Group Plan Contract except after a period of at least 30 days from either the postage paid mailing to the Employer of written notice of such increase, at the Employer's address of mailing as reflected by the records of HFC, or the actual hand delivery to Employer by HFC of written notice of such increase. I HFC shall not decrease the amount of benefits to be provided pursuant to this Group Plan Contract except after a period of at least 30 days from either the postage paid mailing to the Employer of written notice of such decrease, at the Employer's address of mailing as reflected by the records of HFC, or the actual hand delivery to Employer by HFC of written notice of such decrease. Decrease of benefits will be contingent upon Employer's agreement with HFC's proposed benefit reduction and rate will be renegotiated. K. HFC shall keep confidential all files, records, documents and any other information pertaining to Enrollees which identifies individuals who receive professional services from HFC. HFC further agrees to restrict internal distribution of all such information and release such information internally only when necessary to the provision of services to Enrollees. Except for use reasonably necessary to the provision of services under this Group Plan Contract, or reasonably necessary to evaluate the quality of care delivered, such information shall not be disclosed without the written consent of the Enrollees. Notwithstanding the foregoing, confidential information maybe disclosed if required or permitted by applicable law. L. HFC shall require that all Providers have malpractice liability insurance coverage for $1,000,000 each occurrence and $1,000,000 in the aggregate. A HFC will carry: 1. Comprehensive general liability insurance, $1,000,000 each occurrence (bodily injury and property damage), and Business personal property insurance on all HFC facilities in the amount of $65,000. 2. Statutory Worker's Compensation for all HFC employees 3. Fidelity Bond July 12, 2000 s N. Upon termination of a Provider Agreement by a Contracting Provider ("Provider") HFC shall be liable for covered services rendered by such Provider to Enrollees who are under the care of such Provider at the time of such termination until services being rendered by the Provider are completed unless HFC makes appropriate provision for the assumption of such services by another contracting Provider. O. Every contract between HFC and its Contracting Providers will, as required by law, contain a provision to the effect that Enrollees shall not be responsible for payment to any Provider who has contracted to provide services to HFC in the event that HFC should fail to pay the Provider for services rendered. An Enrollee will forfeit one (1) EAP session for any appointment made with such Contracting Provider and not kept, except in those cases where: (a) the Contracting Provider is notified at least 24 hours in advance of the appointment that it will not be kept. X111-30191 Do ii HillHillia DHIIt The Grievance Committee will be responsible for hearing and resolving grievances between HFC and its Enrollees and Providers. The Grievance Committee will also monitor patterns of grievances in order to formulate policy changes and procedural improvements. The Grievance Committee shall be composed of one member of HFC's Board of Directors, one Provider appointed by HFC's Board of Directors, and one Enrollee appointed by HFC's Board of Directors. The primary input to the grievance Committee shall be RFC's complaint forms and other complaints which are telephoned into HFC or are received in writing by HFC. As to each complaint received in person or by telephone, a written record shall be made, including the date, identification of the individual recording the grievance and its disposition. A written record of tabulated grievances shall be periodically reviewed by HFC's Board of Directors and the President of HFC. The review procedure shall be documented, including the procedure used in consideration of tabulating grievances periodically in relation to policy and procedure review. HFC's President shall be primarily responsible for maintenance of the Grievance Committee's procedures and for conducting monthly review of the operations of the Grievance Committee and for monitoring any emergent patterns of grievances in order to formulate policy changes and procedural improvements in HFC's administration. July 12, 2000 s The President will assure that complaints are promptly reviewed by the management or supervisory staff responsible for the services or operations which are the subject of one or more complaints. Complaint forms and a copy of this grievance procedure shall be made readily available at each facility of HFC and at each Provider's office. Such forms shall be promptly made available upon receipt of a request therefore by mail, by telephone, or in person. Each Provider shall provide reasonable assistance as requested by Enrollees in filing grievances with HFC. Assistance will also be available in filing grievances by telephone at (818) 704-1444. The Grievance Committee shall acknowledge in writing by mail the receipt of each complaint and provide the complainant with the name of a representative of HFC who may be further contacted regarding the complaint within twenty (20) days of the receipt of the complaint by HFC. Notice of the disposition of the complaint will be provided to the complainant as expeditiously as is reasonable and normally within (30) days of the date upon which the complaint is received by HFC. Where HFC is unable to distinguish between a complaint and an inquiry, the communication shall be treated as a complaint. HFC and its Providers shall not discriminate against any Enrollee (including cancellation of any Group Plan Contract) in whole or in part on the ground that such Enrollee has filed one or more complaints with HFC. Any grievances from Providers, if an amicable solution cannot be reached by Provider and the Clinical Management Committee, shall be referred to the Grievance Committee and if no resolution is reached through the Grievance Committee, such grievances shall be referred to arbitration. Grievances from Enrollees may be appealed from the Grievance Committee by either the relevant Provider or by the Enrollee. HFC shall inform its Enrollees upon enrollment and annually thereafter of HFC's procedures for processing and resolving grievances, including the location and telephone number where grievances may be submitted. HFC shall keep in its files for a period of five years copies of all complaints and the response of HFC. VI. INDTViDITAL CONTINUATION OF SERVICES HFC offers its professional services only to employer or similarly constituted groups. Accordingly, if an Eligible Employee's group ceases to exist, the Group Subscriber Contract is terminated, the Eligible Employee leaves the group or otherwise becomes ineligible, the Eligible Employee and such Eligible Employee's Eligible Dependents will not be able to remain eligible to receive services from HFC unless the Eligible Enrollee becomes covered by another Group Plan Contract. July 12, 2000 s Although an Enrollee does not choose a Provider with respect to EAP services provided by HFC under this Group Plan Contract, HFC's staff will work with an Enrollee to refer the Enrollee to a Provider who is geographically close to the Enrollee and who is appropriately suited to the Enrollee's needs and preferences. MUM A-144 31 Coverage of Enrollees shall become effective immediately upon the execution of this Group Plan Contract by Employer and HFC and payment by Employer of the sum required by Paragraph II.A. of this Group Plan Contract and shall terminate at such time as this Group Plan Contract shall be terminated pursuant to the provisions hereof. I. Cancellations, Terminations, Nonrenewal: Cancellation, termination or nonrenewal of this Agreement may only be effected in accordance with the following provisions: (a) If HFC shall materially breach this Agreement and shall fail to cure such breach within sixty (60) days following receipt of a written notice to cure, then Employer may cancel this Agreement upon thirty (30) days further written notice to HFC. (b) This Agreement may be canceled, terminated or nonrenewed by HFC for the following reasons: (i) If any premium payment owed to HFC is delinquent for more than thirty-one (3 1) days, HFC will give ten (10) days written notice prior to cancellation. The date of cancellation shall be the last day for which HFC received payment. (ii) Fraud or material misrepresentation by Employer in the use of the services or facilities of HFC or Employer knowingly permits such fraud or material misrepresentation by another. In this event, cancellation shall occur thirty (30) days from the date HFC issues written notice of cancellation. (iii) Employer fails to maintain the minimum employee population of twenty-five (25) employees. In this event, termination shall occur thirty (30) days from the date HFC issues written notice of termination. July 12, 2000 0 0 (iv) HFC and Employer are unable to agree on any rate adjustment provided for hereunder. In this event, termination will occur thirty (30) days from the date HFC issues written notice of termination. (v) HFC provides Employer with sixty (60) days written notice of intent not to renew this Agreement beyond its current term. All benefits under this Agreement shall cease as of the date of cancellation, termination, or nonrenewal with HFC being released from all further obligations. (c) In the event of cancellation by HFC (except in the case of fraud or deception in the use of services or facilities of HFC or knowingly permitting such fraud or deception by another) or by Employer, HFC shall, within thirty (30) days, return to Employer the prorated portion, if any, of the money paid to HFC which corresponds to any unexpired period of which payment has been received, less any amounts due HFC. (d) Acceptance by HFC of the proper prepaid or periodic payment, after termination of this Agreement and without requiring new application, shall reinstate the Agreement as though it had never terminated or been canceled unless HFC shall, within five (5) business days of receipt of such payment, either refund the payment so made or issue to the other party a new contract accompanied by written notice stating clearly those respects in which the new contract differs from the terminated contract in benefits, coverage, or otherwise. 2. Arbitration: Except as otherwise provided herein, any controversy or claim arising out of or relating to this contract, including any claims for tort liability, bad faith liability, breach of contract, punitive damages or any other claim shall be submitted to binding arbitration before the American Arbitration Association. 3. Liability of HFC upon Provider Termination: Upon termination of a Provider Agreement, HFC shall be liable for covered services rendered by such Provider to an Enrollee who retains eligibility under the Group Plan Contract and who is under the care of such Provider at the time of such termination until the services being rendered by such Provider are completed, unless HFC makes appropriate provision for the assumption of such services by another Contracting Provider. 4. Enrollees Held Harmless: As required by California law, every contract between HFC and a Provider shall provide that in the event HFC fails to pay the Provider, the Enrollees of HFC shall not be liable to the Provider for any sums owed to the Provider by HFC. 5. All material published or distributed by Employer concerning this Group Plan Contract shall be approved by HFC prior to use. July 12, 2000 0 • 6. Both parties to this Group Plan Contract agree to permit and encourage the professional relationship between Providers and Enrollees to be maintained without interference and in a manner which would enhance the confidentiality of services. T All notices provided hereunder shall be deemed as having been properly made upon depositing the same in the United States mail, postage prepaid, and addressing such notices to HFC at its administrative office, or to Employer at the address appearing last on the books of HFC. 8. This Group Plan Contract contains all of the provisions of the agreement between parties hereto, and no promise or agreement not contained herein shall be binding on the parties unless the same is in writing, signed by the parties hereto and attached to this Group Plan Contract. Only an officer or director of HFC has the power to change, modify or waive the provisions of this Group Plan Contract, and then only in writing. Consent of Enrollees is not required to effect any such change. 9. Neither this Group Plan Contract nor any benefits hereunder, including the payment of money, is assignable, except with the prior consent of HFC. 10. If any provision of this Group Plan Contract is declared invalid or unenforceable by any arbitrator, court or other competent authority, the remaining provisions hereof shall remain in full force and effect. The failure of either party to protest any default or breach shall not constitute a waiver of such party's rights under this Group Plan Contract, or such party's rights upon any subsequent default or breach. 11. This Group Plan Contract shall be governed by and construed under the laws of the State of California. 12. Indemnification: HFC hereby agrees to indemnify and hold employer, its elective and appointive boards, officers, agents and employees, harmless from any liability for damages or claims for damages for personal injury, including death, as well as claims for property damage which may arise from HFC's negligent acts, errors, or omissions, under this Agreement. HFC agrees to and shall defend employer and its elective and appointive boards, officers, agents and employees from any suits or actions at law or in equity for damages caused, or alleged to have been caused, by reason of any of the aforesaid negligent acts, errors, or omissions. Employer hereby agrees to indemnify and hold HFC, its elective and appointive boards, officers, agents and employees, harmless from any liability for damages or claims for damages for personal injury, including death, as well as from claims for property damage which may arise from negligent acts, errors, or omissions under this Agreement. Employer agrees to and shall defend HFC and its elective and appointive boards, officers, agents and employees from any suits or actions at law or in equity for damages caused, or alleged to have been caused, by reason of any of the aforesaid negligent acts, errors or omissions. July 12, 2000 EJ 13. Claims incurred by HFC prior to or on the date of termination of either an individual Enrollee or the Group Plan Contract itself, will be paid by HFC. IN WITNESS WHEREOF, the parties have caused this contract to be executed at 4 4 California this _`19 day of LUL 4 12000. CITY OF SAN JUAN CAPISTRANO HOLMAN FAMILY COUNSELING CENTER ("HFC") A California Corporation (Signature) Ron Holman, Ph -D (Name) (Title) ?-til -';k-006 (Date) July 12, 2000 BENEFIT SCHEDULE EXHIBIT A EAP ONLY COMPANY NAME City of San Juan Capitrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 OF COMPANY: Municipality DIVISIONS: San Juan Capistrano, CA 92675 ADMINISTRATORS: N/A HOLMAN CO: HFC MEDICAL INSURANCE CARRIER: California Pers FREE EAP SESSION: 3 free EAP sessions BENEFIT RENEWAL Annually, per problem area, per family unit CONTRACT RENEWAL 07/01/01 WHEN APPLICABLE: 1. Late Cancel/No Show Penalty: An Enrollee will forfeit one (1) session Contracting Provider and not kept, except in those cases where the Contracting Provider is notified at least 24 hours in advance of the appointment that it will not be kept. 2. Management Referral for job-related problems included? Unlimited supervisor training on the management referral process. July 12, 2000 3. CISD Services/Seminars Available (indicate rate): Julia July 12, 2000 Silva is authorized to request CISD services. Available at $150 per therapist, per hour, plus travel expenses. 4. Unique Implementation Requirements: None 5. Dependent eligibility age limits and/or if the dependent is a student: 19/23 6. Insurance Renewal Date: 7/1/00 7. Following EAP sessions, refer enrollees to: California Pers Aetna (800) 756-7039 Blue Sheild Access + HMO (800) 997-3770 Cigna (800) 832-3211 Health Net (800) 654-9821 Kaiser Permanente (800) 464-4000 Maxicare (800) 234-6294 PacifiCare (800) 624-8822 PERS Care (Blue Cross) (877) 737-7776 PERS Choice (Blue Cross) (877) 737-7776 Universal Care (800) 635-6688 8. Are benefits contingent on medical insurance? No. July 12, 2000 The + 0 =- HOLMAN Group Managed Mental Health Care Services July 19, 2000 Ms. Julia M. Silva Personnel Manaer City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 Dear Julia: Enclosed please find a ratified original of our Group Contract for the City of San Juan Capistrano. We look forward to providing our services to the City of San Juan Capistrano this contract period. If there is any way I can be of assistance to you, please do not hesitate to contact me. Truly Yours, Holzhauer Executive Enclosure Cc: Mike A. Lugo, The Rule Group illi. 2 ' 2000 Where Caring Professionals Make The Difference 21050 Vanowen Street • Canoga Park, CA 91303 (818) 704-1444 • (800) 321-2843 • FAX (818) 704-9339