Resolution No. 94251
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RESOLUTION NO. 9425
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING THE EXECUTION OF A
LETTER OF UNDERSTANDING AMENDING AGREEMENT WITH
UNITED OF OMAHA LIFE INSURANCE COMPANY REGARDING
PLAN COVERAGE FOR EMPLOYEE
WHEREAS, the City of Vernon has agreements with United of
Omaha Life Insurance Company ("Omaha") for administering the City's
employee health care plan; and
WHEREAS, on August 22, 1989, the City Council of the City of
Vernon adopted Resolution No. 5657 approving an Administrative
Services Agreement with United of Omaha Life Insurance Company
("Omaha") that was effective September 1, 1989 (the "Agreement"); and
WHEREAS, Omaha denied the claims of Chino Valley Medical
Center/Chino Emergency Medical Association (Claim No. 064030733500),
Jorge F. Perez (Claim No. 063320531900), Fahim Gheybi (Claim No.
063560400900), and Brian J. Loveless (Claim No. 063610712100)
(collectively, the "Medical Providers"), for services rendered to Dan
Downing, for emergency room services; and
WHEREAS, Omaha based their denial of the claims upon a
determination that the Medical Providers are out of network providers
and not covered under the Agreement; and
WHEREAS, under the terms of the Agreement, the City makes
all final decisions on plan claims; and
WHEREAS, the Risk Manager reviewed the appeal of Dan Downing
and suggested that the City allow the one time only claims of
approximately $2,612.32 due to the circumstances and the fact that Mr.
Downing went to the nearest hospital for emergency treatment; and
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WHEREAS, in accordance with the direction of the City
Council on June 25, 2007, the Risk Manager executed an ASO Appeal
Review Request dated August 13, 2007, subject to the City Council's
approval of a letter of Understanding; and
WHEREAS, in order to avoid a delay in the processing of the
claims, the Risk Manager executed a Letter of Understanding with Omaha
on August 21, 2007, to allow benefit coverage for the Medical
Providers for Dan Downing, subject to ratification by the City
Council; and
WHEREAS, the Letter of Understanding was executed with the
understanding that any benefit allowed pursuant to the Letter of
Understanding will not apply the specific and aggregate stop loss
provisions under policy G0002R05; and
WHEREAS, the City Council desires to approve and ratify the
actions of the Risk Manager in executing the Letter of Understanding
respecting Dan Downing.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
finds and determines that the recitals contained hereinabove are true
and correct.
SECTION 2: The City Council of the City of Vernon hereby
approves and ratifies the execution of a Letter of Understanding with
United of Omaha Life Insurance Company by the Risk Manager on
August 21, 2007, a copy of which is attached hereto as Exhibit A and
incorporated herein by reference.
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SECTION 3: The City Clerk of the City of Vernon shall
certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 2nd day of October, 2007.
TEST:
MANUELA GI ON, ity Clerk
Name: Leonis C. Malbura
Title: Mayor
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, MANUELA GIRON, City Clerk of the City of Vernon, do hereby
certify that the foregoing Resolution, being Resolution No. 9425, was
duly adopted by the City Council of the City of Vernon at an adjourned
regular meeting of the City Council duly held on Tuesday, October 2,
2007, and thereafter was duly signed by the Mayor or Mayor Pro-Tem of
the City of Vernon.
(SEAL)
MANUELA GI N, City Clerk
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EXHIBIT
UNITED OjOMAHA LIFE INSURANCE COAIFANY
Woodward Health Care Service Center
P.O. Box 9
Woodward, OK 73802
�RIIIIlr7L �11W it
August 21, 2007
Mr. Willard Yamaguchi
City of Vernon
4305 S. Sante Fe Ave.
Vernon, CA 90058
Re: Dan Downing
Dear Mr. Yamaguchi,
This letter serves as an amendment to the Administrative Services Agreement between United of Omaha
Life Insurance Company ("Company") and the City of Vernon (the "Agreement"). The terms of this letter
are made a part of the Agreement and are subject to all provisions of the Agreement not in conflict with the
provisions of this letter.
The City of Vernon and Company agree as follows:
Company shall, as an exception to the terms of the City of Vernon's self -funded group health plan
(Group Plan G00021105), allow in -network benefits to apply to claim numbers 063320531900;
063560400900; 063610712100; and 064030733500. The claims were incurred between November 9,
2006 and November 10, 2006 by Mr. Dan Downing. Despite our recommendation that the claims be
processed as out -of -network according to the plan benefits, the City has requested an adjustment to the
Claims.
Any additional payment made as a result of this agreement will not be applied to the specific and
aggregate stoploss plan.
Notwithstanding anything to the contrary in the Agreement, the City of Vernon agrees that it shall
indemnify, defend and hold Company harmless from any liability, loss, costs, expenses or damages
(including, without limitation, attorneys' fees, court costs and extra -contractual and punitive damages)
incurred Vy Company arising out of or resulting from this letter or any act or omission of Company in
the performance of its duties under this letter. This obligation to indemnify, defend and hold Company
harmless shall be in addition to, and shall not replace, any other obligation of Employer in the
Agreement to indemnify, defend and hold Company harmless.
4. Company assumes no responsibility for any tax or legal consequences that the City of Vernon, the plan
sponsor or any person covered under the City of Vernon's plan may incur under any state or federal
law as a result of this letter.
Company and the City of Vernon acknowledge and agree that Company only provides ministerial
claims processing services under the self -funded group health plan and that Company has no authority
to act, and does not act, as a fiduciary for the plan in any manner whatsoever.
6. The terms of this letter shall be read together and construed as one document with the Agreement, but
to the extent of any inconsistency or ambiguity, this letter shall govern.
Mr. %%7illard Yarnar uchi
August 2I. 2007
Page 2 of 2
Re: Mr. Dan Downing
7. Except as expressly provided in this letter, all of the provisions ()l'the Agreement shall remain in full
force and effect.
S. «'here the provisions of this letter and those ol'the croup health plan conflict, the provisions of this
letter will apply.
9. 'file terms of this letter may be modified or intended only by an instrument in writing, duly executed
and delivered by the parties hereto.
10. Anv number of counterparts of this letter may be executed and each such executed counterpart shall be
deemed an original.
Sincerely,
Cory Michcl
Vice President. UnderR•riting
Date:
1(,R1�'D 1 O and .A 'C;EPI'E[) POR:
13 1 • � � -
f
nr
fo b;;iinrd by rrpresentanve of the City of rrnonl']'life: Risk Liana
Date: August 30, 2007
cc: Group Claims
SUPPORTING
DOCUMENTS
UNITED 0f OrtAHA LIFE INSURANCE COMPANY
Woodward Health Care Service Center
P.O. Box 9
Woodward, OK 73802
August 21, 2007
Mr. Willard Yamaguchi
City of Vernon
4305 S. Sante Fe Ave.
Vernon, CA 90058
Re: Dan Downing
Dear Mr. Yamaguchi,
M, RHO
This letter serves as an amendment to the Administrative Services Agreement between United of Omaha
Life Insurance Company ("Company") and the City of Vernon (the "Agreement"). The terms of this letter
are made a part of the Agreement and are subject to all provisions of the Agreement not in conflict with the
provisions of this letter.
The City of Vernon and Company agree as follows:
Company shall, as an exception to the terms of the City of Vernon's self -funded group health plan
(Group Plan G0002R05), allow in -network benefits to apply to claim numbers 063320531900;
063560400900; 063610712100; and 064030733500. The claims were incurred between November 9,
2006 and November 10, 2006 by Mr. Dan Downing. Despite our recommendation that the claims be
processed as out -of -network according to the plan benefits, the City has requested an adjustment to the
claims.
Any additional payment made as a result of this agreement will not be applied to the specific and
aggregate stoploss plan.
Notwithstanding anything to the contrary in the Agreement, the City of Vernon agrees that it shall
indemnify, defend and hold Company harmless from any liability, loss, costs, expenses or damages
(including, without limitation, attorneys' fees, court costs and extra -contractual and punitive damages)
incurred iiy Company arising out of or resulting from this letter or any act or omission of Company in
the performance of its duties under this letter. This obligation to indemnify, defend and hold Company
harmless shall be in addition to, and shall not replace, any other obligation of Employer in the
Agreement to indemnify, defend and hold Company harmless.
4. Company assumes no responsibility for any tax or legal consequences that the City of Vernon, the plan
sponsor or any person covered under the City of Vernon's plan may incur under any state or federal
law as a result of this letter.
5. Company and the City of Vemon acknowledge and agree that Company only provides ministerial
claims processing services under the self -funded group health plan and that Company has no authority
to act, and does not act, as a fiduciary for the plan in any manner whatsoever.
6. The terms of this letter shall be read together and construed as one document with the Agreement, but
to the extent of any inconsistency or ambiguity, this letter shall govern.
Mr. Willard Yanuwniclii
August 21, 2007
Page 2 of'2
Re: fir. Dan Downine
7. Except as expressly provided in this letter, all ol'the provisions of the Agreement shall remain in full
force and effect.
S. Where the provisions of this letter and those ofthe group health plan conflict, the provisions of -this
letter will apply.
9. The terms of this letter may be modified or amended only by an instrument in writing, duly executed
and delivered by the parties hereto.
10. Any number of counterparts of this letter may be executed and each such executed counterpart shall be
deemed an original.
Sincerely,
Cory Michel
Vice President, Underwritirw
Date:
AC;lttyi L) 7'O and 1 EP"l'F,D FOR
(To be signed by representative of the C5n of Vernonl
Title; Risk ilapager
Date: August 30, 2007
cc: Group Claims
CITY CLERK'S OFFICE
INTEROFFICE MEMORANDUM
DATE: October 15, 2007
TO: Willard Yamaguchi, Chief Deputy City Attorney/Risk Manager
FROM: Nelly Giron, City Clerk
RE: Resolution No. 9425 - A Resolution of the City Council
of the City of Vernon Approving and Ratifying the
Execution of a Letter of Understanding Amending
Agreement with United of Omaha Life Insurance Company
Regarding Plan Coverage for Employee
Transmitted herewith is a copy of,Resolution No. 9425 referenced
above, which was approved by City Council on October 2, 2007.
Thank you.
NG:dr
c: Karina Rueda
Resolution No. 9425