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At-39O <br /> Flexible Benefit Administrators, Inc. <br /> ADMINISTRATIVE SERVICES AGREEMENT— COBRA/HIPAA <br /> This Agreement, which shall be effective on the day of 1st day of January, 2012, has been entered <br /> between Orange County, a political subdivision of the State of North Carolina, with principal offices <br /> at 200 E. Margaret Lane, Hillsborough, North Carolina 27278 (hereinafter referred to as Client) and <br /> FLEXIBLE BENEFIT ADMINISTRATORS, INC., a Virginia Corporation whose mailing address is Post <br /> Office Drawer 2070, Virginia Beach,Virginia 23450(hereinafter referred to as FBA). <br /> This Agreement shall be for a period of one year beginning on the effective date set forth above (the <br /> "Anniversary Day'). This Agreement will renew automatically for additional periods of one year on the <br /> same terms, covenants and conditions unless FBA receives written notice from Client of Client's desire <br /> not to renew at FBA's address appearing above not less than sixty (60) days prior to the next effective <br /> Anniversary Day following the conclusion of the year period then in effect, or unless FBA notifies Client in <br /> writing not less than sixty (60) days prior to the next effective Anniversary Day of its intent not to renew <br /> the Agreement. <br /> Client desires to have FBA provide administrative and clerical functions related to Client's compliance <br /> with Health Care Coverage Continuation provisions of the Consolidated Omnibus Budget Reconciliation <br /> Act of 1985(COBRA)and the Health Insurance Portability and Accountability Act of 1996(HIPAA). <br /> 1. In consideration for the fees and charges listed below, FBA hereby agrees to perform the <br /> following administrative and clerical functions: <br /> a. Sending of required notices to current COBRA Participants and all Principal Qualified <br /> Beneficiaries (PQBs), once instructed to do so by Client via COBRA QUALIFYING <br /> EVENT NOTIFICATION for Medical, Dental, Vision, EAP and FSA for COBRA Events. <br /> FBA will prepare one Enrollment packet with two enrollment forms. One enrollment form <br /> will be for Medical only to be returned to FBA and the other enrollment form for the <br /> remaining plans to be returned directly to Orange County. <br /> b. Communicating with PQBs by mail and/or telephone regarding COBRA coverage. <br /> c. Billing, Collecting and Reporting of Premiums for COBRA Medical Only. <br /> d. Reporting enrollees to Client for COBRA Medical Only. <br /> e. Reporting terminations to Client for COBRA Medical Only. <br /> f. Per Clients request, FBA will not send Initial Notification/Department of Labor Letters to <br /> recently hired active employees at the time of their initial enrollment in the group benefit <br /> plan. <br /> g. Per Client's request, FBA will not send Global Rights Notification to all currently insured <br /> employees to inform them of all COBRA/HIPAA rights. <br /> h. If applicable, FBA will send notification of Disability Extension of eleven additional months <br /> of coverage to disabled COBRA participants for COBRA Medical Only. <br /> i. If requested by Client, FBA will send notification of Open Enrollment Period. <br /> j. If requested by Client, FBA will provide Additional HIPAA Certificates up to 24 months <br /> after participation for COBRA Medical Only. <br /> 1 <br />