2001 S Personnel - NCACC & Cinga for Health Insurance

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` ANNUAL PARTICIPATION AGREEMENT RESOLUTION TO ADOPT THE |NTERbOCAL AGREEMENT AND T]JOIN THE NORTH CAROLINA ASSOCIATION OF COUNTY COMMISSIONERS HEALTH INSURANCE TRUST VVITNES8ETH: ' WHEREAS, the Member Group desires to provide to its employees insurance and other group benefits as authorized by G. S. 153A-92(d); and WHEREAS, the North Carolina Association of County Commissioners Health Insurance Trust, d.b.a. NCACC Group Benefits Pool ("the Pnpi^) has been established by counties pursuant to G. S. 153A-445(m)(1) and G. S. 16OA-460 through 16OA-464; and WHEREAS, it is desirable for the Member Group to join the Pool in order to provide a method of risk sharing for health-related claims of its employees; NOW, THEREFORE, BE IT RESOLVED that the Board of the Member Group hereby adopts the interlocal agreement entitled "Interlocal Agreement for a Group Self Insurance Fund for Health, Dental, Life and Disability Risk Sharing,' and thereby joins and agrees to participate in the Pool, which has been formed to create a group fund to pay and service the health-related claims of the employees of the counties and other local agencies joining the Pool. FURTHER, BE IT RESOLVED that the undersigned official of the Member Group is authorized to execute the Agreement to join the Pool. TERMS AND CONDITIONS 1. Agreement and Continuation of Coverage. The term of this Agreement is for one (1) year commencing on the medical benefit plan effective date, A Member Group's coverage will be automatically renewed on the anniversary date even though payment for this coverage may not have been received. This Continuation of Coverage will be on the same terms and conditions as the expiring coverage until and unless notified by the Member Group. Each renewal shall be subject to recalculation of contributions. 2. Applicable Coverages. This Agreement applies to those coverage limits, deductibles and exposures as stated in the Summary Plan Description or otherwise provided to the Member Group at renewal. 3. Contribution Determination. Contributions are based upon the number of employees and the number of dependents applied to a specific rate, which includes estimated claims liability and/or fees, combined to create a Member Group's total annual contribution, It is the responsibility of the Member Group to provide accurate exposure data within thirty(30)days of the first of each month. Should this not be done, it will be at the discretion of the Pool to adjust contributions accordingly. 4. Charges. Changes in rates, discounts and other charges will occur only on the Member Group's renewal date and will remain in effect for a twelve (12) month period. However, the Pool reserves the right to make contribution changes in the event of substantive changes in the governing laws or the underlying plan assumptions. It is the responsibility of the Pool to inform the Member Group sixty (60) days prior to the effective date of such off cycle 5. Contribution Collection. Contributions are due on or before the fifth (5 th)of each month. 6. Claims Administration. a. Claims Filing/Reporting. All claims must be reported to the Claims Administrator in order to receive reimbursement. It is the responsibility of the employees of the Member Group to report any eligible claims. Claims must be filed as outlined in the Summary Plan Description. If a claim is made or suit is brought against the Member Group, the Member Group shall immediately forward to the Pool every demand, notice, summons or other process received by the Member Group or its representative.