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Home My WebLink About2011-392 HR - Community Eye Care to provide optional vision benefits to employees elect coverage kb COMMUNITY EYE CARE, LLC VISION SERVICES AGREEMENT Employ Orange County Government Address: Human Resources Dept.,200 S. Cameron St.,PO Box 8181 City: Hillsborough State: NC Zip: 27278 Telephone: 919-245-2558 Fax: 919-644-3009 E-mail: dshepherdAco.oran e Company Contact: Diane Shepherd Tax ID#: 566000327 Total Employees with Company: 825 Date: January 1, 2012 This vision services agreement is made and entered into by and between Community Eye Care, LLC, a North Carolina vision benefits company with its principal office located in Charlotte, Mecklenburg County, North Carolina (hereinafter referred to as "CEC"), and Orange County Government, a public sector employer located in Hillsborough, Orange County, North Carolina (hereinafter referred to as "Orange County"). RESPONSIBILITIES OF CEC. For the duration of this agreement, CEC shall: • Administer the routine vision benefit outlined in Schedule 1 (Benefit and Rates). • Maintain an up-to-date database of member eligibility. • Invoice Orange County once per month,based on the most current eligibility file. • Maintain an adequate network of credentialed providers. • Credential participating providers in accordance with NCQA standards. • Manage claims processing and claims payment in an accurate and timely manner. • Manage member services related to the CEC vision plan. RESPONSIBILITIES OF ORANGE COUNTY. For the duration of this agreement, Orange County shall: • Offer the CEC vision plan to its employees as an optional (voluntary)benefit. • Periodically transfer accurate enrollment data to CEC. • Payroll deduct on behalf of CEC vision enrollees, and forward the deducted amounts to CEC once per month. • Include CEC plan descriptions in all appropriate Orange County communications to employees (e.g.,benefits manual, informational mailings, etc.). PERFORMANCE STANDARDS. CEC will administer the Orange County vision plan in accordance with industry standards. Should Orange County identify any issues related to CEC's performance of its duties, Orange County will bring these to the attention of CEC, and CEC will take steps to resolve the issues. Both CEC and Orange County agree that deficiencies in service or other administrative functions should be addressed promptly and that reasonable attempts should be made to achieve satisfactory resolution within 60 days or less. TERM. This agreement becomes effective on January 1, 2012 and will remain in effect for an initial term of twelve (12) months. It will automatically renew on each anniversary date for a similar term until such time as it is terminated in writing by Orange County. In the absence of serious and persistent performance issues, this contract cannot be terminated at any time during a twelve (12) months benefit cycle. However, if Orange County wishes to terminate the CEC vision plan at the end of a twelve (12) months benefit cycle, the County may do so by providing 60 days' prior written notice to CEC. NOTICES. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Community Eye Care, LLC Attention: Diane Shepherd 2359 Perimeter Pointe Parkway P.O. Box 8181 Suite 150 Hillsborough,NC 27278 Charlotte,NC 28208 Notice shall be deemed duly served upon its deposit in a repository of the United States Postal Service according to the requirements of this section. DISPUTES. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. The Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. Community Eye Care,LLC: Orange County Government: ' r By: By: of Title: coo CF"D Title: Date: IoZ ka Vaa Date: This instrument has been approved as to technical content. Katherine Cathey, Department Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. —U",4,0 A Aw. Office of the Finance Director This instrument has been approved as to form and legal sufficiency. Of " e of the County Attorney Schedule 1—Benefit and Rates The routine vision benefit offered by CEC to employees of Orange County consists of- One routine eye examination every 12 months ($20 co-pay) A $150 allowance for eyewear every 12 months A standard contact lens fitting, as needed,for new fits or re-fits ($20 co-pay) The allowance can be applied to frames, spectacle lenses, contact lenses, special lens options, or any combination. As long as the member selects eyewear having a retail price that's less than or equal to the allowance, they incur no out-of-pocket expense for eyewear at the time of service. If the selected eyewear has a retail price that exceeds $150, the member is responsible only for the balance(i.e.,retail minus $150). The 3-tier semi-monthly rates are as follows: Employee Only $4.87 Employee+ One $9.27 Employee+Family $13.65 The above rates are guaranteed for three years (36 months). The CEC vision plan will be offered to employees as a pre-tax benefit, with payment handled through payroll deduction. Members who obtain exams and eyewear from a non-credentialed provider still receive their full benefit. Such encounters are not treated as "out-of-network" in the traditional sense. The member simply submits a claim to Community Eye Care and is reimbursed for the cost of their exam (minus the $20 co-pay) and for the cost of their eyewear(up to a maximum of$150). NOTES ♦ The Community Eye Care vision plan applies solely to routine eye examinations and the purchase of eyewear. The following are not covered under the plan: a) medical eye care, b) surgical eye care, c) low vision services, d)emergency eye care, e)periodic contact lens evaluations ♦ Benefits may not be carried forward to a subsequent benefit period. ♦ Coordination of benefits is not permitted. ♦ Family coverage includes the employee, spouse and any children or persons who are listed as dependents for income tax purposes. ♦ Vision benefit coverage will remain in effect for a minimum of twelve (12) months (or, with respect to new employees who enroll mid-year, until the next renewal date). Covered members aren't permitted to terminate coverage prior to the next open enrollment period unless: a) the employee is terminated from employment,or b) the employee has undergone a qualifying event. At the time of open enrollment, vision coverage will automatically renew unless voluntarily terminated by the employee. ♦ Additions or deletions of members which are not received by the first day of a given month will be effective as of the first day of the following month. Pro-rating of benefit rates for a partial month's coverage is not permitted. ♦ Notice of termination will need to be received within thirty(30)days of an employee's termination date to obtain a credit. Community Eye Care will only be obligated to provide a credit for previously terminated employees dating back sixty(60)days. ♦ CEC vision plan members whose employment with Orange County becomes terminated will be given the option of continuing their vision coverage at the same rates that applied prior to termination of employment. The administration of continued coverage will be entirely the responsibility of CEC. Orange County will retain no administrative or financial obligations whatsoever with respect to CEC vision enrollees who are no longer employed by the County.