2006-040-RES-Intergovernmental employee benefits pool

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IITML t41 Intergovernmental Employee Benefits Pool CONTINUATION OF COVERAGE ADMINISTRATIVE AGREEMENT City of Paris May 2006 WHEREAS, the undersigned Employer is an Employer Member of the TML Intergovernmental Employee Benefits Pool (hereinafter referred to as the "Pool"); WHEREAS, the undersigned Employer sponsors an employee benefit plan; WHEREAS, the undersigned Employer is responsible for the administration of its employee benefit plan as the Plan Administrator; and WHEREAS, the undersigned Employer wants the TML Intergovernmental Employee Benefits Pool to assist the Employer in complying with the requirements of Continuation of Coverage as required by Federal law. NOW THEREFORE, in consideration of the promises, mutual covenants and agreements contained herein, the undersigned Employer and the Pool agree as follows: I. Effective Date As of the first day of , 20_ the Pool will commence Continuation of Coverage administration for the undersigned Employer for all qualifying events occurring thereafter and during the term of this agreement. II. Employer Duties 1. The undersigned Employer will notify the Pool's Billing/Eligibility Representative assigned to the Employer via FAX or Telephone (with a written follow up) within one (1) business day of a qualifying event, as defined by the Continuation of Coverage statute and its amendments, of a Covered Employee for which the Employer has knowledge. Examples of this include termination; resignation; death; retirement if the employee does not enroll for retiree coverage when offered under the Employer's benefit plan; reduction in hours (including reduction to zero hours) and absence from work for an injury or illness after all earned sick leave, vacation leave and FMLA has been exhausted. 2. The undersigned Employer will distribute Attachment A, which advises each Covered Individual of their rights and responsibilities under Continuation of Coverage. The Employer will certify through a letter to the Pool that the Attachment A was distributed to all Covered Individuals as of the date the Pool commenced Continuation of Coverage Administration. 3. The undersigned Employer will distribute Attachment A to all employees who become covered by the Employer's benefit plan after the date the Pool commenced Continuation of Coverage administration and include verification of the distribution with the enrollment card when it is submitted to the Pool. 4. The undersigned Employer will notify the Pool via FAX or Telephone (with a written follow-up) within one (I) business day of gaining knowledge that a Covered Individual has legally separated, divorced or is no longer eligible for coverage e.g. a child, over age 19, who is no longer a full-time student as defined by the Employer's health benefit plan or the Covered employee or dependent is voluntarily dropped from coverage. 5. The undersigned Employer will notify the Pool at least ten (10) business days prior to any open enrollment period. The notice to the Pool will include the dates of the open enrollment. 6. The undersigned Employer will immediately notify the Pool of any suspected claim, demand or suit arising from the administration of Continuation of Coverage. EXHIBIT A.