Anthem Blue Cross (Blue Cross of California) - FY2019-007 Anthem Blue Cross
EMPLOYEE ASSISTANCE PROGRAM
GROUP EAP AGREEMENT
("EAP Agreement")
for
City of Rancho Palos Verdes
Anthem Blue Cross (herein referred to as "EAP Service Provider") agrees to provide the
Employee Assistance Program services (EAP Services) herein specified for Group.
EAP AGREEMENT EFFECTIVE DATE 1/1/19
This EAP Agreement becomes effective at 12:01 a.m., on the Effective Date.
A Binding Arbitration Clause is included in this EAP Agreement.
Anthem Blue Cross is the trade name of Blue Cross of California.Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company
are independent licensees of the Blue Cross Association.ANTHEM is a registered trademark of Anthem Insurance Companies,Inc.
CA_Agreement Enhanced 110818
TABLE OF CONTENTS
DEFINITIONS 1
ELIGIBLE EMPLOYEE FEE 2
EAP SERVICES, EXCLUSIONS, LIMITATIONS, AND ADMINISTRATIVE POLICIES 2
HOW TO OBTAIN EAP SERVICES 2
ELIGIBILITY 3
COMMENCEMENT AND DURATION OF THIS EAP AGREEMENT 3
ADMINISTRATION 4
PROFESSIONAL- PATIENT RELATIONSHIP 4
GENERAL PROVISIONS 5
SERVICES EXHIBIT- EAP SERVICES, EXCLUSIONS, AND LIMITATIONS 9
ELIGIBLE EMPLOYEE FEE EXHIBIT 13
BINDING ARBITRATION EXHIBIT 14
ARTICLE I
DEFINITIONS
The following terms, when used in this EAP Agreement or any amendments, riders, exhibits or
schedules hereof, are defined as follows:
1.1 EAP Services mean those services delineated in the SERVICES EXHIBIT that an EAP
Participant is entitled to receive as a result of or pursuant to this EAP Agreement, and
that are hereby incorporated by reference into and subject to the terms of this EAP
Agreement.
1.2 EAP Agreement or Agreement means the contract entered into between EAP Service
Provider and a Group under which EAP Service Provider provides EAP Services to EAP
Participants. EAP Agreement(s) includes arrangements established by EAP Service
Provider, or by persons or entities utilizing the EAP Practitioner, pursuant to a contract
with EAP Service Provider.
1.3 Group means any Employer, Labor Union or Labor Management Trust Fund,
association, or other Group to which this EAP Agreement is issued.
1.4 EAP Practitioner means, with regard to any health-related services provided under this
Agreement, an appropriately licensed health care professional who has agreed to
provide EAP Services for EAP Participants. In limited situations involving health-related
services, EAP Practitioner can also include licensed health care professionals who are
not participating in the applicable EAP network, but who have been approved by EAP
Service Provider and have agreed to perform a one-time or set number of EAP Services
for a particular EAP Participant. For non-health-related services provided under this
Agreement, including but not limited to legal consultations, financial consultations, and
concierge or convenience services, EAP Practitioner means an appropriately trained
and/or licensed professional approved by and/or with an agreement with EAP Service
Provider to provide a one-time or set number of EAP Services to an EAP Participant.
1.5 EAP Participant(s) means an Eligible Employee and any Eligible Household Members
who are entitled to EAP Services under this Agreement and for whom Eligible Employee
Fees are paid by Group.
1.6 Eligible Employee(s) means the Group's eligible employees as determined and
specified by the Group. Eligible Employee(s) may also include other employees, as
otherwise agreed upon by Group and EAP Service Provider.
1.7 Eligible Household Member(s) means the spouse, domestic partner, dependents, and
others whose place of residence is the same as the Eligible Employee, and/or those
dependents who do not share the same residence as the Eligible Employee but due to
applicable state law or court order are required to be covered under this EAP
Agreement.
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ARTICLE II
ELIGIBLE EMPLOYEE FEE
2.1 Group shall pay to EAP Service Provider a monthly fee and any other charges ("Eligible
Employee Fee") to cover all EAP Participants. The amount of the Eligible Employee
Fee and payment specifications under this EAP Agreement are set forth in the
ELIGIBLE EMPLOYEE FEE EXHIBIT.
2.2 EAP Service Provider shall not increase the Eligible Employee Fee, except upon at least
sixty (60) calendar days advance written notice to Group.
2.3 The Group will pay all Eligible Employee Fees, unless other provisions for payment are
agreed to in advance by EAP Service Provider.
2.4 If a state or any other taxing authority imposes a tax on EAP Service Provider that is
based on the Eligible Employee Fee, the Eligible Employee Fee stated in this EAP
Agreement will be increased by an amount sufficient to cover that tax. This increase will
begin on the date the tax goes into effect. Any subsequent change to the tax may result
in a further increase in Eligible Employee Fee.
ARTICLE III
EAP SERVICES, EXCLUSIONS,
LIMITATIONS AND ADMINISTRATIVE POLICIES
3.1 EAP Service Provider and Group agree that EAP Service Provider or its designee shall
provide EAP Services to EAP Participants under this EAP Agreement as set forth in
SERVICES EXHIBIT.
3.2 EAP Services do not include assessment or treatment by a psychiatrist.
3.3 EAP Service Provider may assist EAP Participants to obtain necessary and appropriate
levels of care in the community or through the EAP Participant's health plan.
ARTICLE IV
HOW TO OBTAIN EAP SERVICES
4.1 All EAP Services must be obtained by contacting EAP Service Provider directly for
authorization and referral for EAP Services to an EAP Practitioner. EAP Service
Provider does not reimburse EAP Participants for unauthorized treatment or services
• obtained from non-EAP Practitioners. EAP Service Provider maintains an online EAP
Practitioner directory and a 24-hour toll-free or local telephone number to find an EAP
Practitioner. In non-emergency situations, EAP Participants are provided names of EAP
Practitioners or other resources. When the EAP Participant contacts the EAP Service
Provider to obtain non-emergency EAP Services, the EAP Service Provider will conduct
a telephone assessment. The telephone assessor will make a good faith effort to:
provide crisis intervention over the telephone; arrange an appointment with an EAP
Practitioner, or if an EAP Practitioner is not reasonably available or accessible, provide
access to a licensed mental health professional in the EAP Participant's area and/or
provide names of licensed mental health professionals in the area; or direct the EAP
Participant in obtaining more intensive, acute care services. EAP Services are not
intended to be emergency services. Any EAP Participant calling for an emergency or
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urgent situation will be immediately referred to a licensed mental health professional or
an appropriate facility.
ARTICLE V
ELIGIBILITY
5.1 Eligible EAP Participants will be able to obtain EAP Services on the EAP Agreement
Effective Date. The ability to obtain EAP Services under this EAP Agreement will
terminate at 11:59 P.M. on the last day of an EAP Participant's eligibility or termination
of this Agreement, whichever occurs first.
5.2 The Group shall provide a count of all Eligible Employees upon implementation of this
EAP Agreement. The Group shall inform the EAP Service Provider when the count
varies by 10% from any previous report.
5.3 Only EAP Participants are eligible for services under this EAP Agreement.
5.4 Group shall be responsible for determining Eligible Employees. Any disputes or
inquiries regarding eligibility (including renewal and reinstatement) shall be referred by
the EAP Service Provider to the Group, which shall advise the EAP Service Provider of
its determination.
5.5 Eligibility under this EAP Agreement shall be limited to residents of the United States,
including any U.S. Territories.
5.6 EAP Service Provider shall have the sole right to terminate eligibility of any EAP
Participant who uses threatening or aggressive behavior.
ARTICLE VI
COMMENCEMENT AND DURATION OF THIS EAP AGREEMENT
TERMINATION - RENEWAL
6.1 EAP Service Provider shall have the sole right to change EAP Services or other
provisions in this EAP Agreement upon at least sixty (60) days advance written notice to
Group. If Group does not object or reject such changes before the 60 day notice period
expires, such changes shall be deemed accepted by the Group.
6.2 The Initial Term of this EAP Agreement shall be one year beginning on the Effective
Date of this EAP Agreement and shall automatically renew for one year periods
(hereinafter the "Renewal Term") unless at least thirty (30) calendar days prior to the
end of the Initial Term or any Renewal Term, the Group or EAP Service Provider
provides the other party with written notice of termination.
6.3 Should either party be in default by the failure to reasonably perform any of the
covenants and conditions contained herein, the non-defaulting party shall have the right
to give the defaulting party written notice of the default. The defaulting party shall have
thirty (30) days from the receipt of written notice to remedy the breach, default or failure
to perform. If the default is not cured within the time period noted, the EAP Agreement
will automatically terminate. EAP Service Provider may, at its sole discretion, reinstate
this EAP Agreement after receipt of the proper Eligible Employee Fee if such payment is
received on or before the due date of the succeeding payment. Both parties may
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terminate this EAP Agreement immediately if the other party should engage in
fraudulent conduct with respect to this EAP Agreement.
6.4 Notwithstanding any other provision, this EAP Agreement may be terminated at any time
by Group or EAP Service Provider upon at least ninety (90) days written notice to the
other.
6.5 In the event of termination of this EAP Agreement, EAP Service Provider agrees that
EAP Practitioner will complete the provision of EAP Services that were, in EAP Service
Provider's reasonable opinion, being delivered prior to such termination and continuity of
care warrants completion of such services subject to applicable EAP Services covered
by this Agreement (hereinafter "Post Termination Services"). In the event EAP Service
Provider provides Post Termination Services, both parties agree that those Post
Termination Services shall be provided and reimbursed by Group in accordance with the
terms of this Agreement.
ARTICLE VII
ADMINISTRATION
7.1 EAP Service Provider agrees to investigate and resolve any complaints or grievances
received from EAP Participants with regard to EAP Services in accordance with the
Grievance Procedures provisions stated in the Combined Evidence of Coverage and
Disclosure Form. Disputes between the Group and EAP Service Provider will be
resolved in accordance with the ARBITRATION EXHIBIT attached to this EAP
Agreement.
ARTICLE VIII
PROFESSIONAL-PATIENT RELATIONSHIP
8.1 EAP Service Provider will make every reasonable effort to arrange for EAP services as
herein provided in accordance with the prevailing national and regional professional
standards.
8.2 Group understands and acknowledges that the relationship between the EAP Participant
and EAP Practitioners and other participating professionals shall be subject to the rules,
limitations, and privileges incident to any professional relationship, including but not
limited to the doctor-patient or therapist-patient relationship. EAP Service Provider shall
be solely responsible, without interference from Group or any of its agents, to the EAP
Participant for arranging EAP Services, subject to Section 8.3.
8.3 Group understands and acknowledges that the operation and maintenance of the EAP
Practitioners' offices and the provision of all services shall be solely and exclusively
under the control and supervision of the EAP Practitioner, including, but not limited to,
all authority and control over the selection of staff, supervision of personnel and
operation of the professional practice, and/or the provision of any particular professional
service or treatment.
ARTICLE IX
GENERAL PROVISIONS
9.1 Group understands and acknowledges that this EAP Agreement provides EAP Services
only, is not an insurance policy, and does not indemnify nor reimburse any EAP
Participant or Group for the cost of health care services.
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9.2 EAP Service Provider will furnish promotional materials to Group as agreed upon. Group
shall distribute only approved EAP materials to EAP Participants.
9.3 Unless prohibited by applicable state or federal law, any dispute or controversy arising
between Group and EAP Service Provider or between an EAP Participant and EAP
Service Provider, involving this EAP Agreement, any of its terms and conditions, its
breach or nonperformance shall be settled pursuant to the BINDING ARBITRATION
EXHIBIT attached to this EAP Agreement.
9.4 Group, together with its respective successors and assignees, agrees to indemnify,
defend, and save EAP Service Provider, its parent, affiliates, subsidiaries and their
respective officers, directors, employees and agents harmless from and against all loss,
cost, claims, actions, and liabilities, including reasonable attorney's fees, arising in
connection with this EAP Agreement as a result of, or attributable to, the intentional act
or gross negligence of Group, or misconduct of group, or Group's officers, directors,
employees, or agents.
9.5 EAP Service Provider agrees to indemnify, defend, and save Group, its parent, affiliates,
subsidiaries and their respective trustees, officers, directors, employees and agents
harmless from and against all loss, cost, claims, actions, and liabilities, including
reasonable attorney's fees, arising in connection with this EAP Agreement as a result of,
or attributable to, the intentional act or gross negligence of EAP Service Provider, or
EAP Service Provider's officers, directors, employees, or agents.
9.6 Whenever it shall become necessary for either party to serve notice on the other
respecting this EAP Agreement, such notice shall be in writing and shall be served by
certified mail, return receipt requested, addressed as follows:
a. If served on Group, it shall be addressed to:
City of Rancho Palos Verdes
30940 Hawthorne Blvd.
Rancho Palos Verdes, CA 90275
(310) 544-5331
b. If served on EAP Service Provider, it shall be addressed to:
Anthem EAP
Anthem Blue Cross
9655 Granite Ridge Drive, 6th floor
San Diego, California 92123
9.7 EAP Service Provider shall maintain an EAP Practitioner network to provide EAP
Services to Group. Subject to applicable California state or federal law and regulation,
EAP Service Provider shall have final authority to interpret its contracts with providers,
and the Group agrees that (a) it is not a party to EAP Service Provider's contracts with
providers and (b) it will accept EAP Service Provider's interpretations of said contracts.
Furthermore, EAP Service Provider shall have full authority and discretion to resolve any
questions or disputes with providers that participate in any of EAP Service Provider's
provider networks, except as applicable law provides for judicial or regulatory review of
such disputes, and the Group will accept said resolution of such matters as final.
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9.8 In the event that EAP Service Provider fails to pay the EAP Practitioner for costs of EAP
Services, the EAP Participant shall not be liable to the EAP Practitioner for any sums
owed. EAP Service Provider does not pay non-EAP Practitioners nor reimburse EAP
Participants for any sums they may pay directly to any EAP Practitioner for services
rendered.
9.9 If any provision of this EAP Agreement is held to be illegal or invalid for any reason,
such decision shall not affect the validity of the remaining provisions of this EAP
Agreement, and such remaining provisions shall continue in full force and effect unless
the illegality or invalidity prevents the accomplishment of the objectives and purposes of
this EAP Agreement.
9.10 In the event Group is regulated under the Employee Retirement Income Security Act of
1974 (ERISA), Group covenants and agrees that it and not EAP Service Provider shall
be responsible for meeting all requirements of ERISA. EAP Service Provider will
cooperate with Group in supplying Group with any information within its possession to
aid Group in meeting any ERISA reporting requirements.
9.11 In the event Group is subject to the Consolidated Omnibus Budget Reconciliation Act
(COBRA) and any regulations adopted thereunder, or any similar state law requiring the
continuation of EAP Services for EAP Participant, and the EAP Participant is eligible to
retain EAP Services under the EAP Agreement during any continuation period or
election period, the Group must continue to certify the eligibility of the EAP Participant
and/or pay the monthly Eligible Employee Fee for continuation coverage.
9.12 EAP Service Provider may designate an account manager who shall serve as the liaison
between EAP Service Provider and Group.
9.13 The relationship between Group, EAP Service Provider and EAP Practitioner arising
from this EAP Agreement is that of independent contractors. Neither this EAP
Agreement, nor the activities of Group, EAP Service Provider and EAP Practitioner
pursuant to this EAP Agreement, shall constitute the parties as joint venturers, partners,
principal and agent, master and servant, or employer and employee; and neither party
shall hold itself out to the public as having other than an independent contractor
relationship with the other party. None of the parties shall have the power to bind or
obligate the other party in any manner, other than as is expressly set forth in this EAP
Agreement.
9.14 This EAP Agreement is non-assignable by either party without the prior written consent
of the other party. EAP Service Provider may, in its sole discretion, delegate
administrative functions to a vendor, successor, subsidiary, affiliate, parent or any other
entity under its control. This EAP Agreement is entered into by and between the parties
identified herein and for their benefit and the benefit of only the parties. There is no
intent by either party to create or establish third party beneficiary status or rights or their
equivalent in any EAP Participant or third party, other than the parties, that may be
affected by the operation of this EAP Agreement, and no such EAP Participant or third
party shall have any right to enforce any right or claim any benefit created or established
under this EAP Agreement.
9.15 This EAP Agreement, together with the Combined Evidence of Coverage and Disclosure
Form, any endorsements and amendment, constitute the entire EAP Agreement of the
parties. This EAP Agreement may only be changed by a written modification signed by
EAP Service Provider.
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9.16 To the extent not preempted by federal law or regulation, this Agreement will be
governed, interpreted and enforced to remain in the compliance with the laws of the
state of California, along with applicable federal statutes and regulations. Nothing
contained in this Agreement will be construed as EAP Service Provider doing business
in any state or jurisdiction in which it is not duly authorized.
9.17 EAP Service Provider acknowledges that it is a "covered entity" (as defined in 45 C.F.R.
pt. 160.103) for purposes of the Health Insurance Portability and Accountability Act of
1996 ("HIPAA") when providing the EAP Services. EAP Service Provider represents
and warrants that for as long as the EAP Service Provider creates, receives, maintains
or transmits the "protected health information" (PHI) (as defined in 45 C.F.R. pt.
160.103) of EAP Participants, EAP Service Provider will comply with HIPAA, the Health
Information Technology for Economic and Clinical Health (HITECH) Act and their
implementing regulations with respect to EAP Participants' PHI.
In addition, it is understood and agreed that for purposes of maintaining EAP Participant
privacy, provider-patient confidentiality, and EAP Service Provider's duties and
responsibilities as the Covered Entity in connection with the requirements imposed by
HIPAA and the privacy and security regulations promulgated thereunder, all records
relating to services provided under this Agreement shall be confidential property of EAP
Service Provider and can only be disclosed to Group upon written release by EAP
Participant or otherwise required by law.
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IN WITNESS WHEREOF, the parties have caused this agreement to be executed in duplicate
by affixing the signatures of duly authorized officers.
Anthem Blue Cross City of Rancho Palos Verdes
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Jeff Spahr 6'4W U4 YAP
Printed Name Printed Name
VP, Specialty Business Development toSPU"v-( (1r.rL( 4 G6Z-
Title Title
190 S. Via Merida gO t-IO P JTK6W e, &-VD .
Street Address Street Address
Thousand Oaks, CA 91362 2JO K,0 12, 5 V SGSCf9'
City, State, Zip City, State, Zip 9 --7-
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Page 8
SERVICES EXHIBIT
EAP SERVICES, EXCLUSIONS & LIMITATIONS
A. EAP CORE SERVICES are included in all group agreements
1. Up to 4 counseling sessions per unique presenting problem, per 12 month
period, per EAP Participant. Counseling sessions shall be per unique presenting
problem for issues or concerns directly impacting the EAP Participant.
Counseling sessions are provided when the EAP assessment reveals that the
presenting problem has a reasonable and likely chance of improving as a result
of short-term counseling that is focused on problem resolution. Notwithstanding
any provision to the contrary, EAP Service Provider shall not cover any
counseling sessions beyond the limit noted above, unless agreed to in writing by
EAP Service Provider.
2. Referral to appropriate healthcare benefit and/or clinical resources in the
community in situations where the EAP Participant's presenting problem
warrants long-term treatment, hospitalization or a more specialized level of care.
3. 24 hours per day/ 7 days per week/ 365 days per year toll-free telephone access
to a mental health clinician.
4. Legal Referrals & Discounted Fees: One free 30-minute telephone or in-person
consultation with a licensed attorney.
5. Financial Consultation: Unlimited telephone consultations with an appropriate
Financial Consultant.
6. Identity Monitoring and Theft Recovery: Credit monitoring and telephone
consultation to help recovery from and minimize the impact of a breach of
identity.
7. Tobacco Cessation: Online educational tools and unlimited access to the EAP
website for information and referral.
B. EAP ENHANCED SERVICES
® EAP Enhanced Services
By checking this box, Group has elected to receive the Core Services as
listed in section A as well as the Enhanced Services listed in section C.
Fees and charges for the EAP Enhanced Services shall be in accordance with
the Eligible Employee Fee Exhibit attached to this Agreement.
1. Program Orientation
a. EAP Service Provider shall supply Group with an Employee Orientation
program designed to introduce and train employees on the available EAP
Services.
2. Personalized Account Management
a. A designated Account Manager will serve as an account liaison between
the EAP Service Provider and Group to ensure overall success of the
EAP.
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b. Consultation with the Group regarding the EAP Services, including
program design, development and implementation of such EAP Services.
3. EAP Training and Critical Incident Response Services.
a. Trainings
i EAP Service Provider agrees to provide a total of 6 onsite training
hours per contract year made available upon Group's request for
workshops and training sessions, and/or EAP representation at
health/wellness/benefits fairs. Additional hours shall be billed at a fee
for service rate.
b. Critical Incident Response (CIR)
i A licensed clinician is provided onsite to meet with affected
employees in response to a traumatic event in the workplace.
ii EAP Service Provider agrees to provide or conduct up to 4 CIR hours
per contract year for Group. CIRs are subject to the limitations of the
attached Agreement, the covered EAP Services and corresponding
exclusions. Additional hours shall be billed at a fee for service rate].
3. Consultations
a. Unlimited telephone consultation available for management in regard to
workplace related issues.
b. Unlimited Critical Incident Response Management Consultation (CIRM)
provided to assist Group in organizing and planning its response to a
significant traumatic event in the workplace.
c. Consultations to management regarding reorganizations that affect
employees.
5. Consultations to employees and management to assist with the successful
reintegration of employees who are returning to work after an extended absence
for behavioral health or substance abuse issues. Consultation on Group's policy
and procedures related to Drug-Free Workplace requirements and substance
abuse.
6. Promotional Materials
a. Materials will be provided that explain the EAP Services and assist Group
in promoting the EAP to employees. Materials will be provided within a
reasonable period of time after the execution and effective date of the
Agreement, by the EAP Service Provider. On an annual basis the group
may request replacement documents to educate new employees, and a
reasonable supply as determined by EAP Service Provider in order to re-
educate existing employees. EAP Service Provider shall send such
materials to the Group in bulk, unless mutually agreed to otherwise by
both parties.
b. The EAP Service Provider will periodically distribute electronic materials
such as monthly and quarterly promotions to Group's designated
recipient(s).
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6. Work Life Service
a. Unlimited consultation to provide resources and information related to
child/adult care and daily living issues. This includes telephone
consultations, live chat and online web-based self search.
7. Activity Reporting
a. Depending on group size and plan design the Group will receive either
Quarterly, Semi-Annual or Annual EAP utilization reports with program
recommendations.
8. ADDITIONAL BUY UP OPTIONS:
a. Tobacco Cessation: Online educational tools and telephone consultation
with a tobacco cessation coach, unlimited access to the EAP website for
information and referral.
b. US Dept. of Transportation Substance Abuse Professional Evaluator
- Network and case management services. Available as an integrated
PEPM rate, or on a Fee- For- Service basis.
c. Fitness For Duty services:
A traditional FFD evaluation that assesses the EAP Participant's
emotional and psychological capacity to perform their designated job.
A Fitness for Duty Violence Screen (FFD-VS). A traditional fitness-for-
duty evaluation that incorporates additional screening for violence
potential across specific risk factors for predatory violence. The FFD-VS
is designed for those situations when threats, violence, hostility or anger
are the prominent features of the behavioral concern.
LIMITATIONS
1. In those situations where the EAP Participant's needs are beyond the scope of
the EAP Services described herein or as reasonably interpreted by EAP Service
Provider, the EAP Participant may be referred to a local resource or the Group's
group health plan or health benefit/insurance plan for services that are not a part
of or covered by the terms of this Agreement.
2. Under the terms of this Agreement, Critical Incident Response Services shall be
limited to "short-term" interventions Service hours in excess of the contracted
upon amount shall be billed on a fee for services basis.
3. EAP Service Provider will not be liable for any failure to perform any of its
obligations hereunder by reason of acts of God or the elements; acts, delays and
failures to act by governmental authorities; riots, insurrections, terrorism,
sabotage and war; interruption, suspension, curtailment or other disruption of
utilities; or other matters beyond such party's reasonable control.
EXCLUSIONS - EAP Services do not include the following:
1. EAP Service Provider is not responsible for the inclusion or exclusion of any
particular service or benefit under an EAP Participant's other coverage, such as
a group health plan or health benefit/insurance plan.
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2. Evaluations or reports for a legal proceeding.
3. Authorizations for an employee to take a leave of absence or time off from the
workplace.
4. Counseling mandated by a court of law or government agency, except as
otherwise covered under this Agreement.
5. Specialized treatment or evaluations required as a condition of parole, probation,
custody, visitation or forensic evaluations.
6. Determinations or reports related to Family Medical leave Act or Short/Long
Term Disability.
7. Any onsite service where the safety of the provider would be considered at risk.
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ELIGIBLE EMPLOYEE FEE EXHIBIT
1. The Eligible Employee Fee is $1.20 per Eligible Employee per month.
2. On-site Critical Incident Response Management in excess of the services
outlined in SERVICES EXHIBIT, will be billed at$300.00 per hour, per service
provider.
3. On site Employee Training or Educational Workshops in excess of the services
outlined in SERVICES EXHIBIT, will be billed at $250.00 per hour, per presenter.
4. US Department of Transportation Substance Abuse Professional evaluation and
case management services will be billed at Five Hundred Fifty Dollars $550.00
per case.
5. Fitness for Duty Evaluations
a. Traditional Fitness for Duty Evaluation: $2,500.
b. Psychological Fitness for Duty Violence Screen $3,500.
c. Additional specialized services available and billed at a rate of up to $500
per hour.
d. Cancelation fee of up to $1200 may apply.
6. Additional EAP Services and alternative rate schedules may be available to the
Group upon EAP Service Provider's discretion and written agreement.
7. The Group will reimburse all mutually agreed upon travel costs of EAP Service
Provider and/or subcontracted vendors retained by EAP Service Provider to
provide any additional services beyond those listed in this Agreement.
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BINDING ARBITRATION EXHIBIT
ALL DISPUTES INCLUDING BUT NOT LIMITED TO DISPUTES RELATING TO THE
DELIVERY OF SERVICES UNDER THE POLICY/PLAN OR ANY OTHER ISSUES RELATED
TO THE POLICY/PLAN AND CLAIMS OF MEDICAL MALPRACTICE MUST BE RESOLVED
BY BINDING ARBITRATION, IF THE AMOUNT IN DISPUTE EXCEEDS THE
JURISDICTIONAL LIMIT OF SMALL CLAIMS COURT. It is understood that any dispute
including disputes relating to the delivery of services under the plan or any other issues related
to the plan, including any dispute as to medical malpractice, that is as to whether any medical
services rendered under this contract were unnecessary or unauthorized or were improperly,
negligently or incompetently rendered, will be determined by submission to arbitration as
provided by California law, and not by a lawsuit or resort to court process except as California
law provides for judicial review of arbitration proceedings. Both parties to this contract, by
entering into it, are giving up their constitutional right to have any such dispute decided in a
court of law before a jury, and instead are accepting the use of arbitration. YOU AND ANTHEM
BLUE CROSS AGREE TO BE BOUND BY THIS ARBITRATION PROVISION AND
ACKNOWLEDGE THAT THE RIGHT TO A JURY TRIAL OR TO PARTICIPATE IN A CLASS
ACTION IS WAIVED FOR BOTH DISPUTES RELATING TO THE DELIVERY OF SERVICE
UNDER THE POLICY/PLAN OR ANY OTHER ISSUES RELATED TO THE POLICY/PLAN
AND MEDICAL MALPRACTICE CLAIMS.
The Federal Arbitration Act shall govern the interpretation and enforcement of all proceedings
under this Binding Arbitration provision. To the extent that the Federal Arbitration Act is
inapplicable, or is held not to require arbitration of a particular claim, state law governing
agreements to arbitrate shall apply.
The arbitration findings will be final and binding except to the extent that state or federal law
provides for the judicial review of arbitration proceedings.
The arbitration is initiated by the Member making a written demand on ANTHEM BLUE
CROSS. The arbitration will be conducted by a single neutral arbitrator from Judicial Arbitration
and Mediation Services ("JAMS"), according to JAMS' applicable Rules and Procedures. If for
any reason JAMS is unavailable to conduct the arbitration, the arbitration will be conducted by a
single neutral arbitrator from another neutral arbitration entity, by agreement of the Member and
Anthem Blue Cross or by order of the court, if the Member and Anthem Blue Cross cannot
agree. If the parties cannot agree on the individual neutral arbitrator, the arbitrator will be
selected in accordance with JAMS Rule 15 (or any successor rule).
The costs of the arbitration will be allocated per the JAMS Policy on Consumer Arbitrations.
Unless You and Anthem Blue Cross agree otherwise, the arbitrator may not consolidate more
than one person's claims, and may not otherwise preside over any form of a representative or
class proceeding.
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