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HomeMy WebLinkAboutResolution 88-R-26 Authorizing CM to Execute a One Year Extension with CCMSI04/27/2026 88-R-26 A RESOLUTION Authorizing the City Manager to Execute a One-Year Contract Extension with Cannon Cochran Management Services Inc. for Third Party Administration of General Liability and Worker’s Compensation Claims WHEREAS, the City of Evanston and Cannon Cochran Management Services Inc. (“CCMSI”) executed a Professional Services Agreement (“Agreement”) for third party administration of general liability and worker’s compensation claims in 2021 and subsequently executed two one-year extensions in 2024 and 2025; and WHEREAS, the Evanston City Council believes entering into a one-year extension from May 1, 2026 to April 30, 2027 to this Agreement with CCMSI is in the best interests of the citizens of Evanston, NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF EVANSTON, COOK COUNTY, ILLINOIS: SECTION 1: That the City Manager is hereby authorized and directed to sign, and the City Clerk is hereby authorized and directed to attest on behalf of the City of Evanston, a one-year extension to the Agreement between the City and CCMSI. SECTION 2: That the City Manager is hereby authorized and directed to negot iate any terms of an Agreement as may be determined to be in the best interests of the City. SECTION 3: That this Resolution shall be in full force and effect from and after its passage, approval, and publication in the manner provided by law. Page 1 of 17 88-R-26 _______________________________ Daniel Biss, Mayor Attest: ______________________________ Stephanie Mendoza, City Clerk Adopted: __________________, 2026 Approved as to form: ______________________________ Alexandra B. Ruggie, Corporation Counsel Page 2 of 17 April 27 SA-Life of Agreement 5 1 26 SERVICE AGREEMENT BETWEEN CITY OF EVANSTON AND CANNON COCHRAN MANAGEMENT SERVICES, INC. THIS SERVICE AGREEMENT is made and entered into this 1ST day of May, 2026, by and between City of Evanston (the “Client”), and Cannon Cochran Management Services, Inc. (“CCMSI”), a Delaware corporation. It is agreed between the parties hereto as follows: A. APPOINTMENT OF CCMSI. The Client hereby appoints CCMSI, and CCMSI hereby agrees to serve, as Third Party Administrator (“Administrator”) of the Client’s insurance program as described within Exhibit A Fee and Payment Schedule (“Exhibit A”). All functions of CCMSI shall be performed until [termination of this Agreement (“Life of Agreement”). B. FUNCTIONS OF CCMSI. During the term of this Agreement, the regular functions of CCMSI as the Client’s Administrator shall include the following: 1. Claim Administration. (a) Claim Management and Administration. In compliance with its Best Practices, CCMSI will manage and administer all claims of the Client that occur during the period of this Agreement. All claim payments shall be made with Client funds. CCMSI will act on behalf of Client in handling, monitoring, investigating, overseeing and adjusting all such actual and alleged claims. (b) Claim Settlement. CCMSI will settle claims of the Client with Client funds. (c) Claim Reserves. CCMSI will establish reserves for unpaid reported claims and unpaid claim expenses. (d) Allocated Claim Expenses. CCMSI will pay, at market rates, all Allocated Claim Expenses with Client Funds. Allocated Claim Expenses are charges for services provided in connection with specific claims by persons or firms which are eligible claim expenses under the Client’s program. Notwithstanding the foregoing, Allocated Claim Expenses will include all expenses incurred in connection with the custody, investigation, adjustment, settlement or defense of Client claims, even if such expenses are incurred by CCMSI. Allocated Claim Expenses will include, but not be limited to, charges for: 1) Independent medical examinations of claimants; 2) Managed care expenses, which may include the services provided by comp mc™, CCMSI’s proprietary managed care program; 3) Fraud detection expenses, which may include the services provided by FIRE, CCMSI’s proprietary Special Investigation Unit (SIU), and other related expenses associated with the surveillance, detection, reporting and prosecution of fraudulent claims, including legal fees; Page 3 of 17 City Of Evanston - SERVICE AGREEMENT Page 2 of 15 4) Attorneys, experts, and special process servers; 5) Court costs, fees, interest and expenses; 6) Depositions, court reporters and recorded statements; 7) Independent adjusters and appraisers; 8) Index bureau and OFAC (Office of Foreign Assets Control) charges; 9) MMSEA/SCHIP compliance charges; 10) Electronic Data Interchanges (“EDI”) charges if required by state law; 11) CCMSI personnel, at their customary rate or charge, but only with respect to claims outside the state of their assigned office and only if such customary rate is communicated to the Client prior to incurring such cost; 12) Actual reasonable expenses incurred by CCMSI employees outside the state of their assigned office for meals, travel, and lodging in conjunction with claim management; 13) Police, weather and fire report charges that are related to claims being administered under Client’s program; 14) Charges associated with accident reconstruction, cause and origin investigations, etc.; 15) Charges for retrieval of medical records, personnel documents, and other documents necessary for adjudication of claims under Client’s program; 16) Charges associated with Medicare Set-Aside Allocations and other related MSP Services; 17) Legal bill review expenses, which include the services provided by CLEAR, CCMSI’s proprietary legal bill review program; 18) Other expenses normally recognized as Allocated Loss Adjustment Expenses (“ALAE”) by industry standards. (e) Subrogation. CCMSI will monitor claims for subrogation. (f) Provision of Reports. CCMSI will provide reports to the Client as mutually agreed upon by the parties. (g) Service Plan. CCMSI will cooperate with the Client in the drafting and periodic revision of a Quality Service Plan (QSP), claim handling instructions, or similar document if applicable that Page 4 of 17 City Of Evanston - SERVICE AGREEMENT Page 3 of 15 contains claim handling instructions, a schedule of reports, and other details of Client’s insurance program as mutually agreed upon by the parties. The document shall be maintained in CCMSI’s iCEBAR software application. 2. CLEAR Legal Bill Review Services. CCMSI will provide the Client with CLEAR Legal Bill Review Services upon mutual agreement of the parties and in exchange for payment of the applicable CLEAR fees stated in Exhibit A. The CLEAR Legal Bill Review Services shall include: (a) Audit of all legal invoices submitted by Client-approved law firms for adjudication in compliance with Client’s Defense Counsel Billing Guidelines and generally accepted legal billing principles; (b) Generation of an analysis report for each legal invoice reviewed. The report will be included with each check to the appropriate law firm and include details and supporting documentation for any deductions applied to the original billing; and (c) Generation of periodic standard reports summarizing Client’s overall savings results with metrics to analyze individual law firm performance. 3. comp mc™ Managed Care Services. CCMSI will provide the Client with comp mc™ managed care services upon mutual agreement of the parties and in exchange for payment of the applicable comp mc™ fees stated in Exhibit A. The comp mc™ Managed Care Services may include but not be limited to usual and customary medical bill re-pricing, state fee schedule medical bill re- pricing, preferred provider organization medical bill re-pricing, specialty medical and hospital bill negotiation, medical bill state reporting, pharmacy network services, field case management services, telephonic case management services, utilization review services, nurse triage services, and First Notice of Loss reporting services. 4. MMSEA/SCHIP Compliance Services. CCMSI, in conjunction with it reporting agent/MSP vendor, will comply with applicable MMSEA and Section 111 reporting requirements on behalf of the Client in exchange for payment of the applicable MMSEA/SCHIP fees stated in Exhibit A and conditioned upon Client’s provision of an active Responsible Reporting Entity Number and written authority for CCMSI to report data on Client’s behalf. The MMSEA/SCHIP Compliance Services shall include: (a) Querying of all qualifying claims to CMS for determination of Medicare eligibility on a monthly basis; (b) Collection of additional mandatory data regarding claims with verified Medicare eligibility; and (c) Reporting of all claims meeting CMS reporting guidelines. C. CLIENT RESPONSIBILITIES. Client agrees to: Page 5 of 17 City Of Evanston - SERVICE AGREEMENT Page 4 of 15 1. Report all claims, incidents, reports or correspondence relating to potential claims in a timely manner. 2. Reasonably cooperate in the disposition of all claims. 3. Claim Funding. a. Provide Funds in a timely manner to pay all claims and expenses. If utilizing an escrow account, provide Funds on a periodic basis as mutually agreed upon per the Quality Service Plan, claim handling instructions, or similar document if applicable. Funds shall include those required to pay all claims and expenses covered by insurance carriers or other parties. CCMSI will work with Client to obtain timely reimbursement of such covered payments from insurance carriers or other parties but will not advance any such amounts. b. If utilizing an escrow account, provide Funds in an amount that maintains a Claim Deposit equal to one and a half (1.5) times the average total of claim and expense payments for the previous six (6) months, adjusted for funding frequency. The required Claim Deposit will be monitored and adjusted as necessary per this calculation. The Claim Deposit is and shall remain the property of the Client. CCMSI will return excess Funds to Client in a timely manner upon recalculation of Claim Deposit or termination of the Agreement. c. If utilizing an escrow account, provide advance funding (“Prefunding”) to pay all claim and expense transactions in excess of a mutually agreed upon amount per the Quality Service Plan, claim handling instructions, or similar document if applicable. d. If utilizing an escrow account, provide all manner of Funds and Prefunding via Automated Clearing House (ACH) Electronic Funds Transfer (ETF). 4. Respond to reasonable information requests in a timely manner. 5. Identify in writing all insurance carriers applicable to CCMSI’s claim handling responsibilities contemplated in this Agreement that CCMSI will have claim or data reporting requirements. In this regard, Client agrees to provide CCMSI with a complete copy of the current excess or other insurance policies, including applicable endorsements and audits, applicable to Clients insurance program and this Agreement. CCMSI assumes no responsibility of any kind for not reporting an otherwise reportable claim to any carrier that Client has failed to disclose to CCMSI and/or provide CCMSI with a copy of the applicable insurance policy and reporting instructions relative to that carrier. 6. When applicable, obtain and provide CCMSI with an active Registered Reporting Entity (RRE) number through the Centers of Medicare & Medicaid Services that CCMSI is explicitly authorized to use for mandatory MMSEA Section 111 reporting. When applicable, client agrees to maintain this RRE # by fulfilling CMS’s annual recertification process. Page 6 of 17 City Of Evanston - SERVICE AGREEMENT Page 5 of 15 7. Pay any fees or costs charged by any carrier or prior Administrator of Client for the conversion of data associated with CCMSI handling run-off claims for Client, or for the general transfer of data to CCMSI’s operating systems. 8. Promptly pay all fees to CCMSI as outlined in Exhibit A. D. OPERATING EXPENSES. The Client agrees to be responsible for and pay all of its own operating expenses other than service obligations of CCMSI. Such operating expenses shall include but not be limited to charges for the following: 1. All costs associated with Client meeting its state security and licensing requirements; 2. Certified Public Accountants 3. Attorneys, other than provided for in Section B.1. (d) 3) and B.1. (d) 4) of this Agreement; 4. Outside consultants, actuarial services or studies and state audits; 5. Independent payroll audits; 6. Allocated Claims Expenses incurred pursuant to Section B. 1. (d) of this Agreement; 7. All applicable regulatory fees and taxes; 8. Educational and/or promotional material, industry-specific loss control material, customized forms and/or stationery, supplies and extraordinary postage, such as bulk mailing, express mail or messenger service. 9. National Council on Compensation Insurance, NCCI, charges; 10. Excess and other insurance premiums; 11. Costs associated with the development, record keeping and filing of fraud statistics and plans, but only if required by any state or regulatory authority having jurisdiction over Client; 12. Other operating costs as normally incurred by the Client. E. BOOKS AND RECORDS. 1. (a)CCMSI shall maintain all claim information relating specifically to the Client which is necessary to the performance of CCMSI’s obligations under this Agreement (the “Records”). The Records and implicated privileges shall remain at all times the sole property of the Client if self-insured or the Client’s respective Carrier if subject to a deductible insurance policy. (b)The Records shall not include any manuals, forms, files and reports, documents, customer lists, rights to solicit renewals, computer records and tapes, financial and strategic data, or information Page 7 of 17 City Of Evanston - SERVICE AGREEMENT Page 6 of 15 which documents CCMSI’s processes, procedures and methods, or which CCMSI employs to administer programs other than the Client. The items specified in this Paragraph E. 1. (b) shall at all times be and remain the sole and exclusive property of CCMSI, and the Client shall not have any ownership, interest, right to duplicate or right to utilize these items except for the above documentation or information that relates solely to Client’s program. 2. During the term of this Agreement, CCMSI shall provide the Client with copies of the Records, if so, requested by the Client. Any reasonable costs of reproduction of the Records shall be borne by the Client. 3. CCMSI shall make the Records available for inspection by any duly authorized representative of the Client, any governmental or regulatory authority having jurisdiction over CCMSI or the Client, or pursuant to court order. F. NON-SOLICITATION OF EMPLOYEES. During the term of the Agreement and for two (2) years thereafter, the Client and CCMSI mutually agree not to recruit, solicit or hire any employee of the other without written permission. G. OTHER INSURANCE. If CCMSI places any specific or aggregate excess insurance, reinsurance, or other insurance product associated with this Agreement, then customary commissions and fees will be retained by CCMSI. H. TERM AND TERMINATION. 1. Term of Agreement. The first term of this Agreement shall be for one (1) years beginning on May 1, 2026 and terminating on April 30, 2027. Unless the Agreement is terminated as set forth in paragraph H. 2., it will automatically renew for a successive one (1) year term. At least ninety (90) days prior to the expiration of each one (1) year term of this Agreement, the parties shall enter into good-faith negotiations regarding any proposed change in Agreement terms or fees. If there are no changes requested by either party, then the Agreement will automatically renew under the same terms and fee arrangement as the prior term. 2. Termination of Agreement. This Agreement may be terminated: (a) By mutual agreement of the parties hereto; (b) Upon expiration of the current term of this Agreement if either party has given the other at least ninety (90) days written notice of its intention to terminate as set forth in paragraph H. 1.; (c) Upon dissolution of the Client’s self-insurance program whether voluntary or due to cessation of Client’s authority to self-insure; (d) Upon dissolution of the Client’s self-insurance program due to Client insolvency or bankruptcy; Page 8 of 17 City Of Evanston - SERVICE AGREEMENT Page 7 of 15 (e) Upon ninety (90) days written notice by either party if the other party is in material breach of any term, covenant or condition contained herein; provided, however, that as a condition precedent to termination under this Section H. 2. (e), the terminating party shall give written notice to the other party, who shall have sixty (60) days from the date of such notice to cure or correct the grounds for termination. If the grounds of termination are not corrected or cured during the sixty (60) day period, this Agreement may be terminated on the termination date specified in the notice, but not prior to the expiration of the ninety (90) day period described herein. 3. Services Following Termination of Agreement. In the event that CCMSI’s services are being provided on a Life of Agreement basis and this Agreement is terminated or non-renewed for any reason, CCMSI will cease providing services and turn over to the Client all Records in CCMSI’s possession, which shall include all open and closed files. Upon the Client’s request and subject to agreement by CCMSI, CCMSI will be paid a reasonable negotiated fee to: (a) Provide for continued administration of the open claim files; (b) Cooperate with any successor Administrator in the orderly transfer of all functions, including providing a runoff listing of open claim files if desired by the Client and any other records reasonable and necessary for a successor administrator; and (c) Provide an electronic transfer of data if such is feasible, with the cost of providing such borne by the Client. The electronic transfer of data will be subject to a flat fee of $10,000. I. SERVICE FEE PAYMENTS. The Client shall pay to CCMSI a service fee as outlined in the Fee and Payment Schedule attached hereto as Exhibit A. J. ARBITRATION. If an irreconcilable difference of opinion or claim should arise between the Client and CCMSI as the interpreters of any matter relating to this Agreement, such matter will be submitted to mediation and arbitration as the sole remedy available to both parties. Any such mediation or arbitration will take place in the City of Chicago, Illinois and will be conducted in accordance with the then-current rules of the American Arbitration Association. K. RELATIONSHIP OF PARTIES. With respect to the services provided by CCMSI in this Agreement, CCMSI is considered an independent contractor. Nothing in this Agreement shall be construed to create a relationship of employer/employee, partners or joint ventures between the Client and CCMSI. This Agreement is non-exclusive, and CCMSI shall have the right to perform services on behalf of other individuals, firms, corporations and entities. L. INDEMNIFICATION. 1. Indemnification by Client. The Client agrees that it will indemnify and hold harmless CCMSI and CCMSI’s directors, officers, employees, agents, shareholders, subsidiaries and other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorney’s fees Page 9 of 17 City Of Evanston - SERVICE AGREEMENT Page 8 of 15 incurred by CCMSI as a result of breach of this Agreement by the Client, explicit instruction by the Client, or alleged misconduct, error or omissions by the Client, or by any of the Client’s trustees, directors, officers, employees, agents, shareholders, subsidiaries, or other affiliates in connection with the performance of this Agreement. Agents as used herein include third party vendors selected by Client. 2. Indemnification by CCMSI. CCMSI agrees that it will indemnify and hold harmless the Client and the Client’s trustees, directors, officers, employees, agents, shareholders, subsidiaries, members, or other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorney’s fees incurred by the Client as the result of breach of this Agreement by CCMSI or alleged misconduct, error or omissions by CCMSI, or by any of CCMSI’s directors, officers, employees, agents, shareholders, subsidiaries or other affiliates in connection with the performance of this Agreement. M. CHANGE IN CIRCUMSTANCES. In the event the adoption of any statute, rule or regulation materially changes the nature of the relationship between the parties hereto or the legal or economic premises upon which this Agreement is based, the parties hereto shall undertake good faith negotiations to amend the terms of this Agreement to account for such changes in a reasonable manner. This includes the happening or development of a local, regional, national or global health situation, crisis, pandemic, or catastrophic event that would impact the volume and type of claims to be administered by CCMSI under this Agreement. In the event of any such occurrence, either party may contact the other in good faith and seek to amend the terms and / or service fees applicable to this Agreement. N. SOFTWARE ACCESS. The Client may be provided with the right to use one or more CCMSI Applications in connection with the services provided by CCMSI in this Agreement. CCMSI Applications include iCE, MyReports, and Loss Control Resources. The right to use CCMSI Applications is non-exclusive, limited to the term of this Agreement per paragraph H.1., non-transferable and is solely for the internal business use of Client. CCMSI owns and reserves all rights, title, and interest in and to the CCMSI Applications. Client has no right to receive a copy of the object code or source code to the CCMSI Applications. Client may not attempt to: 1. License, sell, lease or otherwise make the CCMSI Applications available to any other party. Client will not provide any access, passwords or other information regarding the CCMSI Applications to any third parties and/or competitors of CCMSI without the prior written consent of CCMSI; 2. Use the CCMSI Applications in any way that violates any law, regulation or mandate, or the term of this Agreement; or 3. Take any action that jeopardizes confidential or proprietary information held by CCMSI. Client is responsible for any confidential or proprietary information accessed or downloaded by Client from the CCMSI Applications, including the implementation of appropriate information security controls surrounding such information. Except as expressly provided in this Agreement, CCMSI Applications are provided “as-is”. CCMSI disclaims all other warranties, express, implied, or statutory, including the implied warranties or merchantability, satisfactory quality, title, fitness for a particular purpose, non-infringement, Page 10 of 17 City Of Evanston - SERVICE AGREEMENT Page 9 of 15 compatibility, security, quiet enjoyment, or accuracy. Without limiting the foregoing, CCMSI does not warrant that access to or use of the CCMSI Applications will be uninterrupted or error-free. CCMSI will provide support for the CCMSI Applications in the two most recent two versions of the Internet Explorer, Chrome, Firefox and Safari browsers. O. MISCELLANEOUS. 1. Governing Law. This Agreement shall be governed by and construed in accordance with the internal laws of the State of Illinois without regard to principles of conflicts of law. 2. Timing of Services. CCMSI may exercise its own reasonable judgment, within the parameters set forth herein and in compliance with state regulations, as to the time and manner in which it performs the services required hereunder. Additionally, CCMSI will be held to a standard of like administrators performing like services for customers such as Client. 3. Successors in Interest. This Agreement shall be binding upon, and inure to the benefit of, the successors in interest and permitted assigns of the parties hereto. 4. Severability. The invalidity or unenforceability of any particular provision of this Agreement shall not affect the other provisions hereof, and this Agreement shall be construed in all respects as if the invalid or unenforceable provision had been revised to the minimum extent necessary to make it valid and fully enforceable under applicable law. 5. Paragraph Headings. All paragraph headings in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 6. Waiver. The failure of any party to enforce any provisions of this Agreement shall not constitute a waiver by such party of any provision. A past waiver of a provision by either party shall not constitute a course of conduct or a waiver in the future with respect to that same provision. 7. Notice Provision. All notices, requests and other communications required under this Agreement shall be in writing and delivered by hand or mailed, registered or certified, return receipt requested, postage paid, or sent via a nationally recognized overnight courier to the other party at the following address: Client: City of Evanston 909 Davis St Evanston, IL. 60201 CCMSI: Cannon Cochran Management Services, Inc. 2 E. Main St. Danville, IL 61832 Attn: Chief Financial Officer Page 11 of 17 City Of Evanston - SERVICE AGREEMENT Page 10 of 15 8. File Destruction Policy. CCMSI will maintain electronic claim file records or hard copy files (where applicable) on behalf of Client for as long as necessary to protect the applicable statute of limitations and in accordance with CCMSI’s Client Record Retention Policy. 9. Insurance. CCMSI will purchase and maintain insurance coverages for its performance of the services contemplated in this Agreement. Minimum policy limits are as follows: Workers Compensation – Statutory Professional - $5,000,000 General Liability - $1,000,000 / $2,000,000 Umbrella - $5,000,000 Cyber Coverage - $5,000,000 10. Escheatment. CCMSI is responsible for complying with all applicable abandoned property or escheat laws, making any required payments, and filing any required reports on CCMSI escrow accounts. 11. Confidential Information. Confidential Information includes nonpublic information that is exchanged between the Client and CCMSI, including, without limitation, information relating to the business, financials, personnel, customer data and operating procedures. Confidential Information includes information whether in written, electronic, or oral form created and relating to services provided under the Agreement. All Confidential Information is proprietary. Client and CCMSI may use the other party’s Confidential Information only for the purpose of this Agreement and will limit its disclosure to only those persons or entities reasonably necessary to perform under the Agreement. 12. Information Security. CCMSI is responsible for the protection of the confidentiality, availability, privacy and integrity of Client information in our custody. CCMSI has implemented an Information Security Policy that has been developed to comply with applicable federal and state laws or regulations and industry best practices. The Information Security Policy applies to all CCMSI personnel, including temporary employees, independent contractors and vendors with access to CCMSI systems. 13. Entire Agreement/Amendment. This Agreement sets forth the full and final understanding of the parties hereto with respect to the matters described herein and supersedes any and all prior agreements and understandings between them, whether written or oral. This Agreement may be amended only by written document executed by the Client and CCMSI. Page 12 of 17 City Of Evanston - SERVICE AGREEMENT Page 11 of 15 Executed this ____ day of ________________, 20__. CANNON COCHRAN MANAGEMENT SERVICES, INC. By:___________________________________________ John E. Kluth II Its: Chief Financial Officer CITY OF EVANSTON By:___________________________________________ It’s:___________________________________________ Page 13 of 17 City Of Evanston - SERVICE AGREEMENT Page 12 of 15 EXHIBIT A FEE AND PAYMENT SCHEDULE Service Agreement Term: 5/1/2026 – 4/30/2027 Services Fees Claims Administration (minimum) $97,500 CCMSI will manage all claims for the Life of Agreement for a fee as follows: Claims will be analyzed by the number and type of claim on an ongoing basis and priced on a per claim basis as outlined below. Workers’ Compensation: Indemnity Claims - $1,100 Per Claim Medical Only Claims - $175 Per Claim Complex/Enhanced Medical Only Claim Surcharge - $350 Per Claim Incident Only - $41 Per Claim Liability Auto Liability Bodily Injury - $1,000 Per Claim Auto Liability Property Damage – $515 Per Claim Auto Collision/Comprehensive – $500 Per Claim FPPC - $550 Per Claim General Liability Bodily Injury - $1,000 Per Claim General Liability Property Damage - $515 Per Claim Error & Omission - $1,159 Per Claim Professional Liability - $1,159 Per Claim Annual Increases: There will be a 3% fee increase to Claim Administration Fees per year. This does not apply to the Complex/Enhanced medical only surcharge fee, Admin fee or other annual fees. Workers’ Compensation Claim Definitions ▪ Indemnity Claims – Claims involving lost-time, questionable compensability, legal involvement/client attorney representation, subrogation, second injury fund, probable permanent impairment, jurisdictional issues, coverage issues and complex medical issues that are assigned or transferred to indemnity adjusters for claims handling. Page 14 of 17 City Of Evanston - SERVICE AGREEMENT Page 13 of 15 ▪ Medical Only Claims – Claims which have no issues of lost time, no evidence of other indemnity benefit exposure, no obvious question of compensability, no evidence of potential subrogation or second injury recovery, no evidence of problematic medical issues and no requirement or need for any formal statements (3-point or 2-point verbal contact is not required). ▪ Complex/Enhanced Medical Only – Medical only claims that have 6 or more paid medical transactions and total paid dollars greater than $2,500. ▪ Incident Only Claims – Reported claims which require only input into RMIS system and requires no claims management activity. Annual Administration Fee • Dedicated client service team • Development of specific client service requirements • Monthly loss reporting • Quarterly claim reviews at client’s request • Issuance of 1099’s • Assistance in filing all required state forms including state mandated assessments. o If Client has directed CCMSI to utilize a third-party vendor selected by Client for the provision of services, then such assistance will be the responsibility of the third-party vendor. • Preparation for, compliance with and response to regulatory audits • Account Management and Administration $15,000 Subrogation Fee 20% of recovery with a cap of $50,000 per claim. comp mc™ Managed Care Service Fees Fee Schedule, Usual & Customary Re-pricing $10.00 per bill PPO Network Access 33% of savings below state fee schedule Hospital/Specialty Review 33% of savings below state fee schedule Pharmacy Benefit Program 33% of savings Page 15 of 17 City Of Evanston - SERVICE AGREEMENT Page 14 of 15 Telephonic Case Management Market Rate Utilization Review Market Rate FNOL Reporting / Nurse Triage Market Rate Medical Bill State Reporting (for applicable medical bills to reportable state) $1.50 Ancillary Fees State Reporting / EDI Fees Current - $15.00 per Initial Report, $10.00 per Subsequent Report Market Rate Index Bureau Current - $20.00 per Index Market Rate MMSEA/SCHIP Compliance Fee Current - $25.00 per Claim. Market Rate Annual RMIS Fees Risk Management Information System (iCE) cost to include: 5 User ID’s (each additional user is $200 per user per year). Internet access to claim files; the ability to email your adjuster and Account Manager; access to our library of template risk management reports together with initial training and ongoing support. $2,500 Annual OSHA Fees Access to OSHA reporting module $7,500 CLEAR Legal Bill Review Fees Guarantee: If Legal Bill Review savings achieved for Client is less than the 2.2% total service fee incurred on an annual basis, the Client will be refunded the difference between the service fee incurred and the amount actually saved on invoices. Therefore, service fees will never exceed the savings achieved for Client on an annual basis. 2.2% of billed legal expenses Other Fees Custom Reporting CCMSI will provide special reports (reports not currently programmed or written) for a fee of $150 per hour for system programming time. CCMSI will provide an estimate of charges before any work is done. TBD Data Feeds TBD Page 16 of 17 City Of Evanston - SERVICE AGREEMENT Page 15 of 15 CCMSI will provide data feeds as requested by Client. CCMSI will provide an estimate of one-time and ongoing charges before any work is done. Carrier Fees If applicable, Client will be responsible for payment of any carrier fees associated with the transition of claim handling responsibilities to CCMSI. TBD Taxes CCMSI fees will be increased by any applicable Sales, Gross Receipts, or similar (excluding income) taxes imposed by Federal, State or Local bodies. TBD Billing Schedule The quarterly installments of $30,625 will be due on the 1st day of May, August, November, and February. Any additional charges over the $97,500 minimum claim fee will be billed quarterly thereafter. $122,500 Page 17 of 17