ORDER NO.29218 CONTRACT AMENDMENT UNITED OF OMAHA LIFE INSURANCE COMPANY Came to be heard this the 27a' day of June 2005, with a motion made by Commissioner Baldwin, seconded by Commissioner Letz. The Court unanimously approved by vote of 3-0-0 the amended contract to the Administrative Services Agreement of January 1, 2005 between United of Omaha Life Insurance Company and Kerr County. l ~ ~~/~ COMMISSIONERS' COURT AGENDA REQUEST - PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT. MADE BY: Barbara Nemec MEETING DATE: June 27, 2005 OFFICE: Treasurer TIME PREFERRED: 9:30 A.M. SUBJECT: (PLEASE BE SPECIFIC) Condider and discuss an amendment to the Administrative Services Agreement of January O1, 2005 between United of Omaha Life Insurance Company and Kerr County as requested by Don Wallace and Associates and County Judge to sign same. EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON) NAZvIE OF PERSON ADDRESSING THE COURT: Barbara Nemec ESTIMATED LENGTH OF PRESENTATION: 5 mins. IF PERSONNEL MATTER -NAME OF EMPLOYEE: Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and 552, Government Code, is as follows: Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday. THIS REQUEST RECEIVED BY: THIS REQUEST RECEIVED ON: All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been prepazed for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be appreciated and contribute towards you request being addressed at the eazliest opportunity. See Agenda Request Rules Adopted by Commissioners' Court. Page 1 of 1 Barbara Nemec From: "Michelle Burnett" To: "Barbara Nemec" Sent: Thursday, June 16, 2005 9:07 AM Attach: thompson, G000487A.doc Subject: FW: Kerr County Exception-Cheryl Thompson Barbara, Attached is the exception form that will need to be sign before Cheryl can get a reimbursement on her vision exam from earlier in the year. I also discussed this with Judge Tinley to get his opinion. He thought it would be okay since we didn't have the details on the vision benefit. Please read and call or email me if you have questions. Once complete you may fax or email back to me. Michelle Burnett, Director of Account Management Wallace & Associates 628 N. 123 Bypass #3 Seguin, TX 78155 (830)372-4042 --- fax (830) 303-5380 This e-mail, including attachments, may include confidential information. It may be used only by the person or entity to which it is addressed. If the reader of this a-mail is not the intended recipient or his or her authorized business associate, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this a-mail in error, please notify the sender by replying to this message and delete this a-mail immediately. 6116/05 UNITED Of OMAHA LIPS INSUAANCB COMPANY Woodward Health Care Service Center P.O. Box 9 Woodward, OK 73502 June 10, 2005 Ms. Barbara Nemec Ken County 700 Main St. Kemille, TX 78028 Re: Exception-Cheryl Thompson Deaz Ms. Nemec, This letter serves as an amendment to the Administrative Services Ageement of January 1, 2005 between United of Omaha Life Insurance Company ("Company") and Ken County, G000487A (the "Ageement"). The terms of this letter aze made a part of the Ageement and are subject to all provisions of the Ageement not in conflict with the provisions of this letter. Kerr County and Company agee as follows: 1. Company shall, as an exception to the terms of Ken County's self-funded goup health plan, allow in- network vision benefits for services incurred on January 31, 2005 by Ms. Thompson. This agreement will result in a payment of $60.00. 2. Any payment made as a result of this ageement will not be applied to the specific or aggegate stoploss provided by the Company. 3. Notwithstanding anything to the contrary in the Ageement, Ken County agees that it shall indemnify, defend and hold Company harmless from any liability, loss, costs, expenses or damages (including, without limitation, attorneys' fees, court costs and extra-contractual and punitive damages) incurred by Company arising out of or resulting from this letter or any act or omission of Company in the performance of its duties under this letter. This obligation to indemnify, defend and hold Company harmless shall be in addition to, and shall not replace, any other obligation of Employer in the Agreement to indemnify, defend and hold Company harmless. 4. Company assumes no responsibility for any tax or legal consequences that Kerr County, the plan sponsor or any person covered under Ken County's plan may incur under any state or federal law as a result of this letter. 5. Company and Kerr County acknowledge and agree that Company only provides ministerial claims processing services under the self-funded goup health plan and that Company has no auUrority to act, and does not act, as a fiduciary for the plan in any manner whatsoever. 6. The terms of this letter shall be read together and construed as one document with the Ageement, but to the extent of any inconsistency or ambiguity, this letter shall govern. 7. Except as expressly provided in this letter, all of the provisions of the Ageement shall remain in full force and effect. Ms. Bazbaza Nemec June 10, 2005 Page 2 8. Where the provisions of this letter and those of the group health plan conflict, the provisions of this letter will apply. 9. The terms of this letter may be modified or amended only by an instrument in writing, duly executed and delivered by the parties hereto. 10. Any number of counterparts of this letter may be executed and each such executed counterpart shall be deemed an original. Cory Michel Vice President, Underwriting Date: AGREED TO and ACCEPTED FOR By: ) ~"~--~.,.,,,_ STo be signed by representative of Kerr County) Title: ~2 rQ ~~. Date: /_ _ Z7_n .~ ohm= z9zi~ Cc: Group Claims