HomeMy WebLinkAboutAllen Hospital-5/9/2016-Letter of AgreementUnitjPoint Health
Alien Hospital
LETTER 01? AGREEMENT
ALLEN HOSPITAL grees to provide the following services to employees, spouses arni family
dependents of CITY OF WATERLOO.
1) Provide pxomptaccess to the employees forthe Employee Assistanee Prograni Services.
2) Provide a$sessrnent, short-term counseling and or referral to appropriate community
service provides, being sensitivo to tlie einployee's flnanoial status and jiealt}j eure
benefits. Bcnefits inelude 6 BAP sessions per employee, domestio partner and
dependenls per balendar year, with limit of 3 issuesfpersorj/year.
3) Seeure a Relea* of Jnformatiori from the employee allowing ALLIEN UOSPITAL to
conhrm the emjloyee's inyolvenient with the referral provider.
4) Maintain aeouSe case 'nanagement records and eomply with all State and Federal
gtatutes regardiiig eonfidentiality.
5) Frovide supervfory/rnanageinent staff of CJTY OE WATERLOO traitiing specific to
utilization ofth Fmployee Assi8tance Prograrn, within 45 days ofthe prograna initiation.
6) Provide hrtormition to alI employees af CITY 01? WATERLOO mgarding utilization
ofthe Brnployee Assitance Prograrn.
7) Provide CITY 01? WATERLOO with written yearty reports outlining utilization.
8) As requested, ptovide oonsultation to supervisory/management staff,
CITY Ohi' WATLRLOo agrees to:
1) Pay ALLEN HOSPITAL a fee per oapita of $25.O0 per eaeh employee per year.
Quarterly billing will be for serviees available in the upcoming cjuarter. Terms are net 30
days.
2) Supply ALLEN HOSPITAL with infonnation on the insurance benefits ofthe
oontraoting eompany'
3) Provide access th all employees to the Btnployee Assistance Program ofALLEN
IIOSPITAL and written hiformation as to utilization.
[4 UnityPoini Health
Alien Hospithl
LETITIR OF AGREiMENT.con6uued
CITY 0)? WATERLOO
PAGETWO
4) Frovide ALLEN ROSPITAL with a copy ofthe company substaaee abuse polioy.
This Agreernent is made as ofJuly 1,2016 and shall conthlue in effect forone (1) year. Inthe
event the Agreement l3etween ALLEN HOSPITAL Employee Assistance Proam and CITY
0E WATERLOO is �xtended, the Agreement Shall automatioally be extended for a perod
oonsistent with that poriod. The existing capitated fce will rernain in effeet until 1/01/2017, at
which time ALLEN HOSPITAL reserves Lhe rght to insUtute a rate inerease. Bither party may
disconthuie this Agredment upon sixty (60) days prior written notice. Termination betwcen
ALLEN lHOSNTALiBinployee Assistanee Program and CITY OF WATERLOO shalt eause
this agreemeut to autoinatioally tenninate.
BY:
AMBLA K. IDEL "ARDBLLE
FRESIDBNT & CEO
ALLEN HOSPIT.AL
DAEL:
BY:
/ At
0/414 BY:
.JA'PSCFIARA, L,MI-IC, CADC
E'jT' AGBR
• £VN HOSBITAL
13Y:
QtJBNTIN HART
MAYOR
CITY OF WATERLOO
DAIE:
DATE:
DATE:
S ZY HARES
CITYC BRIC/URDIRECTOR
CITY OF WAThRLOO