HomeMy WebLinkAboutCC Resolution 9094 (Employee Assistance Program)RESOLUTION NO. 9094
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
SAN RAFAEL EXTENDING THE CONTRACT WITH
PERSONAL PERFORMANCE CONSULTANTS, INC., FOR
CONTINUATION OF EMPLOYEE ASSISTANCE PROGRAM
(EAP) FOR CITY EMPLOYEES THROUGH JUNE 30,
1995. (at a fee not to exceed $10,000.80
per fiscal year)
RESOLVED, that the City Council of the City of San Rafael,
does hereby authorize the Mayor and City Clerk to execute on
behalf of the City of San Rafael, a contract agreement between
the City of San Rafael and Personal Performance Consultants,
Inc., designating Personal Performance Consultants as the EAP
provider for eligible City of San Rafael employees. Said
contract shall be extended through June 30, 1995, at a fee not to
exceed $10,000 per fiscal year.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael
hereby certify that the foregoing Resolution was introduced and
adopted at a regular meeting of the City Council of San Rafael,
on Monday, the 7th day of February, 1994, by the following vote
to wit:
AYES: COUNCILMEMBERS: Cohen, Heller, Thayer, Zappetini &
Mayor Boro
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
Fa
JE E -M. LEON CIN , CITY CLERK
0 ?K% '� G� I A I // �6 '?v
EMPLOYEE ASSISTANCE PROGRAM
RENEWAL AGREEMENT
This Agreement, effective July 1, 1993, by and between MEDCO
BEHAVIORAL CARE OF CALIFORNIA, INC. dba PERSONAL PERFORMANCE CONSULTANTS
OF CALIFORNIA, INC., 1620 26th Street, Suite 2050, Santa Monica,
California 90404, (310) 453-6727 (PPC®) and CITY OF SAN RAFAEL, 1400 5th
Avenue, San Rafael, CA 94915-1560 (San Rafael).
RECITALS
1. Assured Health Systems (AHS) and San Rafael have previously
entered an agreement dated July 1, 1992 for AHS to provide an
Employee Assistance Program (EAP). PPC is the successor in interest
by merger, to AHS.
2. PPC and San Rafael desire to renew said agreement to continue
the EAP.
THEREFORE, in consideration of the mutual covenants contained in
this Agreement, and other good and valuable consideration, the parties
agree as follows:
1. PRINCIPAL SERVICES AND COVERAGE
Based on discussions with San Rafael officials, PPC will provide an
EAP designed to serve approximately 360 Covered Employees of San Rafael
and their Family Members. PPC will provide directly to Enrollees the
services described in paragraphs 5.6 - 5.7 of this Agreement. Medco
Behavioral Care of California, Inc. shall not be obligated to provide any
services to individuals outside the State of California:
2. TERM AND RENEWAL
The term of this Agreement shall be for two (2) years, extending
from July 1, 1993 through June 30, 1995. The Agreement shall be
automatically renewed for successive two-year terms from the anniversary
date of this Agreement unless terminated as provided in paragraph 9.1 of
this Agreement or either party gives to the other written notice of
nonrenewal not less than ninety (90) days prior to the expiration of the
term of this Agreement or any renewal hereof. Provided, however, that if
the City of San Rafael fails to appropriate funding for the second year
of the first term of this Agreement, the City of Rafael may elect to
terminate this Agreement, if and only if it provides PPC written notice
by April 1, 1995 of termination effective July 1, 1995. Except as
otherwise specifically limited in this Agreement, the parties reserve the
right to modify the terms of this Agreement upon renewal with respect to
the number of Covered Employees, professional fee, and other terms agreed
upon by the parties.
3. PROFESSIONAL FEES
3.1 Amount
In consideration of the
Agreement by PPC, San Rafael
$20,001.60. which reflects an
$10,000.80.
EAP-RNW.3C
services to be performed under this
shall pay PPC a total contract fee of
annualized professional fee of
1C 0 rl-;h V
San Rafael
3.2 Payment Schedule
San Rafael agrees to pay PPC quarterly installments of
$2,500.20 payable on or before the first day of the first calendar
month of each contract quarter, commencing on July 1, 1993. San
Rafael shall pay a prorated portion of the quarterly installment for
any fraction of a quarter at the beginning or the end of the term of
this Agreement. In the event that San Rafael fails to pay any
amount when due, the delinquent amount shall bear interest at the
lesser of two percent per month or the maximum rate of interest
allowable by law.
3.3 Services and Costs Covered
PPG's professional fee covers all services and costs hereunder
exclusive of postage and stationery associated with home mailings,
and costs associated with employee communication materials and
reports developed exclusively for San Rafael, if any.
3.4 Enrollee Financial Obligation
No individual Enrollee shall be obligated in any way to pay for
services rendered by PPC in accordance with the terms of this
Agreement, including the payment of deductibles, copayments, or co-
insurance. By statute, every contract between PPC and its Panel
Providers provides that in the event that PPC fails to pay the
Provider, the Enrollee shall not be liable to the Provider for any
sums owed by PPC.
4. DEFINITIONS
For purposes of this Agreement and any other document executed or
provided in connection with this Agreement, the following terms shall
have the meanings given them in this Section unless the context requires
otherwise:
4.1 Employee Assistance Program (the EAP):
A systematic program to help employees resolve personal
problems, such as family conflict, drug or alcohol abuse, stress,
marital discord, personal finances, and other personal problems, and
to provide training, consultation, and other management services
relating to the effective utilization of the EAP by employers and
their employees.
4.2 Provider:
A psychologist, clinical social worker, marriage, family and
child counselor or other professional licensed or certified under
the laws of the State of California to deliver counseling services.
4.3 PPC Counselor:
A Provider who, as an employee of PPC, delivers services to
Enrollees.
4.4 Clinical Affiliate:
A Provider who has a contract with PPC to deliver services to
Enrollees.
4.5 Panel Provider:
A PPC Counselor or Clinical Affiliate.
EAP-RNW.3C 2 San Rafael
4.6 Covered Emplovee:
A regular full-time or regular part-time employee of San
Rafael.
4.7 Familv Member:
A member of a Covered Employee's household and his/her
unmarried dependent children, whether or not residing with the
Covered Employee. Children of a Covered Employee are not considered
dependents if they are in the military service.
4.8 Enrollee:
An individual eligible for participation in the EAP under this
Agreement as a Covered Employee or a Family Member (as defined in
this Agreement) of a Covered Employee.
4.9 Familv Unit:
A Covered Employee together with his/her Family Members, if
any.
4.10 Inperson Session:
A fifty (50) minute counseling session for one or more
Enrollees, individually or with members of his/her family, at a PPC
office or the office of a PPC Clinical Affiliate.
4.11 Evidence of Coverage:
The document issued to an Enrollee setting forth his/her
eligibility for participation in the EAP.
4.12 Brief Counselinq:
A problem -focused form of individual or family outpatient
counseling that (a) seeks resolution of problems in living (e.g.,
parenting concerns, emotional stress, marital and family distress,
alcohol- and drug-related problems) rather than basic character
change; (b) emphasizes counselee skills, strengths and resources;
(c) involves setting and maintaining realistic goals that are
achievable in a one to five month period; (d) encourages counselees
to practice behavior outside the counseling session to promote
therapeutic goals; and (e) in which the counselor provides
structure, interprets behavior, offers suggestions, and assigns
"homework" activities.
5. PROGRAM SERVICES
PPC will provide San Rafael the following services during the term
of this Agreement:
5.1 Policy and Procedure Review
Working with San Rafael management, PPC will review the
existing EAP policy statement and procedures to assure that the EAP
fits the current needs of San Rafael, its managers, and its
employees. As indicated by this review, PPC will make suggestions
for policy and procedure modifications. PPC will also assist San
Rafael in a review of mental health and substance abuse coverage
accorded San Rafael employees and their dependents.
EAP-RNW.3C 3 San Rafael
5.2 Supervisor Traininq
Supervisor orientation will be conducted for new managers and
supervisors at least once per year for groups of 20-25. Additional
orientation and refresher training sessions will be conducted as
needed, at San Rafael's request.
5.3 Supervisor Resource and Trainina Manuals
PPC will provide its professionally designed Supervisor
Resource & Training Manuals to all new supervisors attending
training.
5.4 Onaoina Manaqement Consultation
PPC will provide consultation, as requested, for any supervisor
considering the referral of an employee to the EAP. PPC will assist
the supervisor in the "supportive confrontation" process as needed.
In the case of a "supervisor -referred" employee, PPC will remain in
regular contact with the referring supervisor.
5.5 Emplovee Communications
PPC will consult with San Rafael on the employee communications
program and provide selected promotional materials and activities.
5.6 Personal Consultation Service
PPC will provide experienced counselors to make assessments of
Participant problems and to provide Brief Counseling, involving up
to eight (8) inperson sessions per problem, as clinically
appropriate. Access to service will be available through self -
referral or supervisor referral.
The limits of confidentiality established with San Rafael
management in policy and procedure development will be fully
explained to Participants prior to program participation.
Counseling will be provided by appointment on weekdays,
evenings, and Saturdays. For emergency responsiveness, PPC will
provide a round-the-clock answering service, with counselors on call
24 -hours a day, seven days a week. Emergency requests for service
will be accorded immediate attention.
All counselors will have graduate level degrees in behavioral
sciences and a minimum of three years clinical experience.
Counseling will be available at any of PPC's offices and at the
offices of PPC's Clinical Affiliates statewide. Enrollees will be
able to make an appointment for counseling by calling (800) 333-8EAP
(Los Angeles County) (toll-free); (714) 252-9131 (Orange County);
(415) 969-1919 (Mountain View area); (408) 432-8737 (San Jose area);
(415) 291-0211 (San Francisco); (619) 487-1770 (San Diego area); or
toll-free (800) 888 -CARE (all other areas). All offices utilized
will meet PPC's high standards of ease of entry/exit, location,
parking, and general Enrollee comfort to assure maximum utilization
and confidentiality of counseling services.
5.7 Referral Service
PPC will refer Participants requiring extended counseling
services, specialized services, or medical care to treatment
resources in the community. Fees for professional services provided
by resources other than PPC will be the responsibility of the
Participant and/or his or her group health plan or other benefit
programs, as applicable. For those Participants who have been
EAP-RNW . 3 C 4 San Rafael
N.
7
referred to outside resources, PPC will contact both the provider of
care and the Participant to confirm that the referral is
appropriate.
PROGRAM EVALUATION
6.1 Program Reportinq
PPC will provide San Rafael's management quarterly reports
containing utilization statistics, a review of all programming
activities for the quarter, and suggestions for program
reinforcement. All reporting will be done in such a way to assure
the confidentiality of counseling services.
6.2 Consumer Evaluation
Participants using PPG's counseling services will be accorded
the opportunity to evaluate anonymously the service received through
a Service Evaluation Card provided Participants. Supervisors making
referrals will also have an opportunity to evaluate anonymously the
effectiveness of the EAP as a supervisory tool.
6.3 Peer Review
PPC will conduct an internal peer review to assure consistent
quality and to serve as a staff development aid. Case files of San
Rafael Participants will be included in the population of EAP cases
from which PPC draws a random sample to critique performance of
PPC's counselors.
ENROLLEE DISPUTES AND COMPLAINTS
7.1 Grievance Committee
PPC shall maintain a Grievance Committee comprised of two PPC
Providers and a Chairperson. The Grievance Committee shall provide
supervision over, and review grievances not resolved by, PPC's
Clinical Director. The Chairperson of the Grievance Committee shall
be appointed by PPC's Board of Directors and shall be an officer of
PPC. The Chairperson shall have primary responsibility for the
maintenance of the grievance procedures, for the review of their
operations, and for the utilization of any emergent patterns of
grievances in the formulation of policy changes and procedural
improvements in PPG's administration.
7.2 Complaint Forms
An Enrollee may file a complaint about PPC's services or that
of a Provider by appearing in person, writing, or calling PPC,
collect, to:
Clinical Director
1111 Chess Avenue
Foster City, CA 94404
(415) 358-8585
Complaint forms and copies of the grievance procedure shall be
available at each PPC office and at the office of each Clinical
Affiliate. In addition, complaint forms shall be sent to Enrollees
on request. Completed forms should be submitted to the above
address. Assistance will be provided by a PPC representative to
anyone attempting to file a grievance in person or by telephone.
EAP-RNW.3C 5 San Rafael
7.3 Grievance Procedure
Within twenty (20) days of receiving a complaint, the Clinical
Director will contact the Complainant to acknowledge receipt of the
complaint, to solicit details of the complaint from the Enrollee,
and to conduct an investigation. Within thirty (30) days, the
Clinical Director shall notify the Complainant of the disposition of
the complaint. If the complaint cannot be resolved by the Clinical
Director, or the complainant requests a review of the disposition of
the Clinical Director, the complaint shall be reviewed by PPC's
Grievance Committee. The Complainant may present additional
information to the Grievance Committee for the purpose of such
review. The Complainant shall be notified of the decision of the
Grievance Committee within thirty (30) days of the request for
review.
7.4 Grievance Records
A written record shall be made of each complaint received in
person, by mail, or by telephone, including the date, the name of
the person recording the complaint, and the resolution. The
Grievance Committee will tabulate the types and numbers of
grievances being received for periodic review by PPC's Board of
Directors, its Public Policy Committee, and its Chief Operating
Officer in connection with their consideration and formation of
PPC's policy. The Grievance Committee shall include in its periodic
reports recommended corrective actions to be taken in light of the
pattern of grievances received.
7.5 Prohibition of Retaliation
Neither PPC nor any Provider will discriminate against an
Enrollee for having filed a complaint. The Grievance Committee will
investigate any alleged retaliation and take appropriate action.
$. LIMITATIONS, EXCEPTIONS AND EXCLUSIONS
8.1 Choice of Providers
PPC will choose the Panel Provider who will deliver services to
an Enrollee. However, PPC will take into account an Enrollee's
choice of Panel Provider, whether due to dissatisfaction or other
reasonable cause. In any event, PPC is obligated to make services
available only through Panel Providers.
8.2 Liability of Enrollee for Pavment
If an Enrollee chooses to receive counseling or referral
services from any Provider other than a Panel Provider to whom PPC
assigns the Enrollee for a particular problem, PPC will not pay for
services rendered to the Enrollee by such Provider, and the Enrollee
may be liable to the Provider for the cost of services.
8.3 Exclusions
PPC has no
services other
Agreement. In
the following:
obligation under this Agreement to provide any
than the services described in paragraph 5 of this
particular, PPC has no obligation to provide any of
EAP-RNW.3C 6 San Rafael
a. Evaluations required by any California or Federal judicial
officer or other governmental official or agency mandating that
an Enrollee undergo counseling;
b. Performance of evaluations or recommendations to be used in
child custody proceedings, child abuse proceedings, criminal
proceedings, workers compensation proceedings, or any legal
actions of any kind;
C. Performance of professional assessments for fitness for
duty determinations or excuses for leaves of absence or time
off.
9. TERMINATION
9.1 Termination
Termination of this Agreement may only be effected as follows:
In the event of any material breach of this Agreement, in addition
to any other remedy available at law or in equity, the party not in
breach shall be entitled to terminate this Agreement on thirty (30)
days prior written notice to the party in breach. Provided, PPC
shall not terminate this Agreement for non-payment of its
professional fees unless the San Rafael payment is delinquent for
more than thirty-one (31) days, San Rafael has been duly notified
and billed by PPC, and at least fifteen (15) days have elapsed since
the date of notification and, provided, further, the receipt by PPC
of the proper payment from San Rafael after cancellation of this
Agreement for delinquent payment shall reinstate the Agreement as
though it had never terminated unless PPC shall within five (5)
business days of receipt of such payment, either (1) refund the
payment so made; or (2) issue to San Rafael a new agreement
accompanied by written notice stating clearly those respects in
which the new agreement differs from the terminated agreement in
services, coverage, or otherwise.
9.2 Effect of Termination
9.2.1 PPC Materials
Upon the effective date of termination, San Rafael's
right to use PPC Supervisor Resource & Training Manuals,
employee communications materials, and other EAP materials
furnished by PPC during the term of this Agreement shall
terminate.
9.2.2 Refund of Prepaid Fees
In the event of termination by either party (except in
the case of fraud or deception in the use of PPC services or
facilities or knowingly permitting such fraud or deception by
another), PPC shall, within thirty (30) days, return to San
Rafael the prorata portion, if any, of the money paid to PPC
which corresponds to any unexpired period for which payment has
been received, less any amount then due PPC.
EAP -RM. 3C 7 San Rafael
9.2.3 Pavment to Providers
PPC will make payment to Panel Providers for services
authorized by PPC prior to termination and provided thereafter
in accordance with this Agreement.
10. SAN RAFAEL OBLIGATIONS
10.1 Distribution of Information
San Rafael shall distribute to Covered Employees its
information about the EAP and their eligibility for participation in
the EAP, and copies of PPG's Evidence of Coverage and Disclosure
Form. The Evidence of Coverage and Disclosure Form is a summary
only; this Agreement should be consulted to determine the governing
contractual provisions. _
10.2 Notice of Cancellation
In the event PPC sends notice of cancellation for any reason to
San Rafael, San Rafael shall, within 30 days of receipt of such
notice, mail promptly to each Covered Employee a legible, true copy
of such notice and shall promptly provide PPC with proof of such
mailing and the date thereof.
10.3 Annual Update
San Rafael shall provide PPC on each anniversary of this
Agreement a current statement of the number and location(s) of
Covered Employees.
11. ELIGIBILITY FOR SERVICES
11.1 Commencement of Coveraqe
The eligibility of a Covered Employee for services under this
Agreement shall commence on the first day of his/her employment by
San Rafael following the availability of service to Enrollees as set
forth in paragraph 2 of this Agreement. Family Members shall
commence eligibility on the same date.
11.2 Termination of Eliqibilitv
The eligibility of a Covered Employee for services under this
Agreement shall terminate on the earlier of the last day of his/her
employment by San Rafael or termination of this Agreement. Family
Members shall remain eligible for services until the eligibility of
the Covered Employee related to them ceases or until they cease to
be Family Members as defined in paragraph 4.7, whichever occurs
first. However, any Enrollee will be entitled to receive the full
number of counseling sessions identified in paragraph 5.6 of this
Agreement for an identified problem, as clinically appropriate, if
he/she has a scheduled appointment with a Panel Provider for that
problem prior to the last date of eligibility as specified in this
paragraph. PPC may terminate the eligibility of any Enrollee for
fraud or deception in the use of the services provided by it or for
knowingly permitting such fraud or deception by another, however,
PPC will not terminate the eligibility of any Enrollee because of
his/her health status or use of the EAP.
EAP-RNW.3C 6 San Rafael
11.3 Individual Continuation of Services
An individual Enrollee does not have the right to renew his or
her eligibility for services under this Agreement once his/her
relationship (employment or otherwise) to San Rafael is terminated.
An Enrollee's right to receive such services is determined solely by
this Agreement.
11.4 Review by Commissioner
If any person believes that an Enrollee has been canceled or
denied services or eligibility under this Agreement because of an
Enrollee's health status or requirements for health services, he/she
may request a review by the Commissioner of Corporations of the
State of California under Section 1365(b) of the California Health
and Safety Code.
12. DISRUPTION OF SERVICE BY PANEL PROVIDERS
12.1 Notice to San Rafael
In the event that any termination, breach of contract, or
inability to perform of any Panel Provider could materially and
adversely affect San Rafael, PPC of California shall provide San
Rafael reasonable written notice thereof.
12.2 Continuation of Care
In the event that the Panel Provider from whom an Enrollee
receives counseling under this Agreement terminates his/her
contractual relationship with PPC, PPC will arrange for another
Panel Provider to deliver counseling services to such Enrollee
without charge to San Rafael or the Enrollee.
13. RELATIONSHIP OF PARTIES
The relationship of PPC to San Rafael shall be that of independent
contractor. PPC assumes no responsibility for the supervision of any San
Rafael employee; such supervision and/or decisions regarding the employee
are the responsibility of San Rafael.
14. CONFIDENTIAL RELATIONSHIP
Any information concerning San Rafael, its products, services,
personnel policies, or any other aspect of its business learned by PPC in
the course of providing services pursuant to this Agreement shall be held
in confidence and not be disclosed by PPC or any person or organization
without the prior written consent of San Rafael. Notwithstanding the
confidential treatment of San Rafael's business information, PPC may
identify San Rafael as a PPC client.
15. RECRUITMENT OF PPC PERSONNEL
San Rafael agrees not to recruit directly any professional employed
by PPC for any San Rafael program that would replace any PPC EAP or
conduct any business activity in competition with PPC during the term of
this Agreement and for 18 months after termination of this Agreement. In
the event of violation of this restriction, San Rafael shall pay PPC as
liquidated damages an amount equal to the annual salary of such person on
the last day of his/her employment with PPC.
EAP-RNW.3C 9 San Rafael
16. COMPLIANCE WITH LAWS
16.1 Anti -Discrimination Laws
PPC will not discriminate against any Enrollee or employee or
applicant for employment because of race, color, religion, sex,
national origin, ancestry, marital status, sexual orientation, or
age. PPC will reasonably accommodate disabled Enrollees seeking
services. PPC agrees to comply with all applicable state and
federal statutes, Executive Orders and regulations relating to
nondiscrimination in employment and delivery of services.
16.2 Confidentialitv Laws
PPC agrees to comply at all times with the Confidentiality of
Medical Information Act, California Civil Code 56 et seq. and all
other applicable laws relating to the confidentiality of counseling
records. Limits of confidentiality will be established with
management and explained to Enrollees prior to program
participation.
17. INDEMNIFICATION AND INSURANCE
17.1 Indemnification by PPC
PPC assumes the risk of liability for and shall indemnify,
defend, protect, and save harmless San Rafael, its officers,
directors, agents, and employees from and against any and all
claims, damages, liabilities, losses, and expenses (including
attorney's fees) for all injury, including death, to any person or
persons whomsoever and damages to any property whatsoever due to
any
negligent or willful act or omission by PPC arising out of or in
the
course of services under this Agreement. Provided, however, San
Rafael shall promptly notify PPC of any claim that may give rise
to
PPG's obligations under this paragraph and provided further that
PPC
shall have the sole discretion to determine the action to be taken
to defend against and/or to compromise any such claim.
17.2 Insurance
Without limiting the scope or extent of the protection afforded
San Rafael for the liabilities assumed by PPC herein, PPC shall
maintain in force for the life of this Agreement liability insurance
to cover the liability assumed by PPC under the foregoing agreement
of indemnity with limits of liability not less than $1,000,000.00
per occurrence.
17.3 Indemnification By San Rafael
17.3.1 Mandatory Referrals to EAP
In the event that at any time San Rafael requires that
any Covered Employee participate in the EAP as a condition of
continued employment, San Rafael shall assume the risk of
liability for and indemnify, defend, protect, and save harmless
PPC, its officers, directors, employees, and Clinical
Affiliates from and against any and all claims, damages,
liabilities, losses, and expenses (including attorney's fees)
for all injury, including death, to any person or persons
whomsoever and damages to any property whatsoever arising out
EAP-RNW.3C 10 San Rafael
of any and all personnel actions of San Rafael relating to such
Covered Employees.
17.3.2 Restriction of Providers
In the event that at any time San Rafael restricts
PPG's choice of providers to which referrals for treatment may
be made, whether through a provider panel maintained by San
Rafael or by its insurance carrier or managed care vendor other
than PPC, San Rafael shall assume the risk of liability for and
indemnify, defend, protect, and save harmless PPC, its
officers, directors, employees, and Clinical Affiliates from
and against any and all claims, damages, liabilities, losses,
and expenses (including attorney's fees) for all injury,
including death, to_any person or persons whomsoever and
damages to any property whatsoever arising out of referral to
any such provider or providers, unless such provider was at the
time of the referral also a provider in PPC's provider network.
18. MISCELLANEOUS
18.1 Amendment
This Agreement may be amended at any time by mutual Agreement
of the parties provided that before any amendment shall be
operative, it shall be reduced to writing and signed by San Rafael
and PPC. PPC may not increase the professional fee nor decrease the
level of services during the term of this Agreement except upon the
written agreement of San Rafael.
18.2 Governinq Law
This Agreement shall be governed by and construed according to
the laws of the State of California. The EAP set forth in this
Agreement is subject to Chapter 2.2 of Division 2 of the California
Health and Safety Code and to Subchapter 5.5 of Chapter 3 of Title
10 of the California Code of Regulations. Any provision required to
be in this Agreement by either of the above shall bind PPC whether
or not any such provision appears in this Agreement.
18.3 Notices
All written notices under this Agreement shall be sent to the
parties at the following addresses:
To San Rafael:
Darryl Chandler
Personnel Officer
City of San Rafael
1400 5th Avenue
San Rafael, CA 94915-1560
To PPC:
Douglas E. Studebaker, President
Medco Behavioral Care of
California, Inc.
1620 26th Street, Suite 2050
Santa Monica, CA 90404
and
Legal Department
P.P.C., Inc.
1401 S. Brentwood Blvd., Suite 400
St. Louis, MO 63144
EAP-RNW.3C 11 San Rafael
Invoices for amounts due PPC under this Agreement shall be sent to
San Rafael at the following address:
Address: 1400 5th Avenue
City, State, Zip: San Rafael, CA 94915-1560
Attention: Darryl Chandler, Personnel Officer
Each party may designate a different address by giving to the other
party written notice of such change.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed, effective the day, month, and year first above written.
MEDCO SEHAV RALA C'A,�RE OF CALIFORNIA, INC.
Date: 'S Y By: ��`
CITY OF 7SANF
Date. B Al.,B ro, May
Attest:
4+.-rk
Jea&e`'M. Leoncini, City C e
EAP-RNW.3C 12 San Rafael
S A M P L E
PERSONAL PERFORMANCE CONSULTANTS OF CALIFORNIA, INC.
1620 26th Street, Suite 2050
Santa Monica, California 90404
(310) 453-6727
EMPLOYEE ASSISTANCE PROGRAM
COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM
WHAT IS THE EAP?
It is a professional counseling service provided by an independent,
outside firm, Personal Performance Consultants of California, Inc.,
(PPC®) to help you and the members of your household resolve personal
problems. The EAP is set up to provide brief counseling for a broad
range of problems...
• parenting concerns
• marriage and family distress
• alcohol and drug misuse
• stress related to financial and legal problems
• emotional stress
• conflicts at work or home
• life crises
• other personal problems
Brief counseling is outpatient counseling that is problem -focussed, that
emphasizes skills and strengths and encourages practicing new behaviors;
that involves setting goals achievable in a one to five month period;
that involves interpretation, suggestions, and a framework provided by
the counselor; that you may utilize alone or together with members of
your household.
WHAT ARE THE LIMITATIONS OF THIS SERVICE?
You and the members of your household are entitled to receive up to eight
counseling sessions per problem, as clinically appropriate.
WHAT DOES THE COUNSELING SERVICE INVOLVE?
You will discuss your personal problem(s) with an experienced, licensed
professional counselor. Counseling is a 3 -stage process...
• clarifying and understanding the problem
• identifying choices
• developing an action plan
The EAP counselor will not tell you what to do about your problem. He or
she will ask you about the problem; find out what solutions you have
tried; identify what you want to do; and help you make a plan to solve
the problem. For most problems, a plan of action can be developed in 3-4
sessions. Sometimes the plan may involve referral to a resource outside
PPC --when a specialized resource, longer term assistance, or
hospitalization is needed. Most people are served solely through the EAP
and do not require referral.
EAP-RNW.3C 13 San Rafael
WHO IS ELIGIBLE?
Ask your employer who is eligible to receive PPC services.
WHEN DOES COVERAGE COMMENCE AND TERMINATE?,
You are covered from the first day you become an employee of your
employer to the last day you are an employee. Your household members are
covered during the same time you are.
Your eligibility will remain in effect each month for which your employer
pays the appropriate fee to PPC. Your eligibility will cease in the
event that your employer's contract with PPC terminates. If your
eligibility stops after you have received your first counseling session,
but before you have received the full number of sessions to which you are
entitled, you can still receive the full number, as clinically
appropriate. Your coverage cannot be canceled or not renewed because of
your health status or your use of the EAP. If you think this has
happened, you may request review by the California Commissioner of
Corporations and/or call (415) 358-8585, collect, or send a letter to
"Clinical Director, PPC, 1111 Chess Avenue, Foster City, California
94404" to make a complaint as described below. Your coverage can be
terminated by PPC for fraud or deception in the use of counseling
services.
WHAT DOES IT COST?
You and your household members have no obligation to pay for counseling
services provided by PPC. The full cost of this service is paid by your
employer. There are no co -payments, co-insurance, or deductible payments
applicable to PPC services. All counselors are under contract with PPC.
By law, every contract between PPC and its counselors provides that, in
the event PPC fails to pay for your services, you will not be liable to
the counselor for any sums owed by PPC. If you and the PPC counselor
decide additional services not covered by this program are necessary or
if you obtain services by counselors who do not have a contract with PPC,
you will be responsible to pay for them. Sometimes your group health
plan will cover these costs. The decision to use any outside resources
will be up to you. PPC will not pay you back for any sums you pay to any
counselor.
MAY I CHOOSE MY OWN COUNSELOR?
PPC maintains a large panel of excellent counselors who have been
screened and are monitored by PPC. A counselor from this panel will be
assigned to you.
WHAT IF I AM DISSATISFIED WITH MY COUNSELOR?
If you are dissatisfied with your counselor, a new one will be assigned
to you, if possible. In the event you have a complaint regarding any PPC
services or any of PPC's counselors, or you have a dispute about PPG's
services, you are entitled to call (415) 358-8585, collect, or send a
letter to "Clinical Director, PPC, 1111 Chess Avenue, Foster City,
California 94404." You may make your complaint by telephone or you may
request a complaint form. Each complaint will be acknowledged within 20
EAP-RNW.3C 14 San Rafael
days and will be investigated by PPG's Clinical Director. Notice of the
outcome of your complaint by PPG's Clinical Director will be given to you
within 30 days of its receipt. If you are dissatisfied with the Clinical
Director's resolution of your complaint, you may request review by PPC's
Grievance Committee. Additional information may be submitted to the
Grievance Committee. You will be notified of the Grievance Committee's
decision within 30 days of your request. In addition, following
completion of your series of counseling sessions, you will receive a
Service Evaluation Card on which you may express your opinion or submit
your complaints.
WHAT SERVICES ARE NOT INCLUDED?
PPC provides only assessment, brief counseling, referral to treatment
providers for long-term or specialized treatment, and follow-up on
referrals. PPC does not perform evaluations or professional
recommendations for purposes of legal proceedings or fitness for work
determinations, excuses for leaves of absence or time off. PPC does not
provide counseling that a person is required to obtain by a court or
government agency.
CONFIDENTIALITY
All EAP records and services will be treated with the strictest
confidentiality. PPC will not share information concerning your
involvement in the EAP without your written permission unless life,
safety, or national security is seriously threatened or disclosure is
otherwise required by law when such circumstances are indicated. Your
counselor will consult with other professionals at PPC to determine if
disclosure is necessary. Professional auditors not employed by the
company may examine the information to evaluate the EAP; the auditors
will not disclose information identifying your participation in the EAP
to anyone.
If your company refers you to the EAP for a work performance problem, PPC
will confidentially inform the person who referred you whether you attend
the EAP and whether you cooperate with the counseling plan. No further
information will be shared with the company without your written
permission.
WHAT HAPPENS WHEN THE CONTRACT EXPIRES?
The contract with your employer is renewable. PPC may change its fees,
services, or the terms of its contract with your employer on any renewal
of the contract, unless otherwise mandated by law.
MAY COVERAGE BE CONTINUED AFTER ELIGIBILITY CEASES?
You and/or members of your household may be able to continue coverage for
PPC services on an individual basis, at your/their cost, following the
end of employment, the breakup of your family, or your death. If you
have questions about whether you/members of your household may elect to
continue eligibility for PPC services, ask your employer.
EAP-RNW.3C 15 San Rafael
HOW MAY I PARTICIPATE IN SETTING THE PUBLIC POLICY FOR THE EAP?
PPC appoints up to three clients to its Public Policy Committee to
participate in establishing public policy for the EAP. If you are
interested in being appointed to the committee, write to the Public
Policy Committee, PPC, 1620 26th Street, Suite 2050, Santa Monica,
California 90404.
HOW MAY I OBTAIN FURTHER INFORMATION?
Your employer may provide brochures and other materials on the EAP. If
there are slight variances between those materials and this form, this
form should be regarded as more accurate. If you desire further
information, call PPC toll-free at (800) 333-8EAP. A copy of the
contract between PPC and your -employer will be furnished on your request.
THIS COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM CONSTITUTES ONLY A
SUMMARY OF THE PPC PROGRAM. THE CONTRACT AND YOUR EMPLOYER'S EAP POLICY
AND PROCEDURES MUST BE CONSULTED TO DETERMINE THE EXACT TERMS AND
CONDITIONS OF COVERAGE.
HOW DO I OBTAIN SERVICES?
To make an appointment, you may call PPC directly between 8:30 a.m. and
5:15 p.m., Monday through Friday, as follows:
(800) 333-8EAP (Los Angeles County) (toll-free)
(714) 252-9131 (Orange County)
(415) 969-1919 (Mountain View area)
(415) 291-0211 (San Francisco)
(619) 487-1770 (San Diego area)
(408) 432-8737 (San Jose area)
(800) 888 -CARE (all other areas) (toll-free) (5:00 a.m. - 5:00 p.m.)
In crisis situations, you may call PPC at (800) 888 -CARE any time, day or
night, 7 days a week, to speak to a counselor.
EAP-RNW.3C 16 San Rafael