1983-011-Authorizing Town Manager To Execute An Amendment To The Group Medical And Hospital Service Agreement Between The Town And Kaiser Foundation Heath Plan, Inc.RESOLUTION NO. 1983 -i1A
A RESOLUTION OF THE TOWN OF LOS GATOS AUTHORIZING
THE TOWN MANAGER TO EXECUTE AN AMENDMENT TO THE
GROUP MEDICAL AND HOSPITAL SERVICE AGREEMENT
BETWEEN THE TOWN AND KAISER FOUNDATION HEALTH
PLAN, INC.
WHEREAS, the Town of Los Gatos and Kaiser Foundation Health Plan, Inc.
entered into a Group Medical and Hospital Service Agreement;
and
WHEREAS, the parties now wish to enter into a minor amendment to the
aforesaid Agreement;
NOW, THEREFORE, BE IT RESOLVED BY THE TOWN COUNCIL OF THE TOWN OF
LOS GATOS, that the Town Manager is hereby authorized to
execute the attached 111983 Amendments" to the aforesaid
Agreement on behalf of the Town.
PASSED AND ADOPTED by the Town Council of the Town of Los Gatos, Cali-
fornia, at a Regular meeting held this 17 day of
January 1983, by the following vote:
AYES: COUNCIL MEMBERS Joanne Benjamin, Terrence
J. Daily, Thomas J. Ferrito, MarLyn J.
Rasmussen & Mayor Brent N. Ventura
NOES: COUNCIL MEMBERS None
ABSENT: COUNCIL MEMBERS None
ABSTAIN: COUNCIL MEMBERS None
A f
SIGNED:
MA R OF THE TOWN OF LOS GATOS
ATTEST:
DEPUTY CLERK OF THE TOWW OF LOS GATOS
FOU1VL7AT10lY
ac-
HE.acrr -r PLArv, rive.
A Nonprofit Corporation
Northern California Region
GROUP MEDICAL.AND HOSPITAL SERVICE AGREEMENT
AMENDMENT
Group No. 931
The Group Medical and Hospital Service Agreement between Kaiser Foundation Health Plan, Inc. and the Group named below is
amended as follows:
See attached "1983 Amendments ".
COVERAGE: All Subscribers have "_ S "Coverage. All Family Dependents have" S "Coverage.
MONTHLY PAYMENTS: The monthly payments per Family Unit required under this Agreement are shown below:
Basic Rate Structure
Subscriber
Subscriber with one Family Dependent
Subscriber with two or more Family Dependents
Variables to Basic Rate Structure
For each Member age 65 or older who is (a) not entitled to
benefits under Part B of Medicare, or (b) entitled to benefits
under Part B of Medicare but has not assigned such benefits
to Health Plan
For each Member (up to 3 per Family Unit) entitled to bene-
fits under both Parts A and B of Medicare who has assigned
Part B benefits to Health Plan:
Subscriber
Subscriber's spouse (or child if there is no spouse)
Other Family Dependents
LIMIT ON SUPPLEMENTAL CHARGES for calendar year1983:
For one Member of a Family Unit
For two Members of a Family Unit
For three or more Members of a Family Unit
Date Accepted , 19
Group Town of Los Gatos
P. 0. Box 949
Los Gatos, CA 95030
By Group Representative
By:
HOa310 1 -83
5 57-51 Total
S 57 51
Add S 56 51 S J14 02
Add S 50.79 S 164. 81
Add S —0—
Subtract S
-17.55
Subtract $
17.55
Subtract S
11.83
$ 575.00
S 1,150.00
S 1,650.00
Executed at Oakland, California to take effect
• • •:
KAISER FOUNDATION HEALTH PLAN, INC.,
A California nonprofit corporation
By:
Authorized Re resentative Northern California
854 SS (PtoC) MH_C C1,N CpLr3 dep9 td /R 39.96/38.96
'k�APSAEJQ
POLJNOA7710N
HEALTH PLAN, INC.
I. GROUP MEDICAL AND HOSPITAL SERVICE AGREEMENT
1. Section 1, DEFINITIONS.
Section Q, Extended Care Services, is amended to read as follows:
"Q. Extended Care Services: Skilled inpatient services which are (i) medically necessary, (ii) ordered by
an Attending Physician, (iii) customarily provided by Skilled Nursing Facilities, and (iv) above the level of
custodial, convalescent, intermediate, or domiciliary care.
[Note.-Section I -Q was lettered I -R in the 198] printing ofthe Service Agreement, and was relettered "Q"
in the 1981 Amendments.
2. Section 2, ELIGIBILITY, ENROLLMENT AND COVERAGE.
Section 2- A(2)(c) is amended by deleting the word "child" and substituting the word "person ".
3. Section 6, EXCLUSIONS, LIMITATIONS AND REDUCTIONS.
a) Setion 6 -A(8), Durable Equipment, is amended by deleting the word "tents" and substituting the
words "dispensing equipment (including oxygen,) ".
b) Section 6- A(9)(d) (as amended in the 1981 Amendments] is amended to read as follows:
"(d) Prosthetic devices and cataract lenses are provided at no charge to Medicare Members and Part B
Members."
c) Section 6 -C(1), Injuries or Illnesses Caused by Third Parties, is amended to read as follows:
"(1) Injuries or Illnesses Caused or Alleged lobe Caused by Third Parties. This reduction does not
apply to Medicare Members.
(a) Services Rendered at Facilities Contracting with Health Plan. If any injury or illness is
caused or alleged to be caused by any actor omission of a third party, services and other benefits
are furnished or arranged by Physicians and Hospitals at Non - Member Rates. Payment of
these charges is the Member's reponsibility, except that, the Member is not required to pay any
portion of such charges which is in excess of the total amount of any settlement orjudgment the
Member, his or her estate, parent or legal guardian receives from or on behalf of the third party
on account of such injury or illness.
(b) Emergency Services Received at Facilities Not Contracting with Health Plan. If any
injury or illness is caused or alleged to be caused by any act or omission of a third party,
payments under Section S of the Benefit Schedule(s) are made for the services of physicians,
hospitals and other providers not contracting with Health Plan; however, the Member must
reimburse Health Plan for any amounts paid by Health Plan up to the amount of any settlement
or judgment the Member, his or her estate, parent or legal guardian receives from or on behalf of
the third party on account of such injury or illness. Health Plan may condition payment upon
execution by the Member, his or her estate, parent or legal guardian of an agreement (i) to
reimburse Health Plan accordingly, and (ii) directing his or her attorney to make payments
directly to Health Plan."
4. Section 7, CONVERSION AND TRANSFER.
Section 7 -B, Change of Residence. fA11 references in this Section to Kaiser /Prudential Health Plan are
deleted. Kaiser /Prudential Health Plan is now a "Health Plan Region" as defined in Section 1 ofthe Service
Agreement, and its name has been changed to Kaiser Foundation Health Plan of Texas.
EX -GR
II. BENEFIT SCHEDULE(S)
I. Section C, HOUSE CALLS.
This Section is amended to read as follows:
"Necessary house calls by Physicians and by visiting nurses when prescribed by a Physician are
provided within the Service Area. A house call is prescribed only when a Physician determines that
necessary care can best be provided in the home.
1) Physicians' Calls. Physicians' house calls are provided at a charge of $5.00 per call for each
Member who requires attention at the same household.
2) Nurses' Calls. No charge is made for prescribed calls by visiting nurses."
2. Section I, COSMETIC SURGERY AND PROSTHETIC DEVICES FOLLOWING. MASTECTOMY.
The last sentence is Section I -I is amended to read "Except for Medicare Members, this benefit is limited
to Members who undergo mastectomy on or after July 1, 1980."
3. Section K, EXTENDED CARE SERVICES.
The second sentence in Section K is amended to read, "Extended Care Services including nursing care,
bed and board, physical, occupational, and speech therapy, medical social services, prescribed drugs and
medications and medical supplies, appliances and equipment ordinarily furnished by the Skilled Nursing
Facility."
4. Section M, TREATMENT FOR ALCOHOLISM, DRUG ABUSE AND DRUG ADDICTION.
The second sentence in the first paragraph ( "Mental health services for treatment of alcoholism, drug
abuse or drug addiction are provided . in accord with Section N. ") is deleted.
5. Section Q, PAYMENT IN LIEU OF SERVICE BENEFITS.
A sentence is added to the end of this Section, as follows: "Members must pay Supplemental Charges that
would be due if the services received under this Section Q were received from Physicians, Hospitals or
Medical Offices."
6. Section R, SERVICE BENEFITS IN OTHER HEALTH PLAN REGIONS AND IN THE AREA
SERVED BY KAISER/PRUDENTIAL HEALTH PLAN.
This Section is retitled as follows:
R. SERVICE BENEFITS IN OTHER HEALTH PLAN REGIONS. [All references in this
Section to Kaiser /Prudential Health Plan are deleted. Kaiser /Prudential Health Plan is now a "Health
Plan Region" as defined in Section I of the Service Agreement, and its name has been changed to Kaiser
Foundation Health Plan of Texas. [
Section S, EMERGENCY SERVICES RECEIVED FROM PROVIDERS NOT CONTRACTION
WITH HEALTH PLAN.
Section S -2. Continuing or Follow -Up Treatment. [All reference in this Section to KaiserlPrudential
Health Plan are deleted. Kaiser /Prudential Health Plan is now a "Health Plan Region-as defined in
Section 1 ofthe Service Agreement, and its name has been changed to Kaiser Foundation Health Plan of
Texas. [
RESOLUTION NO. 1983 -11
A RESOLUTION AUTHORIZING THE TOWN MANAGER
TO EXECUTE A PROPOSED AMENDMENT TO WEED
ABATEMENT PROGRAM AGREEMENT BETWEEN COUNTY
OF SANTA CLARA AND TOWN OF LOS GATOS.
BE IT RESOLVED, AND IT IS HEREBY RESOLVED that the Town Council of
the Town of Los Gatos, California, does hereby authorize the Town Manager
to execute that proposed amendment to the agreement between the County of
Santa Clara and the Town of Los Gatos entitled "Second Amendment to
Agreement Between County of Santa Clara, and Town of Los Gatos for Abate-
ment of Weeds."
PASSED AND ADOPTED BY THE TOWN COUNCIL OF THE TOWN OF LOS GATOS,
CALIFORNIA, at a regular meeting held this 3rd day of
January , 1983, by the following vote:
AYES: COUNCIL MEMBERS Joanne Benjamin Terrence
J. Daily Thomas J. Ferrito Marlyn J
Rasmussen and Mayor Brent N Ventura
NOES: COUNCIL MEMBERS
ABSENT: COUNCIL MEMBERS
ABSTAIN: COUNCIL MEMBERS None
SIGNED:"
MAYOR OF THE TOWN OF LOS GATOS
ATTEST:
�x
CLER 0 HE OWN 0 LOS GAT S-
17
SECOND AMENDMENT TO AGREEMENT
BETWEEN COUNTY OF SANTA CLARA
AND TOWN OF LOS GATOS FOR
ABATEMENT OF WEEDS
The agreement previously entered into on March 6, 1978 between
the County of Santa Clara (County) and the Town of Los Gatos
(Town), as amended on June 15, 1981, is hereby amended to increase
the charge for County's costs in administering the weed abatement
program and to provide for administration of the program by any
County official designated by the County Board of Supervisors.
IT IS AGREED between the parties as follows:
1. Statement of Costs. Section 5 of the agreement for abate-
ment of weeds shall be amended to read as follows:
County shall render to Town an itemized statement or report of
the cost of the weed abatement services performed for the respec-
tive parcels of land in the Town on or before the tenth day of
August of each year, which shall include the County's administra-
tive cost of 65% of the cost of the weed abatement contractor for
the respective parcels for which services were performed. The
statement shall include the description of the lots and parcels of
land for which services were performed, and verification by signa-
ture of the County official administering the weed abatement
program.
2. County Administration. Section 14 is added to the agree-
ment for abatement of weeds to read as follows:
This agreement shall be administered on behalf of County by
the County Building Inspector or by any other County official
designated by the County Board of Supervisors.
-1-
3. Effective Date. This agreement shall be effective on the
date of execution by the parties. The increased charge for
County's administrative costs shall be effective commencing pith
the 1983 weed abatement season.
Executed by the County of Santa Clara on
COUNTY OF SANTA CLARA
ATTEST: Clerk Chairperson, Board of Supervisors
Board of Supervisors
Executed by the
Town of Los Gatos on
January
3, 1983
TOWN OF LOS
GATOS
Town Managexp Town of Los Gatos
Approved as to form
�
QIA
Robert J. Men�ft -e
Deputy County Counsel
ATTEST:
)
Clerk of the Town of Losj"Gatos
Ix
RJM:mw
0947L
-2-