AG 20-009 - NAVIA BENEFIT SOLUTIONS INC. RETURN TO. EXT:
CITY OF FEDERAL WW LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: A-4 IWAI e _ e .,,
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ORIGINATING STAFF PERSON: EXT: e95-39 3. DATE REQ,'B__ .. l.,,
TYPE OF DOCUMENT(CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT(E.G.,RFB,RFP,RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES/CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT(E.G.BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ OTHER CONTRACT AMENDMENT AG# � �� ❑ INII�I'' OCAL
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PROJECT NAME:.. � .. , ......
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NA ADDREOSNT 54) ... j4 � Iv "^ ' uTELEPHONE
SIGNATURE NAME q° II FA mm
TITLE "ff 0
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I I IIBITS AND ATTACI II[� NTS: ,qj-1Ol1i7,WORK OR's'LlwICES COh4Pl.:,NSXI'10N El NYAZANS E.,R QUIREMEN I'S/CERTIFICATE, r I AI.,I.,
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
. TERM: COMMENCEMENT DATE: � t 4w_0
COMPLETION DATE:
TOTAF CALCULATEDHURLY L OR C IB k' a I ��1""I 1 " 6 SCHEDULE OF EMPLOYEES (INCLUDE EXPENSES AND SALES TAX,IF ANY)
TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE:❑YES ❑NO IF YES,MAXIMUM DOLLAR AMOUNT: $ ..., a.....................................
IS SALES TAX OWED ❑YES ❑NO IF YES,$ PAID BY:❑CONTRACTOR❑CITY
RETAINAGE: RETAINAGE AMOUNT: ❑RETAINAGE AGREEMENT(SEE CONTRACT) OR ❑RETAINAGE BOND PROVIDE
❑ PURCHASING: PLEASE CHARGE TO: l „arl .. ........ :... 1 // r0............................. .......................................
0. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATEAPPROVED
❑ PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW _ (
1. COUNCIL APPROVAL(IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNPCIL DATE: COUNCIL APPROVAL DATE:
2. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT A;d�_ _g 1 . DATE REC'D: 01
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,LICENSES,EXHIBITS
• CREATE ELECTRONIC REM INti ER/N JTI-FICATION FOR-1 BION-T-I-I PRIOR TO XPIRATION.DATE
(Include dept.support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIAL/DATE SIGNED
❑ LAW DEPARTMENT
❑ SIGNATORY(MAYOR OR DIRECTOR)El CITY CLERK
..
❑ ASSIGNED AG# AJ 0_”"
"..I �. . ........
❑ SIGNED COPY RETURNED DATE SENT:
;OMMENTS:
Ii�nIR
navia
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NAVIA BENEFIT SOLUTIONS ADMINISTRATIVE SERVICES AGREEMENT(v.2020)
CONTRACT INFORMATION PAGE
This NAVIA ADMINISTRATIVE SERVICES AGREEMENT ("Agreement") is entered into as of the
Effective Date by and between Navia Benefit Solutions, Inc. ("Navia"), a Washington Corporation, and
the below-named Employer("Employer").
Name of Employer:
..m City of Federal Way
Effective Date: 01/01/2020
Notices Sent to Employer 33325 8th Ave. South
Federal Way,WA 98003
Notices Sent to Navia _ 60
_. 0 Naches Ave SW
Renton,WA 98057
IN WITNESS WHEREOF, Employer and Navia have reviewed the forgoing Agreement in its
entirety and have caused their undersigned Representative(s)to execute this Agreement, the same
being duly authorized to do so.
EMPLOYER NAVIA BENEFIT SOLUTIONS,INC.
SIGNATURE: "� SIGNATURE:
u�
NAME: 9 -11
NAME: HILARIE Al'1"'KE
TITLE: ,� - TITLE:CEO ......
DATE: DATE: 1/15/2020
C
tdbrev 12232019
TABLE OF CONTENTS
Article 1: Dofiuitiouo.....--..~—__.-.... ........ _................ ~_.._-..-..~................... --___.._--...|
1.1 AFFILIATE-......................---......... -'.—..~,...-....~.~'............................^^...........~^.............
...�
1.2 A(@0EEMENT,._-_..............__.__.~~. ....... _~-.—_~~...........
...~~-._~^^..~--,.,�
1.3 BENEFIT PLANS --_—.................._—_—_ ........._—_—_--_--......— ........--_.......
.l '
].4 Bl8T,�IS8 .............. ....._~.,.,,,,,..^.,~..,^,..~~,^.^^^—.`...,.~---_—.__—.l
1.5 CARD BEClPlENT................................................. .........
—_—_____---._~—_--...-_~|
1.6 CARD SERVICES PROVIDER—_ ...........,._ ................... ......—^-^.^-._.......,.—~ ...................1
1.7 CARRXER...-_...---........... _..,,,-..,,...~......_._~....—..~.......~...---- ..............---....._l
1.8 CLAIMS ADMINISTRATOR ____. ...............^..__.......—______ ............. ............ ,A
1.9 COBRAELECTION NOTICE..... ~_,,',,---...^~......__,_........... ............. ......,, ........^__.^.,_I
lJOCODE....................................................................................... ___—._—' ..........---...—..l
1.11 COVERED DEPENDENT........................................ .... ... ........................ ......---........... .........,,.2
1J2 COVERED EMPLOYEE...—__—__--........ __._—. ...... __.... — ... ........ .......--._�Z
1.13 COVERED INDIVIDUAL....... .........,.-.......... ............. ...............---... ............... .........---2
1.14 DISBURSEMENT REPORT,~.~_, .............,,^,,.,,,,---~,,,,,~.,,~_^.......~^~,,,^......^.~,^_^.2
1]5 ELIGIBILITY AND PAYROLL DEDUCTION REPORT 2
1.16 E[.,ECIRONIC PAYMBNTCARD~...._........._.,,,,.,..~,. ..................._......................~ .......-..~2
1,17 EI.1GIBLBEMPLOYEE.......................... ..............'_................. ...—_................ ..............---.........2
1J8EXHIBIT................. ........ --------.---............................. —. ...................._— ..........2
1.19 FBES.._....'.—~....~.................^._..~..~~-.—...........~^—.~~_---............._~_............2
120 GRACE PERIOD =... ... -'---_^.`'=^-=-__---.- ... .—=_— .......... ...----2
1.21 PROPERTY RTG}ITS.~.—................~..~.......~....~....._....—..,.2
122 PARI'Y OR.PAR]FIBS—__...... ............_...........--__'_ ......___--_....................... --2
123 PLAN .,.~,^,,~ ......-3
124 PLAN APPLICATION_..... . ....... —___--_-- .......... ........._....... -_—_ ........
_—.'3
1.25 PLAN D000MENT. .........----...... _-.^~__~~...... ....... ........-...... .^^'^~`^^'^^'^.~''^~—~^^-3
126 PLAN YEAR.......---................. ......... ........ .................—__.— ...... _'_-._-__-3
1.27 REPRESENTATIVE......_....... ----- ... ....
—'--------'------------�
1.28 -~,-~..-_..~-,~.^—........,.~~... ... -, ...... __-.-,......~......~~._^^—.~.3
129 SCHEDULE..... ----..~ ........... -- ----..... ...... ...... .............. .................... ...... ......... ....9
1.30 SERVICES.......................... ... ----............. ............... ......---...._----------_—_-3
1.31 SPECIFIC RIGHTS NOTICE.,,-............_.,......................~_......,....................-.~.__.. ........3
132 SUBCONTRACTOR... -......................... ....... _--_-~- ........._—._ ....... ....... ...... --3
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mure,_ uuuxo o
L33WE OR US... .. ........ ......... ......... . ......... ....... .... ...... . ............. ....... ..................... .........3
1.34 YOU OR YOUR...... ......... ......... ......... .....I— ....,.,,, ,..,..,..3
1.35 YEAR-TO-DATE REPORT......................................................................................................,....3
Article II. Relationship and Term...... . ......... ......... ......... ......... ......... ......... .........4
2.1 RELATIONSHIP OF THE PARTIES........,....... ......... ......... . ........ ....... .. ..... .. ..4
2.2 TERM OF THE AGREEMENT— ......... .... ..... ................................. ......... . ........ ....--A
2.3 TERMINATION WITHOUT CAUSE..........................................................................................4
2.4 TERMINATION FOR CAUSE.......... ....................... ....................................... .......A
2.5 POST TERMINATION OBLIGATIONS.. ......... ......... ......... .......... . ...,—A
ArticleIII. Fees..............................................................................................................................................5
3.1 FEES FOR SERVICES ...... . . ....... ......:.. ... ...... ....................... ......... ........ ....... ...., . ..,.,..5
3.2 FEES FOR ADDITIONAL SERVICES........................................................................................5
3.3 FEE TERMS AND CHANGES IN FEES............. ...... . .......5
Article IV Warranties and Representations... ......................... ......... ................... .........6
4.1 MUTUAL WARRANTIES AND REPRESENTATIONS .............................................................6
4.2 NAVIA'S WARRANTIES AND REPRESENTATIONS............................................................6
Article V. Information and Records.........................., , ........ ......... .......,. ......... .....,...6
5.1 RECORDS GENERALLY. ......... ................................... .................................6
5.2 CONFIDENTIAL AND PROPRIETARY INFORMATION-GENERALLY......... ..........6
5.3 MEDIA RELEASES AND PUBLIC ANNOUNCEMENTS--, 7
5.4 PROTECTED HEALTH INFORMATION .....—.. ..... ......... ....... ...,...8
5.5 INTELLECTUAL PROPERTY RIGHTS,......... ...,..8
5.6 ONLINE SERVICES................................. ...................,. ...........,...,....,,.........., ..,......8
Article VI. Liability and Indemnification................ ....m.... ........, ,..... ....8
6.1 LIMITATION ON LIABILITY..... ......... ......... ........ ....... ---.............. ,..,..................8
6.2 INDEMNITY ......... ..................... :.. ...... .......... ........ ......... ......... .........
6.3 REMEDIES... ........ .. ...... ......... ......... ......... ................................. ........... ......................9
6.4 STATUTE OF LIMITATIONS...... ......................... .................., ......... .. . ....... .....,. . ,..,..,...10
Article VII Miscellaneous...... ......... 10
7.2 SECTION HEADINGS..... ...................... ........ .... .. . .... ................... ..< ,.,...
7.3 WAIVER OF RIGHTS--.. ......... ... ...... ......... ......... ......... ........ ......... ......... .........10
7.4 INVALID/ILLEGAL/UNENFORCEABLE PROVISIONS.,.................................... .............—10
7.5 AMENDMENT............................................................................................................................10
ii
tdbrev_12232019
7.6 AGREEMENT.............................................................................................................................10
7.7 NOTICES....... .... ................. ....... .. ... ...... ......... ......... ......... ................ . . ....... .... .....10
7.8 CONSENT----... 11
7.9 THIRD PARTY BENEFICIARIES.. ............. . ..... ......... ......... ......... ......... ...............11
7.10 -ADVERTISING..............................................................................................:....................::......41 -
BENEFIT PLAN SERVICE SCHEDULE(S)AND FEES.........................................................................12
CAFETERIA PLAN SERVICE SCHEDULE............................................................................................16
FLEXIBLE SPENDING ARRANGEMENT SCHEDULE............ .....................17
EXHIBIT A BUSINESS ASSOCIATE AGREEMENT.-...... ........ 20
EXHIBIT B EMPLOYER CERTIFICATION .............................. ................... . ..... ............25
EXHIBIT B EMPLOYER CERTIFICATION. ...... ... ......... . ........ ................................ ..................27
tdbrev_12232019
NAVIA ADMINISTRATIVE SERVICE AGREEMENT
Employer has asked Navia to provide administrative services for certain employee Benefit Plans
maintained by Employer as described in this Agreement. In consideration of the mutual promises
contained in this Agreement,Employer and Navia agree as follows:
GENERAL TERMS AND CONDITIONS
ARTICLE I: DEFINITIONS
All capitalized terms in this Agreement not defined in this Section shall have the meanings set forth in the
Sections or Schedules of this Agreement in which they are defined.
1.1 AFFILIATE
"Affiliate" means a business entity now or hereafter controlled by, controlling or under common control
with a Party. Control exists when an entity owns or controls directly or indirectly 50% or more of the
outstanding equity representing the right to vote for the election of directors or other managing authority
of another entity.
1.2 AGREEMENT
"Agreement"means the following: the Contract Information Page,the General Terms and Conditions,the
Schedules and the Exhibits that are specifically incorporated by the Parties into this Agreement by
reference.
1.3 BENEFIT PLANS
"Benefit Plan(s)" means one or more employee benefits plans, 132 Transportation benefits, COBRA
Administration, or Direct Billing Administration established and maintained by Employer for the benefit
of its employees and their eligible dependents for which Navia provides Services in accordance with this
Agreement.
1.4 BUSINESS DAY
"Business Day"means Monday through Friday, excluding days deemed to be federal holidays.
1.5 CARD RECIPIENT
"Card Recipient" means the individual to whom Card Services Provider issues an Electronic Payment
Card in accordance with this Agreement.
1.6 CARD SERVICES PROVIDER
"Card Services Provider" means the third party chosen by Navia to issue Electronic Payment Cards in
accordance with this Agreement and/or process electronic payment card transactions.
1.7 CARRIER
"Carrier"means the insurance Carrier or other benefit provider designated by the Employer.
1.,8 CI,AT"SIS ADMINISTRATOR _
"Claims Administrator"means Navia.
1.9 COBRA ELECTION NOTICE
"COBRA Election Notice"means the election form included in the Specific Rights Notice.
l
tdbrev_12232019
1.10 CODE
"Code" means the Internal Revenue Code of 1986 and the regulations thereunder, as amended from time
to time.
1.11 COVERED DEPENDENT
"Covered Dependent" means any person other than the Covered Employee who is covered under a
Benefit Plan by virtue of his relationship to the Covered Employee.
1.12 COVERED EMPLOYEE
"Covered Employee" means any of Employer's employees or former employees who are enrolled in a
Benefit Plan or who have established a Health Savings Account as defined in Code Section 223.
1.13 COVERED INDIVIDUAL
"Covered Individual"means a Covered Employee or a Covered Dependent.
1.14 DISBURSEMENT REPORT
"Disbursement Report" means a file or report created by Navia, posted to the Website that details the
benefit disbursements.
1.15 ELIGIBILITY AND PAYROLL DEDUCTION REPORT("EDR")
"Eligibility and Payroll Deduction Report"means a file or report created by Navia, posted to the Website,
and verified by the Employer against payroll deductions for each processing date.
1.16 ELECTRONIC PAYMENT CARD
"Electronic Payment Card"means a debit card or store value card used to pay for eligible expenses under
the Benefit Plan(s).
1.17 ELIGIBLE EMPLOYEE
"Eligible Employee" means an employee that is eligible for the Benefit Plan(s) as determined by the
Employer.
1.18 EXHIBIT
"Exhibit" means the document or documents specifically incorporated by the Parties into this Agreement
by reference that describe the specific rights, duties, and obligations of the Parties.
1.19 FEES
"Fees"means the amount that must be paid as indicated in each Schedule.
1.20 GRACE PERIOD
"Grace Period"means the 2.5-month period after the end of the Plan Year during which eligible expenses
incurred during that time may be applied toward the previous Plan Year.
1.21 INTELLECTUAL PROPERTY RIGHTS
"Intellectual Property Rights" means all intellectual property rights throughout the world, including
copyrights, patents, mask works, trademarks, service marks, trade secrets, inventions (whether or not
patentable), know how, authors' rights, rights- of attribution, and other proprietary rights and all
applications and rights to apply for registration or protection of such rights.
1.22 PARTY OR PARTIES
"Party"means Employer or Navia collectively,and Employer and Navia shall be referred to as"Parties".
2
tdbrev 12232019
1.23 PLAN ADMINISTRATOR
"Plan Administrator"means Employer.
1.24 PLAN APPLICATION
"Plan Application"means the online or form questionnaire provided by Navia to Employer used to gather
Employer and Plan design information.
1.25 PLAN DOCUMENT
"Plan Document" means a document that describes the Plan's terms and conditions related to the
operation and administration of the plan.
1.26 PLAN YEAR
"Plan Year"means a period of time determined by the Employer no longer than 12 months.
1.27 REPRESENTATIVE
"Representative"means an officer,director, or individual with authority to bind the Party.
1.28 RUN-OUT-PERIOD
"Run-out Period"means the period of time after the end of the Plan Year during which Covered Individuals
can submit claims.
1.29 SCHEDULE(S)
"Schedule(s)" means the document or documents specifically incorporated by the Parties into this
Agreement by reference that describe the specific Services and the specific rights and obligations of the
Parties with respect to such Services.
1.30 SERVICES
"Services" means Benefit Plan related administrative services as described specifically in the Schedules,
together with any materials, supplies, tangible items or other goods Navia furnishes in connection with
the Services.
1.31 SPECIFIC RIGHTS NOTICE
"Specific Rights Notice" means the notice that must be provided to each qualified beneficiary in
connection with a COBRA qualifying event.
1.32 SUBCONTRACTOR
"Subcontractor" means a third-party to whom a Party has delegated or subcontracted any portion of its
obligations set forth herein.
1.33 WE OR US
"We"or"Us"means Navia.
1.34 YOU OR YOUR
'You"or *.your,,, iritatis Entploycr.
1.35 YEAR-TO-DATE REPORT
"Year-to-Date Report" means a file or report created by Navia, posted to the Website that details
contributions, disbursements, and benefit election, if applicable.
tdbrev_12232019
ARTICLE IL RELATIONSHIP AND TERM
2.1 RELATIONSHIP OF THE PARTIES
Navia is an independent contractor. Nothing in this Agreement or in the activities contemplated by the
Parties hereunder shall be deemed to create an agency, partnership, employment, or joint venture
relationship between the Parties, their Affiliates, or any of their Subcontractors or Representatives
Employer acknowledges that Navia is not an accounting or law firm. No Services, and no written or oral
communications made by Navia during the course of providing Services, are or should be construed by
Employer as tax or legal advice.
2.2 TERM OF THE AGREEMENT
This Agreement shall be in effect from Effective Date set forth on the Contract Information Page and
will continue until such time as the Agreement is terminated as set forth herein("Term"). Each Schedule
may have a later effective date than this Agreement to the extent that Employer and Navia agree to the
terms set forth in the Schedule after this Agreement has already become effective. If the Employer uses
the Services of Navia,this Agreement will be deemed to be in effect as of the date Navia begins providing
such Services even if a copy of this Agreement has not been signed and returned by the Employer—all
fees and monthly charges will be due and payable as set forth herein.
2.3 TERMINATION WITHOUT CAUSE
Either Party may terminate this Agreement for convenience, without cause, at any time without further
charge or expense with at least sixty (60)calendar days prior written notice to the other Party.
2.4 TERMINATION FOR CAUSE
In addition to any other remedies available to a Party, a Party may immediately terminate this Agreement
upon the occurrence of a Termination Event by the other Party by providing written notice of termination
to the other Party.
The following events constitute a Termination Event:
(a) Employer fails to pay the applicable Fees or satisfy the applicable funding requirements as set
forth herein;
(b) Failure of a Party to cure a material breach(to the extent curable)within thirty (30) calendar days
after written notice of the breach and intent to terminate is provided by the non-breaching Party;
(c) Employer files for bankruptcy,becomes or is declared insolvent(generally unable to pay its debts
as they become due), is the subject of any proceedings (not dismissed within 30 days) related to
its liquidation, insolvency or the appointment of a receiver or similar officer, makes an
assignment for the benefit of all or substantially all of its creditors,takes any corporate action for
its winding-up, dissolution or administration, enters into an Agreement for the extension or
readjustment of substantially all of its obligations, or recklessly or intentionally makes any
material misstatement as to its financial condition. In the interest of risk reduction for both
Parties, Navia may immediately suspend Benefit Plan processing (including debit cards) without
notice upon the occurrence of any of the circumstances described in this section (c). Upon
written notice to Employer,Navia may terminate services for a Covered Employee for persistent
abusive,offensive, or similar behavior toward Navia employees.
2.5 POST TERMINATION OBLIGATIONS
(a) If Employer terminates this Agreement, Navia shall reasonably cooperate with Employer to
transition information to Employer or a new third party pursuant to the reasonable instructions of
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tdbrev_12232019
Employer, in accordance with the terms of this Agreement, as necessary to enable the new service
provider to perform'services without disruption to Covered Individuals. Employer is obligated to
reimburse all reasonable costs and expenses incurred by Navia for continued administration
during the transition process (including administration Fees during the claims run-out period) and
transitioning any necessary information as set forth herein. Covered Individual claims submitted
to Navia after termination of the Agreement or expiration of the claims run-out period, whichever
is later,will be denied and Participants will be redirected to the Employer and Navia will have no
further responsibility with respect to Covered Individual claims received after such time.
(b) The rights and obligations of the Parties that by their nature must survive termination or
expiration of this Agreement in order to achieve its fundamental purposes include, without
limitation, Section 5.1 through Section 5.5, Article VI, Section 7.7, and the Business Associate
Agreement Exhibit.
(c) Termination of this Agreement shall not terminate the rights or obligations of either Party arising
prior to the effective date of such termination. Notwithstanding anything to the contrary herein upon
termination of this Agreement,all Fees,funding,and other amounts owed will become immediately due
and payable.
ARTICLE III. FEES
3.1 FEES FOR SERVICES
The Fees that Employer must pay Navia for Services are set forth in the Fee section of each Schedule. To
the extent that Navia sends a monthly invoice, all Fees are due upon receipt of the monthly invoice;
however, there is a thirty (30) day period after which 1.5% interest per month will accrue with respect to
any unpaid Fees to the extent Navia does not terminate the Agreement in accordance with Article III
herein. If the invoice is mailed by Navia, the recipient is deemed to have received the invoice within
three (3) Business Days after Navia mails the invoice. Failure to timely and completely pay such Fees
may also result in suspension of all or part of the Services provided or, in Navia's discretion, termination
of the Agreement.
3.2 FEES FOR ADDITIONAL SERVICES
Additional Fees for additional Services not listed in the Schedules shall be as mutually agreed in writing
between Employer and Navia prior to performance. Such Fees may result from Employer's specific
requests for legal guidance provided by an outside firm, development time, or third-party audit Fees.
3.3 FEE TERMS AND CHANGES IN FEES
(a) Fees are effective beginning with the Effective Date unless otherwise provided herein.
(b) Navia may change Fees to the extent that (i) changes are made in applicable law that materially
affect the rights and obligations of Navia set forth herein, (ii) Employer amends the Benefit Plan
in a manner that materially impacts the Services provided herein; or (iii)Navia provides written
notice of a proposed Fee change to Employer. If Employer does not affirmatively reject any
proposed Fee changes in :writiirg within.-ti°dirty (30) days of aeceivhig written Aiotice of :the — —
proposed Fee changes from Navia, such proposed Fees will become effective the first day of the
month following the end of the thirty-day response period. If Employer does not agree with such
proposed Fee changes, Employer may terminate the Agreement with no less than thirty (30) days
prior written notice from the date that Navia notified Employer of the Fee changes.
5
td brev_12232019
ARTICLE IV. WARRANTIES AND REPRESENTATIONS
4.1 MUTUAL WARRANTIES AND REPRESENTATIONS
Each Party represents and warrants the following:
(a) the Party's execution, delivery and performance of this Agreement: (i) have been authorized by
all necessary corporate action, (ii) do not violate the terms of any law, regulation, or court order
to which such Party is subject or the terms of any material agreement to which the Party or any
of its assets may be subject and(iii)are not subject to the consent or approval of any third party;
(b) This Agreement is the valid and binding obligation of the representing Party, enforceable against
such Party in accordance with its terms;
(c) Such Party is not subject to any pending or threatened litigation or governmental action which
could interfere with such Party's performance of its obligations hereunder; and
(d) Both Parties will perform their respective obligations under this Agreement in compliance with
all laws,rules,regulations, and other legal requirements applicable to the Party.
4.2 NAVIA'S WARRANTIES AND REPRESENTATIONS
(a) Navia represents and warrants that the Services shall reasonably conform to the Schedules
described herein.
(b) Other than as specifically set forth herein,Navia makes no representation or warranty, express or
implied, written or oral, and, to the full extent permitted by law, disclaims all other warranties
including, but not limited to, the implied warranties of merchantability or fitness for a particular
purpose.
4.3 EMPLOYER'S WARRANTIES AND REPRESENTATIONS
Employer represents and warrants they are not subject to any pending or threatened litigation,
governmental action, or investigation from the IRS,DOL,HHS, or otherwise with respect to any Benefit
Plans. If Employer is subject to any litigation, action, or investigation, or becomes subject while this
Agreement is in effect,Employer shall promptly notify Navia in writing in advance of the Effective Date
of this agreement, or within 10 days of Employer becoming aware of such litigation,action,or
investigation. ,
ARTICLE V: INFORMATION AND RECORDS
5.1 RECORDS GENERALLY
Employer and Navia shall retain records and supporting documentation sufficient to document its
satisfaction of its obligations under this Agreement in accordance with laws and generally accepted
accounting principles for at least seven(7)years from the date such record or documentation is created.
5.2 CONFIDENTIAL AND PROPRIETARY INFORMATION- GENERALLY
(a) The term "Confidential Information" shall mean this Agreement and all non-public data, trade
secrets, business information and other information of any kind whatsoever that a Party
("Discloser") discloses, in writing, orally, visually or in any other medium, to the other Party
("Recipient") or to which Recipient obtains access and that relates to Discloser or, in the case of
Navia, its customers. A "writing" shall include an electronic transfer of information by e-mail,
6
tdbrev 12232019
over the Internet or otherwise. Confidential Information shall not include Benefit Plan
information (i.e. card swipe data, Benefit Plan reports, claims, explanation of benefits and other
Protected Health Information). Such information will be protected under the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA") Health Information Technology for
Economic and Clinical Health Act(HITECH"), and/or other applicable privacy and security laws.
(b) Each of the Parties, as Recipient, hereby agrees that it will not, and will cause its Representatives,
Affiliates, vendors, Subcontractors, and third-parties not to disclose Confidential Information of
the other Party, during or after the Term of this Agreement, other than on a"need to know"basis
and then only: (a) for the purposes of providing, enhancing, optimizing, or auditing the Services
or to satisfy a legal or contractual requirement; (b) provided that any Representatives, Affiliates,
vendors, Subcontractors, and third-parties who receive Confidential Information are subject to a
written confidentiality agreement that shall be no less restrictive than the provisions of this
Section.
(c) Recipient shall not use or disclose Confidential Information of the other Party for any purpose
other than to carry out its obligations set forth herein.
(d) Recipient shall treat Confidential Information of the other Party with no less care than it employs
for its own Confidential Information of a similar nature that it does not wish to disclose, publish,
or disseminate,but not less than a reasonable level of care.
(e) Upon the Discloser's written request following expiration or termination of this Agreement for
any reason, the Recipient shall promptly return or destroy all Confidential Information in the
possession of Recipient or Recipient's Representatives, Affiliates, vendors, Subcontractors, and
third-parties, provided that"either Party may retain copies of such files as needed to administer the
Benefit Plan(s) or to protect its interests. If it is determined that returning or destroying all
Confidential Information of Employer is infeasible Navia shall extend the protections of this
Agreement to such Confidential Information.
(f) The obligations of confidentiality in this Section shall not apply to any information that (i)
Recipient rightfully has in its possession when disclosed to it, free of obligation to Discloser to
maintain its confidentiality; (ii) Recipient independently develops without access to Discloser's
Confidential Information; (iii) is or becomes known to the public other than by breach of this
Section or (iv) is rightfully received by Recipient from a third party without the obligation of
confidentiality. Any combination of Confidential Information disclosed with information not so
classified shall not be deemed to be within one of the foregoing exclusions merely because
individual portions of such combination are free of any confidentiality obligation or are
separately known in the public domain.
(g) A Party's Confidential Information and any results of processing Confidential Information or
derived in any way therefrom shall at all times remain the property of that Party.
5.3 MEDIA RELEASES A D,PUBEIC ANNOUNCEMENTS-
Employer
1 NO1<JN EMEI TSEmployer may not issue any media releases,public announcements and public disclosures, relating to this
Agreement or use the name or logo of Navia, including, without limitation, in promotional or marketing
material or on a list of vendors, provided that nothing in this paragraph shall restrict any disclosure
required by legal, accounting or regulatory requirements beyond the reasonable control of the releasing
Party.
7
tdbrev 12232019
5.4 PROTECTED HEALTH INFORMATION
Protected Health Information ("PHI"), as defined by 45 C.F.R. 160.103, if any, that is used or disclosed
by the Parties in accordance with this Agreement, will be governed by the terms and conditions set forth
in the Business Associate Agreement between the Parties. Employer agrees that Navia may communicate
confidential, PHI or otherwise sensitive information to Employer and hold Navia harmless in the event
Employer misroutes or improperly uses or discloses such information where such information was used
or disclosed by Navia for purposes of administration of the Benefit Plan(s) or used or disclosed for the
purposes of carrying out Navia's duties and responsibilities under this Agreement.
5.5 INTELLECTUAL PROPERTY RIGHTS
Each Party shall retain all rights in and/or title to its respective Intellectual Property Rights. Other than as
expressly provided in this Agreement, (a)nothing contained herein shall be construed as granting a Party
any license, right,title, or interest in or to any of other Party's Intellectual Property Rights and (b)neither
Party is developing any work product for the other.
5.6 ONLINE SERVICES
(a) Navia may provide access to a password-protected website maintained by Navia or Navia's
Subcontractor(s) in connection with the Services (the "Website"). Navia may unilaterally make
reasonable adjustments and improvements to the Website at any time and without prior notice.
Neither Navia nor Navia's Subcontractor is under any obligation to make any adjustments to the
Website that are requested by Employer or any other third party.
(b) The Website may include information related to Navia's other services and/or links to other
websites to the extent permitted by law. Navia neither grants a license for nor is responsible for
any external links to third party websites provided on the Website.
(c) Employer acknowledges that Employer and the Covered Individuals are solely responsible for
maintaining the hardware and/or software necessary to access the Website.
ARTICLE VI: LIABILITY AND INDEMNIFICATION
6.1 LIMITATION ON LIABILITY
(a) NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY SPECIAL,-INDIRECT,
INCIDENTAL, CONSEQUENTIAL, PUNITIVE OR EXEMPLARY DAMAGES,
INCLUDING, BUT NOT LIMITED TO, LOST PROFITS, LOSS OF DATA, OR COST OF
SUBSTITUTE SERVICES ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT OR THE SERVICES PERFORMED HEREUNDER UNDER ANY THEORY
OF LIABILITY EVEN IF SUCH PARTY ALLEGED TO BE LIABLE HAS KNOWLEDGE
OF THE POSSIBILITY OF SUCH DAMAGES, PROVIDED, HOWEVER, THAT THE
LIMITATIONS SET FORTH IN THIS SECTION SHALL NOT APPLY TO OR IN ANY
WAY LIMIT THE OBLIGATIONS OF THE SECTIONS ENTITLED "INDEMNITY," AND
"CONFIDENTIALITY AND PROPRIETARY INFORMATION". IF NAVIA IS FOUND
LIABLE TO EMPLOYER FOR ANY DIRECT DAMAGES, SUCH DAMAGES SHALL NOT
EXCEED AN AMOUNT EQUAL TO ACTUAL DAMAGES OR THE FEES PAID FOR
SERVICES GIVING RISE TO THE CLAIM WITHIN THE TWELVE (12) MONTHS
PRECEDING THE CLAIM,WHICHEVER IS LESS.
(b) Navia is not liable for the acts or omissions of a prior administrator or the acts or omissions of
Employer if prior administration was conducted by Employer.
8
tdbrev_12232019
(c) Navia shall not be liable for any action, conduct, or activity taken by Navia, or any failure to act,
at the request of Employer.
(d) Neither party will be liable for and will be excused from any failure or delay in satisfying its
obligations set forth herein if such failure or delay is caused by circumstances beyond its control,
including but not limited to any natural disaster (such as earthquakes, hurricanes or floods),
emergency conditions (such as war, riot, fire, theft, severe inclement weather, or labor dispute),
outages, legal constraint or governmental action or inaction, breakdown or failure of equipment
not due directly to the negligence of the Party maintaining the equipment, or the act, omission,
negligence or fault of the other party. This section does not excuse Employer from its
obligations to pay any of the Fees or to fund the Benefit Plans as provided herein.
Navia neither assumes nor underwrites any liability of Employer under the Benefit Plans, and acts only as
provider of the services specifically described herein. Navia shall not be responsible for any over
disbursed benefits, including but not limited to over disbursements due to insurance claim adjustments
after benefits have been reimbursed. The Services performed shall be ministerial in nature and shall be
performed in accordance with the direction, guidance, framework, and interpretation of the Benefit
Plan(s) established and communicated by Employer. Navia shall have no discretionary authority or
control over the Benefit Plan(s), funds, and Covered Individuals. Specifically, the Employer has the
absolute authority with respect to the control, management, investment, or disposition and utilization of
all plan assets, if any; and Navia shall neither have nor be deemed to exercise any discretion, control, or
authority with respect to the disposition of any plan assets.
6.2 INDEMNITY
(a) Each Party ("Indemnitor") shall indemnify, defend, and hold harmless the other Party, its
Representatives, successors and permitted assigns (collectively, the "Indemnitee") from and
against any and all claims made or threatened by any third party and all related losses, expenses,
damages, costs and liabilities, including reasonable attorneys' Fees and expenses incurred in
investigation or defense ("Damages"), to the extent such Damages arise out of or relate to the
following:
i. Any negligent act or omission or willful misconduct by an Indemnitor, its Representatives or
its Subcontractor; or
ii. Any material breach in a representation, covenant, or obligation of the Indemnitor contained
in this Agreement.
(b) Indemnitee shall give Indemnitor reasonably prompt notice of, and the Parties shall cooperate in,
the defense of any such claim, suit or proceeding, including appeals, negotiations and any
settlement or compromise thereof, provided that Indemnitee must approve the terms of any
settlement or compromise that may impose any un-indemnified or nonmonetary liability on
Indemnitee.
(c) Navia shall riot be liable to Employer for mistakes of judgineiit.w other actions Wkell ill good
fiiith unless such error results directly from an intentionally wrongful or grossly negligent act of
Navia.
6.3 REMEDIES
The remedies under this Agreement shall be cumulative and are not exclusive. Election of one remedy
shall not preclude pursuit of other remedies available under this Agreement or at law or in equity.
9
tdbrev_12232019
6.4 STATUTE OF LIMITATIONS
The Parties agree that no legal action may be brought by a Party ("Plaintiff') against the other more than
two (2) years after the date the claim giving rise to such action became known by the Plaintiff or,
exercising reasonable diligence should have been known by the Plaintiff.
ARTICLE VII: MISCELLANEOUS
7.1 SECTION HEADINGS
Section headings are included for convenience or reference only and are not intended to define or limit
the scope of any provision of this Agreement and should not be used to construe or interpret this
Agreement.
7.2 WAIVER OF RIGHTS
No delay, failure, or waiver of either Party's exercise or partial exercise of any right or remedy under this
Agreement shall operate to limit, impair, preclude, cancel, waive, or otherwise affect such right or
remedy. Any waiver by either Party of any provision of this Agreement shall not imply a subsequent
waiver of that or any other provision of this Agreement.
7.3 INVALID/ILLEGALIUNENFORCEABLE PROVISIONS
If any provision of this Agreement is held invalid, illegal, or unenforceable, the validity, legality, or
enforceability of the remaining provisions shall in no way be affected or impaired thereby.
7.4 AMENDMENT
Except as otherwise set forth herein, no amendments of any provision of this Agreement shall be valid
unless made by an instrument in writing signed by both Parties specifically referencing this Agreement.
7.5 AGREEMENT
(a) This Agreement, the Schedules, and any Exhibits reflect the final, full and exclusive expression
of the agreement of the Parties and supersedes all prior agreements, understandings, writings,
proposals, representations and communications, oral or written, of either Party with respect to the
subject matter hereof and the transactions contemplated hereby.
(b) This Agreement may be executed by the Parties in one or more counterparts, and each of which
when so executed shall be an original but all such counterparts shall constitute one and the same
instrument. The Parties agree to accept a digital image of this Agreement, as executed, as a true
and correct original and admissible as best evidence to the extent permitted by a court with proper
jurisdiction
(c) Notwithstanding the general rules of construction, both Employer and Navia acknowledge that
both Parties were given an equal opportunity to negotiate the terms and conditions contained in
this Agreement and agree that the identity of the drafter of this Agreement is not relevant to any
interpretation of the terms and conditions of this Agreement.
(d) This Agreement shall be governed by the applicable laws of Washington without regard to any of
its conflict of law principles and any dispute arising out of this Agreement will be settled in any
court of competent jurisdiction in King County,Washington.
7.6 NOTICES
(a) All legal notices required to be sent by one Party to the other Party under this Agreement shall be
given to the Parties in writing to the addresses identified on the Contract Information Page or to
10
tdbrev_12232019
such other addresses as the Parties may substitute by written notice given in the manner
prescribed in this Section as follows:
L By first class, registered or certified United States mail, return receipt requested and
postage prepaid,
ii. Over-night express courier,
iii. By hand delivery to such addresses, or
iv. Electronic mail with return receipt.
(b) Such notices shall be deemed to have been duly given (i) five (5)Business Days after the date of
mailing as described above, (ii) one (1) Business Day after being received by an express courier
during business hours,or(iii)the same day if by hand delivery or by email
7.7 CONSENT
Wherever this Agreement requires either Party's approval or consent such approval or consent shall not be
unreasonably withheld or delayed.
7.8 THIRD PARTY BENEFICIARIES
Except as expressly set forth in this Agreement,the Parties do not intend the benefits of this Agreement to
inure to any third party, including but not limited to Covered Individuals and Eligible Employees, and
nothing contained herein shall be construed as creating any right, claim or cause of action in favor of any
such other third party, against either of the Parties hereto.
7.9 ADVERTISING
Navia may indicate in its marketing materials and proposals to other prospective customers that this
Agreement has been awarded and may describe the nature and objective(s) of this engagement. No such
statements by, or materials of,Navia will disclose any Employer Confidential Information.
7.10 INSURANCE
Navia agrees throughout the term of the Agreement to maintain in full force and effect commercial
general liability, umbrella liability, error and omissions liability, and professional liability insurance
coverage in a reasonable amount, and workers' compensation insurance in the amount required by law, at
its own expense. Upon request,Navia shall furnish to Employer a certificate of insurance evidencing the
same.
11
tdbrev_12232019
BENEFIT PLAN SERVICE SCHEDULE(S)AND FEES
Employer has established one or more of the following Benefit Plans (the "Plan" or "Plans") for
purposes of providing benefits administration and/or reimbursement of certain eligible expenses
incurred by Covered Individuals:
• Cafeteria Plan Document and Forms
• Health and Dependent Care Flexible Spending Arrangements
• Health Reimbursement Arrangements
• Section 132 Transportation and Parking Plan
• Code Section 223 Health Savings Account
In addition, Employer may offer one or more of the following other Plans for purposes of complying
with applicable laws or providing additional benefits.
• Wellness Plan
• Federal COBRA Administration
• Direct Billing or Direct Billing Administration
Employer has asked Navia to assist it with its administrative obligations under one or more of the
Plans identified above. The specific Plan-related Services are described in each Schedule. Only those
Services chosen by Employer pursuant to an Application and for which the applicable Fee is paid as
set forth in the Fee section of each Schedule(or, as set forth below with respect to additional requested
Services),will be provided by Navia.
ARTICLE I.STANDARD BENEFIT PLAN SERVICES
1.1. Employer is solely responsible for the operation and maintenance of the Plans. It is Employer's
sole responsibility and duty to ensure that each Plan complies with the applicable laws and
regulations, and Navia's provision of Services under this Agreement does not relieve Employer of
this obligation.
1.2. If applicable to the particular Plan,Navia will provide Navia's standard plan document, summary
plan description, and forms to be used by Employer as a template for creating the governing
documents for the Plan(s). Such standard documents and forms have been prepared in
accordance with the standard of care set forth in the Agreement but are general in nature and do
not take into consideration facts and circumstances specific to Employer and Employer's Plans.
Consequently, Navia makes no warranties and representations that such documents and forms
will comply with applicable law as they relate to the Plan(s). Navia is not responsible for making
any changes or amending the documents. It is Employer's responsibility to review the documents
and ensure they conform to the facts and circumstances specific to Employer and the Plans, and
ensure the documents comply with applicable laws. Employer shall also make such documents
available to Covered Individuals as required by law.
1.3. Employer will provide to Navia timely, accurate and complete information relating to the
Covered Individuals and the Plans as is necessary for Navia to satisfy its obligations hereunder.
Employer shall provide information in the format and method approved by Navia (consolidated
spec file) In the event such information(i.e. data reports and files)requires manual processing or
requires a method not in Navia's business process, such processing shall be subject to Fees
(Noncompliant File Processing Fee) as provided in the applicable Schedule. In the event that the
12
tdbrev®12232019
information is not timely reported or verified, and in the event that there are disbursements made
by Navia that would not have been made if the occurrence had been reported on the same day of
each such occurrence, then Employer shall be responsible for such disbursements and shall
reimburse Navia therefore upon request by Navia. Employer shall be responsible for accurate
Participant payroll deductions, reporting of deductions, and W-2 reporting and shall ensure that
any terminated employer contacts (human resources, payroll, broker contacts, or other Employer
contacts with access to the Website) are immediately reported to Navia on the same day of the
occurrence. Employer shall be responsible for any consequences of failing to report such
terminations on the same day of the occurrence, including by not limited to the unauthorized
disclosure of information to former Employer contacts. Navia is not "a person" who is
responsible for administering or providing benefits under the COBRA benefit within the meaning
of Internal Revenue Code section 4980B (e)(1)(B). Navia is not responsible for the payment of
excise taxes imposed under Internal Revenue Code section 4980B and is not responsible for the
preparation or filing of Internal Revenue Service Form 8928. Navia shall provide such
information as Employer reasonably requests in order to calculate excise taxes imposed under
Internal Revenue Code section 4980B or to prepare IRS Form 8928. With respect to COBRA
services,Navia is merely a collection agent for the employer and any amounts collected belong to
the Employer. Employer agrees to reimburse Navia for any taxes, or other similar charges, in
connection with COBRA administration, assessed against Navia.
Employer understands and agrees that Navia may rely on all information provided to it by
Covered Individuals and/or Employer in accordance with this Agreement as true and accurate
without further verification or investigation by Navia. Navia shall not be responsible and shall be
held harmless for the receipt of inaccurate and/or incomplete information or data files. Navia
shall not be responsible for any delays in providing services under this Agreement and any
financial or adverse consequences due to the receipt of the inaccurate and/or incomplete
information or data files or for Employer's failure to send data files.
1.4 If applicable to the Plan(s), Navia will send education and engagement materials in the form of
electronic mail campaigns direct to Employees and make enrollment kits (describing the benefit),
enrollment forms, online enrollment specification files, and claim forms available on the Website
and/or to Employer for distribution to Covered Individuals. Navia is only obligated to process
claims submitted to Navia in accordance with the instructions set forth on Navia's claim forms.
Navia will process claims in accordance with applicable law, its standard operating procedures,
and the terms of the Plan to the extent that such terms are provided to Navia and are consistent
with Navia's standard operating procedures. Navia may also provide claims submission
capabilities via online and through a smart phone application for certain Plans. If Navia denies a
request for reimbursement, Navia will review the 1st level appeal. If the Plan provides for 2
levels of appeal Employer will be responsible for the final determination. Employer shall be the
fiduciary and Plan Administrator of the Benefits Plans and shall be responsible for interpreting
the Plans, its provisions, terms and conditions and make any and all determinations as to
eligibility, appeal, and change in status events, as applicable.
1.5 In the event that a Covered Employee is reimbursed less than is otherwise required by the Plans,
Navy awilB proniptly_adjjust..d e underg aynient to-the extent that Employer h ,saiisfiedits funding,
obligations as set forth herein. If it is discovered that a Covered Employee was overpaid, or the
Covered Employee fails to substantiate an Electronic Payment Card Transaction as required by
applicable rules and regulations, Navia will make reasonable attempts to request repayment of
overpaid or unsubstantiated Electronic Payment Card claims or offset the ineligible payment
against any claims for future eligible expenses in accordance with applicable rules and
regulations. If the Covered Employee fails to repay or offset, Navia will notify Employer upon
Employer's written request for such report or data. Employer is responsible for taking any
13
tdbrev_12232019
additional action permitted or required by law (e.g., including such amounts in income or
garnishing wages consistent with applicable laws). Navia shall have no obligation to request
repayment or offset to the extent such overpayment is a result of Employer's acts or omissions,
such payments were authorized by Employer or Employer, has failed to satisfy its funding
obligations.
1.6 The specific funding requirements are set forth in each Schedule. Generally, Employer shall
make sufficient employer funds from its general assets available to pay benefits under the Plan(s).
These employer funds shall not be deemed employee salary reductions or plan assets. Employer
shall grant Navia withdrawal authority over the account sufficient to enable it to pay benefits. If
at any time the amount of benefits payable under the Plan exceeds the amount received Employer
shall transfer an amount necessary to fulfill its funding obligations under the applicable Plan(s).
Navia will deposit these Employer funds into a Navia owned account to facilitate the payment of
claims. Any interest generated by Employer funds deposited into the Navia owned account shall
belong to Navia as reasonable compensation under this Agreement. Navia may use such funds
for any legal purpose including, but not limited to, to offset any fees of the financial institution
with respect to such account. To the extent that such interest (after deducting applicable fees) is
not in excess of LIBOR plus 2-percent,Navia shall be entitled to retain such interest. Navia will
return interest in excess of these permissible amounts to the Employer and the Employer agrees
that it will use such amounts in accordance with applicable laws, including but not limited to
ERISA when applicable.
Navia may suspend processing all benefit payments, electronic payment cards, and any other
reimbursements, and distributions in the event Employer fails make sufficient funds available to
pay benefits under the Plan(s) and/or fails to fund the Plan(s) according to the relevant Schedule.
Navia shall not be responsible or liable for the funding of claims for benefits under any Plan. If at
any time Navia has paid out more in benefits than received in funding (based upon either
individual Covered Employee accounts or the Plan(s) aggregate balance) Employer shall deliver
to Navia an amount equal to that deficit upon Navia's written request. If such funding is not
received within two (2) days Navia may suspend all Services including but not limited to
suspension of Electronic Payment Cards and benefit reimbursements.
1.7 If relevant to the Plan(s),Navia shall provide on-site enrollment meetings and attendance at
benefits fairs,as reasonably requested by Employer, for the Fee and costs set forth in the
Schedule.
1.8 Navia shall provide customer support weekdays, 5 a.m.to 5 p.m.Pacific Time, excluding
holidays.
1.9 Navia will conduct Nondiscrimination Testing("NDT") required under the Code for the attached
Schedules. Navia will provide Employer with a Request for Information ("RFI")form requesting
the data necessary to complete the NDT or provide an online version of the RFI. Within a
reasonable amount of time after receipt of the requested information, Navia will provide test
results, which will be based solely on the information provided by Employer and/or information
maintained by Navia in accordance with the Schedule. Such test results are not intended as legal
or tax advice and shall not be relied upon as legal or tax advice. Navia is under no obligation to
advise Employer regarding specific corrective measures beyond providing the test results.
1.10 Employer may review reports summarizing the Plan via the Website. Employer is responsible for
reviewing the reports submitted by Navia and notifying Navia of any errors of which it is aware
within a reasonable period of time after reviewing them.
14
tdbrev-12232019
ARTICLE II. ELECTRONIC PAYMENT CARD SERVICES
2.1. If applicable to the Plan(s) selected in the attached Schedule(s), at Employer's request and
payment of all applicable Fees, the Card Services Provider may make an Electronic Payment
Card available to Covered Individuals through which eligible expenses may be paid in
accordance with the following terms:
2.2. Covered Employees or Employer shall provide to Navia a valid email address for each
Covered Employee requesting an Electronic Payment Card.
2.2.1. The Card Services Provider will issue an Electronic Payment Card to each Card
Recipient within thirty (30) days of Navia's receipt of the Covered Employee's
enrollment data or the Covered Employee's online, electronic mail or form request.
Employer understands and acknowledges that the Card Services Provider issues
Electronic Payment Cards based solely on the information provided by Employer.
Navia and the Card Services Provider have no obligation to verify or confirm that
Card Recipients are Covered Individuals.
2.2.2. Card Recipients must agree to use the Electronic Payment Card in accordance with the
terms of the Cardholder Agreement that accompanies the Electronic Payment Card.
The Electronic Payment Card will be deactivated if the Covered Individual fails to use
the Electronic Payment Card in accordance with the Cardholder Agreement or as
otherwise required by applicable law.
2.2.3. The Electronic Payment Card may be used by Card Recipients to pay for eligible
expenses (as defined by applicable law and the applicable Plan to the extent consistent
with Navia's standard operating procedures) in accordance with the applicable rules
and regulations.
2.2.4. Navia will require substantiation of expenses paid with the Electronic Payment Card
in accordance with the requirements set forth in the Code and/or other applicable
guidance. The Electronic Payment Card will be deactivated if the Card Recipient fails
to provide the requested substantiation in a timely manner as determined by Navia in
accordance with Federal guidelines.
2.2.5. All Cards will be deactivated on the date this Agreement is terminated, the date that
Employer fails to satisfy its funding obligations as set forth herein, the date Employer
files for bankruptcy and/or as necessary to prevent fraud or abuse (as determined by
Navia).
15
tdbrev,_12232019
CAFETERIA PLAN SERVICE SCHEDULE
Employer has established a Code Section 125 Plan to allow eligible employees to pay for their share of
certain Benefit Plan coverage with pre-tax salary reductions (including but not limited to Employer
contributions).
This Schedule is incorporated into and made a part of the Agreement. The responsibilities of the
Parties set forth in this Schedule are in addition to any responsibilities set forth in the Agreement. If
there is a conflict between this Schedule and any other part of the Agreement with respect to the
subject matter of this Schedule, the Schedule will control. In all other conflicts, the Agreement
controls. Capitalized terms not otherwise defined herein are defined as set forth in the Agreement.
ARTICLE I. STANDARD SERVICES
I. Navia will provide a sample Code Section 125 plan document, summary plan description, and
forms for review by Employer and Employer's legal counsel. Such standard documents and
forms have been prepared in accordance with the standard of care set forth in the Agreement
but are general in nature and do not take into consideration facts and circumstances specific to
Employer and the Benefit Plans. Consequently, Navia makes no warranties and
representations that such documents and forms will comply with applicable law as they relate
to the Benefit Plans. Navia is not responsible for making changes or amending the documents.
2. All Benefit Plan elections and changes to elections will be processed as instructed by
Employer and in accordance with the terms of the sample plan document referenced in 1.1
above and applicable law. Employer will provide Eligible Employees with election and
change of election forms provided by Navia. If necessary for Navia to administer the other
Services provided under this Agreement, Employer will collect and submit the completed
election forms and/or change of election forms to Navia as soon as possible after receipt of
such forms but no later than the effective date of such elections or change of elections.
Employer is responsible for determining who is eligible for the Benefit Plan and who has
satisfied the requirements to become a Covered Individual in the Benefit Plan. In addition,
Employer is ultimately responsible for determining whether a requested change in election is
permitted.
16
tdbrev_12232019
HEALTH FLEXIBLE SPENDING ARRANGEMENT("HEALTH FSA")AND DEPENDENT
CARE FLEXIBLE SPENDING ARRANGEMENT("DAY CARE FSA")SCHEDULE
BENEFIT PLAN SERVICE SCHEDULE(S)AND FEES
This Schedule is incorporated into and made a part of the Agreement. The responsibilities of the
Parties set forth in this Schedule are in addition to any responsibilities set forth in the Agreement. If
there is a conflict between this Schedule and any other part of the Agreement with respect to the
subject matter of this Schedule, the Schedule will control. In all other conflicts, the Agreement
controls. Capitalized terms not otherwise defined herein are defined as set forth in the Agreement.
As part of the Services,Employer has asked Navia to assist it with Flexible Spending Arrangement
("FSA")administration as more particularly described in this Schedule below.
1. RESPONSIBILITIES OF NAVIA
1.1. IMPLEMENTATION
Navia shall implement the Plan subject to the Plan Application and the direction and
approval of Employer.
12 PLAN PROCESSING AND ADMINISTRATION Navia shall:
1.2.1. Provide claim reimbursements by check or direct deposit. Such claim
reimbursements will be issued within two (2)Business Days after the later of-
(1)
£(1) the scheduled processing date; (2) the date Employer reconciles the
Eligibility and Payroll Deduction Report ("EDR") or submits an approved
payroll report; or(3)the receipt of funds as required in the funding section.
1.2.2. Provide notification of online availability of the EDR, Disbursement, and
Year-to-Date report.
1.2.3. Provide annual year-end report within ninety (90) days after the claims Run-
Out Period has expired.
1.2.4. Perform claims adjudication, including verification of date, service, and cost
of service.
1.3. PLAN DESIGN OPTIONS
1.3.1. If Employer provides for the Grace Period under IRS Notice 2005-42 (the
"Grace Period") Navia shall process claims against the prior Plan Year for
services incurred through the 15th day of the third month following the end of
the Plan Year. If applicable, apply any residual balance of Grace Period
claims against the current Plan Year benefit.
1.3.2. If Employer provides for Carryover Administration under IRS Notice 2013-71
(I lie ,Carryover")N'atvia shall: _
1.3.2.1. Carry over the lesser of the balance in the Health FSA as of the
Carryover Date or $500, from the previous year into the immediately
following Health FSA Plan Year. The "Carryover Date" shall mean
the date on or about the 15th day after the last day of the Run-Out
Period. The"Balance"shall mean Health FSA Plan Year election less
disbursements of the Health FSA.
17
tdbrev,_12232019
1.3.2.2. Reduce the prior year Health FSA election according to the amount of
the Carryover.
1.3.2.3. Establish a Health FSA election for Covered Employees with
Carryover amounts that failed to enroll in the Health FSA in the
immediately following Health FSA Plan Year. Monthly participant
Fees shall apply as of the Carryover Date.
1.3.2.4. Adjudicate and process claims against the carryover amount after the
Carryover Date. Upon request, Navia shall apply claims incurred in
the immediately following year against unused amounts in the prior
year before the Carryover Date. Such adjustments shall be subject to
a Fee of$65.00 per adjustment.
2. RESPONSIBILITIES OF EMPLOYER
2.1, IMPLEMENTATION
Employer shall timely provide the Plan Application and any other information
reasonably necessary for Navia to satisfy its obligations hereunder.
2.2. REPORTING
Employer shall submit an approved payroll file or reconcile the EDR against payroll
deductions for each processing date through the Website. If Employer cannot or does
not perfonn this responsibility, Navia may charge $65.00 per reconciled report. If
Employer fails to provide the approved payroll file or reconcile the EDR for more than
forty-five(45)days from the pay date deduction Navia may suspend claim processing.
2.3. FUNDING
For the initial term, Employer shall remit to Navia within 30 days after the
commencement of the FSA Plan Year an Employer deposit equal to ten percent(10%)
of the projected annual elections for the Plan (the "Deposit") or $2,500, whichever is
greater. At the beginning of each subsequent Plan Year Navia reserves the right to
recalculate the Deposit for that Plan Year to be paid by Employer within 30 days after
the commencement of such Plan Year. Said sum, or the portion thereof not utilized,
shall then be reimbursed to Employer one-hundred and eighty days (180)after the end
of the final Plan Year.
3. FEES
3.1. Plan Year Fees:
$600.00 annual fee for the Plan administration
3.2. Monthly Processing and Administration Fees:
3.2.1. $5.15 per month per FSA Covered Employee, $100/month minimum (for
Participants 1-100)
3.2.2. $4.15 per month per FSA Covered Employee(for Participants 101-200)
3.2.3. $3.15 per month per FSA Covered Employee(for Participants 201+)
3.2.4. $6.00 enrollment fee per Participant.
3.3. California Assembly Bill No. 1554 Notice (only provided upon Employer's written
request): $3.50 per paper notice mailed or$4.00 for two paper notices mailed.
18
tdbrev_12232019
3.4. Enrollment form processing: $4.00 per enrollment for received and processed.
3.5. Summary Plan Description Fee: $3.50 per Summary Plan description printed and
mailed to Employer or Covered Employees. Provided only upon Employer request.
3.6. Electronic Funds Transfer: $10.00 per returned item, from attempted deposit in
Covered Employee account.
3.7. Electronic Funds Transfer: $10.00 per failed direct debit from Employer account.
3.8. Enrollment Meetings and Benefit Fairs: For on-site enrollment meetings and
attendance at benefit fairs by Navia:
3.8.1. Employer shall pay to Navia$75.00 per hour, or $300.00 per eight-hour day,
whichever is less;
3.8.2. Air travel and lodging expenses shall be charged to Employer at Navia's cost;
3.8.3. Automobile mileage is charged at $ .36/mile, plus $37.50/hour driving travel
time.
3.8.4. Air travel time is charged as a full day cost, of$300.00 per day.
3.9. Plan Document Amendment Fee: In the event that Employer wishes to make changes
to the Plan on any, date other than [lie Plan anniversary date, Employer shall pay to
Navia the following Fees:
3.9.1. $150 per amendment pertaining to general Plan design, eligibility or benefits.
3.10. Ad Hoc Reporting: $75 per hour for manual reports not part of the Navia reporting
suite.
3.11. Noncompliant File Processing Fee: $150 per month
3.12. Mailing Fee: $1.10 per mailing.
19
tdbrev 12232019
EXHIBIT A BUSINESS ASSOCIATE AGREEMENT
This Exhibit is incorporated into and made part of the Agreement. The responsibilities of the Parties
set forth in this Exhibit are in addition to any responsibilities set forth in the Agreement. If there is a
conflict between this Exhibit and any other part of the Agreement with respect to the subject matter of
this Exhibit,this Exhibit will control. In all other conflicts,the Agreement controls. This Exhibit is
intended to comply with the Business Associate Agreement provisions set forth in 45 CFR§§ 164.314
and 164.504(e), and any other applicable provisions of 45 CFR parts 160 and 164,issued pursuant to
the Health Insurance Portability and Accountability Act of 1996,Public Law 104-191 as amended,
including by the Health Information Technology for Economic&Clinical Health Act of the American
Recovery and Reinvestment Act of 2009('ARRA"),(collectively "HIPAA").
Navia recognizes that in the performance of Services under the Agreement it may have access to,
create,and/or receive from the Benefit Plan(s)or on its behalf Protected Health Information("PHI').
For purposes herein,PHI shall have the meaning given to such term in 45 CFR § 164.103, limited to
the information created or received from the Benefit Plan(s)or on its behalf by Navia. Whenever used
in this Exhibit A other capitalized terms shall have the respective meaning set forth below or in the
Agreement,unless a different meaning shall be clearly required by the context. In addition, other
capitalized terms used in this Exhibit A but not defined herein or in the Agreement, shall have the
same meaning as those terms are defined under HIPAA. This Exhibit shall be automatically amended
to incorporate changes by Congressional act or by regulations of the Secretary that affect Business
Associate or Covered Entity's obligations under this Exhibit.
L. Definitions.
1.1. Breach. "Breach"shall have the same meaning as the term"breach"in 45 CFR
164.402.
1.2. Business Associate. "Business Associate"shall mean Navia Services,Inc. ("Navia").
1.3. Covered Entity. "Covered Entity"shall mean the Benefit Plan(s).
1.4. Electronic Protected Health Information. "Electronic Protected Health Information"
("ePHI")shall have the same meaning as the term"electronic Protected Health
Information"in 45 CFR 160.103, limited to the information created,received,
maintained, or transmitted by Business Associate on behalf of Covered Entity.
1.5. HHS. "HHS"shall mean the Department of Health and Human Services.
1.6. HIPAA. "HIPAA"shall mean the Health Insurance Portability and Accountability
Act of 1996.
1.7. HITECH. "HITECH"shall mean the Health Information Technology for Economic
and Clinical Health Act.
1.8. Individual. "Individual"shall have the same meaning as the term"individual"in 45
CFR 160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
1.9. Privacy Rule. "Privacy Rule"shall mean the Standards for Privacy of Individually
Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.
1.10. Protected Health Information. "Protected Health Information"("PHI")shall have the
same meaning as the tern"protected health information"in 45 CFR 160.103, limited
to the information created,received,maintained, or transmitted by Business Associate
on behalf of Covered Entity.
1.11. Required by Law. "Required by Law"shall have the same meaning as the term
"Required by Law"in 45 CFR 164.103.
1.12. Secretary. "Secretary"shall mean the U.S. Secretary of the Department of Health and
Human Services or his or her designee.
20
tdbrev_12232019
1.13, Security Incident. "Security Incident"shall have the same meaning as the term
"security incident"in 45 CFR 164.304,
1.14, Security Rule. "Security Rule"shall mean the Security Standards and Implementation
Specifications at 45 CFR Part 160 and Part 164, subparts A and C.
1.15, Standards for Electronic Transactions Rule. "Standards for Electronic Transactions
Rule"means the final regulations issued by HHS concerning standard transactions and
code sets under the Administration Simplification provisions of HIPAA,45 CFR Part
160 and Part 162.
1.16. Subcontractor. "Subcontractor"shall have the same meaning as the term
"subcontractor"in 45 CFR 160.103.
1.17. Unsecured Protected Health Information. "Unsecured Protected Health Information"
shall have the same meaning given the term"unsecured protected health information"
in 45 CFR 164.402.
2. Obligations and Activities of Business Associate
2.1. Business Associate agrees to not use or disclose PHI other than as permitted or
required by this Agreement or as Required by Law.
2.2. Business Associate agrees to take reasonable efforts to limit its use and disclosure of,
and requests for,PHI to the minimum necessary to accomplish the intended purpose of
the use, disclosure,or request. The foregoing minimum necessary standard does not
apply to: 1) disclosures or requests by a health care provider for treatment purposes;
(2) disclosures to the Individual who is the subject of the information; (3)uses or
disclosures made pursuant to an Individual's authorization; (4)uses or disclosures
required for compliance with HIPAA; (5)disclosures to HHS when disclosure of
information is required under the Privacy Rule for enforcement purposes; (6)uses or
disclosures that are required by other law.
2.3. Business Associate agrees to develop, implement,maintain,and use appropriate
administrative,technical, and physical safeguards to protect the privacy of PHI and
comply with applicable requirements under the Security Rule.
2.4. Business Associate shall notify Covered Entity of any Breach of Unsecured PHI of
which it becomes aware. Such notice shall include,to the extent possible,the
information listed in Section 2.6. A Breach shall be treated as discovered as of the
first day on which such Breach is known, or by exercising reasonable diligence would
have been known,to any person, other than the individual committing the Breach,
who is an employee, officer, or other agent of Business Associate.
2.5. Notice shall be made without unreasonable delay and in no case later than sixty (60)
calendar days after the discovery of a Breach by Business Associate.
2.6. Notice of a Breach shall include,to the extent possible the following:
2.6.1. Identification of each individual whose Unsecured PHI has been or is
reasonably believed to have been accessed,acquired,used, or disclosed as a
result of the breach.
2.6.2. A brief description of what happened,including the date of the Breach and the
date of the discovery of the Breach, if known.
2.6.3.. A descript:iuii of the types..of Unsecured PHI di t_werc involved in tote Breach
(such as full name, Social Security number, date of birth,home address, or
account number).
2.6.4. The steps Individuals should take to protect themselves from potential harm
resulting from the Breach.
2.6.5. A brief description of any action taken to investigate the Breach,mitigate
losses, and to protect against any further Breaches.
21
tdbrev_12232019
2.6.6. Contact procedures for Individuals to ask questions or learn additional
information,which shall include a toll-free telephone number, an e-mail
address,web site, or postal address.
2.7. If a law enforcement official determines that a notification or notice would impede a
criminal investigation or cause damage to national security, such notification,notice
or posting shall be delayed in accordance with 45 CFR 164.412.
Upon Covered Entity's request,Business Associate will provide notice of Breach to
the Individual(s)affected and such notice shall include,to the extent possible,the
information listed in 2.6.,unless,upon occurrence of a Breach, Covered Entity
requests to disseminate or Navia and Covered Entity agree that Covered Entity will
disseminate the notice(s). Any notice provided by Covered Entity to the Individual(s)
shall comply with the content requirements listed in section 2.6., as well as any
requirements provided under HIPAA,HITECH,and other applicable government
guidance. Any notice required to be provided to HHS will be provided by Covered
Entity. Business Associate agrees to report to Covered Entity any Use or Disclosure
of PHI not provided for by this Exhibit and/or any Security Incident of which it
becomes aware,provided that notice is hereby deemed given for Unsuccessful
Security Incidents and no further notice of such Unsuccessful Security Incidents shall
be given. For purposes of this Section,"Unsuccessful Security Incidents"mean,
without limitation,pings and other broadcast attacks on Navia's firewall,port scans,
unsuccessful log-on attempts, denial of service attacks, and any combination of the
above, as long as no such incident results in unauthorized access, acquisition,Use, or
Disclosure of Protected Health Information. Notification(s)under this Section, if any,
will be delivered to contacts identified by the Employer by any means Navia selects,
including through e-mail. Navia's obligation to report under this Section is not and
will not be construed as an acknowledgement by Navia of any fault or liability with
respect to any Use,Disclosure,or Security Incident.
2.8. Business Associate shall require each of its subcontractors, agents, or brokers,that
creates,receives,maintains, or transmits PHI on behalf of Covered Entity to enter into
a written agreement with Business Associate that provides satisfactory assurances that
the subcontractor will appropriately safeguard that information, including without
limitation the subcontractor's agreement to be bound by the same restrictions and
conditions that apply to Business Associate with respect to such information.
2.9. Business Associate agrees to make internal practices,books,and records,including
policies and procedures and PHI relating to the use and disclosure of PHI available to
the Secretary,within ten(10)Business Days after receipt of written request or
otherwise as designated by the Secretary for purposes of the Secretary determining
Covered Entity's compliance with the Privacy Rule
2.10. Business Associate agrees to document disclosures of PHI and information related to
such disclosures as required for Covered Entity to respond to a written request by an
Individual for an accounting of disclosures of PHI in accordance with 45 CFR
164.528. Business Associate will not be obligated to record disclosures of PHI or
otherwise account for disclosures of PHI if neither Covered Entity nor Business
Associate is required to account for such disclosures pursuant to the Privacy Rule.
2.11„ Business Associate agrees to provide to Covered Entity or,upon Covered Entity's
request,to an Individual,within ten (10)Business Days after receipt of written
request,information collected in accordance with Section 2.10 of this Exhibit, in order
to permit Covered Entity to respond to a written request by an Individual for an
accounting of disclosures of PHI in accordance with 45 CFR 164.528.
2.12, Business Associate agrees to provide access, at the request of Covered Entity and
within ten(10)Business Days after receipt of written request,to PHI in the custody
22
tdbrev-12232019
and control of Business Associate in a Designated Record Set,to Covered Entity or,as
directed by Covered Entity,to an Individual in order to meet the requirements under
45 CFR 164.524. If PHI is maintained in a Designated Record Set electronically, and
an electronic copy of such PHI is requested,Business Associate will provide an
electronic copy in the form and format requested if it is readily producible in such
form and format. If it is not readily producible in such format,Business Associate
will work with the Covered Entity or, at the Covered Entity's request,the individual to
determine an alternative form and format that enable Covered Entity to meet its
electronic access obligations under 45 CFR 164.524.
2.13. Business Associate agrees to make any amendment(s)to PHI in a Designated Record
Set in the custody or control of Business Associate within ten(10)Business Days after
receiving written request from the Covered Entity or, upon Covered Entity's request,
as requested in writing by an Individual pursuant to 45 CFR 164.526.
2.14. In the event that Business Associate transmits or receives any Covered Electronic
Transaction on behalf of the Covered Entity, it shall comply with all applicable
provisions of the Standards for Electronic Transactions Rule to the extent Required by
Law, and shall ensure that any subcontractors or agents that assist Business Associate
in conducting Covered Electronic Transactions on behalf of the Covered Entity agree
in writing to comply with the Standards for Electronic Transactions Rule to the extent
Required by Law.
2.15. Business Associate shall not directly or indirectly receive payment in exchange for
any PHI of an Individual unless Covered Entity or Business Associate received a valid
authorization from the Individual, in accordance with 45 CFR 164.508,unless
permitted under the HIPAA rules.
2.16. Business Associate shall not use PHI for marketing purposes without a valid
authorization from the affected Individuals,unless such communication is permitted
under the HIPAA rules
2.17. Business Associate shall not use or disclose genetic information for underwriting
purposes in violation of the HIPAA rules.
3. Permitted Uses and Disclosures by Business Associate
3.1. Except as otherwise limited in this Agreement,Business Associate may use or
disclose PHI to perform functions, activities, or services for, or on behalf of,Covered
Entity related to the Administrative Services Agreement between Business Associate
and Covered Entity.
3.2. Except as otherwise limited in this Agreement,Business Associate may disclose PHI
for the proper management and administration of Business Associate,provided that
such disclosures are Required by Law,or Business Associate obtains reasonable
assurances from the person to whom the information is disclosed that it will remain
confidential and be used or further disclosed only as Required by Law or for the
purpose for which it was disclosed to the person, and the person notifies Business
Associate of any instance of which it is aware in which the confidentially of the
information has been Breached.
3 ; Except ept as��,1 ,r•wise limited i,ii this, ga«�;,a�ment, 1 usiness Associate ��r ay use PHI to
provide Data Aggregation services to Covered Entity as permitted by 45 CFR
164.504(e)(2)(i)(B).
3.4. Except as otherwise limited in this Agreement,Business Associate may use PHI for
the proper management and administration of Business Associate or to carry out the
legal responsibilities of Business Associate.
3.5. Business Associate may use PHI to report violations of law to appropriate Federal and
State authorities, consistent with 164.5020)(1).
23
tdbrev_12232019
3.6. Except as expressly permitted by this Agreement,Business Associate shall not use or
disclose PHI in any manner that would violate the requirements of the Privacy Rule if
done by Covered Entity.
4. Obligations of Covered Entity and Employer
4.1. Covered Entity shall notify Business Associate of any limitation(s)in its notice of
privacy practices of Covered Entity in accordance with 45 CFR 164.520,to the extent
that such limitation may affect Business Associate's use or disclosure of PHI.
4.2. Covered Entity shall notify Business Associate of any changes in, or revocation of,
permission by Individual to use or disclose PHI,to the extent that such changes may
affect Business Associate's use or disclosure of PHI.
4.3. Covered Entity shall notify Business Associate of any restriction to the use or
disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR
164.522,to the extent that such restriction may affect Business Associate's use or
disclosure of PHI.
4.4. Employer acknowledges and agrees that Business Associate may disclose PHI in its
possession to Employer's workforce as necessary to administer the Plan(s). Employer
shall timely notify Business Associate in writing of any terminations or changes of
such employees. Employer shall indemnify and hold harmless Business Associate and
its employees for any and all liability Business Associate may incur as a result of any
improper use or disclosure of PHI by or caused the Plan,Employer, or Employer's
Workforce.
5. Permissible Requests by Covered Entity
5.1. Covered Entity shall not request Business Associate to use or disclose PHI in any
manner that would not be permissible under the Privacy Rule if done by Covered
Entity, except for uses or disclosures for the purposes of data aggregation,
management, and administrative activities of Business Associate.
6. Miscellaneous
6.1. It is agreed that due to the manner in which PHI is retained and the retention
requirements of the Internal Revenue Service, returning or destroying all of the PHI
received from Covered Entity or created or received by Navia on behalf of Covered
Entity,is infeasible. Therefore,Navia shall extend the protections of this Agreement
to such PHI and shall limit further uses and disclosures of such PHI to those purposes
that make the return or destruction infeasible, for so long as Navia maintains such
PHI.
24
tdbrev 12232019
EXHIBIT B EMPLOYER CERTIFICATION
This Exhibit is incorporated into and made part of the Agreement. The responsibilities of the Parties
set forth in this Exhibit are in addition to any responsibilities set forth in the Agreement. If there is a
conflict between this Exhibit and any other part of the Agreement with respect to the subject matter of
this Exhibit,this Exhibit will control. In all other conflicts,the Agreement controls.
Employer sponsors a Benefit Plan•or Benefit Plans where certain members of Employer's workforce
perform services in connection with administration of the Benefit Plan(s). Employer acknowledges
and agrees that the Standards for Privacy of Individually Identified Health Information (45 CFR Part
164, the "Privacy Standards"), prohibit the Benefit Plan(s) or its Business Associates from disclosing
Protected Health Information (as defined in Section 164.501 of the Privacy Standards) to members of
Employer's workforce unless Employer agrees to the conditions and restrictions set out below. To
induce the Benefit Plan(s) to disclose Protected Health Information to members of Employer's
workforce as necessary for them to perform administrative functions for the Benefit Plan(s),Employer
hereby accepts these conditions and restrictions and certifies that the Benefit Plan(s) documents have
been amended to reflect these conditions and restrictions. Employer agrees to:
1. Not use or further disclose the information other than as permitted or required by the Plan
Document or as required by law;
2. Ensure that any agent or subcontractor, to whom it provides Protected Health Information
received from the Benefit Plan(s), agrees to the same restrictions and conditions that apply to
Employer with respect to such information;
3. Not use or disclose Protected Health Information for employment-related actions and
decisions or in connection with any other benefit or employee Benefit Plan of Employer;
4. Report to the Benefit Plan(s) any use or disclosure of the Protected Health Information of
which it becomes aware that is inconsistent with the uses or disclosures permitted by the
Benefit Plan(s) or required by law;
5. Make available Protected Health Information to individuals in accordance with Section
164.524 of the Privacy Standards;
6. Make available Protected Health Information for amendment by Covered Individuals and
incorporate any amendments to Protected Health Information in accordance with Section
164.526 of the Privacy Standards;
T Make available the Protected Health Information required to provide an accounting of
disclosures to Covered Individuals in accordance with Section 164.528 of the Privacy
Standards„
8. Make its internal practices, books, and records relating to the use and disclosure of Protected
Health Information received from the Benefit Plan(s) available to the Department of Health
and Human Services for purposes of determining compliance by the Benefit Plan(s) with the
Privacy Standards;
25
tdbrev_12232019
9, If feasible,return or destroy all Protected Health Information received from the Benefit Plan(s)
that Employer still maintains in any form, and retain no copies of such Information when no
longer needed for the purpose for which disclosure was made, except that, if such return or
destruction is not feasible, limit further uses and disclosures to those purposes that make the
return or destruction of the information infeasible;and
10. Ensure the adequate separation between the Benefit Plan(s) and members of Employer's
workforce, as required by law.
26
tdbrev�12232019