ADMINISTRATIVE SERVICES AGREEMENT
This ADMINISTRATIVE SERVICES AGREEMENT ("Agreement") by and between SAFEGUARD
HEALTH ENTERPRISES, INC., a Delaware corporation, on behalf of its various
subsidiaries ("SafeGuard"), and TOTAL DENTAL ADMINISTRATORS HEALTH PLAN, INC.,
an Arizona corporation ("TDAHP"), sets forth the terms pursuant to which
SafeGuard and TDAHP agree to the administration of one or more individual and
group dental health coverages to be provided to persons eligible for such
coverage under dental health benefits programs ("Members") paid for by
employers, health and welfare funds, and others ("Groups"), and arises out of
the following circumstances:
A. TDAHP is a Prepaid Dental Plan Organization in the State of Arizona that
provides or arranges prepaid dental HMO Products for its enrollees in
geographically defined service areas ("Service Areas").
B. SafeGuard through its subsidiaries is licensed in various states to provide
prepaid dental plan benefits to its enrollees.
C. SafeGuard desires that TDAHP administer a prepaid dental plan in Arizona so
as to provide benefits to those SafeGuard Members who reside in Arizona
based upon contracts that arise out of the State of Arizona.
D. TDAHP desires to provide prepaid dental plan benefits to SafeGuard Members
in accordance with the terms and conditions of this Agreement.
In consideration of the mutual promises set forth herein, the parties hereto
agree as follows:
1. PRODUCTS TO BE OFFERED. From time to time SafeGuard will enter into a
contract with a Group whereby the Group will have employees residing within the
State of Arizona. TDAHP agrees to provide services to SafeGuard whereby Members
will receive prepaid dental plan services from TDAHP through its providers
within the State of Arizona. The products currently being sold by SafeGuard are
attached hereto marked Exhibit A (the "Products"). From time to time, SafeGuard
may modify, eliminate or add products and will provide sixty (60) days advance
written notice to TDAHP of such changes, additions or deletions.
2. ADMINISTRATIVE AND OTHER SERVICES.
2.1 MARKETING. SafeGuard may in the ordinary course of business market the
Products in all states in which its subsidiaries are licensed. From time to
time, instances will arise where a Group with whom SafeGuard contracts has
members residing in the State of Arizona.
2.2 ENROLLMENT.
2.2.1 Enrollment. TDAHP will conduct all necessary enrollment meetings
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for Members, and will obtain enrollment cards for those persons to be covered by
TDAHP through its relationship with SafeGuard. TDAHP shall maintain all
enrollment information on its system.
2.2.2 Customer Service. TDAHP shall perform all necessary customer
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service to members enrolled in TDAHP through Groups to support the enrollment
functions.
2.2.3 Disclosure Statements. TDAHP shall be responsible for producing
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and distributing disclosure statements reasonably necessary and/or required by
law of the state of Arizona to be furnished by it to assure the availability of
appropriate information for enrollees regarding the dental health care services
to be provided to Members by TDAHP.
2.3 ELIGIBILITY LISTING. SafeGuard shall provide TDAHP with a monthly list
of Members by the 20th day of the month preceding the month of coverage for each
month this Agreement is in effect.
2.4 QUALITY ASSURANCE AND UTILIZATION REVIEW. TDAHP shall have sole
responsibility for the resolution of all grievance lodged by Members, all
quality assurance, and all utilization review functions as may be required by
the state of Arizona in connection with TDAHP's license.
2.5 BILLING AND COLLECTION OF PREMIUMS. SafeGuard shall provide all
necessary services for billing premiums, reconciling accounts, and the
collection of premiums from Groups not domiciled in the state of Arizona for the
Products.
2.6 REPORTING.
2.6.1 Complaints. Any complaints received by one party regarding the
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service, coverage or benefits provided by the other party, shall be promptly
referred to the appropriate party for resolution. Each party will report to the
other the nature and disposition of such customer complaints.
2.6.2 Other Reports. Administrative and other services provided by one
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party on behalf of the other shall be monitored by the other through reports and
other information exchanged between the parties as agreed upon by the parties
from time to time.
2.7 TAXES. TDAHP shall be responsible for reporting and paying all required
state premium income and other taxes, assessments and regulatory fees for
Members enrolled in Arizona.
3. COMPENSATION AND PAYMENT. SafeGuard shall pay to TDAHP the actual amount
of its health care expenses for coverage for Members for the Products sold by
SafeGuard and for which TDAHP provides services to SafeGuard Members enrolled in
Arizona, plus twenty percent (20%) of such actual health care expenses. Such
payment shall be due and payable by SafeGuard to TDAHP within twenty (20) days
after the end of each month this agreement is in effect after TDAHP submits an
invoice to SafeGuard for the services provided herein. TDAHP shall be
responsible for paying all of its own administrative expenses in connection with
each Member enrolled, but shall not be responsible for any broker commission
that may be required to be paid in connection with any contract for a Group
through which such Members are enrolled.
4. PROVIDERS. TDAHP agrees to maintain a panel of participating dental
providers consisting of general dentists and specialists ("Providers") that is
reasonable adequate to service the need of the Members. TDAHP shall be solely
responsible for the payment of all provider compensation of any kind and nature
due to Providers as a result of members covered under this agreement. TDAHP
shall also be responsible for all Provider credentialing as may be required
under applicable state law. A copy of the initial TDAHP Provider list is
attached hereto marked Exhibit B. Not less frequently than fifteen (15) days
following the end of each calendar quarter, or within fifteen (15) days after
request by SafeGuard, TDAHP shall provide to SafeGuard a current list of
Providers.
5. TERM AND TERMINATION. This Agreement shall commence on the Effective
Date as set forth below, shall remain in effect for a period of three (3) years
from date, and will terminate: (a) on the date of insolvency or cessation of
operations of TDAHP, or (b) on the date of SafeGuard's insolvency or cessation
of operations. Termination of this Agreement shall not terminate the rights or
liabilities of either party to perform its obligations to the other party or the
obligations of TDAHP to Members pursuant to a contract for any Product with a
Group, for those obligations arising during any period when this Agreement was
in force, and such obligations shall remain in effect through the end of any
such contract with a Group until the termination of such contract.
6. ARBITRATION. If any dispute relating to this Agreement or administration
thereof arises which cannot be resolved to the satisfaction or SafeGuard and
TDAHP, the parties shall submit the dispute to binding arbitration. The
arbitrators are not bound by any rule of law, except that the arbitration will
be conducted under the Commercial Arbitration Rules of the American Arbitration
Association then in effect. The arbitration shall be conducted in Orange
County, California. The parties shall share fees and expenses of the
arbitrator. The prevailing party in such arbitration shall be entitled to
receive as part of the arbitrator's award, attorneys' fees and costs.
7. INSOLVENCY/CESSATION OF OPERATIONS. Except as expressly provided to the
contrary herein, if TDAHP or SafeGuard becomes insolvent, this Agreement shall
be discontinued automatically as of the date of insolvency. Insolvency or
insolvent shall mean (a) a final determination made by a court of competent
jurisdiction that SafeGuard or TDAHP is insolvent, or (b) all operations of
SafeGuard or TDAHP cease. For the purposes of this Agreement, the date of
insolvency shall be the date on which the insurance authorities or the court
declares SafeGuard or TDAHP insolvent or the date on which SafeGuard or TDAHP
has ceased all operations, whichever date is later in time.
8. LITERATURE AND PUBLICITY. No party will distribute any literature or
other material or release any publicity or information relating to this
Agreement without the other party's prior written consent, which consent shall
not be unreasonably withheld if such distribution or release is reasonably
appropriate to effect the objectives of this Agreement.
9. EXCLUSIVE AGREEMENT. For the term of the Agreement, SafeGuard agrees to
utilize TDAHP exclusively to provide the services described herein to SafeGuard
Members in the State of Arizona. TDAHP may contract with other health care
plans and may provide benefits directly to members in Arizona notwithstanding
this Agreement. SafeGuard agrees not to offer for sale or sell any prepaid
dental plan in the State of Arizona for the term of this Agreement.
10. CONFIDENTIALITY. The parties will maintain a free exchange of
information regarding matters relating to this Agreement. Each party will
notify the other of any complaints, inquiries, or litigation with respect to
matters related to this Agreement and shall cooperate and assist in the defense
of such matters. Each party shall allow the other to audit such parties records
related to this Agreement. All information provided by one party to the other
hereunder shall be treated by the other party, its agents, officers, employees
and representatives, in a confidential manner, and in compliance with all
applicable state and federal laws. Each party agrees to prevent the
unauthorized disclosure of any such information. Each party agrees to keep
confidential all non-public information regarding the other party or its
activities that it obtains pursuant to this Agreement. Further, each party
agrees to maintain the confidentiality of individual medical records and related
information as required by each party's established policies and practices or
required by law. Each party may, however, disclose otherwise confidential
information to any state or federal regulatory agency when required by law. Any
breach of the terms of this covenant shall be deemed a material breach of this
Agreement. In the event of any such breach, the aggrieved party shall be
entitled to seek an injunction restraining the other from disclosing any
confidential information, and to pursue any other legal remedies available to
such party for any actual or threatened breach. This covenant regarding
confidentiality shall survive the termination of this Agreement.
11. INSURANCE. Each party, at its sole expense, shall maintain in full
force and effect, insurance to provide at least the following protection: (a)
bodily injury and property damage with limits of not less than One Million
Dollars ($1,000,000); and (b) errors and omissions liability which TDAHP will
use its best efforts to obtain during the term of the Agreement with limits to
be determined by mutual agreement by the parties hereto; (c) multi-perils all
risk insurance including contents, and valuable papers with limits of not less
than One Million Dollars ($1,000,000); workers' compensation and unemployment
insurance of types and levels required by applicable laws and regulations.
12. ACCESS TO BOOKS AND RECORDS. Each party shall make available to the
other all of its books and records relating to this Agreement, and to any
regulatory agency having jurisdiction over the parties for the purpose of
inspection, examining and copying: (a) at all reasonable times, (b) in a form
maintained in accord with the general standards applicable to such book or
record keeping, and for the duration of this Agreement plus thirty-six (36)
months, or, if longer, as required by applicable state law.
13. INDEPENDENCE OF CONTRACTING PARTIES. TDAHP and SafeGuard are each a
separate and independent entity. Nothing in this Agreement establishes an
employee relationship, an agency, a partnership, a joint venture, or an
association between TDAHP and SafeGuard or any of its affiliates or
subsidiaries.
14. RIGHTS OF THIRD PARTIES. The parties do not intend, and nothing in this
Agreement shall be deemed, to give any person other than the parties hereto any
right or interest based on this Agreement. The parties reserve the right to
amend this Agreement by mutual consent or to terminate it without notice to or
consent of any person not a party to this Agreement.
15. NO ASSIGNMENT. This Agreement may not be assigned by either party
without the prior written consent of the other party.
16. GOVERNING LAW. The validity, interpretation and performance of this
Agreement shall be governed by and constructed in accordance with the laws of
the state of Arizona.
17. COSTS. Unless otherwise agreed, each party shall bear the cost of its
legal, accounting, consulting and other services necessary to comply with its
duties and obligations under this Agreement.
18. AMENDMENT. This Agreement may be amended only by written agreement
signed by the parties hereto.
19. NOTICES. Notices regarding this Agreement shall be sent certified mail,
return receipt requested and shall be addressed as follows:
TDAHP: SafeGuard:
Total Dental Administrators Health Plan, Inc. SafeGuard Health Enterprises, Inc.
0000 Xxxx Xxxxxxxx, Xxxxx 000 00 Xxxxxxxxxx
Xxxxxxx, XX 00000 Xxxxx Xxxxx, XX 00000
Attention: Xxxxxx Xxxxxxxxxxx, President and Attention: Xxxxxx X. Xxxxxxxx, Senior
Chief Executive Officer Vice President and General Counsel
Fax: (000) 000-0000 Fax: (000) 000-0000
IN WITNESS WHEREOF, the UNDERSIGNED have caused this Agreement to be executed
effective as of December 31, 2001 (the "Effective Date").
TDAHP SafeGuard
TOTAL DENTAL ADMINISTRATORS SAFEGUARD HEALTH ENTERPRISES, INC.,
HEALTH PLAN, INC., An Arizona Corporation a Delaware corporation
By: /s/ Xxxxxx Xxxxxxxxxxx By: /s/ Xxxxx X. Xxxxxxx
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Name: XXXXXX XXXXXXXXXXX Name: XXXXX X. XXXXXXX
Title: President and Chief Executive Officer Title: President and Chief Executive Officer
By: /s/ Xxxxxx X. Xxxxxxxx
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Name: XXXXXX X. XXXXXXXX
Title: Senior Vice President and Secretary
