HomeMy WebLinkAbout1993-09-28; City Council; 12412; APPROVAL OF A NEW EMPLOYEE ASSISTANCE PROGRAM PROVIDERI.. 1
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WOOF CARLSBAD - AGENB~ BILL 4:: [
AB # 12, Y/b TITLE: DEI
MTG. 9-28-93 APPROVAL OF A NEW EMPLOYEE CIT
CIT DEPT. HR ASSISTANCE PROGRAM PWMDER
RECOMMENDED ACTION:
Adopt Resolution No. 93-236 approving National Resource Consultants i
the City’s new Employee Assistance Program (EAP) provider.
ITEM EXPLANATION:
The intent of an Employee Assistance Program is to resolve employee
problems that are affecting job performance and to provide counseling ai
treatment when necessary for emotional, occupational, substance abuse,
marital/relationship and medical problems. In addition, an EAP provider
can provide employee and management training, critical incident
debriefings, twenty-four hour crisis telephone contact and referral
services to screened, professional community resources.
For the last ten years the City has contracted with an outside firm to
provide employee assistance services to City employees and their
dependents. In October of 1992, the City solicited proposals from other
companies interested in bidding for the City’s EAP contract. In
conjunction with the Human Resources Department, a group of managers
from various City departments interviewed and evaluated five EAP
providers in July 1993.
National Resource Consultants, or NRC, is a well respected employee
assistance provider based in San Diego. The company has experience wit’
both public sector and private sector clients with large, medium and sm
sized employee populations. NRC is headquartered in Mission Valley, wit
offices in numerous San Diego communities including Carlsbad, Del Mar,
Rancho Bernardo, Chula Vista, Encinitas and others.
It is staff’s recommendation that, effective October 1, 1993, the City
contract with National Resource Consultants (NRC) for provision of
employee assistance services. NRC will provide (1) short term counselin
services at no cost to the employee, (2) referral services to community
resources who are part of the City’s health insurance programs, (3)
training of City managers and supervisors on how to effectively utilize
the EAP to facilitate early detection and intervention, (4) consultation
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PAGE 2 OF A8 # )1,’-i/L 1.
with managers and supervisors concerning specific work-related
personnel problems, and (5) 24 hour telephone availability for use in
crisis situations.
The Human Resources Department will receive periodic updates on the
level of participation in the Employee Assistance Program, including
measures of user satisfaction with the service provided. This contract
will be in effect for a one (1) year period and is renewable on an annual
basis for a period not to exceed three (3) years.
FISCAL IMPACT:
The contract with National Resource Consultants will cost approximatel)
$15,000 per year. This figure includes $13,000 for the basic EAP and an
additional $2,000 for supervisory training costs. Funds for these service
have been included in the Human Resources Department fiscal year 1993-
94 operating budget.
EXHIBITS:
1. Resolution No. ~43- 276
2. Signed contract with National Resource Consultants
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XESOLUTION NO. 93-276
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF CARLSBAD, CALIFORNIA, APPROVING
THE SELECTION OF NATIONAL RESOURCE
CONSULTANTS (NRC) AS THE CITY’S EMPLOYEE
ASSISTANCE PROGRAM PROVIDER.
WHEREAS, since January 1984, the City of Carlsbad has
offered an Employee Assistance Program (EAP) to its employees anc
their dependents; and
WHEREAS, the City is interested in offering this service in th
future using an alternate EAP provider; and
WHEREAS, staff has interviewed and evaluated five separate
EAP providers and is recommending that National Resource
Consultants (NRC) be awarded the City’s EAP contract.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the
City of Carlsbad, California, as follows:
1. That the above recitations are true and correct.
2. That the City Council approves National Resource
Consultants as the City’s Employee Assistance Program provider
effective October 1, 1993.
3. That the City Council authorizes the attached contract
with National Resource Consultants to provide EAP services for th
employees of the City of Carlsbad and their dependents.
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PASSED, APPROVED, AND ADOPTED at a regular meeting of the
SEPTEMBER , Carlsbad City Council held on the 28th day of
1993, by the following vote, to wit:
AYES: Council Members Lewis, Stanton, Kulchin
NOES: None
ABSENT: Council Members Nygaard ,
ATTEST:
#& AQd-2-
ALETHA L. RAUTENKRANZ, City Clerk
(SEAL)
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NATIONAL RESOURCE CONSULTANTS, INC.
GROUP SUBSCRIBER CONTRACT
Agreement made and executed as of the 1st day of October, 1993 by and betwc
National Resource Consultants, Inc., hereinafter referred to as "NRC," and CITY (
CARLSBAD, hereinafter referred to as "Group," is made with reference to the following fa(
NRC is a California corporation, licensed as a specialized Knox-Keene health c
service plan, whose primary purpose is to operate a specialized health care service plan offer
Employee Assistance Programs (EAPs).
A.
B. Group desires to obtain the services herein specified for and on behalf of
Subscribers and Enrollees as defined herein.
THEREFORE, the parties agree:
ARTICLE I
DEFINITIONS
The following terms, when used in this Agreement or any amendments hereof are defii
as follows:
1.1 Act means the box-Keene Health Care Service Plan Act of 1975 (Califor
Health and SafeFCode Sections 1340 et seq.).
1.2
1.3
Benefits mean those services an eligible Enrollee is entitled to receive hereunc
Group means any Employer, Labor Union or labor management Trust Fund
other Subscriber Group.
1.4 Enrollee is defrned as a Subscriber and any eligible dependents as defined ur
the eligibility requirements of this Agreement and as determined by Group who are actu
enrolled in and eligible to receive benefits under said Agreement.
1.5 Evidence of Coverage or Combined Evidence of Coverage and Disclosure Fc
means the document issued to the Subscriber which summarizes the essential terms of
Agreement.
1.6 Provider means a licensed California professional under contract to NRC
perform assessment, brief counseling, and referral. This term also refers to outside professio
who perform services upon referral from NRC.
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1.7 Regulations means those regulations promulgated and officially adopted by tl
California Department of Corporations under the box-Keene Act.
1.8 Subscriber is defined as an eligible employee, retired employee or survivil
spouse who is otherwise eligible for coverage under the eligibility requirements determined I
Group, and who is enrolled hereunder and for whom periodic payments are made by i
Employer.
ARTICLE I1
PREPAYMENT FEES
2.1 Group shall pay NRC the total sum indicated in subparagraph 2.2, per quarter F
Subscriber. This rate is subject to change on an annual basis. NRC shall give Group 30 da
advance notice prior to change in rate.
2.2 Group shall pay to NRC a premium for each eligible Subscriber (which sE
include dependents) as follows: $6.25 per employee per quarter.
2.3 The prepayment fee is paid by Group, unless other provisions for payment
agreed to in advance by NRC.
2.4 Group shall send one check covering all Subscribers to NRC at the addr
indicated in paragraph 9.3, commencing on the date indicated in paragraph 6. I, and continu
each month thereafter on said date for the duration of this contract.
2.5 Group acknowledges and understands that this contract provides solely i
exclusively for services to be performed at NRC provider facilities. This contract provides
services only, is not an insurance policy and does not indemnify nor reimburse any Subscri
or Group for the cost of health care services.
2.6 Group will furnish announcement brochures, management guidebooks, and ca
as required by the program.
2.7 Group agrees to pay NRC for pre-approved travel expenses outside San Di
county.
ARTICLE 111
PRINCIPAL BENEFITS, EXCLUSIONS,
LIMITATIONS AND ADMINISTRATIVE POLICIES
3.1 NRC and Group agree that NRC shall provide services to Subscribers of GI
under the Plan set forth attached as EXHIBIT ONE, except as limited in the Exclusions
Limitations section. EXHIBIT ONE IS AN ESSENTIAL PART OF THIS AGREEMEN?
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3.2 EAP Services must be obtained from NRC designated Providers by calling t NRC toll-free number 800-999-7222 or (619) 291-0330 in San Diego.
3.3 Additional services beyond the EAP may be covered by Group’s employee welfa
benefit plan.
ARTICLE IV
HOW TO OBTAIN BENEFITS
Benefits must be obtained from NRC designated EAP Providers by calli
NRC. NRC provides a toll-free or local telephone number. In non-emergency situatioi
Enrollees are offered an appointment within 48 hours. NRC does not reimburse Enrollees 1
any unauthorized treatment from noncontracting providers. During business hours, any Enroll
calling for service outside the NRC service area or with an emergency or urgent situation
immediately referred to a licensed mental health professional for a telephone assessment. ‘I
telephone assessor may provide crisis intervention over the telephone, arrange a same-d
appointment with the EAP Provider in the Enrollee’s area, locate an EAP Provider if necessa
or assist the Enrollee in obtaining more intensive, acute care services. After business hou
Enrollees are forwarded to NRC’s 24-hour phone number and receive a call from a licem
mental health professional for a telephone assessment within 15 minutes.
ARTICLE V
ELIGIBILITY
5.1 Group shall provide a monthly count of eligible Subscribers. Group shall se
an eligibility list to NRC upon NRC’s request, specifying the names and other identifying d
. for each Subscriber to be covered for the succeeding month.
5.2 The determination of who is eligible to be a subscriber and who is actually
subscriber in the Plan shall be determined by Group, and NRC shall have the right to rely uj
that determination. Any disputes or inquiries regarding eligibility, including rights regard
renewal, reinstatement and the like, if any, shall be referred by NRC to Group, which shall tl
advise NRC of its determination.
5.3 Dependents shall include:
a. The lawful spouse who shares the same household of the subscriber, i
all newborn infants whose coverage shall commence from and after
moment of birth. Adopted children shall be covered from and after
date of placement. Except as stated above, dependents shall be eligible
coverage on the day the Subscriber acquires such dependent.
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b. Dependents shall also include all unmarried children under the age
nineteen (19) years who are chiefly dependent on the Subscriber f
support and maintenance. Extension of eligibility may be made up to t
age of twenty-three (23) years for unmarried children who are principal
dependent upon the Subscriber and are registered students in regular, fu
time attendance at an accredited school, college or university.
Coverage shall not terminate while a dependent child is and continues
be (1) incapable of self-sustaining employment by reason of men
disability or physical handicap; and (2) chiefly dependent upon t
Subscriber for support and maintenance.
Upon request, NRC may choose to extend the definition of dependent
include a significant other who shares the same household, parents in I
subscriber’s household who are chiefly dependent on the subscriber
support and maintenance, or other person whose impact on the subscril
might adversely affect the subscriber’s well-being or work performan
If such a person is not covered under the Group’s definition of eligibili
the referral may be limited to specific community resources.
c.
d.
ARTICLE VI
COMMENCEMENT AND DURATION OF THIS CONTRACT
TERMINATION - RENEWAL
6.1 Coverage shall commence at 12:Ol A.M. on October 1, 1993 for all Subscrib
enrolled on the day when the Plan starts. Coverage for new subscribers shall commence at 12
A.M. on the first day of employment or at the end of any Group designated probationary peril
Coverage terminates at 1159 P.M. on the last day of eligibility for participation in the Gro
whether the last day of employment or the last day of eligibility for any continuation of coveri
period.
6.2 This contract shall be effective on the date indicated in paragraph 6.1 above, i
shall continue until the end of the month of September, 1994. NRC shall not increase the am0
of prepaid payment, except upon at least 30 days written notice, nor shall NRC decrease bene
in this agreement except upon 30 days written notice.
Renewal Provisions: The term of this contract shall be one year beginning
the effective date of this contract at which time it may automatically be extended for tl-
additional one-year periods or part thereof. Contract extension will be based upon satisfact
performance and the Group’s needs. Or, the parties may renew this contract at the end of
term hereof, and by mutual consent modify or alter this contract; provided, however, that !
modifications, amendments, alterations or renewals shall be in writing, duly executed by t
parties hereto, and attached to this contract. There is no individual right of renewal. Only gra
are eligible to enter into or renew subscriber agreements with NRC.
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6.3
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6.4 Termination Provisions: Should either party be in defaklt by the failure
reasonably perform any of the covenants and conditions contained herein, the non-defaulting pa
shall have the right to give the defaulting party thirty (30) days written notice, specifying t
default. If the default is not cured, the contract will be terminated, excepting therefrom GrouI
failure to remit the monthly prepayment fees, or provide eligibility list as required, in which cs
fifteen (1 5) days written notice shall apply. The defaulting party shall then have the thirty (3
days, or fifteen (1 5) days in the case of the failure to remit the appropriate prepayment fees,
eligibility list when due, from receipt of notice, in which to remedy the default or failure
perform.
Both parties agree that NRC shall have the absolute right to terminate ti
contract should Group fail to remit the monthly prepayment fees or eligibility list, within I
fifteen (1 5) day period after notice.
Receipt by the plan of the proper prepaid or periodic payment after cancellati
of the contract for nonpayment shall reinstate the contract as though it had never been cancel
if such payment is received on or before the due date of the succeeding prepaid or perioc
payment. The Plan may, if such payment is received more than 15 days after the issuance oft
notice of cancellation, refund such payment within 20 business days and there will be
reinstatement of the contract.
NRC will not terminate or fail to renew the eligibility of any individi
subscriber or enrollee because of health status or use of the EAP. If any person believes that tl
agreement has been terminated or any enrollee or subscriber has been denied services under tl
agreement because of health status or requirements for health services, the enrollee may requ
a review by the Commissioner of Corporations of the State of California.
Both parties may terminate this Agreement immediately if the other party shoi
engage in fraudulent conduct with respect to this Agreement.
This Agreement may be terminated at any time without cause by Group upon
days written notice.
6.5 In the event of termination of this contract, each NRC participating provider 1
agreed to complete all assessment, brief counseling, and referral services which have been start
prior to the date of termination, pursuant to the terms of this contract.
6.6 Pursuant to Section 1365(b) of the Knox-Keene Act, any Subscriber who alleg
his enrollment has been canceled or not renewed because of his health status or requirement .
services, may request review by the California Department of Corporations.
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ARTICLE VI1
ADMINISTRATION
7.1 With regard to the distribution of all materials, such as Combined Evidence of
Coverage and Disclosure Form and other materials required to be distributed pursuant to the
box-Keene Act or any regulation issued pursuant thereto, Group shall be responsible to
distribute such materials to the Subscribers andor eligible participants.
7.2 NRC shall also provide telephone or in-person emergency service twenty-foul
hours a day, seven days a week, to all Enrollees. If the Enrollee’s provider office is unavailable
the Enrollee shall call NRC’s offices during normal business hours, or in the case of an after
hours emergency.
7.3 NRC agrees to duly investigate and resolve any and all complaints received fron
Enrollees with regard to the nature of professional services rendered. Any inquiries or complaint
shall be made to NRC by writing or calling NRC at the address and telephone number indicate1
herein. NRC shall maintain a grievance system in compliance with the Knox-Keene Act.
Grievance Report Forms and copies of the Grievance Procedures are availab
at each facility of the plan. Enrollees may send a written cornplaint or call NRC directly 1
resolve their complaint. NRC will acknowledge receipt of the complaint and provide notice 1
the complainant of whom may be contacted with respect to the complaint within 20 days.
If the enrollee is not satisfied with the resolution offered at the first level, t€
grievance is directed to the next management level.
If the grievance is not resolved to the Enrollee’s satisfaction at the second levi
it will be directed to the Quality Management Committee in the case of a quality of care issL
or the Vice President, Operations or designee in the case of an administrative issue. The Qualj
Management Committee or the Vice President, Operations or hidher designee will review I
applicable data within 15 days.
The enrollee will be advised in writing of the findings and recommendatic
within 30 days of the receipt of the Grievance Report.
Enrollees file a complaint or grievance by calling (619) 291-0330 in San Dit
or 1-800-999-7222 in all other areas regarding the complaint.
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ARTICLE VI11
QUALITY CONTROL AND
PROFESSIONAL-PATIENT RELATIONSHIP
8.1 NRC is responsible for and agrees to arrange for services and care as herr provided in accordance with the prevailing professional standards.
8.2 It is expressly understood that the relationship between the Enrollee and N1
participating professionals shall be subject to the rules, limitations, and privileges incident to
doctor-patient relationship. NRC shall be solely responsible, without interference from Grc
or any of its agents, to the Enrollee for arranging counseling and treatment.
8.3 It is understood by Group that the operation and maintenance of the participat
offices, and the rendition of all services shall be solely and exclusively under the control 2
supervision of the NRC provider, including all authority and control over the selection of st
supervision of personnel, and operation of the professional practice, and/or the rendition of
particular professional service or treatment.
8.4 NRC will undertake to see that the services provided to Enrollees by provic
shall be performed in accordance with nationally accepted professional standards of reasoni
competence and skill of providers as applicable prevailing at the time of service.
8.5 If NRC shall subcontract any of the work to be performed under this contracj
NRC, NRC shall be fully responsible to Group for the acts and omissions of NRC’s subcontra
and of the persons either directly or indirectly employed by the subcontractor, as NRC is foi
acts and omissions of persons directly employed by NRC. Nothing contained in this coni
shall create any contractual relationship between any subcontractor of NRC and Group. E
shall bind every subcontractor and every subcontractor of a subcontractor by the terms of
contract applicable to NRC’s work unless specifically noted to the contrary in the subcontra1
question approved in writing by Group.
ARTICLE IX
GENERAL PROVISIONS
9.1 If a dispute should arise regarding the performance of work under this agreer
the following procedure shall be used to resolve any question of fact or interpretatior
otherwise settled by agreement between parties. Such questions, if they become identified a:
of a dispute among persons operating under the provisions of this contract, shall be reducl
writing by the principal of NRC or the Group’s Human Resources Department. A copy of
documented dispute shall be forwarded to both parties involved along with recommended me1
of resolution which would be of benefit to both parties. The Human Resources Departme
principal receiving the letter shall reply to the letter along with a recommended methi
resolution within ten (10) days. If the resolution thus obtained is unsatisfactory to the aggr
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party, a letter outlining the dispute shall be forwarded to the City Council for their resolutiol
through the Office of the City Manager. The City Council may then opt to consider the directec
solution to the problem. In such cases, the action of the City Council shall be binding upon thi
Rarties involved, although nothing in this procedure shall prohibit the parties seeking remedie
available to them at law.
9.2 Each party to this Agreement, together with their respective successors an
assigns, agrees to defend and indemnify the other parties to this Agreement and hold the]
harmless from and against all loss, cost, claims, actions, liabilities and attorneys' fees arising i
connection with this Agreement as a result of or attributable to the intentional act or negligenc
of such party, or such party's officers, directors, employees, agents, or independent contractor
Whenever it shall become necessary for either party to serve notice on the 0th
respecting this Agreement, such notice shall be in writing and shall be served by certified ma
return receipt requested, addressed as follows:
9.3
a. If served on Group, it shall be addressed to:
CITY OF CARLSBAD
Human Resources Department
1200 Carlsbad Village Drive
Carlsbad, CA 92008-1 989
(619) 434-2852
b. If served on NRC, it shall be addressed to:
NATIONAL RESOURCE CONSULTANTS, INC.
2835 Camino del Rio South, Suite 300
San Diego, California 92108
(619) 291-0330
9.4 NRC is subject to the requirements of Chapter 2.2 of Division 2 of the He:
and Safety Code (the "Act") and Subchapter 5.5 of Chapter 2 of Title 10 of the California C
of Regulations (the "Regulations"), and any provisions required to be in the contract by eithe
the above shall bind NRC whether or not provided in the contract.
In the event that the Act or Regulations thereunder set forth any requirer
which is not included herein or is contrary to this Agreement, it shall supersede the applic
provisions of this Agreement and shall be binding unto the parties hereto.
9.5 Nothing contained herein shall preclude NRC from changing the location oj
of its provider offices, as long as it retains a sufficient provider network to provide servici
Group.
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9.6 In the event any of NRC’s contracted participating Providers should termina
his relationship with NRC, breach his contract with NRC or be unable to render servicc
hereunder, and Group andor its Subscribers will be adversely or materially affected, NRC wi
give the Group and/or its Subscribers written notice thereof.
9.7 Upon termination of a provider contract, NRC shall be liable for covered servicc
rendered by such provider to a Subscriber or Enrollee who retains eligibility under this contre
or by operation of law under the care of such provider at the time of such termination until t
services being rendered to the Subscriber or Enrollee by such provider are completed, unless NF
makes reasonable and medically appropriate provision for the assumption of such services bj
contracting provider.
9.8 In the event that NRC fails to pay the participating Provider for costs
assessment, brief counseling, and referral, by statute the Enrollee shall not be liable to t
Provider for any sums owed by the plan. In the event NRC or the employee’s full service hea
plan fails to pay a non-participating Provider, the Enrollee may be liable to the non-participatj
Provider for the cost of services rendered.
9.9 If any provision of this contract is held to be illegal or invalid for any reas
such decision shall not affect the validity of the remaining provisions of this contract, and SI
remaining provisions shall continue in full force and effect unless the illegality or invalid
prevent the accomplishment of the objectives and purposes of this contract.
9.10 In the event Group is regulated under the Employee Retirement Income Secui
Act of 1974 (ERISA), Group covenants and agrees that it and not NRC shall be responsible
meeting all requirements of ERISA. NRC will cooperate with Group in supplying Group v
any information within its possession to aid Group in meeting any ERISA reporting requireme
NRC is not and shall not be designated the administrator or fiduciary of the Plan.
9.11 If the Subscriber andor Enrollees are eligible to retain coverage under
contract during any Continuation of Coverage period or election period necessary for Groi
compliance with requirements of the Consolidated Omnibus Budget Reconciliation Act (COBI
and any regulations adopted thereunder, or any similar state law requiring the Continuatior
Benefits for Subscriber andor Enrollees, the Group must continue to certify the eligibility of
Subscriber andor Enrollees and pay the monthly prepayment fees for COBRA coverage for :
Subscribers andor Enrollees.
9.12 This Agreement is non-assignable by either party without the prior wr
consent of the other party. NRC may, in its sole discretion, delegate administrative functioi
other entities.
9.13 NRC shall perform the services provided for herein in NRC’s own way a
independent contractor and in pursuit of NRC’s independent calling, and not as an employt
Group. NRC shall be under control of Group only as to the result to be accomplished, but
consult with Group as provided for in the request for proposal.
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NRC is an independent contractor of Group. The payment made to NR
pursuant to the contract shall be the full and complete compensation to which NRC is entitle
Group shall not make any federal or state tax withholdings on behalf of NRC. Group shall n
be required to pay any workers’ compensation insurance on behalf of NRC. NRC agrees
indemnify Group for any tax, retirement contribution, social security, overtime payment,
workers’ compensation payment which Group may be required to make on behalf of NRC or a
employee of NRC for work done under this agreement.
NRC shall be aware of the requirements of the Immigration Reform and Cont
Act of 1986 and shall comply with those requirements, including, but not limited to, verifyi
the eligibility for employment of all agents, employees, subcontractors and consultants that i
included in this agreement.
9.14 This contract constitutes the entire agreement of the parties. This contract n
only be modified by a writing executed by the parties.
IN WITNESS WHEREOF, the parties have executed this agreement on the date
forth on page one (1) hereof.
CLAUDE A. LEWIS
(Print)
NATIONAL RESOURCE CONSULTANTS, INC.
By: - /$&& /@K447
Nicholas M. Krnich Presi
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EXHIBIT ONE PRINCIPAL BENEFITS, EXCLUSIONS, AND LIMITATIONS
Benefits
NRC agrees to provide the following services:
1. Ongoing consultation regarding the benefits provided in this Employee Assistar Program Agreement, including the overall design, development, management a
implementation of such benefits.
Appropriate individual case management including:
Evaluation of employee and family member problems, appropriate brief counseling (c
to six sessions per incident of treatment when the Enrollee’s or Enrollee’s fam
member’s problem(s), in the judgement of the EAP Provider, are subject to signific
improvement as a result of short-term care) andor referral to screened resources
ongoing or specialized treatment or services.
Consultation to Group employees and management to assist with reintegration
employees who have been in alcohol or drug treatment or who have been absent duc
other mental health related reasons.
Follow-up on each case to determine rate of success of the rehabilitation process or n
for further assistance.
Liaison between Group and all counseling and helping agencies that service Gr
employees and their families in matters related to the benefits available under
Employee Assistance Program.
Assistance with continuous and ongoing in-service training of Group supervis
management, including one in-depth training session for Group personnel schedule(
appropriate and consistent with business needs.
Assistance in providing information about the benefits available under the Emplc
Assistance Program to Group employees through pamphlets, posters and other approp
means.
Ongoing evaluation and reporting sufficient to enable Group to measure the effective
of the Employee Assistance Program.
Ongoing formal recommendations for the upgrading and improvement of the Prog
including the development of an annual report of Employee Assistance Program re5
Critical incident debriefings, consultation and counseling in response to trauma a
worksite, subject to the limitations stated herein.
2.
3.
4.
5.
6.
7.
8.
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0 V a,
EXHIBIT ONE
PRINCIPAL BENEFITS, EXCLUSIONS, AND LIMITATIONS
Limitations and Exclusions
1. Benefits under this Agreement are limited to a maximum of six sessions per incident
treatment when the Enrollee’s or Enrollee’s family member’s problem(s), in
judgement sf the EAP Provider, are subject to significant improvement as a result
short-term care. NRC’s benefits work in conjunction with the benefits provided under
Group’s full-service health plan that may cover, to the extent determined by the Grc
services of physicians, hospitals, mental health and substance abuse providers.
NRC is not responsible for the inclusion or exclusion of any particular health care ben
in the Group full-service health plan.
Critical incident debriefings, consultation and counseling in response to trauma at
worksite shall be limited to short term intervention within the capacity of NRC’s prov
network. In the case of massive trauma caused by major disasters or other events cau
massive trauma, NRC shall not be responsible for the results of circumstances beyonc
control that prevent NRC from completely responding to all service requests.
2.
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