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Home My WebLink About2025-0166 - - 2025 SHIBA MOU - Statewide Health Insurance Benefits Advisors (SHIBA) Docusign Envelope ID: E96E37EE-A5F1-4D1B-9F90-512214C77BA5 Memorandum of Understanding An Agreement Between Solid Ground, Statewide Health Insurance Benefits Advisors (SHIBA) program Partner Organization: Auburn Senior Activity Center Street Address: 808 9th Street SE City State, Zip: Auburn WA, 980002 Contact Person: Radine Lozier Phone: 253-288-7440 Email: rlozier@auburnwa.gov Web Site: www.auburnwa.gov/seniors This Memorandum of Understanding (MOU) is a letter of agreement between your agency and SHIBA/Solid Ground which defines the basic provisions that will guide our working relationship. SHIBA volunteers provide free and unbiased information on Medicare. Volunteers offer information people can use to make decisions based on their own unique needs, values, and circumstances. SHIBA volunteers can provide information about: o Original Medicare o Prescription drugs o Low-income programs to help pay for Medicare o Medigap (Medicare Supplement) plans o Medicare Advantage plans o Medicare fraud and abuse SHIBA Volunteers Training and Certification: SHIBA Volunteers are trained and certified by the Office of the Insurance Commissioner (OIC). To become a certified SHIBA volunteer, and remain active, individuals must meet the following minimum requirements: 1 Docusign Envelope ID: E96E37EE-A5F1-4D1B-9F90-512214C77BA5 • Attend Solid Ground's Volunteer Orientation which includes an anti-racism orientation. • Attend a confidentiality training on an annual basis. • Attend an 8-hour Medicare Basic Training. • Pass an exam to become a certified SHIBA volunteer. • Attend monthly trainings hosted by OIC to stay up to date with the changes in Medicare. The volunteer must attend 8 out of the 9 trainings per year • Pass a National background check processed by OIC. • Agrees to only provide free unbiased, and confidential healthcare information and advice. • SHIBA volunteers do not sell or pick out insurance plans for clients. • SHIBA volunteers cannot have active insurance license during their time as a SHIBA volunteer. • SHIBA volunteers agree to follow site location health and safety guidelines including masking, physical distancing, and/or vaccination verification. • SHIBA volunteer agrees to follow site/agency code of conduct guidelines. SHIBA PARTNER ORGANIZATION RESPONSIBILITIES: • Provide a private meeting space to maintain confidentiality of counseling sessions. Amenities that are not required but preferred, are access to computer, a telephone, printing ability, and access to the internet for SHIBA volunteers and the people they serve. Check all that apply: Required: Optional: Access to private meeting space X Access to a computer X Access to a phone X Ability to print X Access to Internet X • Schedule appointments and reminder calls for participants with the volunteer assigned to the site during the hours agreed. • Display and share SHIBA promotional and informational materials (e.g., posters, flyers, brochures) on the premises to inform people of services available to them through the program. 2 Docusign Envelope ID: E96E37EE-A5F1-4D1B-9F90-512214C77BA5 • Receive approval from SHIBA Program Coordinator before posting any SHIBA related promotional, informational materials including event or program blurbs shared with the public that was written or produced by any agency or organization other than the Office of the Insurance Commissioner or Solid Ground. • Provide SHIBA program coordinator with information pertaining to volunteer accomplishments and the impact they have on your agency, participants, and community if requested. • Ensure that volunteers have access to a partner site staff member and a safe environment for their volunteer assignment. Comply with any appropriate WA State and King County health and safety regulations. • Keep the SHIBA coordinator informed of COVID-19 protocols such as volunteer vaccine requirements. • Read and understand the supplemental volunteer insurance policy. Please note coverage limits. https://s14621.pcdn.co/wp-content/uploads/2015/12/RSVP- VollnsuranceBrochure.pdf • Notify the SHIBA Program Coordinator in the event of an accident involving a SHIBA volunteer. • Agree to not discriminate against SHIBA volunteers or participants on the basis of race, color, national origin (including limited English proficiency), sexual orientation, age, political affiliation, religion, or on the basis of disability. • Maintain the SHIBA program as accessible to persons with disabilities (including mobility, hearing, vision, mental, and cognitive impairments or addictions and diseases) and/or limited English language proficiency and provide reasonable accommodation to allow person with disabilities to participate in programs and activities. • Reach out to the volunteers referred by the SHIBA program within 10 business days about possible placement. Solid Ground will refer the volunteers and the partner organization will make final decisions regarding their placement. SOLID GROUND/SHIBA WILL: • Coordinate training and support of SHIBA volunteers with OIC. • Inform SHIBA volunteers of their responsibilities as a volunteer. • Refer interested SHIBA volunteers for placement at your organization as well as work to find a replacement volunteer if the need arises. • Recognize SHIBA volunteers for their volunteer service. • Provide supplemental accident, personal liability, and auto liability insurance beyond any other coverage available to the volunteer. https://s14621.pcdn.co/wp- content/uploads/2015/12/RSVP-VollnsuranceBrochure.pdf • Provide access to SHIBA promotional and informational materials. ALL PARTIES WILL: 3 Docusign Envelope ID: E96E37EE-A5F1-4D1B-9F90-512214C77BA5 • Both parties agree to indemnify and hold each other harmless from and against any and all claims, expenses and actions based on negligence, including claims, demands and suits alleging property damage or bodily injury (see additional insurance requirements section below). • Communicate and work together on an ongoing basis to serve the needs of SHIBA program participants and volunteers by updating each other on changes to the partner programs and meeting with staff at least once a year to access, discuss, and update participant, volunteer, and site needs. • Train volunteers on their respective missions and scopes of their organization including orienting volunteers to the program site. • Work cooperatively and in partnership to resolve differences or misunderstandings. • Agree to keep SHIBA participant and volunteer's sensitive information confidential. This includes maintaining a private space for SHIBA Medicare counseling sessions away from the public during the length of the counseling appointment. • Agree to not store or disclose SHIBA participants or volunteers' personal protected information (PPI). You can find definitions of what information is included in PPI here: SHIBA's confidentiality requirements (wa.gov). • Understand that confidentiality is protected by Federal law (42CF R Part II and Uniform Health Care Information Act). Violations may result in suspension and/or termination of partnership. More on confidentiality can be viewed here SHIBA's confidentiality requirements (wa.gov) • Comply with the nondiscrimination provisions of the Americans with disabilities act and title VI of the civil rights act of 1964. Insurance Requirements Insurance: Partner Organization needs to hold: 1. General Liability Insurance Policy. Provide a General Liability Insurance Policy, including liability, in adequate quantity to protect against legal liability arising out of MOU activity but no less than $250,000 per occurrence. 2. The insurance required must be issued by an insurance company/ies authorized to do business within the state of Washington. Additional Insurance: 4 Docusign Envelope ID: E96E37EE-A5F1-4D1B-9F90-512214C77BA5 Partner Organization must name Solid Ground as additional insured on their insurance policy and as it relates to this MOU. All policies must be primary to any other valid and collectable insurance. SHIBA Partner Organization must instruct the insurers to give Solid Ground thirty (30) calendar days advance notice of any insurance cancellation. Other Insurance: If Partner Organization is part of an insurance pool, proof of insurance coverage meeting the insurance requirements listed above can in accepted in lieu of the additional insurance requirement. SHIBA partner organizations must provide Solid Ground thirty (30) calendar days advance notice of any insurance cancellations. Please email to: The SHIBA program coordinator, Sam Stones, at sams@solid-ground.org or mail to: Solid Ground Attn: SHIBA Coordinator 1501 N 45th St Seattle, WA 98103 This MOU will remain in effect for 2 years. It may be amended, in writing, at any time with concurrence of both parties. It may also be ended by either party with 30 days written notice. Your agency representative who will serve as liaison with SHIBA/Solid Ground and who will the volunteers staff contact is: Name: Megan Mummert Title: Program Coordinator E-mail: mmummert@auburnwa.gov Phone: 253-288-7441 ******************************************************************* "—Signed by: Initial Signature: 9UUe Oetif f •—F 075D421.10421. fi°j Title of Partner Organization Representative: Parks Di rector • Date: 4/8/2025 "—Signed by: Vo' E42A95 D6E7428 4/4/2025 un eer TerVlCes Manager, Solid Ground _ Signature &Title of SHIBA Program Representative Date 5