HomeMy WebLinkAbout44-97 RESOLUTIONRESOLUTION NO. tttt-9t SCAI{T{ED
A RESOLUTION AUTHORIZING THE RENEWAL OF THE
BLUE CROSSiBLUE SHIELD AND U.S. ABLE LIFE
ACCIDENTAL DEATH AND DISMEMBERMENT AND LONG
TERM DISABILITY GROUP POLICIES FOR POLICY YEAR
MAY I, 1997 THROUGH APRIL 30, 1998, WITH NO
PREMIUM INCREASE.
BE IT RESOLVED BY TIIE CITY COT]NCIL OF TIIE CITY OF FAYETTEVILLE,
ARKANSAS:
Section 1. That the City Council hereby authorizes renewal of the Blue Cross/Blue
Shield and U.S. Able Life Accidental Death and Dismemberment and Long Term Disability Group
Policies for policy year May l, 1997 through April 30, 1998 with no premium increase.
AND APPROVED this 6th day of May ,1997.
APPROVED
\{1\Hanna, Mayor
By
Traci Paul, City Clerk
PASSEDlrtltr.
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Pollcyholdar:
Renewal Date:
Rupresen !adve:
Descrlptlcn of C
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Renewal lt{otification Forrn
CI-TY OF FA YETTEVILLE Group #: 2467
Date Prepared: 2l28lg7
FRANCIS KUEHN
LIFE RT'ED D EP LIFE STD.
1 1N X ANNUAL SALARY
MAXlMUly,l - S150,00J
UFE DEP UFE STD
$31 $$5
$ 17,ggg,o0o.o0 $ 1 7,999,0c0.00 s
$ 5,549.39 Gv 1 .252. E6 s
5 31 S .07 $s
5 5,549,36 $1.252.66 s
lasses;
ALL REG,JEI-AR, FULL-
TIME EMI)LCYEES
WORI.JNT-i A 40 HOUR
WEEK
Cunent Rates
Current Volume
Current Prermium
Your New Rates
Your New Prerniurn
Your Group Policg contairu fiecial wouisioru which uerc requested at the date of issue- please clzeck gour policyurefully and if gau hate questioru, pleasc ccntact your Sales Repruentatiae or USlttu titu.
Comnreotsi
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Yodu Cuoose Us Fon LrE
P.0. Box 1650
LitUe Rock, Arlcansas TZZA}-L6S0
(501) 375-nW
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E rnployer CertificatioR of
Enrollment & Eligibility
L'J.1,!fJl.l Lf 1'Lr , L'll tl vvv
LifeUS tble
We havi revioryed the enrollment for our group plan and oul smplolee recotds. We certiS that:
. Our contribution is: Life & AD&D - 100 % STD -0 %
IITIFORTAM NOTET If Empiqyer Contribution is I00%, all eligible employees mr.tst be enrolled. If employees are
required to pay any paft of the prennium, emplcyees enrollind more than 31 days aJter completW their waiting
pe riod will be required to furnish Evidence of Iirsurability.
. There are . 463 employees eligible to participate in the plan and 463 _are enrolled.
. All persons enrolled in the plan are:
tr mernbers of an eligible class of employees;
E are actively at work at least 40 . . hours Der week, are actively working at their
normal place of empioyrnent, working! in our regular business and are not in a
hospital, nursing!home, convalescent facility, or are not convaiescing from illness
or injury at home; and
f| are directly compensated by us for their servicAs.
EXCEPTIONS;
For any person enrolled not rneeting the above requirement, the following ir:formadon is provided:
NfuTIE DATE L{ST WORKED REASON FOR EXCEPTTON
Representative's Si
Adrninistrator's Si g na
N)a\/or Yo/r.l, CHoosE Us Fon Lme
P.O. Bor 1650
Little Rock, Arkansas 72203-1650
(5ot | 375.7200
ll}uu uri b fupd -A' (f;ldts41) b1 tttrtj{, t f, 6t frry
ITND"RNF (12-93) srrn
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USAble Life
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LCNG TERM DISABILITY RENEWAL
-
Policyholder:
Renewal Date:
Representative:
CITY OF FAYETTEVILLE LTD Policy #: 2467-100
Date Prepared: 2l28lg75t1t97
FRANCIS KUEHN
PLEASE COMPLETE THE FOLLOLVING INFORMATION
Percentag e of Cornpa ny Contribution:1 00.7^
Number of Eltgible Emptoyees: 448 (3-3t-97)
Remarks:
Repre sentatives Sign atu re :Date:
Admini strators Si gn ature Date:
Title
YOUTG(OupPCl2yCCtttiMar9,jacl/r^'vrrro.r!wi,bt,wers€guostodal|l,ag?faCrrsLD. prc.rocrrcctyE..EP.altcyt
czttffly . t lw hat,s gwlijlr1J,, Floes. soi: tsct Jrw Sates Reprasenta aiyc or lJSAbb Lita.
UND.RNF(1-96)
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USAbIe
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Life
-TO Francis Kuehn
FROM:Christy Holt
DAIE:Apri I 17, 1997
ST]BIECT:Ciry of Fal,etteville
Polic.y'#; 2467
RENEWAL DATE;lvtay L, 1997
Just a remindcr that SUBIECT GROUP has the following volunran product(s) in forcc:
VOLUNTARY GROUP LIFE: *'oF EMPLoYEEs ENRoLLED: nII
VOLT'NTARY AD&D: #OF E.\{PLOYEES EI{ROLLED: 2g7
VOLUNT.A.RY SHB: # oF EMpLonEES ETTTROLLED: nlt
1'he voluntary'rates will remain the samc, however, if the group would tike to upgrade tfieir bcncfits or
add e:nployccs, now is the time to do so.
Please remcmber to submit these applications to the GRouP DEPARTMENT along with a memo as towhat has uanspired.
Thank you!
Repre sentative s
S ignature :
Administrators
S ignature :
Date :
Date:
T tIe