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Home My WebLink About58-95 RESOLUTIONRESOLUTION NO. 58795 A RESOLUTION AUTHORIZING THE RENEWAL OF BLUE CROSS AND US ABLE GROLP INSURANCE CONTRACTS FOR THE PERIOD OF MAY 1, 1995 THROUGH APRIL 30, 1996. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYErrEvILLE, ARKANSAS: SOWOn 1. That Council hereby approves the renewal of Blue Cross and US Able Group Insurance contracts to provide health/dental insurance for the city employees for the period of May 1, 1995 through April 30, 1996. A copy of the contracts are attached hereto marked Exhibit "A" and made a part hereof. PASSED AND APPROVED this J8th day of April 1995. ATTES"r: By:t I Traci Paul, City Clerk APPROVED: /41 :4€ C By: Fred Hanna, Mayor USAble Life LONG TERM DISABILITY RENEWAL NOTIFICATION Company Name - Group Number: Representative: Renewal Date: Date Typed: CITY OF FAYETTEVILLE 2467-100 JESSE HANNAH 5-1-95 3-20-95 Amount of Benefit: 60Z OF BASIC MONTHLY EARNINGS NOT TO EXCEED $6.000 Benefit Period: RIM Present Rate Per $100 of Covered Payroll: .46 *********************************** Renewal Rate Per $100 of Covered Payroll: .46 Number of LTD Employees Currently Insured: 420 Monthly Covered Payroll: $830.519 ************************** **** PLEASE COMPLETE THE FOLLOWING Percentage of Company Contribution - Number of Eligible Employees: Remarks: 10034 403 Group Administrator: USAble Life Representative: ***************************************************************** MARKETING REPRESENTATIVE REASSIGNMENT From: To: Regional Manager Dir. of Mkt. USAble Date ihtilJdUS ;U7 72501 378 3333 USAble Life SABLE LIFE BC FAYETTEI ILLE Z001. 001 TO: pumas AMEN FROM: KlIft WILLIE DAM; APRIL 1.2, 1995 SUBJECT; CITY OF Warm= GROUT' NUMBER: 2467-001 RIZTEWAL DATE: JUNE I, 1995 Just a reminder that Subject Group has the following voluntary product(s) in force: VOLUNTARY AD&D VOLUNTARY SHB 4 of employees enrolled 403 4 of employees enrolled Na The voluntary rates will remain the same, huwever if the group would like to up -grade their benefits or add employees. now is the time to do so. Please remember to submit these applications to the Underwriting Departmen-, along with a memo as to what has transpired. Thank you! Group Administrator: 1TSAble Life Representative: -1-t" MARKETING REPRESENTATIVE REA5SIGNMEET FROM: TO: Regional Manager Director of Marketing Date USAble Life • • USAble Life Renewal Notification Form Policyholder: CITY OF FAYETTEVILLE Group 44 2467 Renewal Date* 5-15-95 Date Prepared* 2-24-95 Representative* JESSE HANNAH Description of Classes: LIFE AD&D DEP LIFE STD ALL REGULAR FULL—PIKE EMPLOYEES WORKING A 40 HOUR WEEK 1 1/2 X ANNUAL SALARY MAXIMUM — $150,000 Current Rates Current Volume Current Premium Your New Rates Your New Premium LIFE AD&D DEP LIFE STD $ .28 $ .07 $ $ $ 15,087,673.00 $15,087,673.00 $ $ 4,224.55 $ 1,056.14 $ $ .28 $ .07 $ $ $ 4,244.55 $ 1,056.14 $ $ Your Group Policy contains special provisions which were requested at the date of issue. Please check your policy carefully and if you have questions, please contact your Sales Representative or USA ble Life. Comments: CND-RNF (12-93) srm NAACP 130MPLETE AND SIGN EMPLOYER CERTIFICATION OF ENROLLMENT & ELIGIBILITY ON THE REVERSE SIDE. Y011111 CHOOSE US FOR LIFE RO. Box 1650 Little Rock, Arkansas 72203-1650 (501)375-7200 IMWeLdrisirraWrarcennbytheARBesiUmpany fluSue9 Mg :If Tina 90u211102:11;.V..Protts! fsr.n.B.W5n :00.Z.b.51:£40.0 :029PMZ1 .STSUe3.{W:13.1"..314-1n lcagOd .319 110d Sri .3S001i0.11.p0A 0.111.0 wfl (E6r.Z1).d/sIN.'..UNI) $4101g4lS RUPV .s.,pAppyiasa4daN INO.1JI42.3X3 .}10.:4'NOS.V311 (1.3311101Vl 3,LVU MANN papiaoid uotinu0ju!;$urmoiRj PlifluPulaiimbpi :3ts0qp Teo pairolw uositod :icup 40A 4SNO.11CON3 stAtaalaji :ocu •511 :ppiesuadwoa .4443p4tp .pup f.atuoti iP fu? ss'au lu 04j V.upspipAuoo q0u Ne 40 Iitvp#J lu3Osp1p40.0 ,pinotT*Ijunu 'intclsoy 11!.10PWR pup ssau!sn.q421.0oA ano 11.1$.uppop1/4 luat11401.01up yo ;aappd jp4u4ou :gm IR auppos icipmpp :flni,4 JPO 15Roj 4 :).pom iv:icyrupp .an qs:aicoi.dtup jo..snia :aj.pp.a LIE JO siatitu.ain oprd .0141 .ppllowa :suo•sioja llv • 'PaIlojga OppUVgri0 eogi ?3P.0101;10 aVaitipp saa4oidwa Dfr alp axau • jo :pauapfq .t.isRunj inb3z .acj Illetk pop ad .PPR!FM :Mina idWoo s.;Spp fg uq Ow:?Pllio.lua :”.ae<9.1011P '11.1.n!glald ..?!4).59..pRO AUR .4Vd .p.a4Inia4 Sa.P.6.0.1dLua JI 19.1.101cla .pq lsnui:s.a.aoidep? a.i.cMia fie .4:90fot s!.uppngpluo.3 IpXold.w3 )] :BION1WL11041.11 0:0 - Ewe: is! .uolingbzwo, Ano 'eicjwiro.a spxo.aat :aaicoultup !AM •.pue mu] dnoa .ano Apj pawpaw. :ptp pannajnaa ;anng 41141011.3sI pautp..tua jo u011ompap nicoidut3 en entsn USAble Life 320 W. Capitol • P.O. Box 1650 • Little Rock, AR 72203-1650 (501) 375-7200 AMENDMENT NO. 3 This amendment forms a part of Group Policy No. IA2467-001 Policyholder: CITY OF FAYETTEVILLE The Group policy is hereby amended as fellows: The renewal date s changed to May 1 of each year. The effective date of this amendment is April 1, 1995 issued to the policyholder: The policy's terms and provisions will apply other than as stated in this amendment. Dated at Fayetteville, Ark. (city,stalo City of Fayetteville this 30th day of March 19_95 (Policyholder) GPOL A (7-93) USAble Life c 0 A P:esident AMENDMENT TO THE ARKANSAS BLUE CROSS AND BLUE SHIELD GROUP CONTRACT FOR City of Fayetteville Group Number 090041 Schedule A of the Arkansas Blue Cross and Blue Shield Group Contract is amended to show the rates effective May 1, 1995. Charges for each enrolled employee shall be as follows: HEALTH Monthly Charge Per Covered Employee ONTE PERSON FAMILY COVERAGE COVERAGE $120.27 $306.91 Initial charges shall be paid on the Effective Date and no coverage shall be in effect until such payment is received by the Plan. Subsequent charges shall be payable on or before the same day as the Effective Date of each month thereafter. This Amendment becomes a part of the Arkansas Blue Cross and Blue Shield Group Contract. obert L. Shopta , President ARKANSAS BLUE CROSS AND BLUE SHIELD, A Mutual Insurance Company 601 Gaines Street Little Rock, Arkansas 72201. 110)1 0 igla AMENDMENT TO THE ARKANSAS BLUE CROSS AND BLUE SHIELD GROUP CONTRACT FOR City of Fayetteville Group Number 090041 Schedule A of the Arkansas Blue Cross and Blue Shield Group Contract is amended to show the rates effective May 1, 1995. Charges for each enrolled employee shall be as follows: (COBRA excluding dental HEALTH Monthly Charge Per Covered Employee ONE PERSON FAMILY COVERAGE COVERAGE $106.01 $256.94 Initial charges shall be paid on the Effective Date and no coverage shall be in effect until such payment is received by the Plan. Subsequent charges shall be payable on or before the same day as the Effective Date of each month thereafter. This Amendment becomes a part of the Arkansas Blue Cross and Blue Shield Group Contract. Fast R ert L. Shopta , resident ARKANSAS BLUE CROSS AND BLUE SHIELD, A Mutual Insurance Company 601 Gaines Street Little Rock, Arkansas 72201