HomeMy WebLinkAbout54-98 RESOLUTIONRESOLUTION NO 5 4 - 9 8
A RESOLUTION AUTHORIZING THE CITY OF
FAYETTEVILLE TO EXERCISE THE OPTION TO RENEW
BCBS/U S ABLE LIFE, AD&D AND LTD GROUP POLICIES
FOR POLICY YEAR 5/1/98 THROUGH 4/30/99.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE,
ARKANSAS:
Section 1. That the City Council hereby exercises the city's option to renew BCBS/U.S.
Able Life, AD&D and LTD Group Policies for policy year 5/1/98 through 4/30/99, and authorizes
the Mayor and City to execute the renewal agreements. A copy of the renewal agreements are
attached hereto marked Exhibit "A" and made a part hereof.
PASSED AND APPROVED this SP__ day of May , 1998.
Fred Hanna, Mayor
ATTEST:
By: 41,2g IS -11
Heather Woodruff, City erk
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USAble Life
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Employer Certification of
Enrollment & Eligibility
We have reviewed the enrollment for our group plan and our employee records. We certify that:
• Our contribution is: Life & AD&D - 100 % STD - 0 96
IMPORTANT NOTE: If Employer Contribution is 100%, all eligible employees must be enrolled. If employees are
required to pay any part of the premium, employees enrolling more than 31 days after completing their waiting
period will be required to furnish Evidence of Insurability.
• There are 480 employees eligible to participate in the plan and 48o are enrolled.
• All persons enrolled in the plan are:
[a members of an eligible class of employees;
aare actively at work at least 40 hours per week, are actively working at their
normal place of employment, working in our regular business and are not in a
hospital, nursing home, convalescent facility, or are not convalescing from illness
or injury at home, and
aare directly compensated by us for their services.
EXCEPTIONS:
For any person enrolled not meeting the above requirement, the following information is provided:
NAME
DATE LAST WORKED REASON FOR EXCEPTION
Representative's Signature
Administrator's Signature
UND-RNF (12-93) srm
Mayor
(Title)
Date 'X
Date AM/
YOU'LL CHOOSE US FOR LIFE
P.O Box 1650
Little Rock, Arkansas 72203-1650
(501) 375-7200
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USAble Life
•
LONG TERM DISABILITY RENEWAL
Policyholder: City of Fayetteville
Renewal Date: 5/1/98
Representative: Francis Kuehn
LTD Policy #: 2467-100
Date Prepared: 3/31/98
Amount of Benefit: 60% of bask monthly earnings not to exceed $6,000
Current Rates Per $100 of Covered Payroll: AS
Your New Rates Per $100 of Covered Payroll: 46
Monthly Covered Payroll: siloaintoo•
Your New Premium: $4,824.36
Remarks:
PLEASE COMPLETE THE FOLLOWING INFORMATION
Percentage of Company Contribution: 100%
Number of Eligible Employees: 455
Representatives Signature:
Administrators Signature:
Mayor
Title
Date:
Date: 0/4
Your Group Policy contains special provisions which were requested at the date of issue. Please check your Policy
carefully. If you have questions, please contact your Sales Representative or LISAbte Life.
UND-RNF(1-96)