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HomeMy WebLinkAbout125-99 RESOLUTIONRESOLUTION NO 125-99 A RESOLUTION AUTHORIZING THE MAYOR AND CITY CLERK TO ENTER INTO CONTRACTS WITH USABLE LIFE, INC., TO PROVIDE LIFE, AD&D, AND LTD COVERAGE; AND TO PROVIDE THIRD PARTY ADMINISTRATION FOR AN I.R.S. SECTION 125 FLEXIBLE SPENDING ACCOUNT. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS. Section 1. That the City Council hereby authorizes the Mayor and City Clerk to enter into contracts with USAb1e Life, Inc., to provide Life, AD&D, and LTD coverage; and to provide third party administration for an I.R.S. Section 125 flexible spending account. PASSED AND APPROVED this day of October , 1999. APPROVED. By. //d Fred Hanna, Mayor ATTEST: By ).54 sem,_ 2141, =-••_ ;; . Heather Wo' druff, City Jerk f~ FcvETr f ,�:-SEG 9G yam` k 1 . 4/9p40001. USAble Life P. 0. Box 1650 Little Rock, AR 72203 GROUP INSURANCE APPLICATION TYPE OR PRINT IN BLACK INK 1. Legal Name of Policyholder CITY OF FAYETTEVILLE R-2467 Taxpayer ID# STD 2. Mailing 113 Address of Policyholder WEST MOUNTAIN FAYETTEVILLE City State ARKANSAS Zip+4 72701 3. Street $150,000 Address of Policyholder (if different from above) City State Zip+4 0 other (give details): 4. Name of CEO, President or Owner of Company Name of Insurance DON Contact at Company M. BAILEY Telephone Number of Policyholder 501-521-7700 5. Name of Subsidiary or Affiliate Companies to be Covered N/A Fax Number of Policyholder 501-575-8257 6. Nature of Business CITY/MUNICIPALITY Effective as of Qb— Mo. 12:01 a.m. 01 Day2000Yr. Number of Eligible Employees 528 Number Enrolled for Coverage 528 7. Waiting a. Present b. Future Period Employees 30 DAYS Employer Contribution Life and AD&D STD 100 % Dep. % Life % Hosp. Indemnity % Employees 30 DAYS Other 8. Eligible Employees SEE ATTACHED ADDENDUM NO. 1 Retired Employees Insured Present 0 Yes 0 No Future 0 Yes 0 No 9. Employee Classes SCHEDULE OF INSURANCE Description Life and AD&D STD Other* SEE ATTACHED ADDENDUM NO. 1 • Indicate other benefits sold. 10. Guaranteed Issue Changes in benefit amounts in accordance with the Schedule shown above will become effective on: 0 the first day of the policy month following the date of change; or $150,000 $a the policy anniversary date coincident with or next following the date of change; or (Life and AD&D amounts over Guaranteed Issue are subject to evidence of insurability.) 0 other (give details): 11. Reductions & Termination (Benefit reduction due to age will be effective on the insured's birthday.) O Employee Life and AD&D benefits reduce 33 1/3% of the pre -age 65 amount at ages 65 & 70. Terminate at retirement. ❑ Dependent Life benefits reduce 50% at the spouse's age 65. Terminate at the employee's retirement. O STD benefits reduce 33 1/3% of the pre -age 65 amount at ages 65 & 70. Terminate at retirement. $S Other: SEE ATTACHED ADDENDUM NO. 1 GPOL-APP (2-98) (over) Page 2 of Application 12. Extended Life Insurance Benefits R$ Yes ❑ No If Yes, indicate type of coverage desired: X8 Standard Coverage 0 One-year Extension 13. Dependent Life Insurance ❑ Yes %% No If Yes, indicate correct plan: Spouse Each child over days to months Each child months to years (students to age 0 Plan I $2,000 100 1,000 0 Plan II 0 Other $5,000 200 2,000 14. Short Term Disability Accident Benefits (non -occupational) 0 Yes fl No Begin Day Sickness Benefits Begin Day Maximum Period Weeks Benefits Begin on First Day Hospitalized 0 Yes 0 No ❑ Yes fl No UNITS Available: 0 1 unit only or 0 1 or 2 units as elected by employee Dependent Coverage Available: 0 Yes 0 No Employer Contribution: 16. Voluntary Group Life ❑ Yes %% No 0 STANDARD, or 0 SELECT Guaranteed Issue: 0 No 0 Yes $ # Enrolled If Yes, required employee participation 17. Supplement Hospital Benefit .❑ Yes l8 No Optional Cancer Benefit? 0 Yes 0 No # Enrolled Employer Contribution: 18. Voluntary Accidental Death & Dismemberment fl Yes 0 No # Enrolled Employer Contribution: REMARKS OR SPECIAL PROVISIONS ORIGINAL LIFE AND AWED POLICY WAS EFFECTIVE APRIL 15, 1988. ORIGINAL VOL. AD&D POLICY WAS EFFECTIVE JUNE 1, 1991 — THIS APPLICATION REFLECTS CHANGES EFFECTIVE 1-1-2000. THEREFORE POLICIES #2467-000 S 2467-001 ARE BEING REISSUED UNDER R-2467. It Is understood and agreed that this application shall be made a part of the policy or policies applied for and that no insurance shall be effective until approved by the Company at its Home Office. COMPLIANCE NOTICE: USAble Life does not provide legal or tax advice. Based upon information you have provided us about your group, we will notify you if we perceive any obvious deficiency in your plan, but you must consult your own legal counsel for definitive advice and opinions regarding your plan's compliance. INSURANCE FRAUD WARNING - Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of a crime and subject to fines and confinement in prison. FAYETTEVILLE ARKANSAS Dated at (City, St Signature of Marketing OCTOBER 11, 1999 Date Signature of Policyholder and Title MAYOR 'L._ ' epresentativeid" Signature o arketing anager Signature of Broker, if applicable Addendum No. 001 to be attached to and made part of Application, GPOL-APP (2-98) Application By: City of Fayetteville GROUP LIFE INSURANCE The following questions of the application are addended as follows: Questions #8, #9 and #11. Effective: January 1, 2000 The `Basic Life and AD&D Benefits for eligible employees shall be determined by the following schedule: CLASSIFICATION ;LIFE AND AD&D = ," Class working Class time works regular 1: All at 2: Any who is an average basis. least a full-time employees 40 hours per Employee previously designated staged of 20 Hours customarily week. employed retiree and per week on full- who a 1 1 Times Annual Salary, 1 ,h Times Annual Salary Working Full -Time, Maximum *Insurance amount will higher thousand. Maximum Last Earned $150,000 be rounded to the $150,000* When next The Reductions, Terminations and Special Provisions as shown on page 2 are deleted and the following sha 1 apply: REDUCTIONS, TERMINATIONS AND SPECIAL PROVISIONS Class 1: Employee Life and Accidental Death & Dismemberment: Benefits reduce 33 1/3 % of the pre - age 67 amount at ages 67and 70 and terminates at retirement. Class 2: Employee Life and Accidental Death & Dismemberment: Benefits reduce 33 1/3 % of the pre - age 67 amount at ages 67and 70 and terminates the earlier of age 75 or retirement. Group Life to include Accelerated Benefit Rider. Group AD&D to include Accidental Death Seat Belt Rider. Signature and Title OCTOBER 11, 1999 Date USAble Life P 0 Box 1650 Little Rock, AR 72203-1650 APPLICATION FOR GROUP LONG TERM DISABILITY INSURANCE 1. LEGAL NAME OF POLICYHOLDER CITY OF FAYETTEVILLE R-2467-100 2. MAILING ADDRESS OF POLICYHOLDER 113 WEST MOUNTAIN FAYETTEVILLE, AR 72701 3. STREET ADDRESS OF POLICYHOLDER (if different from above) 4. NAME OF SUBSIDIARIES, DIVISIONS OR AFFILIATES TO BE COVERED N/A 5. NATURE OF BUSINESS CITY/MUNICIPALITY 6. EFFECTIVE DATE 12:01 A.M. MONTH jAwARy 7. ELIGIBLE CLASSES Describe Below DAY 01 YEAR 2000 WILL EMPLOYEES CONTRIBUTE 0 YES TOWARDS COSTS? X® NO (The insurer reserves the right to review and terminate all classes insured under this policy if any class ceases to be covered.) CLASS ALL FULL—TIME EMPLOYEES CLASS WORKING A MINIMUM OF 40 REGULARLY SCHEDULED HOURS PER WEEK. 8. ELIGIBILITY WAITING PERIOD (Should an employee enter another eligible class, he will not be eligible for any additional benefits until he has completed a 30 -day waiting period, and has been actively at work one full day in the new class.) A. PRESENT EMPLOYEES (None, unless specified) B. NEW EMPLOYEES 90 DAYS 9. NUMBER OF EMPLOYEES A. ELIGIBLE 528 528 B. ENROLLED MAXIMUM COVERED PAYROLL PER EMPLOYEE: $ 10,000 PER MONTH 10. AMOUNT OF INSURANCE 60 % (Benefit Percentage) OF BASIC MONTHLY EARNINGSNOTTO EXCEED A MAXIMUM MONTHLY BENEFIT OF $ 6,000 OR % OF THE FIRST $ OF BASIC MONTHLY EARNINGS PLUS % OF THE NEXT $ OF BASIC MONTHLY EARNINGS NOT TO EXCEED A MAXIMUM MONTHLY BENEFIT OF LESS OTHER INCOME BENEFITS STATED IN THE POLICY INCLUDING ❑ PRIMARY SOCIAL SECURITY fl PRIMARY AND FAMILY SOCIAL SECURITY 0 PRIMARY AND FAMILY SOCIAL 0 BACKDOOR INTEGRATION SECURITY WITH 70% ALL SOURCES THE MINIMUM MONTHLY BENEFIT IS $ 50.00 11. ELIMINATION PERIOD 180 DAYS 12. PRE-EXISTING CONDITIONS EXCLUSION ❑ 12/6/24 XX3/6/12 ❑ 12/12 ❑ 5 DAY 0 OTHER GLTD-MAPP (2-98) 13. MAXIMUM BENEFIT PERIOD XCREDUCING BENEFIT DURATION BENEFIT DURATION TO AGE 65 60 MONTHS 48 MONTHS 42 MONTHS 36 MONTHS 30 MONTHS 24 MONTHS 21 MONTHS 18 MONTHS 15 MONTHS 12 MONTHS AGE AT DISABILITY LESS THAN 60 60 61 62 63 64 65 66 67 68 69 (AND OVER) O 65/5/70 AGE AT DISABILITY LESS THAN 60 60-64 65-69 (70 AND OVER) ❑ TO AGE 70 AGE AT DISABILITY LESS THAN 69 • 69 AND OLDER BENEFIT DURATION TO AGE 65 5 YEARS TO AGE 70 BUT NOT LESS THAN 1 YEAR 1 YEAR BENEFIT DURATION TO AGE 70 1 YEAR OTHER O 5 YEARS OR AGE 70 WHICHEVER FIRST OCCURS O 10 YEARS OR AGE 70 WHICHEVER FIRST OCCURS ❑ TO•AGE65 ❑ 5 YEARS OR AGE 65 WHICHEVER FIRST OCCURS O 10 YEARS OR AGE 65 WHICHEVER FIRST OCCURS ❑ OTHER NONE OF THE ABOVE OPTIONS EXTEND THE MAXIMUM BENE- FIT PERIOD BEYOND THE AGE SELECTED EXCEPT FOR A MINI- MUM ONE-YEAR BENEFIT. 14. POLICY FEATURES Ig NO NO A. O YES B. O YES C. 0 YES XX NO D. O YES fl NO E. O YES id NO F. %I YES ONO G. r YES ONO H. O YES %% NO L ki YES NO J. %I YES ONO K. COLA ❑ YES XX NO O YES %l NO L. O YES XX NO M. O YES .fl NO N. %1 YES ONO PARTIAL DISABILITY EDGE EDGE 1 % INDEXATION EXTENSIVE OWN OCCUPATION BENEFIT 60 MONTH OWN OCCUPATION BENEFIT • 36 MONTH OWN OCCUPATION BENEFIT THREE MONTH SURVIVOR BENEFIT YEAR FAMILY INCOME BENEFIT MENTAL ILLNESS LIMITATION PROGRESSIVE PARTIAL DISABILITY ADJUSTMENTS -OPTION I END OF MAXIMUM BENEFIT PERIOD -OPTION II ADDITIONAL PENSION CONTRIBUTION 401K CONTRIBUTION BENEFIT 2 YEAR RATE GUARANTEE 0. ❑'YES f NO ADDITIONAL FEATURES. REMARKS ORIGINAL LONG TERM DISABILITY POLICY EFFECTIVE DATE MAY 1, 1990.- THIS APPLICATIO REFLECTS CHANGES EFFECTIVE 1-1-2000. THEREFORE POLICY 2467-100 IS BEING REISSUED UNDER R-2467-100 15. IS THIS A REPLACEMENT OF SIMILAR COVERAGE ❑ YES %% NO PRIOR INSURANCE 0 YES CREDIT INCLUDED %%NO (If yes. a copy of prior carrier's plan is required for PIC administration) 16. PREVIOUS COMPANY TERMINATION DATE OF PRIOR PLAN 17. PREMIUM MONTHLY (unless otherwise specified) DEPOSIT OF $ TO APPLY ON THE FIRST PREMIUM It is understood and agreed that this application shall be made Section I, part of the Policy applied for and that no insurance shall be effective until approved by the Insurance Company at its Home Office. Insurance Fraud Warning — Any person who knowing y presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guil y of a crime and subject to fines and confinement in prison. MARKETING REPRESENTATIVE BY: SIG URE LE MAYOR FAYETTEVILLE, ARKANSAS TELEPHONE NUMBER (501) 575-8314 DATE OCTOBER 11, 1999 GLTD-MAPP (2-98) Agreement for Administrative Services This agreement specifies the services to be provided to City of Fayetteville hereinafter referred to as "Company" in the ongoing administration of the Company's Section 125 Cafeteria Plan, and the specified responsibilities of the Company. Administrator City of Fayetteville shall be the Plan Administrator and USAble Life, hereinafter referred to as the "Third Party Administrator", shall be engaged as a subcontractor in the performance of administrative services for the plan. Administrative services to be provided by USAble Life: 1. Design a Cafeteria Plan Document, Dependent Care Assistance Plan and Medical Reimbursement Plan to be reviewed by the Company and Company's legal counsel. 2. Design a Prototype Summary Plan Description. City of Fayetteville is responsible for printing the plan description and distributing it to employees. 3. Conduct informational seminars to explain the Cafeteria Plan to the employees if flexible spending accounts are involved 4. Provide participant election forms to be used during the enrollment process. 5. Process initial enrollment forms and revocation forms to initiate the administration function. 6. Provide an employee list to payroll once all elections have been received and keyed into administration software for verification of elections and amounts. 7. Provide claim for reimbursement forms to be used to claim flexible spending account elections. 8. Provide reimbursement checks to employees on a bi weekly basis. 9. Provide a check register for all checks printed (or to be printed) on a bi-weekly basis. 10. Provide each participant a Statement of Account on a quarterly basis for the first, second and third quarters, and monthly for the fourth quarter. 11. Provide discrimination reports on a semi-annual basis. 12. Provide forms to the Company for use by the Company in communicating participant termination's and changes of family status. 13. Provide quarterly Company statements of participation by plan by participant. 14. Provide annual preparation of Form 5500 for City of Fayetteville to review, sign and mail to the IRS. 15. Provide participant election forms at the end of each year for use in making elections for the following year. 16. Provide guidance to the Company as to the operation of the Plan and to maintaining the tax qualification of the Plan as set by the Internal Revenue Code of 1986, as amended from time to time, and successor tax laws. 17. Maintain all Cafeteria Plan documents and files for six months following the end of each plan year, which after that time will be returned to the Company . Communication services to be provided by USAble Life: 1. Present informational seminar to the employee group. 2. Survey the group and analyze for individual savings. 3. Meet with each employee to discuss their individual savings and personal needs. Responsibilities of the City of Fayetteville: 1. Report participant termination's and changes of family status to Administrative Firm to be effective 2 weeks after receipt. 2. Reconciliation of payroll amount redirected to the Cafeteria Plan based on reports provided each month by USAble Life. 3. Distribution of participant statements of account to Company employees. 4. Initiate any action required in the event plan(s) become discriminatory. 5. Secure legal review of the Cafeteria Plan Document and Summary Plan Description from Company's legal counsel. 6. Review, sign and mail the annual Form 5500 to the IRS. 7. Maintain all Cafeteria Plan documents following the end of each plan year in the event the Plan is audited Fees and Terms of Payment The Schedule of Services/Fees is to be attached and made a part of this Agreement. USAble Life has the right to change the Schedule of Services/Fees by giving at least 60 days notice to the Company. Reports and Data All reports and data remain the property of the Company. USAble Life will provide the Company all data, upon request, used by USAble Life in its administration procedures. City of Fayetteville Section 125 Cafeteria Plan Schedule of Fees The fees for City of Fayetteville have been waived. This waiver will remain with the continual enrollment of USAble Life products. If product solicitation is terminated, then USAble Life will re-evaluate the fee structure at that time. One time set-up fee: Monthly fee for Premium Only Participant: Monthly fee for Flexible Spending Participant: Minimum Monthly Charge: $ 0.00 $ 0.00 $ 0.00 $ 0.00 Terms of this Agreement This Agreement will be effective from the date both parties execute this agreement until it is terminated. Either party may terminate this Agreement with 30 days written notice. By_ By af Julie rshall, Senior Vice President Date: OCTOBER 11,. 1222 Date: STAFF REVIEW FORM XX Agenda Request Contract Review Grant Review FOR THE FAYE 1 EVILLE CITY COUNCIL MEETING OF October 5, 1999 FROM: Don Bailey Name Personnel Admin. Services Division Department ACTION REQUESTED: Purchase employee group policies from U S ABLE LIFE to provide Life, AD&D, and LTD coverage plus contract to provide third party administration for an IRS Sec. 125 Flexible Spending Account The contracts effective dates are 1-1-2000 for a one year term with four one year options for renewal by agreement of both parties. COST TO THE CITY: $155,117 Est. Year 2000 Cost of this request Various Account Number Project Number $203,277 Est. Year 2000 Life/AD&D, LTD Ins. Category/Project Budget Category/Project Name. 0 City Wide Funds used to date Program Name $203,277 City Wide Remaining Balance Fund BUDGET REVIEW: Budgeted Item BddgCdordinator get Adjustment Attached Administrative Services Director CONTRACT/GRANT/LEASE REVIEW: GRANTING AGENCY: 9-a/-99 t //�o�e�mdD t -Xu.Qdo 1-ZR-tt Date brie mal Auditor Date Purchasing Officer 9-a\-99 Date ADA Coordinator Date STAFF RECOMMENDATION: Approve request. Division Head D partment Di�ctor A minis r -five Services Director f�- Mayo Date Date zha Date Date Cross Reference New Item: Yes No Prev Ord/Res #. Orig. Contract Date REVIEW POPE Description Conents: Budget Coordinator Acccuntfng Manager City Attorney Purchasing Officer AOA Coordinator Internal Auditor Reference Conents: Meeting Date Page 2 a. FAYETTEVILLE THE CITY Of FAYETTEVILLE, ARKANSAS DEPARTMENTAL CORRESPONDENCE TO: Mayor Fred Hanna and The City Council THRU: Kevin Crosson, Administrative Services Director FROM: Don Bailey, Personnel Director DATE: September 13, 1999 SUBJECT: Employee Group life, AD&D, LTD Voluntary AD&D and Cancer Coverage Policy Renewal The expiration date for each of the above listed employee group insurance policies is -12-31-99. Periodically the City elects to re -bid its coverages to take advantage of either more favorable pricing or to improve its employee benefits. An RFP requesting bids on the above coverages plus the addition of an IRC Section 125 Flexible Spending Account Proposal (Cafeteria plan) was sent to selected insurance companies and advertised on July 18, 1999. The RFP permitted bids to be submitted on the insurance plans, or the Flexible Spending Account Plan or both. Our group insurance RFP specified a one year contract with four one year options to renewal. Five proposals were received and evaluated by the Selection Committee on September 2, 1999. US Able Life was the clear choice of the Committee by having met the RFP requirements for coverage to be provided and offering the best rates with a two year rate guarantee. A comparison of our 1999 rates and the year 2000 rates follows: 1999 2444 LIFE (per $1,000 coverage) .31 .21 AD&D (per $1,000 coverage) .07 .05 LTD (per $100 of covered payroll) .46 .46 Vol. AD&D* (per $25,000 coverage) 3.75 1.50 employee only " 994.00 2.00 family Cancer* Various No change Cafeteria Plan -0- No cost * Employer pays for $25,000 of Voluntary AD&D coverage on each employee. The employee pays 100% of premium for coverage above $25,000 or for family coverage. The employee pays 100% of premium for Cancer coverage he or she may elect. Based on August 1999 enrollments a conservative estimate of annualized premium reduction for the year 2000 as compared to 1999 is $35,000. Note also that reduction in Voluntary AD&D rates apply to any amount the employee has elected over the $25,000 employee coverage paid by the City This provides a significant savings in premium cost to the employee. Enhancements have also been incorporated in the Life policy. Coverage provisions will now permit full payment of the coverage amount to age 67. Previously, a reduction occurred at age 65. A Group Life Accelerated Benefits Rider has been added to make an advance payment of 50% of the eligible benefit in the event of a terminal illness Also, an Accidental Death Seat Belt Benefit Rider has been included into the AD&D Policy. This rider will pay an additional benefit equal to the lesser of the employees full AD&D benefit or $25,000 in the event of a vehicle accident causing death if the seat belt was in use at the time of the accident. US Able, in consideration of employee participation in two of their voluntary group plans (Cancer and Voluntary AD&D) , will at no cost establish and serve as a third party administrator for a Section 125 Cafeteria Plan. Internal Revenue regulations permit group premiums, employee and dependent unreimbursed medical care expense, deductibles and co -payments and dependent care for eligible children and other dependents to be incurred on a pre-tax basis through payroll contributions to a flexible spending account. These expenses are reimbursed to the employee as projected expenses occur. A pre-tax limit of $2,000 on unreimbursed medical expenses for each participant account has been set for the initial plan year Employees must make an annual calendar year election as to expense categories and amounts to be contributed pre-tax. The initial group presentations and enrollments must be completed by November 14 to effect a January 1, 2000 enrollment. Thus to permit installation of this plan on January 1, the Group Renewal/Cafeteria Plan Agenda item has been moved forward to the October 5 meeting in order to allow a 4-5 week enrollment period. Further information pertaining to each of the plans is contained in policy resumes attached hereto. • 2000 Budget Summary By Account - Estimated Long Term Disability (LTD) Accidental Death & Dismemberment (ADD) - Life Insurance Fund General (1010) Street (2100) Community Development (2180) Parks Development (2250) Drug Law Enforcement (2930) Water & Sewer (5400) Solid Waste (5500) Airport (5550) Shop (9700) CADATA 123-DATA\OOADDLTD. W K4 LTD Budget ADD Budget Life Insurance Budget 52,050 $ 17,142 $ 3,458 1,440 606 203 710 315 414 149 7,757 3,309 3,470 1,530 1,020 363 1,775 675 71,260 $ 25,126 $ 78,075 5,187 909 1,065 621 11,636 5,206 1,530 2,662 106,891 • • • • Enhanced Benefit Option Group Term Life/AD&D Proposal Presented to City of Fayetteville by Barbara Lovin August 11, 1999 USAble Life USAble Life is Rated "A-" (Excellent) by the A.M. Best Company • • Presented to: City of Fayetteville USAble Life Facts • USAble Life was originally chartered in December of 1980 as Life of Arkansas to write Life and Accident and Health insurance. During the past 18 years, USAble Life has grown to be a highly successful insurance company involved in both group and individual payroll deduction products. Highlights • The company insures over 500,000 individuals • The company has more than $4.4 billion of insurance in -force • The company has extensive experience in the implementation and enrollment of voluntary payroll deduction products and administration of Section 125 Cafeteria Plans in commercial accounts and educator groups. We offer a complete innovative choice of products, from employer-sponsored group plans to employee -paid supplemental coverage, all at competitive rates. Our portfolio of products includes: • Group and Individual Life • Group AD&D • Short Term and Long Term Disability • Dependent Life • • Voluntary Term Life • Universal Life • Supplemental Hospital Benefits • Cancer coverage and Accident coverage • Voluntary Disability Coverages, both Short Term and Long Term Management and key staff have years of experience working with employers and employees. This experience, along with our state of the art administration system, enables smooth enrollments and administration for all product lines. • USAble Life is rated "A-" (Excellent) by the A.M. Best Company and stands behind a stiong commitment to superior products and customer service. COMPANY HEADQUARTERS: USAble Life USAble Corporate Center 320 W. Capitol, Suite 700 P.O. Box 1650 (72203) Little Rock, Arkansas 72201 Toll Free: 800-648-0271 Telephone: (501) 375-7200 Fax: (501) 378-3333 Page 2 Presented to: City of Fayetteville A Plan of Group Insurance Schedule of Benefits Classification of Employees Class 1 All full time employees who customarily work at least 40 hours per week Class II Any employees previously employed full time who is a designated staged retiree and who works an average of 20 hours per week on a regular basis Amount of Life Amount of AD&D 1.5 Times Salary, 1.5 Times Salary, Maximum $150,000 Maximum $150,000 1.5 Times Salary, 1.5 Times Salary, Maximum $150,000 Maximum $150,000 [Wates, Life Insurance Volume and Monthly Premium Calculations Rates for Group Insurance Life per $1,000 $0.24 AD&D per $1,000 $0.05 Volume of Insurance Life Insurance $21,689,000 AD&D Insurance $21,689,000 Monthly Premium Life Insurance $5,205.36 AD&D Insurance $1,084.45 TOTAL MONTHLY COST $6,289.81 Reductions, Terminations and Assumptions Reductions and Terminations Class I- Life and Accidental Death and Dismemberment benefits will reduce 33 1/3 percent of the pre - age 67 amount at age 67 and at age 70. Benefits terminate at retirement. Class 11- Life and Accidental Death and Dismemberment benefits will reduce 33 1/3 percent of the pre - age 67 amount at age 67 and at age 70. Benefits terminate the earlier of age 75 or retirement. Assumptions Eligible Employees: 528 The foregoing rates are based on employee data submitted with respect to the number of employees listed above in the assumptions section. Actual rates will be based on enrollment. The final rates will be guaranteed for 2 year(s) from the group's effective date. Proposal prepared: August 11, 1999: and expires November 11, 1999 unless renewed. Page 3 • Presented to: City of Fayetteville Life Insurance • • Death Benefit The face amount of the policy, as determined by the schedule, is payable to the employee's beneficiary in the event of his death from any cause. The life insurance will be paid in a lump sum or in installments as specified by the employee or the beneficiary. Active Work or Actively at Work The Insured reports for work at his usual place of employment and is able to perform all the duties of his regular occupation for the entire normal work day. Beneficiary Each employee may name anyone he desires except the employer, as the beneficiary or beneficiaries to whom the insurance is to be paid. This designation may be changed by the employee at any time. Right of Conversion The employee's life insurance automatically ceases 31 days after termination of employment. During this 31 -day period and subject to the terms of the group policy, he may convert his group life insurance without evidence of insurability to an individual life insurance policy (except term insurance) without disability benefits. Total Disability Benefit • If the employee becomes totally disabled from any cause before reaching age 60, the life insurance is continued, subject to the terms of the group policy, for the duration of his total disability without payment of further premiums. If the employee dies before the total disability ceases, the face amount of the life insurance is payable to his beneficiary. • Suicide If an Insured Person, whether sane or insane, dies by suicide within one year of his effective date of insurance, the death benefit will be limited to the amount of premiums paid for this insurance. With respect to employees insured on the effective date of this policy: (1) If this policy replaces another group life policy, the one-year limitation for death by suicide shall be reduced by the number of months an insured employee was continuously insured by the prior plan; and (2) The benefit payable shall be the lesser of the amount otherwise payable under this policy or the amount provided by the prior policy. Page 4 Presented to: City of Fayetteville Life Insurance Termination of Insurance Insurance will terminate automatically on the earliest of the following dates: (a) the last day of the period for which a premium payment is made, if the next payment is not made; (b) the date the insured becomes a member of the armed forces; (c) the date the policy or a specific benefit terminates; (d) the date the insured ceases to be a member of an eligible class; or (e) the date the insured ceases to be actively at work. Page 5