HomeMy WebLinkAboutR-94-40RESOLUTION NO. R-94-40
A RESOLUTION OF THE CITY OF SEBASTIAN, INDIAN RIVER
COUNTY, FLORIDA, PROVIDING FOR PARTICIPATION IN BLUE
CROSS/BLUE SHIELD HEALTH INSURANCE BENEFITS;
AUTHORIZING THE CITY MANAGER TO SIGN, ON BEHALF OF THE
CITY OF SEBASTIAN, THE CONTRACT APPLICATION~ PROVIDING
FOR REPEAL OF RESOLUTIONS OR PARTS OF RESOLUTIONS IN
CONFLICT HEREWITH~ PROVIDING FOR SEVERABILITY; AND
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the city of Sebastian needs to provide its
employees with health insurance benefits; and
WHEREAS, the City Council feels that Blue Cross/Blue shield
will provide the benefits at a reasonable cost and maintain those
costs to the maximum extent possible.
NOW, THEREFORE, BE IT RESOLVED by the city Council of the
city of Sebastian, Indian River County, Florida, that:
SECTION 1. The City Manager of the city of Sebastian,
Indian River County, Florida, is hereby authorized to execute the
Blue Cross/Blue Shield Health Insurance "Contract Application",
on behalf of the City, a copy of the "Contract Application"
having been attached to this Resolution as Exhibit "A" and by
this reference incorporated herein.
SECTION 2. CONFLICT. Ail resolutions or parts of
resolutions in conflict herewith are hereby repealed.
SECTION 3. SEVERABILITY. In the event a court of competent
jurisdiction shall hold or determine that any part of this
Resolution is invalid or unconstitutional, the remainder of the
Resolution shall not be affected and it shall be presumed that
the City Council of the City of Sebastian did not intend to enact
such invalid or unconstitutional provision. It shall further be
assumed that the City Council would have enacted the remainder of
this Resolution without such invalid and unconstitutional
provision, thereby causing said remainder to remain in full force
and effect.
SECTION 4. EFFECTIVE DATE. This Resolution shall take
effect October 1, 1994.
The foregoin~ Resolution was
Councilmember
Councilmember
vote, the vote was as follows:
Mayor Arthur Firtion
Vice Mayor Carolyn Corum
Councilmember Norma Damp
Councilmember Robert Freeland
Councilmember Frank Oberbeck
moved for adoption by
. The motion was seconded by
and, upon being put into a
The Mayor thereupon declare~ this Resolution duly passed and
adopted this /~ '~-- day of //~~ , 1994.
By:
~rthur ~. ~irtion
Mayor
ATTEST:
Kathryn~M. O Halloran, CMC/AAE
City Clerk
(SEAL)
Approved as to Form and Content:
Blue Shield
AN IN~EN~ LtC~EE ~ ~H~ BLV~ CRO~ AND BL
~ ~.w ~ ne~ewa~ ~ Otb.r_
I I. APPLICANT
Application for ·
GROUP CONTRACT
(True (]roup App.)
[] Qroup iv:
[] Div.
Name of Group
Nature el b~einos~
LlSl below ~ub~Idi~ or ~ffilJ~ted comp~ie~ whose employees ar~ lo Dc eligible ~n~ Included wllh Ihl~ ~llcalion,
NAM~ ' ADDRESS
B. Applicanl hereby applies for Blue Cro~.s and Blue Shield cf FIc~lds, Inc. (herein referred to as BcBSF) O~roup contact (herein referred tO aa Ihe Contract).
C- Th~ Co~tract benefits do not ~ver any ae~ice ~r ~upp~ to diagnose or treat any Condition resulting from or in ~onnecliom with ~n Insured's JOb or
empioymenl (e.g.. any ae~ice or eupply ~ich 16 covered by Wo~er'8 Compensation Insurance). Benetl~ Will riel be provide~ u~'~der the COntracl to an
individual who ele~l& exemption hOB Wo~or's Compensation coverage or who waives en~illement lo Worker's Companealion benofite lot which he/~he i~
eligible,
O. Worker's Compensation carrier Is ~B ~a~e of C~t~
~ II. EFFECTIVE DATE / ELIGIBlU~ --
A. Effective dale of this contract shall be ~3-1-94~ The Contract may be terminated by Iht
applicant or ECBSF by giving at least 45 dave prior written noIlee to the Other perry.
30
~. Only active employees who regularly work a minimum of each week and Ihetr eligible dependents, al3all be eligible for covora~
D. Eligible new employees may be covered after ~(~ ~v~, days et omoIoyrnent.
so long as the employee submits an application to SCa~F wltl~ln 30 days el the da~e the individual fl~sl meets the applicable eligibillty roqulremenls.
E, At least -. 7~ % of the eligible employees and ,.~ % of the eligible dependenls must be enrolled under the coniracl on the effective date and
Ihroughou~ the term of tho ¢onlracl,
Dual ODflon Split
Numy[ ~nmlled T o[~ ~,igible P Ir6~[ Enrolled ~PO .MO
F, Ei~roIImenl data; Employees .... ~ ~. ~
Employees wit~ Oependen[~ ~ __ 0
G, BC~F ~hall have ~h~ right to a~It ~h~ ~ll~ant'~ ~aymll re~ra~ m any time ~o confirm eligibility ~e~ ¢~verage: a~plicam a~m~ to luf~l~h a~y ~h mcara~
upon ~e~e~t.
Ilk HEALTH PLAN SUMMARY(eeleot the appropdate ....... box[ ,, ) ,,,al: ,,
A, Tradilionai I'-~Baslc ~Comprehonalve Option iv __ [] Slandard ~ Non-Standard
Preferred Patient Care Classic Option # ~ [] Standard ~ Non.-~tanclarcl
*C. Preferred PaUent Care Point el Service Option # ~R,v*-~/5 [] Slanda~ ~ Non-Standar~
E, Small ~mpioyer Health Cam Benefits Option
F, CAP DaniSh ~S~ndar~ ~Non-Slanda~ ~Wilh OnhoOonli~ ~Wit~oul
G. Ty~e ConlreCl (Including ~umma~ of Benefile)
~l benef~s stand~ ~32~/5 wl~ one ~*~nD. .
t.~., 2 ~uctiblea ~er f~tly
*See DrODosal ben~fit sutmar~ ~=C)S32RY,~/5*
VII. RATES
IV. MAND.~TED BENEFITS SELECTED
Optional Mandated Benefits Offerings - Applicant has
been sdvise~cl of the Iollowing benefil offerings, es
or decline those benefits is Indicate0 below.
~ ~ Mental & Nervous Disorder*
~ ~ Alcohol & Drug Dependency'
* II ~e~, i~l~ata mhm Ma.tel & Ne~euS O~sOr~or ct
& Drag ~nae~y ~eneflm requesled Dy Group,
V. RlO.R O~ON8 iVI, PRE.EX,S~NG
O~. Doughier Maternity J~ Waiv~ Ini~ai Entollme~t
Drug C~rd ProgramI~ WaNed Afte~ ;~Hifll EnroHmenl
~ Other (See Ill-G} Other (See fll-G~
J
Premiums are payable on or before the due date which will be
determined; (options may be subjecl to Home Office approval)
1. Select one: [] Monthly [] Quanor¥
~ Regular Billing - Employee appllcatione should be
submitted thilly (30) days pdor Io proposed effective data,
Table Rating Premiums (Atf.~h tho proposal benefit and rets
C, Premiums I ContribullOne / Funding Arrangements for Composite
Do special funding arrangements apply? [] Yes I.~ No
If a Special FUnding Arrangement applies to Ibis contract the ~roup'a
~Ounli~g and Relenlion Agreement is made a Pa~ of this conlract.
E~ioy~ Total
~htHbbllon ~mmJum
Employee ~ S $ 208.53
Employee / Spouse $ $
Em~lo~e / Child(ran) $ $ $
Employee / Family S $
Comments:
The rates established for this contract will not be changed for the first tWelve (12.) monlhs fcllowl~3g the Initial effective date of coverage. However, ~luo Cross m~y
change tho ~ales which a~e to bo effe~llve after this Initial Iwelve (12) moon1 penes of Coverage by providing nolice to the employer ~1 such changed rates tony-five
(4~) 0aye prior tO their effective date.
[ VIII. APPLICANT RESPONSIBILI~ES ~
A. The applicant shall:
1) Notify each enrollee to the benefte sa eared by the applicant their effective date, and the termination date of Coverage (in this regsrO, applicant sols as
the agent of the enrollees, and in no event shall the appJlCSnl be'deemed an agent of BCBSF fei' this or any olher purpose, nor shalll BCESI= be responsiblc
tot' such notification to enrollees). 2) Deliver to COvered enrollees idamlf cat on cards · ~Ci certificates of COverage furnished by ~CB~. 3) Notify
promplly of any changes In the eligibility el enrOrleee covered under lilts agreement. 4) List any abeenteos al the lime of initial e~rollmem on Ilia ~r3~roDriato
~CB~F form. Applications from absentees will bo ac~pted at ~F Corporate Headqua~ers no later [nan thi~y (30) days fr~)rrt the group's ellectivo date.
5) Colle¢l enrollee contribution if required, and remll premium ~ymen~ to BCBBF as specified above In Semion VII_ Rates, '
B. Applicant heeeby establl~he~ an EmplOyee Welfare aenefil Plan for Iho ~urpo~e of providing for its employees or ihelr beneficiaries medical, surgical,
hospital care, or benefile In tho evenl of
[ iX. FINAL PREMIUMS, BENERTS AND EPPBCTIVE DATE8 ARE SUBJECT TO APPROVAL BY BLUE OROS~ CORPORATE H~DQUARTER8
Issuance el the contract by BCBSF will be deemed acceptance el Ihis application.
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