HomeMy WebLinkAboutCORRESPONDENCE - RFP - P902 BENEFITSChris Ewing
M[rZ-RCC ER
-� MARSH MERCER KROLL
LAr GUYCARPENTER OLIVERWYMAN
November 10, 2008
1225 17th Street, Suite 2200
Denver, CO 80202
303 375 5839 Fax 303 376 0087
ch ris.eMng@mercer.wrn
w .mercer.com
Amy Sharkey, CCP
Compensation and Benefits Manager
City of Fort Collins Human Resources
215 North Mason, 2nd Floor
P.O. Box 580
Ft. Collins, CO 80522-0580
Subject: Confirmation of Coverage PEN EWfi�
Dear Amy, (P 9 ?5
Enclosed please find signed copies of your Confirmation of Coverage forms for the City,of Fort... ;
Collins' Medical, Dental, Vision, Life Insurance and Disability renewals. Rates and benefits
have been outlined in these documents. Please let me know if you have any questions..
Sincerely
Chris Ewing
Copy: Wendy Stone, Kathy Dahlman, Mercer
Cceu!;iv g. Outsourcing. lnvestm en-s.
CONFIRMATION OF COVERAGE: 2009 Renewal - Dental
CARRIER/POLICY* Delta Dental
Client / Legal name: City of Fort Collins
ERISA Plan name: City of Fort Collins
Eligible employees: 1,400
Client / Insured Address: 215 North Mason Street, 2nd Floor
Fort Collins, CO 80522
This document will confine placement of the following coverage(s):
Dental (Basic and Comp plans)
Coverage will be effective on: 1/1/2009
For a period of: 12 months
Rates / fees (including any subsequent period caps or guarantees) for the above -referenced
Dental Fee:
Per.employee $4.17,
Description of Benefits:
Dental Basic Plan:
In Network
Deductible -$50lndividuaV$100 Family
Preventive - 80% coinsurance, Ded. Waived
Basic - 60% coinsurance
Major - 500A coinsurance
Calendar Max - $1,000 (combined w/outof-network)
Orthodontic Services - Not Covered
Dental Como Plan:
In Network
Deductible - $25 IndividuaV$50 Family
Preventive -100% coinsurance, Ded. Waived
Basic - 80% coinsurance
Major- 60% coinsurance
Calendar Max - $2,000 (combined Woutof-network)
Orthodontic Services - Children only
Orthodontic Services - 50% to $1,500 lifetime max
Out -of -Network
Deductible - $50 Individual/$100 Family
Preventive - 60% coinsurance
Basic- 60% coinsurance (Endo. and Oral Surg. 60%)
Major - 50% coinsurance
Calendar Max - $1,000 (combined w!n-network) ..
Orthodontic Services - Not Covered
Out -of -Network
Deductible - $251ndividual/$50 Family -
Preventive - 80% coinsurance
Basic -60% coinsurance (Endo. And Oral Surg 80%)
Major- 50% coinsurance
Calendar Max - $2,000 (combined w/outof-network)
Orthodontic Services -Children only
Orthodontic Services - 50% to $1,500 lifetime max
MERCER
Conditions of coverage(s): None
As an authorized representative, I accept this confirmation of coverage. By signing below, I
acknowledge agreement with the rates and benefits described above and that subsequent
contract(s) shall conform to.this document unless otherwise agreed to in writing.
Authorized Representative: ?D fraa y�
Legal Name of Insurer/
T
Administrator O y/_7AA— I a /d ZQDA
Signature: 3 gar
Date: .. �\w \ BQ
This form must be signed and retumed to Mercer H&B pli'or toyhe effective date of coverage
MERCER