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.
P9az
CONFIRMATION OF COVERAGE: 2009 Renewal • Life
CARRIER/POLICY #:
SunLife
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 confirm placement of the following coverage(s):
4 Basic Life
NI Basic AD&D
J Voluntary Life/AD&D. (Employee/Spouse/Dependent)
4 Voluntary STb,(Advice to Pay)
4 LTD
Coverage will be effective on: 1/1/2009
For a period of: Rate guarantee until 12/31/2011 for STD (Advice to Pay),<D,: ,
Rate guarantee until 1213112010 for all other coverages
Rates / fees (including any subseque nt,period caps,or guarantees) for the above -referenced:
coverage(s) are:
Life AD&D LTD STD Rates/Fees:
Life: $0.20/$1,000
AD&D: $0.04/$1,000 °w
LTD: $0.79/$100 of covered monthly payroll
STD: $1.54 per employee per month (Advice to Pay fee) bv'
Suoolemental life Rates (EE & Spouse
AAge,
Rate
Age
Rate
<30
$0.09
55 — 59
$0.92
30 — 34
$0.11
60 — 64
$1.31
35 — 39
$0.14
65 — 69
$1.80
40 — 44
$0.23
70 — 74
$4.14 ed/
45 — 49
$0.38
Over 74
$4.14
50 — 54
$0.59
Child Life
$.50/$1.00 per EE
MERCER
Supplemental AD&D Rates
Employee Only: $0.04/$1,000
A description of benefits:
Basic Life, AD&D
Life Schedule - 1 x Earnings or Flat $10,000 01`
AD&D Amount - 1 x Earnings or Flat $10,000 LIB
Guarantee Issue - $125,000 01�
Reduction Schedule - To 70% at age 65, to 50% at age 70, to 30% at age 75, to 20% at age 80 0
Supplemental. Life, AD&D -
Supplemental Life Schedule
EE: 1, 2 or 3 earnings; max of 3 z earnings or $500,000 combined with Basic Life 01r
Spouse:$10,000/$25,000/$50,000/$75,000/$100,000 bia ^::• ::
Supplemental:AD&D Schedule
EE: Amount equals voluntary life amount 01r,
Guarantee 'Issue'-
EE:-$125,000 combined with basic Life amount dtc 7.: ,,;;
Spousef"$1d,00o ft�
Child Life-$5;000:or$10,o00petohildre�0V�. ,;:C?
LTD
Benefit Percentage 66 67%
Monthly Benefit Maximum - $7,500 Uv
Elimination Period - 90 Days
Benefit Duration - To age 65 . VV . =
Own •Occupation :-.24 months
STD
Benefit Percentage - 70% Reimbursement i t�
Weekly • Benefit Maximum -:None p,., ; 11.
Maximum Benefit Duration - 90 days
Day Benefits Begin - Accident = 15tb consecutive day, Illness = 151" consecutive day 0-
Conditions of coverage(s): None
As an authorized representative, I accept this confirmation of coverage. By signing below, I .
acknowledge agreementwith the rates and benefits described above and that subsequent
contract(s) shall conform to this document unless otherwise agreed to in writing.
Authorized Representative: kAe
Legal Name of Insurer/ '
Administrator
fVft bile, F,hdn" , /W
Signature: ` A/V
Date:
This form must be signed and returned to Mercer H&S prior to the effective date or coverage
MERCER