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.
Oct 16 2000 16:42
P. 01
CARRIER/POLICY #:
Client I Legal name:
ERISA Plan name:
Eligible employees:
Client insured. Address'.
Anthem
Cityof Fort Collins
City of Fort Collins
1,400
215 Noah Mason Street, 2n6 Floor
Fort Collins, CO 80522
This document will confirm placement of the following eoverage(sY
mployeelSpouselDependent)
J Voluntary LifelAD&D (6
Coverage will be effective On: 1l1/2009
For a period of: Rate uarantae until 12131f2009
od caps or guarantees) for the above -referenced
Rates I fees (including any subsequent peri
noverage(s) are:
e
t I if R tes E& S ou e
AoQ
Rate
Age<30
<30
Rate
$0.04
55 — 59
50 — 64
$0,38
$0.49
30 — 34
$0.04
65 _ 69
$0.83
35 — 39
$0.05
70 — 74
$1.45
40 — 44
45 —49
$0.08
$0.13
Over 74
Child Life
$2.98
$1.50 per EE
50 — 54
$0.20
g lem
nta AD&D$00431$1,000
Yee ml
Only'
$0,057/$1,000
Fa milly:
Fa
Deseription of benefits:
c nlemental4ife Al
Supplemental Schedule, -
EE: $10,000 incremnts to a max of $300,000
Spouse: $10,000 Increments to a max of $300,000
Supplemental AD&D Schedule
$10,000 increments to a max of $150,000
Guarantee issue -
Lesser of $250,000 r 3 x annual earnings
Child Life - $5,000 per
MERCER
P�Y.1E.7m pQ1 �R YfM1H
Oct 16 2008 16:42
will
Condldons of coverage(s)' Nona
A% an authorized representetiva, I accapt this confirmation of co4gmge. By signing below, I
acknowledge agreement with the cater and benefits desorlbed b�' ands st oubseGuent
contract(s) shall wnform to thls docu< ( ess othetvAsa ag /�� yt
Authodzed Representative: ' "
Legal Name of Ineurarl G_
Administrator I
$18nature:
1O �146
Date:
ThIJ kfRl Muef Ga 0l9n00 an0 relumCd f0 B(e6f HSB pl9a' m the CHOC1 C d9 of �OVCrAti2
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MERCER
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