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 Yision.,-_. 7
CARRIERIPOLICYM
Client I Legal name:
ERISA Plan name:
Eligible employees:
VsP
City of Fort Collins
City.of Fort Collins
1,400
Client/ Insured Address: 215 North Mason Street, 2' Floor.
Fort .Colkis, CO 80522
This document will confirm ptacement9fithe,f9flowing coverage(s):
.4'Vision
Coverage will be effective on: 1/11/2009
uW -1251t2010
For 6 period of.
Rates I , fees (Including. any:subseguent . p d'qapr or g'qqrqpioe . s for the above -referenced- per
coverage(s)are;
Fully Insured Rates Netof Commissions
Employee Qnly $0.66
Employee plus Spouse $1
Employee Olus,Chllcl(rian) $ 11172
Employee plus Family $22.08
Description of Benefits:
Ptsin information
Exam ivervEvery 12 Months
LensesEvery: Every 12 Months
Frame Every: Every 24 Months
qoparuenl
Exam $15.60
Materials $15.00,
In Network Allowances
Retail Frame Value: $105.00
Elkitive,contact-Lenses $105.00
Out of Network
Exami nation, up to: S30.00
Single Vision -Lenses, up to: S30.00
Bifocal Lenses, up to: $40.00
Trifocal Lenses,.up to: S50.00
Frame, up to: $3.0.00
Elective Contact . . Lenses, upto'.48,0,011
Dependent Coverage
19125
MERCER
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I
9'.
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 Oeel ent unless -otherwise agreed to in writing.
Authorized Representative: I. O v n G c ry it
Legal Name of Insurer, _
Administrator F
'Signature:
Date: ��'[
-- — This form must be signed andreturned [eof co`dverage.
MERCER.
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