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HomeMy WebLinkAboutResolution - 2005-R0597 - Amendment To Standard Insurance Company Group Life Policy - 12_15_2005Resolution No. 2005-RO597 December 15, 2005 Item No. 5.27 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock, an Amendment to the Standard Insurance Company Group Life Policy held by the City of Lubbock. Said Amendment is attached hereto and incorporated in this Resolution as if fully set forth herein and shall be included in the minutes of the Council. Passed by the City Council this 15th day of December, 2005. ATTEST: Rebe ca Garza, City Secretary APPROVED AS TO CON NT: Scott Snider, Director of Human Resources APPROVED AS TO FORM: M. Knight, Assis gslccdocs/Amendment-Standard Ins Co Grp Life Policy.res Dec. 6, 2005 Resolution No. 2005-RO597 Request for Group Insurance Amendment Standard Insurance Company 900 SW Fifth Avenue Portland, OR 97204-1282 Employee Benefits Consultant: Lee Lane Employee Benefits Service Representative: Charlotte Stevenson Employee Benefits Sales and Service Office. Dallas Employer Name: City of Lubbock Group Number: 643367 As an authorized representative of the Employer, I request that Standard Insurance Company ("The Standard") amend the above Employer's coverage under the Group Policy to make the following change(s): Change the Definition of a member for active members to include all employees regularly working 40 or more hours per week. All Employees who meet the Definition of a Member will be enrolled in the plan irregardless of whether or not they have medical insurance through the City or elsewhere. This is noncontributory life coverage. I request that the amendment become effective on 01-01-06. I understand that the amendment will not become effective unless approved and issued by The Standard. I request that the amendment be approved by The Standard subject to The Standard's usual underwriting requirements, including, if applicable, Evidence of Insurability or a Pre-existing Condition provision. I understand that the amendment, if approved by The Standard, will be issued in the policy language customarily used by The Standard. I understand that any increase in Insurance for a Member who is not Actively At Work all day on the Member's last regular work day before the scheduled effective date of the amendment will be deferred until the first day after the Member completes one full day of Active Work. I request that the amendment, if approved and issued by The Standard, become effective by its terms without any further acceptance by the Employer, and that a copy of this Request for Group Insura e Amendment form be attached to and made a part of the amendment. Sign Name: _ % /V ,r/" j Title: Mayor Print Name: Marc McDougal Date: U-15-05 Standard Online Amendment Request 2/ 15/2006 2:37 PM Resolution No. 2005-RO597 Request for Group Insurance Amendment Standard Insurance Company 900 SW Fifth Avenue Portland, OR 97204-1282 Employee Benefits Consultant: Lee Lane Employee Benefits Service Representative: Charlotte Stevenson Employee Benefits Sales and Service Office: Dallas Employer Name: City of Lubbock Group Number: 643367 As an authorized representative of the Employer, I request that Standard Insurance Company ("The Standard") amend the above Employer's coverage under the Group Policy to make the following change(s): Change the Definition of a member for active members to include all employees regularly working 40 or more hours per week. All Employees who meet the Definition of a Member will be enrolled in the plan irregardless of whether or not they have medical insurance through the City or elsewhere. This is noncontributory life coverage. I request that the amendment become effective on 01-01-06. 1 understand that the amendment will not become effective unless approved and issued by The Standard. I request that the amendment be approved by The Standard subject to The Standard's usual underwriting requirements, including, if applicable, Evidence of Insurability or a Pre-existing Condition provision. I understand that the amendment, if approved by The Standard, will be issued in the policy language customarily used by The Standard. I understand that any increase in Insurance for a Member who is not Actively At Work all day on the Member's last regular work day before the scheduled effective date of the amendment will be deferred until the first day after the Member completes one full day of Active Work. I request that the amendment, if approved and issued by The Standard, become effective by its terms without any further acceptance by the Employer, and that a copy of this Request for Group Insurance endment form be attached to and made a part of the amendment. / Sign Name: Title: _ Mayar Print Name: Marc McDougal Date: 12-15-05 Standard Online Amendment Request 2 / 15 / 2006 2:37 PM