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HomeMy WebLinkAboutCity of Tamarac Resolution R-96-271Temp. Reso. #7613 1 November 18, 1996 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-96- o?%/ A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, AUTHORIZING THE APPROPRIATE CITY OFFICIALS TO EXECUTE AN AGREEMENT BETWEEN THE CITY OF TAMARAC AND THE PRUDENTIAL FOR GROUP DENTAL SERVICES FOR CITY OF TAMARAC EMPLOYEES; PROVIDING FOR CONFLICTS; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, Resolution No. R-96-198 approved The Prudential as the new dental provider for City of Tamarac employees; and WHEREAS, the City of Tamarac desires to enter into an Agreement with The Prudential to provide Group Dental services to the City of Tamarac employees; and WHEREAS, the City Attorney and the Risk Manager have reviewed the Agreement (A copy of the Agreement is attached as Exhibit "A"); and WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in the best interest of the citizens and residents of the City of Tamarac that the City execute an agreement with The Prudential for Group Dental Services for employees of the City of Tamarac. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA: SECTION 1: The foregoing '"WHEREAS" clauses are hereby ratified and confirmed as being true and correct and is hereby made a specific part of this Resolution. SECTION 2: The appropriate City officials are hereby authorized to execute the Agreement between the City of Tamarac, Florida, and The Prudential, for Group Dental Services J 1 Temp. Reso. #7613 2 November 18, 1996 for City of Tamarac employees. SECTION 3: That all necessary budget transfers are hereby approved in order to fund the City's portion from those applicable accounts associated with the savings in the benefits program as approved by Resolution No. R-96-227. SECTIOIt 4: All resolutions or parts of resolutions in conflict herewith are hereby repealed to the extent of such conflict. SECTION 5: If any clause, section, other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications of this Resolution. SECTION 6: This Resolution shall become effective immediately upon its passage and adoption. PASSED, ADOPTED AND APPROVED this ATTEST: CAROL A. EVANS CITY CLERK I HEREBY CERTIFY that I have approved this R LUTION as to form. MITCHELL S. KRAFT CITY ATTORNEY (c:\wpdata\reso7613\sms) 7 day of1996. C7,1-', LARRY M SHKIN VICE MAYOR RECORD OF COMMISSION VO" - MAYOR 4 DIST 1' DIST 4 DIST 3: DIST 4: Gd • HOF. 74940-10/18/96-001 0 Application to • �J The Prudential Insurance Company of America (Prudential) For Group Contract No. G-74940 Applicant: THE CITY OF TAMARAC Address: 7525 North West 88th Avenue Tamarac, Florida 33321 The Group Contract is approved and its terms are accepted. This Application is made in duplicate. One is attached to the Group Contract. The other is to be returned to Prudential. It is agreed that this Application replaces any prior Application for the Group Contract. THE CITY OF TAMARAC II or Corporate Name of Applicant) Dated at F r L} Wy 1 K �. �---� _ _ OvLOie) 4�(Signature and Title) On .erenD&C 1/ 19-9L _ Witness (To be signed by Resident Agent where required by law) 83500 APP 1008 his %.op5i ! a . �, -:emu a ,) Th Company 11 (74940) e-SCa'II i4� ThePrudential Group Insurance Contract Contract Holder: THE CITY OF TAMARAC Group Contract No.: G-74940 Prudential will provide or pay the benefits described in the Group Insurance Certificate(s) listed in the 4D Schedule of Plans of the Group Contract, subject to the Group Contract's terms. This promise is based on the Contract Holders application and payment of the required premiums. All of the provisions of the Group Insurance Certificate(s), attached to and made a part of the Group Contract, apply to the Group Contract as if fully set forth in the Group Contract. The Group Contract takes effect on the Contract Date, if it is duly attested under the Group Contract Schedule. It continues as long as the required premiums are paid, unless it ends as described in its General Rules. Dividends are apportioned each year. The Group Contract is delivered in and is governed by the laws of the Governing Jurisdiction. Ll Secretary �r Chairman of the Board 83500 COV 1004 (1-5)(74940) i Group Contract Schedule Contract Date: October 1, 1996 Contract Anniversaries: October 1 of each year, beginning in 1997. Premium Due Dates: The Contract Date, and the first day of the month beginning with November, 1996. Governing Jurisdiction: State of Florida Associated Companies: Employers who are the Contract Holder's subsidiaries or affiliates, and are reported in writing to Prudential for inclusion under the Group Contract. Minimum Participation Number: 25 INCLUDED EMPLOYERS Included Employers under the Group Contract are the Contract Holder and its Associated Companies, if any. Associated Companies are employers who are the Contract Holder's subsidiaries or affiliates and are . listed in the Group Contract Schedule. An Employee of more than one Included Employer will be considered an Employee of only one of those employers for the purpose of the Group Contract. That Employee's service with all other Included Employers will be treated as service with that one. On any date when an employer ceases to be an Included Employer, the Group Contract will be considered to end for Employees of that employer. This applies to all of those Employees except those who, on the next day, are still within the Covered Classes of a plan of benefits of the Group Contract as Employees of another Included Employer. The plans of benefits for Covered Classes are listed in the Group Contract's Schedule of Plans. The Contract Holder must let Prudential know, in writing, when an employer listed as an Associated Company is no longer one of its subsidiaries or affiliates under common control. Table of Contents (as of the Contract Date): The Group Contract includes these forms with an 83500 prefix: COV 1004(1-5)(74940), GCS 1028(74940), SPR 1001(74940), GR 1019(1-28), MOD 1001(74940), SCH 1001(74940). APP 1008(74940) Attest: 83500 GCS 1028 K (74940) • Schedule of Premium Rates Group Contract No.: G-74940 Classes of Employees to which this Schedule applies: All classes Applicable Coverages Monthly Rate Per Employee All Coverages The premium rates in effect on the Contract Date are those determined by Prudential. Those rates will be shown on the billing notice(s) sent to the Contract Holder (subject to any subsequent corrections). 83500 SPR 1001 1 (74940) 40 General Rules A. PAYMENT OF PREMIUMS - GRACE PERIOD. Premiums are to be paid by the Contract Holder to Prudential. Each may be paid at a Prudential office or to one of its authorized agents. One is due on each Premium Due Date stated in the Group Contract Schedule. The Contract Holder may pay each premium other than the first within 31 days of the Premium Due Date without being charged interest. Those days are known as the grace period. The Contract Holder is liable to pay premiums to Prudential for the time the Group Contract is in force. B. PREMIUM AMOUNTS. The premium due on each Premium Due Date is the sum of the premium charges for the insurance under the Coverages. Those charges are determined from the premium rates then in effect and the Employees then insured. The following will apply if one or more premiums paid include premium charges for an Employee whose insurance has ended before the due date of that premium. Prudential will not have to refund more than the amount of the premium charges for such Employee that were included in the premiums paid for the two month period immediately before the date Prudential receives written notice from the Contract Holder that the Employee's insurance has ended. Premiums may be determined in another way. But it must produce about the same amounts and be is agreed to by the Contract Holder and Prudential. C. PREMIUM RATE CHANGES. The premium rates in effect on the Contract Date are shown in the Group Contract's Schedule of Premium Rates. Prudential has the right to change premium rates: (1) As of any Premium Due Date, upon 45 days advance notice; and (2) As of any date that an employer becomes, or ceases to be, an Included Employer; and (3) For a Coverage, as of any date that the extent or nature of the risk under that Coverage is changed: (a) by amendment of the Group Contract; or (b) by reason of any provision of law or any governmental program or regulation; or (c) by termination of, or any change in, benefits not in that Coverage but considered in determining the premium rates for that Coverage. But, unless the Schedule of Premium Rates or an amendment states otherwise, (1) above will not be used to change premium rates for an insurance or any part that has separate rates before the first Contract Anniversary. Prudential will tell the Contract Holder when a change in the premium rates is made. 83500 GR 1019 (1-28) 4 re - 6-12 _� I • D. DIVIDENDS. Prudential will determine the share, if any, of its divisible surplus allocable to the Group Contract as of each Contract Anniversary, if the Group Contract stays in force by the payment of all premiums to that date. The share will be credited to the Group Contract as a dividend as of that date. Each dividend will be paid to the Contract Holder in cash unless the Contract Holder asks that it be applied toward the premium then due. Prudential's sole liability as to any dividend is as set forth above. Non-profit Clause: This applies if the aggregate dividends under the Group Contract and any other group contract(s) of the Contract Holder exceed the aggregate payments toward their cost made from the Employer's own funds. The Contract Holder will see that an amount equal to the excess is applied for the benefit of insured persons. E. END OF THE GROUP CONTRACT OR OF AN INSURANCE. During or at End of Grace Period - Failure to Pay Premiums: If any premium is not paid by the end of its grace period, the Group Contract will end when the grace period ends. The Contract Holder may request in writing that the Group Contract be ended at the end of the period for which premiums have been paid or at any time during the grace period. Then the Group Contract will end on the requested date, but in no event will it end before the date Prudential receives the written request from the Contract Holder. The Contract Holder is liable to pay premiums to. Prudential for the time the Group Contract is in force. On a Premium Due Date - Failure to Maintain Insuring Conditions: On any Premium Due Date, Prudential may end the part of the Group Contract for Contributory or Nan -contributory Insurance under a Coverage if one or more of the following conditions then exists for that part. But notice of its intent to do so must be given to the Contract Holder at least 45 days in advance. Contributory Insurance: The insured Employees are: (1) less than the Minimum Participation Number; or (2) less than 75% of the Employees who are eligible to request the insurance; or (3) contributing at a rate higher than the maximum, if any, stated in the Group Contract for the insurance. Non-contributory Insurance: The insured Employees are: (1) less than the Minimum Participation Number; or (2) contributing for the insurance. The Minimum Participation Number is shown in the Group Contract Schedule. On a Contract Anniversary: Prudential may end the Group Contract on any Contract Anniversary. But notice of its intent to do so must be given to the Contract Holder at least 45 days in advance. 83500 GR 1019 (1-28) A F. AGE ADJUSTMENT. If an age is used to determine the premium charge for an Employee's insurance and the age is found to be in error, the premium charge for that insurance will then be adjusted to reflect the correct age. If this adjustment results in a change in the amount of premium, any difference between the premium paid and the premium required on the basis of the correct age will be paid as follows: (1) If the adjustment results in an increased premium, the difference will be paid by the Contract Holder when notified by Prudential. (2) If the adjustment results in a decreased premium, the difference will be refunded by Prudential. If the change in age affects the amount of the Employee's insurance under any Coverage, such amount will be changed on the basis of the correct age. Any premium adjustment will take this into account. G. EMPLOYEE'S CERTIFICATE. Prudential will give the Contract Holder an individual certificate to give each insured Employee. It will describe the Employee's coverage under the Group Contract. It will include (1) to whom Prudential pays benefits, (2) any protection and rights when the insurance ends, and (3) claim rights and requirements. H. RECORDS - INFORMATION TO BE FURNISHED. Either the Contract Holder or Prudential, as they agree, will keep a record of the insured Employees. It will contain the key facts about their insurance. At the times set by Prudential, the Contract Holder will send the data required by Prudential to perform its duties under the Group Contract, and to determine the premium rates. All records of the Contract Holder and of the Employer which bear on the insurance must be open to Prudential for its inspection at any reasonable time. Prudential will not have to perform any duty that depends on such data before it is received in a form that satisfies Prudential. The Contract Holder may correct wrong data given to Prudential, if Prudential has not been harmed by acting on it. An Employee's insurance under a Coverage will not be made invalid by failure of the Contract Holder or the Employer, due to clerical error, to record or report the Employee for that insurance. I. THE CONTRACT - INCONTESTABILITY OF THE CONTRACT. The entire Group Contract consists of: (1) the Group Insurance Certificate(s) listed in the Schedule of Plans, a copy of which is attached to the Group Contract; (2) all modifications and endorsements to such Group Insurance Certificates which are attached to and made a part of the Group Contract by amendment to the Group Contract; (3) the forms shown in the Table of Contents as of the Contract Date; (4) the Contract Holder's application, a copy of which is attached to the Group Contract; (5) any endorsements or amendments to the Group Contract; and (6) the individual applications, if any, of the persons insured. No statement of the Contract Holder shall be used in any contest of the insurance under the Group Contract. There will be no contest of the validity of the Group Contract, except for not paying premiums, after it has been in force for one year. 83500 GR 1019 6 (1-28) The Group Contract may be amended, at any time, without the consent of the insured Employees or of anyone else with a beneficial interest in it. This can be done through written request made by the Contract Holder and agreed to by Prudential. But an amendment will not affect a claim incurred before the date of change. Only an officer of Prudential has authority: to waive any conditions or restrictions of the Group Contract; or to extend the time in which a premium may be paid; or to make or change a contract; or to bind Prudential by a promise or representation or by information given or received. A Prudential agent is not an officer. No change in the Group Contract is valid unless shown in: (1) an endorsement on it signed by an officer of Prudential; or (2) an amendment to it signed by the Contract Holder and by an officer of Prudential. But a change in the Group Contract may be made in an amendment to it that is signed only by an officer of Prudential if: (a) The amendment reflects a change in the Group Contract that has been automatically made to satisfy the requirements of any state or federal law or regulation that applies to the Group Contract, as provided in the Conformity With Law section. This change is known as a Statutory Amendment. (b) The amendment reflects a change in group insurance benefits where (i) the benefits are for services and supplies provided through Prudential Health Care Providers; and (ii) the change applies to all group insurance contracts which include these benefits. This change is known as a Managed Health Care Amendment. When the Group Contract is so amended, payment by the Contract Holder of the next premium due under the Group Contract will constitute acceptance of the Managed Health Care Amendment. (c) The amendment reflects a change in Prudential's administration of its group insurance benefits and is intended to apply to all group insurance contracts which are affected by the change. This change is known as a Portfolio Amendment. Prudential will give the Contract Holder written notice of its intent to make a Portfolio Amendment in the Group Contract at least 31 days in advance of the effective date of the Amendment. When the Group Contract is so amended, payment by the Contract Holder of the next premium due under the Group Contract will constitute acceptance of the Portfolio Amendment, unless the Contract Holder has rejected the Amendment, in writing, prior to its effective date. J. IDENTIFICATION CARDS. Any identification cards (called ID Cards below) issued by Prudential in connection with insurance under the health care expense coverages, if any, of the Group Contract are for identification only and remain the property of Prudential. Possession of an ID Card does not convey any rights to benefits under the Group Contract. If any Covered Person permits another person to use the Covered Person's ID Card, Prudential may invalidate that Covered Person's ID Card. K. RELATION AMONG PARTIES AFFECTED BY THE GROUP CONTRACT. The relationship between Prudential and any Hospital is that of an independent contractor. No Hospital is an agent or employee of Prudential, nor is Prudential or any employee of Prudential an employee or agent of any Hospital. Each Hospital will maintain the hospital -patient relationship with 83500 GR 1019 (1-28) 7 I- �6_?-)i • Covered Persons under the Group Contract and is solely responsible to Covered Persons for Hospital supplies and services. The relationship between Prudential and any Prudential Health Care Provider is that of an independent contractor. No Prudential Health Care Provider is an agent or employee of Prudential, nor is Prudential or any employee of Prudential an employee or agent of a Prudential Health Care Provider. Each Prudential Health Care Provider will maintain the provider -patient relationship with the Covered Persons under the Group Contract and is solely responsible to Covered Persons for supplies and services furnished to Covered Persons. Neither the Contract Holder nor any Covered Person under the Group Contract is the agent or representative of Prudential. Neither the Contract Holder nor any Covered Person under the Group Contract will be liable for any acts or omissions: (a) of Prudential, its agent or employees; or (b) of any Hospital or other health care provider with which Prudential, its agents or employees make arrangements for furnishing supplies and services to Covered Persons. L. CONFORMITY WITH LAW. If the provisions of the Group Contract do not conform to the requirements of any state or federal law or regulation that applies to the Group Contract, the Group Contract is automatically changed to conform with Prudential's interpretation of the requirements of that law or regulation. 83500 GR 1019 (1-28) 8 �e_9(-ter--1 i • Modification of the Group Contract The Group Contract is modified to include the following section: END OF EMPLOYMENT An Employee's employment ends when the Employee is no longer actively at work on a full-time basis for the Employer. But, for insurance purposes, the Contract Holder may consider the Employee as still employed and in the Covered Classes for the insurance during certain types of absences from full- time work. The Contract Holder decides which Employees with those types of absences are to be considered as still employed, and for how long. In doing this, the Contract Holder must not discriminate among persons in like situations. An Employee may be considered as still employed up to any time limit for the Employee's type of absence. When so considered, the Employee's insurance under a Coverage will be continued only while the Employee is paying contributions for it at the time and in the amounts, if any, required by the Contract Holder (whether or not that insurance would otherwise be Non-contributory Insurance). But it will not be continued after it would end for a reason other than end of employment. The types of absences and the time limits are shown below, subject to any exceptions. TYPES OF ABSENCES AND TIME LIMITS: For absence due to part-time employment or retirement, there is no time limit. For absence due to disability: Under health care expense Coverages, if any, the time limit is the end of the 29th contract month following the contract month in which the absence from full-time work starts. Under any other Coverages there is no time limit. For absence due to temporary layoff the time limit is the end of the contract month following the contract month in which the absence from full-time work starts. For absence due to leave of absence, there is no time limit. L�:t•14;ktral 114 Dental Expense Coverage Retirement is not an eligible type of absence. 83500 MOD 1001 (74940) �CC-'12-7I 6 Schedule of Plans Effective Date: October 1, 1996 Group Contract No.: G-74940 This Schedule of Plans sets forth the Plan of Benefits that applies to each Covered Class under the Group Contract listed below as of the Effective Date. The Plan of Benefits for a Covered Class is determined by: (1) the Group Insurance Certificates that apply to the Covered Class; and (2) any modification to those Certificates, provided the modification is listed below or included in an amendment to the Group Contract. A copy of each Certificate and any modification to it are attached to the Group Contract and made a part of it. Covered Class: All Employees included in the Covered Classes of the Group Insurance Certificate described below. Plan of Benefits that Applies to this Covered Class: The Coverage(s) described in the Group Insurance Certificate: (a) Prepared for Group Contract No. G-74940; (b) With the Program Date of October 1, 1996; • (c) Bearing the codes "FL-PPDMO; Code 1" and 74940; Ed. 10/96; Doc. #1LTO0001; Rev. #1 " • 83500 SCH 1001 (74940) 10 '`) I 74940-10/18/96-001 • C� Ll Application to The Prudential Insurance Company of America (Prudential) For Group Contract No. G-74940 Applicant: THE CITY OF TAMARAC Address: 7525 North West 88th Avenue Tamarac, Florida 33321 The Group Contract is approved and its terms are accepted. This Application is made in duplicate. One is attached to the Group Contract. The other is to be returned to Prudential. It is agreed that this Application replaces any prior Application for the Group Contract. Dated at THE CITY OF TAMARAC (Full or Corporate Name of Applicant) By (Signature and Title) On , 19 Witness (To be signed by Resident Agent where required by law) 83500 APP 1008 This COPY i R faro&& For Your Files 11 (74940) 74940-10/18/96-001 • • 0 Application to The Prudential Insurance Company of America (Prudential) For Group Contract No. G-74940 Applicant: THE CITY OF TAMARAC Address: 7525 North West 88th Avenue Tamarac, Florida 33321 The Group Contract is approved and its terms are accepted. This Application is made in duplicate. One is attached to the Group Contract. The other is to be returned to Prudential. It is agreed that this Application replaces any prior Application for the Group Contract. Dated at On 83500 APP 1008 THE CITY OF TAMARAC (Full or Corporate Name of Applicant) By (Signature and Title) 19 Witness (To be signed by Resident Agent where required by law) This copy 7 h_ :�� -: E Company �� _�iC 11 (74940)