HomeMy WebLinkAbout1995-09-12; City Council; Resolution 95-254I1 0 a /I
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RESOLUTION NO. 95-254
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CARLSBAD, CALIFORNIA, AMENDING THE CONTRACT WITH
NORTHWESTERN NATIONAL LIFE INSURANCE (NWNL) AND
EXTENDING GROUP VISION CARE BENEFITS THROUGH
VISION SERVICES PLAN (VSP) TO ELIGIBLE CCEA
EMPLOYEES.
WHEREAS, the City of Carlsbad has considered the document
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entitled “EXHIBIT 2” and finds it in the best interest of the City to
amend the City’s contract with Northwestern National Life (NWNL);
WHEREAS, the City of Carlsbad has considered the document
l3 I/ entitled “EXHIBIT 3” and finds it in the best interest of the City to 14
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Plan (VSP); and 16
approve the application for group vision care with Vision Services
WHEREAS, complete and true copies of said documents are
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Insurance fund balance to cover the cost of these health insurance 21
WHEREAS, sufficient funds are available in the Health
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City of Carlsbad, California, as follows: 25
NOW, THEREFORE, BE IT RESOLVED by the City Council of the
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1. That the above recitations are true and correct.
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2. That the Agreements referred to in the recitals above
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are incorporated in this resolution by reference.
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evidenced by the authorized signature of the Human Resources 8
adopted by the City of Carlsbad effective October 1, 1995, as 7
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12 October 1, 1995, will be adopted by the City of Carlsbad effective
l3 October 1, 1995, as evidenced by the authorized signature of the
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3. That the amendment to the City’s contract with
Northwestern National Life (NWNL), dated October 1, 1995, will be
Director on Exhibit 2.
4. That the application for group vision care, dated
15 // Human Resources Director on Exhibit 3.
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5. That $40,000 will be appropriated from the Health
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Insurance fund balance to cover the cost of these health insurance
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Carlsbad City Council held on the 12th day of SEPTEMBER , 7
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1995, by the following vote, to wit:
enhancements.
PASSED, APPROVED, AND ADOPTED at a regular meeting of the
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~ // AYES: Council Members Lewis, Nygaard, Kulchin, Finnila, Hall
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NOES: None
ABSENT: None
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15 ATTEST:
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METHA L. RAUTENKRANZ, City clerk
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LAlllUIL L
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-:. C!.? Route No.
To: Northwestern National Life Insurance Company
Box 20 - Minneapolis, Minnesota 55440
I Home Office use 01 L
Request for Amendment of Group Plan@)
Please be complete and speclfzc in your request.
Group Plan Name CITY OF CARLSBAD
Group Plan Number(s) AS0 24438-4
Effective Date for Amendment(s) 10/01/1995
(if possible, the effective date should be the first day of a plan month)
Request is hereby made to Northwestern National Life Insurance Company for the following
revision(s) to the Group Plan(s) indicated above:
Terminate vision benefits with NWNL for claim account 3 General resulting in an AS0 fee
reduction of $25 per employee per month for the terminated claim account. Vision benefits with
NWNL for all claim accounts has been terminated
Add an annual $250 per family wellness benefit for claim account 3 General to be administered
through the Reimbursement Account Administration Department in Minneapolis, MN. All claim
accounts will now have the wellness benefit.
(If additional space is needed, please use reverse side) /
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Dated "?/.JI , 19 L(
Title i-b4uL%'jWU* 3 &&
3 9279
v f
VISION SERVICE PLAN
APPLICATION FOR GROUP VISION CARE PLAN
.q@ Ob
Vihion Service Plan
P.O. Box 997 IO0
Sacrar~~ento. California 95899-9989
Attn: Sales Department
(X001 852-7600
All applicablc questions must be
completed accurately and in detail to avoid unnecessary
cor-re~pondcncc and delay. ,AddiLionally. applications must be received ~Iurr> (20) clay\ in xlvancc to cnwrc rhe plan i\ iruplcmentcd by the effectjy~.djlte.
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t
, 6 VISION SERVICE PIA* '
.A 1,ICATION FOR GROUP VISION CARE; PIAN
__________________________________________--_-___~~-~R()UP IXFOR&IATION ________I_______________________
CITY OF CARLSBAD I. 1~'tlll legal Il.ln!c. ot plop~\cd grclllp I_ - " -. . ". " .
I,\\ II 14 III ,lpp.slr on I'oliL.1)
:\(l~lIe\> . ~ ". .." .___ 1200 .... ""." Carlsbad __ """"" Village - ""._ Drive _I_ - " - ." . . . . . ._ . .. . -
Carlsbad ('it! .L -..-... ...~.~~..- ... __ Slale CA 'zip 92008 c~ollntl. San Diego
'I'cIcpl>onc I --.. . ..... 1-.434-2852
l'l~lll~i~ld I'tNltact
-
f"U ## 4EL"720Z1825! _"_,."
-. . "". -. .,
Julie Clark TilIC Human Resources Manager ~____ ..".." __
7. L\.'tlO ~11otIid \I nit11 Pa\.nlt;nt ue4orlh'! Debbie Ocampo Title Human Resources A
I'L~lc~lllOl~c ( if$' ) - 434-2855 $0,1875 "_ -
. - "...
3. \\IN) hhou\d \\ifgtit'; I'(~.~~~i~ll~~qtlt...rions! Debbie Ocampo Title Human Resources,
~fc.Ic~'h~llle ( - ~ax#( 67 /20-1875------"-
110~ \\oltlLi h~ like yo~r Eligibility contact to be notified ofcligihility rejection\?
XFas __ Tclcphorlc -hlail
4. I\ there ~on~conc oihcr th;ln your Principal contact who will be responsible for the werall administration of the plml I Henetit\
.U;lfne Title
Direct dial phone Fax # ( ) -
/I l~~~~l/i/jl(~ /j(*t/l,/;/.\ .\ll~j~ij/i~/j.(rr(jr~ t,.vi\r (11 ol/wr. loc.trrio,l.\. pllw.>c, o/1cx.h .W/J(/~OICJ picc.e o$/Jcrper. tt.i~/l twlIt,{.s). (rdl/rc\.\fc\ J. /
1 It'ditt;.rent t'ronl ahow)
5. I1t1 \OLI LIIOU >our Standard Industrq Code'.' Di\ision and Major Group
I\II;\I 1\ IIW Nattlrc ot I;(III~ Bu~ine~~'! government agency
6. Nanlc\ 01' Suh\icliary or .~Ft'iliated Conlpanieb or Division5 who use another name and will be covered by thi5 plan:
N:\XlE CITY/STATE ' NATL;R
l_l_ NIA ______"
"." " _"
7. t3Illing :I~CI~L%\\: l.~irfl~/Or~;~fli~~~~iot~ City of Carlsbad
;4ddf?\\:
(. i I > : .__l__l__
1200 Carlsbad Village Drive
Carlsbad CA 92008 State: Zip:
619 434-2852 Fax #( 619 , 720-1875 l'lll~llc ( ., .. - ""1 __"" ii'ill \cpar;lic I>illing\ hc. rqL1ired~? . yes X N<) ~!f~~tx, pItu.se <lf(<tch or i/ttlictrIt it1 #6 )xI))~P.Y (~'~~~(~.~.~~~~~(~~;(~~l~. 11
iddi~~y 1 oif/r/J , /cl~~pllotrc 1udtir.v tlrwtbtr, crrlrl c'otltclc'[)
lt'.\~l~l~i~~i\tr~~~i\e Sen ~ce Progrml. do claims billings and administrative fee billings go to same person'? -"Yes __ ?ik
>yp/\ c'lJll/iii'I ojlr/ orlc. trtltlrc~.r.s. rcl(,l~l/otrc~.,fir.~ k/fi)r eclc.11 rype o/'lillitt,q/
S. ItTq1c rcporiinz: Contact N/A Title
Filxl ...
~\J~lr~\\ _"_ ""_.."
( 'ti! . .."_ - .." .. "."
I.';I \ # 1 ___"" )-
~- State Zip Phone ( )
9. [)cli\cr hrc>chur.e\ to: x Group's Benefit Administrator __ Third Party Administrator __ Broker/(
//'tjIort, r/r(rtr o11o Io(,(r/ioll, 11I1,trsr ctrrtrcA (1 .\~/~~r~itt piece (fptper ,\.irh tt(lt)/e.y. r/ddre.s.sr.s o/zd t1r~t111er c!fhrol'//lrrr.S t.c,cl~tirotl~
lr(/(/i/iot/d /w 1 orc/tl lw rcyui,.cd /i)r rulrlriplc 1ortlfio~f.s.
__ Othcr
IO. i{llpjl>ili\y r111c\ IOI- 20\ercd enlployees (any exclusions must be based upon conditions pertaining IO employment1 1x1 I'rlll lilllc crnpIo!w\ I\\tIo uork at least 30 hours per week)
( J O~ltc~~~de\~ritw in CIC[:IIII ,e<)..*-
" ".. ."" "___
1/95 - VSP
c d a 'date Of hire +HI++ 1 I V, Gll[lllg pcrlod: >e\\ clllpl~)!ees e eligible on the tirsr day ofthe calendar month f ing
-kwt&ttm~akwetrnph+wwl+ ..
I I ()ltWI. l~lc\cl~ll)c 111 ~lL~l<llll~
13. l'Ol.Il lllll1tlk!l- 0l';lIl c~l\cr'd cIlIpIo!cez 316
I .; l)~~~~~~~~~l~b~l~~:' Ikp*ndc~~~\. IIL*liplhie. ;Ire llle qo\ered ernplo>ec'\ \pou5e and unrnarried dependent children who have not ;ttt:1inec 19th ~IIIII(I.I! 1.11\(1 i~lcltdch an unmarried child it inixpahle ot\elf-\;upport because ofphyhical or mental incapacity th,
111'1111 III IL.~I,IIIII; [Itc .11>11\<. .I~L.I. ~vthcir _..-z4thp hirthd:t>. il';i[tcnding xhool tull-time.
I i I IIC I illl(l I',III> \L~IIIII)I\~I.;IIO~ (it'applicahlc):
1 iilll ' ... . . . .!!A
\<I\ilC... . " ." . . . . . "_ .-
('I[! - "~ """". State Zip
I'llllW 1 ."_. ." J _"""." , Fax #( )
('tll1l:lL.l "." ."."""".. Title
"""""_"""""""""""""""""""""- POLICY DETAILS---------------------------------------
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15, I.'rcqucnc) 01' Sen ice - St;lndard Plan: A(lX424) B(12/12/31) C(l2/I?/l2) n
- ." "" Otl~cr ( t<unPrllollths: LensespInonth.;: Frames-months) or - Exam Only (every-months)
~)L~dllcillllc: 5 25 O0 Tolal cleductihle (applieb to exam and materials) or Split 5 Exam/$ Materials
I 0. ( ;I{)\I~ lw\ pt~~-ch:~\cd Kstended Benefits: - Yes LNo. If yes;
.. ... ('rncrctl c0nt:tir l.cllhc\ - Second Pair ot Glasses __ Vision Therapy -Primary Eyecare - Safety Eyeca
I~'I~*L~II~~II~! OI Scn ice: I~\am-nlonths: Lenses-months: Frames-months __ Deductible S
17 IFOR /.\'Sl KI:l) f'~o~;K.~.\l.s:
I.ir\r III{IIII~I'\ orenlitlnl remiwnce calctll:~tion:
# EES RATE REbIITl
l~.~l~l>lo!cc Or~l! t)r ('olllpo\itc xs =s
I'\SIl (81 l~ltl~cL~.l&llc l<iI\l\ E only 131 x5 7.95 = $ 1.041.45 Efl 74 Family -x $
X 5 12.13 = S 897.67 20.91 = $ 2,321.01
x5 =$
TOTAL = S 4,360.08
I5 I Of< \l~.\l/\ISl/< lII\/.'.YI:'K\'/C'EPKO~~Kt~.~lS: N/A \111111lll~il-;1ll\i~ I.cc: I.l\Cd I'CC. or Percent ofclaims
t)wIuIIcIIIIg I \J\ .IIW f'aynlent) Amount it' Group ib an .Adnlinistrative Service Program ' . . . . . . ". . . . " [per co\.cred employee - LIS quoted) x =S
(# ees)
10 KL~q~~c\tc~I L.l'l~~c~~\c cla~c I Eftecti\e date bhould not precede date of receipt of this application by the company)
'I'hl\ lpolic! \\ 111 hciolltc cl'tccti\e on the 1bt day of , 1995 . provided that all of the folio\
L~~IIII~IL~I~CI prior [(I [hi\ cI'l'ccti\.e date:
.\. ,\ppl~:l~i~~n 11;1\ been received and accepted by Vision Service Plan.
13. \'SI' II;I~ twcn I'urnibhed a li\t. tape or dihkette of all employees showing name. social security number. and nunlber o
( ' ,\ L,l~L*~.L 1'{1r i'ir.\t Inonthh premium (together with ASP advance payment (prefunding). if applicahlel is included here,
~~';Ipplicahle.
ILI! IIIL~III\ .IW liut on the I \I of each conwxutivc: month.
111. 1111, .I;KL'L'III~I~I \\ 111 ~~~~~~~i~~t~c in torce 24 months from the et'fective date.
,*,,?a'
I Gj' \\I'
l? al July 1 .?I iill~l KcporI Inli)rnlation Iit'oxer IO oyee51: Financial ).ear June 30 thrwSh .iSOO \I ill he writ IO tllc pcru)n named ah Principal Conrxl. A cop ot'the report ma! also ) kot~r Broker .II]~ !()I. !,!L1r I.hil-<
-
,\~IIIIIII~\~I.~II~)~.
!'lc;l\c \cm1 il copy to: " "" . . -~..
21. l'rior.co\crage urth L'SP: ).e> x No
It Yes: . Prior C;roup X\;anle-
%':I> prior group ccnerqc:
(Ither c;urier:
-" -. - " . . . . . . .. HhIO Plan rhociation llnioll l3tl1L*l,.-...
2 3. 1'11~ ldcm (\\ ill . .. . . - .. \\ ill no1 x I he ol'l;.red under $ I25 of the Intern:d Revenue Code as an optional henet'it.
14. 4 I IS: l)cr.Lw~t:Ige ot'prc1ni~1111\ to he contributed b) group Percentage ol' premiums to he contributed h! emplo! c'o -
( )Illc.r .._"" ~ "." ".". ... . . ,- -
_"""""""""""""""""""~""""""""~ AGREEMENT---------------------------------------------
'fhc un~ler\ignecl ?roup hereby applic.3 tor vision care covcrage through Vision Service Plan.
It i\ uncie:l.~tocld IIXII:
;\. 'l'llc ~IINI~ \I ill co\cr ;111 employees bpecitied under Itan I2 and pay 100% of the cost (if 3 135: 'tot'coht I.
13. ..\I1 Illruw crnplo~ec~ \\\ill be covered \\hen they become elisible.
C. Coverage will terminate lor an employee on the last day of the month in which his employment terminates.
I). hlenhx paht wvicc for grouph prcvioudy covered by VSP will carry over and remain in force.
'lhi\ application \igneci thib 21 9- day of 5+t&k . I!, 95
Ann Jensen Human Resources Direct0 Title: "_
s hereby designated Broker of Record by the above signed employer
"""_"""~~~""~"~~"""""""~""~"-"""- BROKER/CONSULTANT----------------------------------
I-'irm Nanx
;kkIrcs~:
Cii!,: State: Zip: Phone:( )
co~lllly: Fox #: ( )
C'onract San1s: Title:
( PIeaw Print)
13rokcr ,4x\i\t:ml Nanw:
'r:i\p:i> el I .I). #:" __,"_"
<'~IIIIII~~~~ CIlcch\ 1';1!ahle to: Firm Name Contact Name Not PaiL
Thi\ application \igned hi\ day of . 19-
U) SI;IIC I.iccn~ctl .-\pent: Title:
I'l.l<.\SI< i<S(*I.OSI< :\ ('Ol'k' OF ACENT/BROKER LICENSE.
,w,p&d
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