HomeMy WebLinkAbout940137.tiff RESOLUTION
RE: APPROVE EVIDENCE OF COVERAGE AND OWNER'S MANUAL SIGNATURE SHEET WITH
TAKECARE OF COLORADO, INC. , AND AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado,
pursuant to Colorado statute and the Weld County Home Rule Charter, is vested
with the authority of administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Evidence of Coverage and
Owner's Manual Signature Sheet between TakeCare of Colorado, Inc. , and the County
of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, commencing January 1, 1994, and ending December 31, 1994, with
further terms and conditions being as stated in said evidence of coverage, and
WHEREAS, after review, the Board deems it advisable to approve said
evidence of coverage, a copy of which is attached hereto and incorporated herein
by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Evidence of Coverage and Owner's Manual Signature
Sheet between TakeCare of Colorado, Inc. , and the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said signature sheet.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 26th day of January, A.D. , 1994, nunc pro
tunc January 1, 1994.
BOARD OF COUNTY COMMISSIONERS
ATTEST: LaWauednWELD COUNTY, CO ORADO /Weld County Clerk to the Board � � "( Lea
�/� � � W. H. Webster, Chairman
BY: J� d1 L I li--rx.�" L)
Deputy erk to the Board Dale . Hall, Pr Tem
APP AS TO FORM: C derdst
eorg E. Baxter de
e/
unty t rney ante L. Harbert
/rt<i
Barbara J. Kirkmey r
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Ornnl ae : + 1 Vt TAKtcAet
TAKECARE OF COLORADO, INC
EVIDENCE OF COVERAGE AND OWNER'S MANUAL
SIGNATURE SHEET
The attached Evidence of Coverage and Owner's Manual (Group Agreement) and this Signature
Sheet collectively constitute a contract (Agreement) between TakeCare of Colorado, Inc.
(TakeCare), and the Subscribing Group named below for the provision of specified healthcare
benefits to eligible persons electing to enroll hereunder as Subscribers and Dependents.
1. SUBSCRIBING GROUP:
A. The name, address, and group number(s) of the Subscribing Group are as follows:
Weld County, Colorado Mr. Donald Warden
P.O. Box 7s 757 (303) 467-1001 357o-4000 x yatl
915 Tenth Street
Greeley, Colorado 80632
Group Number(s): NC - 503,Denver - 744, CS - 1031,PPO - 50158
B. The following entities affiliated with the Subscribing Group shall be deemed to
be included within it for purposes of this Agreement:
N/A
C. The number of employees of the Subscribing Group who are eligible to enroll as
Subscribers is 950 and the SIC Code of the Subscribing Group is 900.
2. EFFECTIVE DATE:
This Agreement takes effect 12:01 a.m. on January 1, 1994, and will remain in effect
through 11:59 p.m. on December 31, 1994, subject to the terms and conditions.
3. COVERAGE:
Plan type: 9T
EOC number and edition date: 7560 (1994)
Schedule of Benefits number and edition date: 7564 (1994)
Optional benefits: Rx 5T,7567 (1994)
4. MONTHLY RATE SCHEDULE:
Employee only $144.29
Employee, spouse and dependents (Family) $398.24
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5. PAYMENT ARRANGEMENT/ELIGIBILITY The following specifies payment
arrangements as well as conditions of eligibility for enrollment as a Subscriber that are in
addition to the conditions enumerated in Chapter 4 of the Group Agreement (and, to the
extent that any of the following conditions contradict the terms of chapter 4, the
following shall prevail:
New employees are eligible on the first day of the month occurring on or following
the date of hire and a full monthly premium will be charged. Employees will be
covered through the end of the month in which employment terminates and a full
monthly premium will be charged.
6. UNDERWRITING CONDITIONS The Subscribing Group (A) represents that the
underwriting conditions listed below exist as of the effective date noted in paragraph 2
above, and(B) covenants that all such underwriting conditions shall continue to be met
at all times while this agreement is in force:
Subscribing group must contribute for all subscribers at least 75% of"Employee"
monthly rate or 50% of"Employee and one or more dependent" monthly rate.
If TakeCare (HMO) is part of a multi-option plan offering a TakeCare
Preferred/Indemnity plan the Subscribing Group must have at least 75%
participation of all eligible employees. Military employees or employees covered by
a spouse's plan will not be counted as an eligible employee for the purpose of this
minimum participation requirement. The minimum number of enrolled employees
between the HMO and PPO/Indemnity plans cannot be less than 25 lives.
Additionally,TakeCare reserves the right to re-evaluate the risk at any premium due date
based upon substantial changes to other assumptions including, but not limited to, a
change in demographics; divisions added or deleted; or the offering of an additional
employer sponsored health plan.
Notwithstanding any other provision of this Agreement, TakeCare may terminate this
Agreement on any premium due date if any underwriting condition listed above is not
then being met and notice of intention to terminate has been given to the Subscribing
Group at least 30 days in advance.
7. OPEN ENROLLMENT PROVISIONS: The Group enrollment Period shall be
December 1994.
8. OTHER PROVISIONS: Eligible dependents will be covered as outlined in Chapter 4 of
the Agreement. Payment arrangements for newly acquired dependents shall be the same
as for newly hired employees as described in number 5,
PAYMENT ARRANGEMENTS/ELIGIBILITY.
1/6/94
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9. GOVERNING LAW: This Agreement shall be governed by and construed in accordance
with the internal laws of the State of Colorado.
10. COUNTERPARTS: This Agreement may be executed in two or more counterparts,
each of which shall constitute an original but all of which shall constitute one and the
same instrument.
IN WITNESS WHEREOF,TakeCare and the Subscribing Group have caused this
Agreement to be executed by their respective authorized representatives thereunto duly
authorized.
SUBSCRIBING GROUP TAKECARE
AUTHORIZED REPRESENTATIVE AUTHORIZED REPRESENTATIVE
By: 7174 /J),Pjitbc By: SCE a.
01/31/94
Chairman, Weld County ��. ` aria— �•
Title: Board of Commissioners Title:h1 /69a
eiA
Date: 01/26/94 Date: /ink(/'
ATTEST: Aidied-4;14.
WELD COUNT{ CLERK TO THE BOARD
RV: £314t - �TDTY CLE . TO THE BOARD
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