HomeMy WebLinkAbout960071.tiff RESOLUTION
RE: APPROVE EVIDENCE OF COVERAGE AND OWNER'S MANUAL SIGNATURE SHEET
WITH FHP OF COLORADO, INC., AND AUTHORIZE CHAIR 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 the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, and FHP of Colorado, Inc., commencing January 1, 1996,
and ending December 31, 1996, with further terms and conditions being as stated in said sheet, and
WHEREAS, after review, the Board deems it advisable to approve said sheet, 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 the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, and FHP of Colorado, Inc., be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said sheet.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 15th day of January, A.D., 1996, nunc pro tunc January 1, 1996.
BOARD OF COUNTY COMMISSIONERS
_ \ \ 0Mt/th
WD COUNTY, C/OLORAD/O
A� r 0 <' A l ist_ ,1. (t / *hit,> '-'Lr' �/ L /K`
`�F� Barbara J. Kirkmeyer,/Chair v
.. Clerk to the Board
'1/4. E f r e Baxter, Pro-Te
`',1 uty Cler the Board
Dale-K. Hall
AP ED AS TO F ,77 ���"`, f//,,,w�
Constance L. Harbert
ounty o ey a ) // r ,7
W. H We ster
960071
PE0014
ee.,' fL--; /=fiP
FHP OF COLORADO, INC.
EVIDENCE OF COVERAGE AND OWNER'S MANUAL
SIGNATURE SHEET
The attached Evidence of Coverage and Owner's Manual(Group Agreement), this Signature Sheet, and Group
Application(if any) collectively constitute a contract (Agreement) between FHP of Colorado, Inc. (FHP), 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 Ms. Jewell Vaughn
P.O.Box 758 (970)356-4000 x.4218
Greeley,CO 80632
Company Number: OUR00
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 9111.
2. EFFECTIVE DATE:
This Agreement takes effect 12:01 A.M. on January 1, 1996, and will remain in effect through 11:59
P.M. on December 31, 1996, subject to the terms and conditions of the Agreement.
3. COVERAGE:
EOC Edition: 1996 FHP of Colorado Evidence of Coverage and Owner's Manual(I-IMO)
Medical Plan Copayment Schedule: 10046
Optional benefits: Rx10046
4. MONTHLY RATE SCHEDULE:
Subscriber only $153.08
Subscriber, Spouse and Child(ren)(Family) $422.50
960071
5. PAYMENT ARRANGEMENTS/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 of the month occurring on or following one full pay period.
Employees terminating employment the first through the 15th will be covered through the end of
the month in which their employment terminates; employees terminating employment 16th
through the end of the month will be covered until the end of the following month. Full monthly
premium is due for any employee enrolled for an entire month.
6. UNDERWRITING CONDITIONS:
The Subscribing Group (A)represents that the underwriting conditions listed below exist as of the effective
date noted in number 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
each monthly rate.
If FHP (HMO) is part of a multi-option plan offering an FHP's Preferred (PPO) / 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
employees.
This health plan is available only to employer groups who have 51 or more eligible employees.
If at the anniversary date of this Agreement the number of eligible employees is less than 51
this Agreement may not be renewed. However, the Subscribing Group may be offered the
small employer health benefit plan(s) as defined by Colorado Insurance Law.
Additionally, FHP 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, FHP 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 31 days in advance.
7. OPEN ENROLLMENT PROVISIONS:
The group enrollment period shall be November, 1996.
960071
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 above,
PAYMENT ARRANGEMENTS/ELIGIBILITY.
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 construe an original but
all of which shall constitute one and the same instrument.
IN WITNESS WHEREOF, FHP and the Subscribing Group have caused this Agreement to be executed
by their respective duly authorized representatives.
SUBSCRIBING GROUP FHP
RIZED REPI,E,ENTATIVE AUTHORIZED REPRESENTATIVE
By' • 'w4�4 ccfT �Cti By: ��� �. Bartora J. Kirxmeyer / 01/15/96 SandraG. Peif
j'.Ch'air, Weld County
Title: Board of Commissioners Title: State Manager, Existing Business Development
Date: January 15, 1996 Date: December 13, 1995
CK
weldcry.Olm
960071
Hello