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Home My WebLink About720563.tiff RESOLUTION RE: AGREEMENT BETWEEN WELD COUNTY AND PACIFIC MUTUAL LIFE INSURANCE COMPANY. WHEREAS, Pacific Mutual Life Insurance Company has submitted a proposal for group insurance, Policy No. 8864, covering the employees of Weld County, Colorado, and WHEREAS, the Board of County Commissioners, Weld County, Colorado, believes it to be in the best interests of the County to accept the proposed group insurance covering its County employees and to enter into such an agreement on the basis recited therein. NOW, THEREFORE, BE IT RESOLVED, by the Board of County Commissioners, Weld County, Colorado, that the agreement submitted by Pacific Mutual Life Insurance Company providing insurance coverage for County employees in accordance with Policy No. 8864 as submitted, copy of which is attached hereto and made a part hereof by reference, be, and it hereby is approved. BE IT FURTHER RESOLVED, that the Board be, and it hereby is, authorized to execute the agreement as submitted and to make the same effective forthwith. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 15th day of March, 1972. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO i �� // - ATTEST: • a;144-1. p 1 inne.tr Clerfc/of the Board BY: i /24.,,/ Deputy County Clerk APPRQVED AS TO FORM: County ttorney ii?�'�- 1J' A'/3 720563 • Pacific Mutual Life Insurance Company LOS ANGELES, CALIFORNIA PRELIMINARY APPLICATION FOR GROUP INSURANCE ---- --- Weld County, Colorado NAME OF APPLICANT (FULL CORPORATE NAME) Court House, Greeley, Colorado ADDRESS OF APPLICANT hereby applies to PACIFIC MUTUAL LIFE INSURANCE COMPANY for a plan of group insurance providing the bene- fits as checked below: For Individuals Only For Dependents Life ® ❑ Accidental Death and Dismemberment Weekly Disability ❑ Basic Medical ❑ ❑ Superimposed Major Medical ❑ ❑ Comprehensive Major Medical ® Q It is requested that insurance be effective on The First day of April ig 72 Are benefits applied for replacing, or in addition to, any group insurance currently or formerly in effect? ❑No 0Yes. If "yes", indicate: Name of Company(ies) Blue Cross - Blue Shield Type of coverage(s) Group Medical Has coverage been terminated? ❑No ©Yes. If "yes", when? March 31, 1972 Premium payments are due on the first day of each month and are payable monthly in advance. The insurance applied for shall not become effective unless this application is approved, and an advance payment received by Pacific Mutual Life Insurance Company at its Home Office in Los Angeles, California. Insurance on a contributory basis shall not become effective until the date determined when the required per cent of the eligible employees shall have agreed to make the required contribution to apply toward the premium for the insurance. This is a preliminary application and will become binding on the applicant when it is confirmed by execution of a final application at the time the policy or policies are delivered. No agent has power on behalf of Pacific Mutual Life Insurance Company to make or modify any application for insurance, or to bind the Company by making any promise or representation or by giving or receiving any information. Signed at Greeley, Colorado this Fifteenth day of March 19 72 CITY AND STATE THE BOARD OF COUNTY COMMISSIONERS ATTESTS Q / WELD COUNTY, COLORRADOO7 By Sone--Glenn . Billings SIGNATURE By:Deputy County Clerk M qu dI Her S. 'WileyTITLE Writing Age SIGNATURE rshall H. Anderson GR-3882-C -- • n ^ j Pacific Mutual =wife Insurance Company 523 WEST SIXTH STREET • LOS ANGELES. CALIFORNIA • TELEPHONE (213) 623-1211 MAILING AGGRESS: PACIFIC MUTUAL BUILDING P. O. BOX 56060 LOS ANGELES, CA 80659 Harry G. Bubb Senior Vice President July 6, 1972 Group Insurance Division Barton Buss-Chief Accounting Officer Weld County, Colorado Court House Greeley, Colorado 80631 Group Policies: GL-8864, GR-8864, GM-8864 Effective Date: April 1, 1972 Dear Mr. Buss: It is a pleasure to advise you of our formal acceptance of your application for a Plan of Group Insurance. Upon completion, the contractual and administrative materials will be delivered to you by our resident Group Insurance Representative in your area; he will be happy to furnish any information and assistance you may require. We appreciate your designating Pacific Mutual as the underwriter of your insurance program, and this opportunity to be of service to you. Sincerely yours, DO JJJ4/e1,4atfigCOUtJTY OF WELp $$• Ilcc .r to tr= f k of the Board =of County CommiRsio�Fs Harry G. Bubb HGB:mt JUL 1 .l 1972 C-n.,,.-4,..,„,L, COUNTY CLERK AND RECORDER BY--'._Deputy te. WELD C.0 U N T Y TO ALL EMPLOYEES We are very pleased to announce that effective April 1, 1972, a very comprehensive group insurance plan has been adopted to cover you and your dependents. Weld County is paying the entire cost for the basic life insurance and accidental death and dismemberment protection as well as the cost for employee medical coverage. The coat for dependent medical coverage and optional life and accidental death and dismemberment insurance will be paid through payroll deduction. Basic Life Basic Accidental Death Insurance and Dismemberment Employees with less than 5 years service $2,500.00 $2,500,00 Employees with 5 years service or more $5,000.00 $5,000.00 Reduced to $2,500.00 from age 65 to age 70 and to $1,000.00 thereafter. Monthly Optional Life Optional Accidental Death Salary Insurance and Dismemberment Less than $500.00 $2,500.00 $2,500.00 $500.00 and over $5,000.00 $5,000.00 Reduced 50$ at age 65 and terminated at age 70. Comprehensive Major Medical Coverage For Employees and Dependents Deductible: $100.00 per year per person. The deductible applies only to hospital confinements, prescription drugs, appliances and nursing care due to sickness. No deductible on other benefits. No deductible for accidents. Hospital Benefits: 100$ of the first $2,000.00 in covered charges. Room and Board charges shall be covered up to the semi-private rate not to exceed $!42.00 per day; Intensive Care up to $105.00 per day (10 Days); Convalescent Hospital or qualified Nursing Home Care at $21.00 per day. After the first $2,000.00, the plan will pay 80$ of covered hospital charges. Out-patient Hospital Benefits are covered up to $2,000.00 for accident or sickness and such out-patient coverage is not limited to emergency conditions. Prescription Drugs, Appliances and Nursing Care are payable at 80$ of covered charges. Charges for abnormal pregnancies including Caesarean Section, Ectopic Pregnancy and Miscarriage shall be covered as any other illness. Benefits with no deductible: Doctor Calls in the Home, Office, or Hospital are covered in accordance with the Foundation requirements at 100$ of the 1968 Colorado Relative Value Schedule. Surgical Benefits: Charges made by a Surgeon or Assistant Surgeon including fees for Anesthesia and Radiotherapy are payable in accordance with the Foundation requirements at 100% o£ the 1968 Colorado Relative Value Schedule. Diagnostic Laboratory and X-ray: Charges made for Diagnostic Laboratory and X-ray procedures are payable in accordance with the Foundation requirements at 100% of the 1968 Colorado Relative Value Schedule. Pregnancy Benefits: Charges for normal delivery will be paid up to $500.00. Routine nursery care is covered in full. Well Baby Care: Covers pediatric care up to $90.00 per year up to two years of age in the absence of accident or sickness. An additional amount of $35.00 is available for routine immunizations. Out-patient Psychiatric Care is payable at 80% of $30.00 for the first ten visits followed by 50% of $30.00 for the next sixteen visits. Maximum Benefits - $20,000.00 with an automatic restoration of benefits up to $1,000.00 on the first day of each calendar year. Children shall be covered from birth to age 19 or to age 23 if attending an institution of higher learning. ANALYSIS OF COST Coverage Monthly Cost Basic Life and Accidental Death Paid by Weld County and Dismemberment Employee Medical Paid by Weld County Optional Life and Accidental Death and Dismemberment Employees earning under $500.00 per month $ 2.03 Employees earning $500.00 and over per month $ 4.05 Dependent Medical $23.46 • Pacific Mataal Life Insurance Company SUITE 306 • 288 CLAYTON STREET • DENVER, COLORADO • 8O2O6 TELEPHONE 388-9037 DENVER GROUP AND CLAIMS OFFICE Group Insurance&Retirement Plans February 15, 1972 Mr. Paul Bechthold, C.L.U. P. 0. Box 525 Greeley, Colorado 80631 RE: WELD COUNTY Dear Mr. Bechthold: Please consider this letter our proposal for group insurance covering the employees of Weld County. This proposal assumes that the employer will be paying all of the employee cost. Our quotation assumes 511 employees and 392 dependent units. 2. Life Insurance and Accidental Death & Dismemberment Coverage - . as per specifications. II. Comprehensive Major Medical Benefits: After a $100.00 calendar year deductible for hospital confinements due to sickness, Prescription Drugs, Appliances and Nursing Care only, the plan will pay as follows: A. Hospital Benefits - 100% of the first $2,000.00 in covered charges. Room and Board charges shall be covered up to the semi-private rate not to exceed $112.00 per day; Intensive and Coronary Care up to $81 .00 per day; Convalescent Hospital or qualified Nursing Home Care at $21.00 per day. After the first $2,000.00, the plan will pay 80% of covered hospital charges. Out-patient Hospital Benefits are covered up to $2,000.00 for accident or sickness and such out-patient coverage is not limited to emergency conditions. B. Doctor Calls in the Home, Office, or Hospital are covered in accordance with the Foundation requirements at 100% of the 1968 Colorado Relative Value Schedule. 1/44 February 15, 1972 Page 2 C. Surgical Benefits. Charges made by a Surgeon or Assistant Surgeon including fees for Anesthesia and Radiotherapy are payable in accordance with the Foundation requirements at 100% of the 1968 Colorado Relative Value Schedule. D. Diagnostic Laboratory and X-ray. Charges made for Diagnostic Laboratory and X-ray procedures are payable in accordance with the Foundation requirements at 100% of the 1968 Colorado Relative Value Schedule. E. Prescription Drugs, Appliances and Nursing Care are payable at 80% of covered charges. F. Out-patient Psychiatric Care is payable at 80% of $30.00 for the first ten visits followed by 50% of $30.00 for the next sixteen visits. G. Pregnancy Benefits. Charges for normal delivery will be paid up to $500.00. Charges for abnormal pregnancies including Caesarean Section, Ectopic Pregnancy and Miscarriage shall be covered as any other illness. H. Maximum Benefits - $20,000.00 with an automatic restoration of benefits up to $1,000.00 on the first day of each calendar year. I. Children shall be covered from birth to age 19 or to age 23 if attending an institution of higher learning. PLEASE NOTE: The $100.00 deductible is applied only to hospital confinements due to sickness, prescription drugs, appliances and nursing care. ANALYSIS OF COST Group Life Insurance, per $1,000 $ .711 Accidental Death & Dismemberment, per $1,000 . $ .07 Comprehensive Major Medical Employee Only . $20.30 Dependent Unit . 20.60 Total Family Medical • $110.90 . 4 February 1$, 1972 Page 3 In addition to the above benefits, the Colorado Medical Foundation strongly recommends the purchase of additional coverage for the care of infants for the purpose of preventative medicine and well baby care. To provide this care, we can offer two additional coverages. Routine Nursery Care - Coverage for well babies while in the hospital. Well Baby Care - Coverage for infants up to two years of age in the absence of sickness or accident. Benefit - $90.00 per year for the first two years of life. Routine Nursery Care - $1.76 per dependent unit. Well Baby Care - $1.10 per dependent unit. Sincerely, i A. Brian Roessler Group Sales Representative ABR:mn Hello