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236242 ' � 236�4� ; , . � ORIGINAL TO CITY CLERK � . CITY OF ST. PAUL FILENC'� NO. _ • OFFICE OF THE CITY CLERK C CI RESOLU ON GENERAL FORM PRESENTED BY � C�MMISSI�NE DATF _ WHEREAS, Group Health Plan, Inc. was the only company which submitted a proposal for supplying an additional type of group medical, surgical and hospital coverage to that presently afforded to employees of the City of Saint Paul and Independent School District No. 625 and dependents, under specifications set forth under the City' s Formal Bid No. 2528, authorized pursuant to resolution of the School Board and the Coun.cil by its Resolution, C. F. No. 234679, now, therefore, be it RESOLVED, On the recommendation of the City' s Purchasing Committee and on the recommendation of the City' s Health and� Welfare and Insurance Committee, and subject to a concurring resolution by the School Board of Independent School District No. 625, the Council of the City of Saint Paul hereby authorizes award of a contract to Group Health Plan, Inc. for supplying such alternative"type of coverage to .employees of the City and Independent School District No. 625 and to retired officers and employees of the City and the School District covered under the City' s Group Program in accordance with a contract, copy of whi�ch is hereto attached, marked "Eghibit A" and incorporated herein by reference; be it FURTHER RESOLVED, That the proper City officers are hereby authorized, subject to such concurring resolution by the School Board, to egecute such contract on behalf of the City of Saint Paul. ., . _ FORM APPROVED , Asst Corporation Cou sel ., � , ��1919�� COUNCILMEN Adopted by the Counci 19— Yeas Nays Carlson " DE�1 � g��j� _ Dalglish pproved 19— Holland � Tn Favor Meredith � - '� • Peterson � Mayor Tedesco A Sau►st Mr. President, Byrne PU��Ep p�C 2� �� , �22 a DIIMLICATE TO rWINTER J��J _ CITY OF ST. PAUL FOENCIL N�. �•r �`r OFFICE OF THE CITY CLERK ' , .• COUNCIL RESOLUTION—GENERAL FORM PRESENTED BY . COMMISSIONER DATF _ Wffi�REAS, Group Health Plan, Ino. was the on�.y company whioh gubmitted a propoeal �or supp3.ying an additional tppe oY �roup medioal, aurgiaal a.nd hoepital eoverage to that preaentlq afforded to empioyees o� the City of Saint Paul and Independent School Distriat No. 625 a.nd dependents, under speoificsations aet forth un.der the City' s Formal Bid No. 2528, authorized pursua.nt to resolution o� the School Board and the Counoii by its Resolution, C. F. No. 2346'79, • now� therefore� be it RESOLVED, On the reQOmmendation of the City' s Purohaeing Committee and on the reoommendation of the City' s Health and Welfaxe and Insuranoe Committee, and �ub�eQt to a oonaurring re�olution by the Sohool Board of Independent Sohool DistriQt No. 625, the CounQ11 of the City of Saint Paul hereby suthorizes award of a oontraot to aroup Health Plan, Ino. for eupplying suoh alternative type o� ooverage to �mployees of the City and Independent Sohool Dietriot No. 625 and to retired offioere and employees o� the City and the Sahool Distriot oovered under the City�s Group Program in a000rdance with a oontraot, Qopy of whioh is hereto attached, marked "Eahibit A'� and invorporated herein by referenoe; be it FIIRT�R RESOLVED, That �he proper City o�fiQerB are herebq authorized, sub�eot to euch QonQUrring reeolution by the Sohaol Board� to egeoute auch oontraot on behalf o� the City of Saint P�ul. QEC 19196� COUNCILMEN , Adopted by the Council 19— Yeas Nays Carlson Dalglish f� Approved ��'1 9 1�6� 19._ Holland � Tn Favor Meredith Peterson � Mayor A gainst Tedesco Mr. President, Byrne �22 , . �`, , r • . . . � • , . ' _ " ' � . � _ . ' . . . � , • ' - ' Group Health Plan, Inc. , hereby certifies that the employee � named on the membership card attached to this Certificate • ' � and his eligible dependents, if enrolled for family coverage � ti. . are entitled to the benefits described herein as provided • under and subject to the terms and conditions of the Health , , Benefits Agreement issued to the City of Saint Paul. • Any employee who is not actively working on the day his � '..___,�- _ benefits would otherwise have� become effective, will have • ' � his benefits deferred until he returns to active work. If � � � ' an eligible dependent, in the case of family coverage, is . . ' . confined in a hospital on the date benefits would otherwise ,; , . become effective, they will be deferred until discharge� . , � • from the hospital except in the case of a newborn child who � . ' - remains hospital confined following birth because of disease ` or congenital abnormality. , ' . . � ' ' . : . - . .. � • . . � � , - ' . . , ' � ' � � • " � , ' ' . , , , , • . .. • .. .,. • . • � . . . , . , . • .. � ' � .. . . . , . : : 'r:. • . .�;. . ' y . . t',' ,. , : .. . , , , ty •� ..- . ' ` ' . . ,' ,.. ; . .. .. . . Y . . , � . � . . 4 a r • , , .` " . � . � •� . -' . • • � , . � � � SECTION I . � - . , , . , . � � DEFINITIONS " - � . � , ' � . , ' For The Purposes of This Certificate . � � . • Dependents - Include the employee's spouse and uumarried children � . � . between the ages of one (1) day and nineteen (19) years, or twenty- • � three (23) years for those children regularly attending school and� ' depending upon the employee for more than one-half (1/2) of their • support. . ' GHP Medical Group- Refers to the group of physicians emploqed and , . retained by Group Health Plan, Inc. , to provide medical service to its members. ' • � GHP Physician - Is any physician who is a member of the GHP medical. group as defined herein. � Home Call Service Area - Means that geographic area situated within • � the corporate limits of Minneapolis, St. Paul, St. Anthony, Roseville, Lauderdale, Falcon Heights and Little Canada. � Hospital - Means an institution licensed and operated as a hospital, � � , pursuant to the law of the State within which it is situated, pro- viding (a) facilities regularly used for surgical operations, and (b) - 24-hour nursing service, and is not more than incidentally a place for the aged, drug addicts, alcoholics, or a nursing homeo � Member - Means the employee including eligible dependents when the • � family rate is paid. Phvsician - Means any person who is recognized by the law of the State - in which treatment is received, as qualified to treat the type of in�ury or sickness for which benefits are provided. . Same Condition - Means illness or in�ury that is related to former ill- � ' � ness or in�ury in that. it is (a) within the same ascertainable diagnosis � ' • or set of diagnoses of the former illness or (b) within the scope of � � . ", � complicationa or aequelae .of the former illness or in�ury. ' � . . . ' � . ' . . ; ' • . " ' • • ' � � . , • , " , .' , ,• , . �' .. � � ' . � . • . . . t. • .. - - , . , , • . 1 . . � , i • . � • . • J , ' • • � � • ' • � L • � • ` � � J � SECTION 2 COMPREHENSIVE MEDICAL SERVICES PROVIDED BY THE .GROUP HEALTH MEDICAL CENTER � , . GHP will provide to the member medical-aurgical' and related services by licensed � physicians and surgeons associated with the Group Health Medical Center. The GHP - .�� premium covers the full cost of all such aervices except as otherwise noted below. Services to be provided are: OFFICE VISITS - HOSPITAL MATERNITY CARE . VISITS AND CONSULTATIONS � • , � Complete maternity care is provid- - , Covered ir. full. Im addition to � � • ed by specialists in obstetrics . _ - � family doctors, the GHP Medical, . ', `, and gynecology, including prenatal ; , ' " Center is staffed by physicians �� . � , care, and any complications of , � , • - in seven specialties, (other . . ' � pregnancy. Maternity care is immedi- . . � specialties are provided upon � • � •• ate. � - . referral) . . � •. � . • ' CIiILD CARE - . ' SURGICAL CARE - Complete pediatric care of babies . �� , � � and other children. ' Major and minor surgery, including � - all specialized surgery is coverecY EYE- EXAMINATIONS , in full. � . • � • Eye refractions and treatment. " X-RAY & LABORATORY SERVICES ' , , ADDITIONAL MEDICAL SERVICES . �- Diagnostic x-rays, laboratory pro- - �Includes allergy testing and treat- . , . cedures, cardiograms, basal metabo- ment (member pays for coet of extracta . lism studies, hearing evaluations, used in dissenaitization injections) ; at the GHP Medical Center. adminiatration of anesthesia, blood , . ' ' and blood plasma; heat therapy. ' � PREVENTIVE HEALTH CARE " � HOME CARE ' " Physical check-ups, basic immuni- Emergency home visits by a GHP physi- zations including smallpox vaccin- cian are provided within the home • ation, diptheria and pertussis , • call service area sub�ect to a service : toxoid, tetanus toxoid, and polio charge of $3.00 for each visit re- vaccine. Measles vaccination is quested and made between 7:00 a.m. and � adminietered sub3ect to a service 7:00 p.m. , and $5.00 for each visit charge for the vaccine. between 7:00 p.m. and 7:00 a.m. ' � Appointment Houra - 9:00 a.m. to 5:00 p.m. , Monday thru Friday . ' - 9:00 a.m. to 12:00 noon, Saturdays, for emergency care. � . . ' Doctors on call at all other �hours for emergencies. � • � GROUP HEALTH MEDICAL CENTER „ . . � '. . " � 2500 COMO AVE. , ST. PAUL • , " � ._ � � - (COMO AT EUSTIS) '� . � ' � , � . " � Tel. 645-5851 - night, day and weekend . " A-2 . - : . . �_._.,_______._.��,—. ' � .- -- --=— ___.______-. ;_--_._ .._ . ' . . SECTION 2 CONTINUED. . � - ' , SUPPLEMENTARY SERVICES � ' . If a member requires any of the following services, appliances or equipment and has expended $50.00 for such items during any one calendar year, GIiP will provide such additional services, appliances, or equipment, in excess of $50.00, as may . . be required during that year, without further expense to the member. . • Visiting nurse services, or other licensed nursing service, such as special duty nursing at home or in a legally constituted and operated . - , hospital, as may be deemed necessary by the attending GHP physician. - • Hospital beds, crutches, wheelchairs, belts, trusses, lamps, artifi- cial eyes and limbs and other prosthetic appliances (except dental prosthetic appliances) , orthopedic appliances and incontinance " appliances, as are prescribed by the attending GHP physician. . • Oxygen and the rental� of equipment for the administration of oxygen, when prescribed by the attending GHP physician. . - GHP will make all necessary purchase or rental arrangements whenever a member requires any of the above items or s�rvice. Supplementary services will be provided to a maximum expenditure of $5,000 for the lifetime of the member. . EXCLUSIONS - (applicable to all of Section 2� • Services of physicians outside of the GHP medical group except such as are rendered upon referral arranged bq GHP. • Dental care and dental surgery. , � � o Psychiatric care. � � . � • �Tuberculosis care after diagnosis. � ; -� • Treatment of chronic alcoholism or drug addiction after diagnosis. . • Medications administered by injection other than immunizing agents . used in the basic immunizations covered herein. . . � • LIMITATIONS - (applicable to all of Section 2) � , ' � • Benefits for congenital malformations requiring referral for surgery ' � � are covered on a scheduled basis_to a maximum of $400.00. , . . ' SECTION 3 - . � � HOSPITAL SERVICES � � � - . BENEFITS PROVIDED This plan will pay the following benefits for hospital expenses incurred by the , member anywhere in the world for services and supplies furnished while confined as a bed patient under the order and care of a physician for diagnosis and treat- . ment of illness or in�ury: • Daily. Benefit - Full payment of hospital charges for room and .board when confined in a semi-private room, or up to the hoapital's average semi- private room rate if confined in other than a semi-private room, up to � _ - 365 days per confinement. • Other Hospital Services - Full payment for other services and supplies . ' . ' ' � furnished by the hospital during each day of confinement for which room , and board benefits are payable. Such services and supplies include use - of operating, recovery and treatment rooms and equipment; drugs, dress- ings, intravenous in�ections and sera supplied by the hospital; labora- " � � tory services; diagnostic x-ray examinations, electrocardiograms and basal metabolism tests; oxygen .and its administration; radiation therapy; � � diathermy, inhalations; administration of blood and blood plasma. . , • Regular Local Ambulance Service To The Hospital - Such service ahall, fo,r the purposes of this Plan, be considered the same as and included with Other Hospital Services. EXTENSION OF BENEFITS , • • If a member who has been totally disabled from the date of termination of his coverage becomes confined in a hospital within 90 days of such date, the same hospital benefits will be payable for such confinement � as would have been payable had coverage not terminated. , • � • • If a member is pregnant on the date° of termination of her coverage and ' - incurs hospital maternity expense within 9 months after such termination �� , date, the same hospital benefits will be payable for such expense as would have been payable had coverage not terminated. LIMITATIONS .� ' , • • Benefits for hospital maternity care are, limited to pregnancy, including , ` , " complications or sequalae thereof, conceived after the date the member became covered hereunder, unless such member became covered during the � . initial open solicitation period �or this plan. • . c WHAT IS A CONFINEMENT � •�`Separate admissions to a hospital are considered as separate confinements � if separated by at least 90 days or if such are for entirely unrelated � conditions. Two or more admissions for the same condition separated by ' leas than 90 days are considered as one continuous confinement. � • . .. ' ' � � SECTION 3 . . � RETIREE HOSPITAL SERVICES . �. . . BENEFITS PROVIDED . � This plan will pay the following benefits for hospital expenses incurred by the � member anywhere in the world for services and supplies furnished while confined � as a bed patient under the order and care of a physician for diagnosis and treat- ment of illness or in�ury; � • Daily Benefit - 80% of hospital charges for room and board when con- � fined in a semi-private room, or up to 80% of the hospital's average semi-private room rate if confined in other than a semi-private room, - up to 180 days per confinement. . ° Other Sospital Services - 80% of hospital charges for other services . and supplies furnished by the hospital during each day of confinement for which room and board benefits are payable. Such services and - supplies include use of operating, recovery and treatment rooms and equipment; drugs, dressings, intravenous injections and sera supplied by the hospital; laboratory services; diagnostic x-ray examinations, electrocardiograms and basal metabolism tests; oxygen and its admin- , , istration; radiation therapy; diathermy, inhalations; administration • of blood and blood plasma. ' � ° Regular Local Ambulance Service To The Hospital � Such service shall, ' � for the purposes of this plan, be considered the same as and included • • with Other Hospital Services. . _ � . ERTENSION OF BENEFITS ° �If a member who has been totally disabled from the date of termination • � . . of his coverage becomes confined in a •hospital within 90 days of such date, the same hospital benefits will be payable for such confinement , as would have been payable had coverage not terminated. � ° If a member is pregnant on the date of termination of her coverage and incurs hospital maternity expense within 9 months after such termination date, the same hospital benefits will be payable for such expense as ' would have been payable had coverage not terminated. il� i � WHAT IS A CONFINEMENT , • Separate admissions to a hospital are considered as separate confine- . • • � ments if separated by at least 90 days or if such are for entirely • � unrelated conditions. �ao or more admissions for the same condition - separated by less than 90 days are considered as one continuous con- ' finement. • i , . � . , . - , - . � . " " . - . , . , � • � '. ` SECTION 4 • ' � OUT OF AREA MEDICAL INDEMNITY BEf�EFITS , j � ' . BENEFITS PROVIDED . � •_ - When the member is traveling outside of �the geographic area served by the Group - • � , Health Medical Center and requires physician's care for a medical emergency, the following schedule of benefits is provided: � . • Surt�ical Benefits - $400.00 maximum schedule.. A sample of allowances: � Reduction of simple ankle fracture , $ 70.00 • � , - . . if open reduction $140.00 _ Reduction of fractured femur , $180.00 � • _ if open reduction $360.00 • , Removal of foreign body from eye $ 10.00 ' Tracheotomy $100.00 Debridement of simple wounds $ 20.00 � - Appendectomy $200.00 , • Office and In-Hospital Call Benefits_ - $3.00 per visit to the doctor's " � office and for each doctor visit to the hospital, to maximum of $180.00 . . . per medical emergency. � . • Out-Patient Diagnostic X-Ray and Laboratory Examination Benefits_ - $25.00 maximum allowance per medical emergency. • Accidental Medical Benefits - $25.00 maximum allowance for out-patient medical care of any one in�ury. . �. . • Obstetrical Benefits - The following surgical allowances are payable for " - out-of-area pregnancy expenses: ' , � $37.50 - Miscarriage . . . � . $75.00 - Obstetrical Delivery (payable for delivery occurring while . , , � the member is on approved leave .of absence and temporarily residing outside of the Service Area). ' � "Medical Emergency" as used herein means an acute disability, either medical or � ' as a result of injuries occurring spontaneously and unexpectedly and demanding immediate attention, except that benefits are not limited to medical emergencies for any member who is temporarily residing outside of the Service Area away from his permanent place of residence for at least 30 days but less than one year. � , ' �"Service Area" - The geographic area served by the Group Health Medical Center for � purposes of determin3.ng eligibility for out-of-area benefits, is that area within ' , a 25-mile radius of the Group Health Medical Center. , . . .. ` ' . � ._ �_. , . . . � � . SECTION 5 , , . , . . , . GENERAL PROVISIONS r � LIMITATIONS - The total hospital and out-of-area medical indemnity benefits provided herein shall not in any case exceed the actual expenses incurred by the member within the scope of such benefits. All benefits for maternity care as provided herein are limited to female employees enrolled for family coverage and covered dependent spouses. EXCLUSIONS APPLICABLE TO ALL BENEFITS - Claims arising directly or indirectly from � war or any act attributed thereto; services and facilities provided by or in govern- � ment owned or operated institutions; cases compensable under Workmen's Compensation , Acts or similar law; cosmetic surgery other than restorative surgery; suicide or ' ' attempt thereat; rest cures and custodial care; chronic dialysis for kidney failure; ' transplantation of organs. COORDINATION OF BENEFITS - This limitation applies when a member is also covered by another health benefits plan incluiling Health Insurance for the Aged under Social Security ("Medicare") . When more than one plan exists, one plan normally pays its • benefits in full and the other plan. pays a reduced benefit. The hospital and optional indemnity benefits of this plan will a�ways be paid in full or at a reduced amount • which, when added to the benefits payable by the other plan or plans, will equal 100 percent of the allowable expenses. Allowable expenses are those at least a portion of which are covered by one or more of the plans involved. , � THIRD PARTY ACTIONS - If a member is injured through the act or omission of another � - person, GHP must be reimbursed to the extent of benefits provided under this plan immediately upon collection of damages by the member, or GHP must be subrogated to the member's rights against such third person to the extent of benefits provided under this plan, including the right to bring suit in the member`s. name. � PROOF OF LOSS - Hospital and out-of-area medical indemnity claims should be reported to GHP within 90 days of the date of expense. However, failure to furnish written proof of claim within that time will not invalidate or reduce any claim if it was not � reasbnably possible to give earlier proof, provided written proof is furnished as . , soon as reasonably possibly and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required. � , The hospital and out-of-area medical indemnity benefits described herein � are underwritten for Group Health Plan, Inc. , by MidAmerica Mutual Life � .Insurance Company, 2500 Como Avenue, St. Paul, Minnesota, as evidenced by , ' a master policy issued to Group Health Plan, Inc., which may be seen for . ' inspection at any time on request at the Group Health Plan, Inc. , adminis� trative offices. • r ' ^ , : . '2� � - • • - , . . . , " , �,,5-,�►� ' . _ � � . . ,� HEALTH BENEFITS AGREEMENT . � _ . . . � - QET4JEEN � � � ' ' ' " GROUP HEALTH PLAN, INC. , , . AND � . THE CITY OF SAINT PAUL ^ Group Health Plan, Inc. , herein called Plan, hereby agrees to provide . . - to enrolled employees, herein called members, of the City of Saint Paul, . and Independent School District ��625, herein called the City, medical, - � . � surgical and hospital benefits, in accordance with and sub�ect to the � provisions of this agreement. . ' In consideration of such benefits to be provided, the City agrees to � remit to the Plan through the City's administrative agency monthly premiums on behalf of its enrolled employees. , ' 1. Term of Aqreement: This ,agreement shall become effective on - January 1, 1968, and will continue tm til January l, 1969, and will � be renewed for additional terms of one year each from year to year thereafter at the option of the City. The Plan, however, reserves the right to change the schedule of premium rates applicable to this health benefits agreement or request cancellation of such ' agreement, upon delivery of notice in writing to the City on or before the first day of July preceding the next following yearly term. Notice of cancellation by the City shall be made on or before the .first day of December in any yearly term. � • 2. Premium: The amount of each premium payable imder this agreement , shall be the aggregate of the several amounts with respect to each ' member enrolled hereunder at the time such premium falls due; and the amount so payable with respect to each member shall be determined according to the benefits for which the member is enrolled and the . , , � premium rates applicable to such benefits. Such premium payments � • , � .. shall be made to the administrative agency on or before the last day . . � � - • �, of the month, for each month while this agreement is in force, with • , � • - � � . respect to all persons named on the eligible employee listing main� ; . • - taine.d by the administrative agency. Any employee availing himself � ' , . ' . " ' of early retirement and who remains eligible� for bene.fits hereunder , � _ - � � as provided in Section 4 of tliis agreement, shall make the required ; . , • , • , premium payments directly to the administrative agency on or before . � . ' � the last day of the month beginning with the first month following ', � _ the month for which premiiun has been last paid by the City for such , ' . , ' employee, and for each month thereafter while this agreement is in • �� ; � . ' � force and un.til such retired employee reaches age sixty-f�ve (65) � ` and becomes eligible for premium contribution by the City for such , • retiree benefits. Monthly premiums under this agreement shall be . - as follows: , . ' . . � . ' _ ,.. • ' ' � -, • . , - ' • � , - Premium ' . . - . . Employee � " " , $11.55 � • Employee and family ' . $38.35 . _ • . _ _, � � � Retiree (under age 65) $10.95 , � � - Retiree and� spouse (under age 65) $21.90 • ' . ' Retiree (eligible for Medicare) � $ 8.85 , � . ' Retiree and spouse (eligible for Medicare) $17.70 . : " . , ' ' \ , • '. _ . . Benefits for a new member or for additional or increased benefits - � ". ' . • � � for an existing member which become effective on or before the • ; • • ' fifteenth day of any month shall be provided on the basis of premium � " . paymenC for the full month; 'whereas benefits for a new member or ' • - , . • ', . ;.. . : ` . , ; .::� , :. '. , . ' . . _ • ' '.EXHIBIT A . . _ • , . • � . 1 • . � .. ..• , •.� ": �' � . . , : . : =�. .' , � � : . �,' . ` . �`• •. • � • " ' •/ . ' ," �, / �,. ..� '•••. , �., ` � , . ., ..*, i ' ' . • , , : • . , � , � ', . 1 • • � . . � • . . . • . , ' • • Page 2 � City of Saint Paul - � Health Benefits Agreement . for additional or increased benefits for an existing member which � � . become effective after the fifteenth day of any month shall be provided for the balance of such month without premium therefor. , T'his shall also apply to family benefits. • 3. • Grace Period and Termination: A grace period of thirty-one days, • after the premium due date without interest charge during which • this agreement shall continue in force, shall be granted for the � payment of any premiums due after the initial premium, provided the City has not previously given written notice to the Plan that this • . � � agreement �is to be terminated as of the date of such premium. . If the City fails to pay any premium within the grace period, this • ' ' agreement shall be ,terminated at the end of such grace period, but ' the City shall nevertheless be liable to the Plan for payment of all premiums due and unpaid, together with the premium for the grace period. If, however, written notice is given by the City to the . Plan during the grace period that this agreement is to be terminated before the expiration of the grace period, such agreement shall be � • • . terminated as of the date specified by the City or the date of receipt of such written notice by the Plan, whichever is the later date, and • the City shall be liable to the Plan for the payment of a pro-rata . . , , premium for the period commencing with the last premium due date and �� ending, with the date of such terminat�on. . The termination of this agreement shall not pre�udice any claim • , originating prior to the date of such termination. • 4. EZiqibility of EmpZoyees: The City, through its council, shall have _ sole responsibility for determining; (a) the various classes of _ employees eligible for enrollment under this agreement; (b) the dates - � upon which such employees shall become eligible for benefits; and (c) the continuation of eligibility hereunder; as reflected in City � Council Resolutions, C.F. Nos. 231269 and 235219, and amendments . . - thereto, and the Plan shall be boLm d by such determination. Provided . , ' , further that any employee�who is a member of the class or classes �• . , : � . , of employees authorized �y prior City Council resolution for retiree . , group benefits upon early retirement, shall, upon availing himself � , ' ' � , ' of such early retirement, be eligible for the retiree benefits � � . . � �, . �'" _ provided hereunder. � � � On or before the last day of each month while this agreement is in • � , • ' force, the City shall furnish to the administrative agency the , ' � • � " � names of employees to be added to or deleted from the list of �, • � . - �. employees eligible to receive benefits under this agreement. , � ` . � � Mistakes in the list of eligible employees occurring through „� � � • � inadvertence or clerical error shall be promptly corrected upon . , �.. � � • ' ' discovery of such mistakes and proper payment of premium shall be . • ,• .� ", made by the City and refund of premium shall be made by the Plan, ' • ', • : " ' as the case may be, provided, however, that if the Plan shall have � ', � provided benefits before receiving notice that the recipient was not • � �entitled thereto because of such mistake, there shall be no refund of . premium in connection therewith, unless the Plan is reimbursed for , such benefits. � . -- . � � " • Senefits for any employee shall become effective upon his eligibility " . - � ' ,- . date provided prior written application for enrollment is made. If ', . written application is not made until after such eligibility date but . � . - . within thirty-one (31) days thereafter, benefits shall become effective � - � on the date application is made, If written application for enrollment - � � � � is not made until after thirty-one (31) days from such eligibility date � � � , benefits shall become effective on the date application is approved ' _ .- by 'the Plan provided satisfactory evidence of insurability in writing . . - . - is furnished by such employee. ' . . " - . . � .. If any employee is not actively at�work on the date his benefits .' : , � - . . would otherwise become effective, such benefits shall not become „ • • � effective until the day he "returns to active work. �" • �. - - - . . , , „ • . ' ,. • r , „ . .�. • • • � . ' • . r. ; • � ' ... ' . ...' , . . � . � ; ' , `` � . . .. ... . . - . . . ' • ' �Page 3 • ' - City of Saint Paul Health Benefits Agreement ' . , • . , 5. EZZCJZX)ZZZtt� of ErrrpZot�ee Dependents: An employee with dependents . � . , may enroll for family benefits. In such event benefits for such , dependents shall become effective on the same date as do the - employee's bene�its. A dependent acquired after the effective enrollment date of an employee who is enrolled for family benefits shall become eligible for benefits on the date he becomes a dependent. • An employee enrolled for employee benefits only, who later acquires a dependent may, by making written application to the Plan, enroll for � • family benefits, and benefits for such after-acquired dependent shall � , become effective on the date of appli�ation, provided such application ' • was received by the Plan within thirty-one (31) days after the � date such person became a dependent. If written application is not made until after thirty-one (31) days from the date such person became a dependent, benefits shall become effective on the date - application is approved by the Plan provided satisfactory evidence , � ' , of insurability is furnished in writing for such dependent. ' � ' If an enrolled dependent is confined in a hospital an the date that • his benefits would otherwise become effective, such benefits shall • � not become effective tmtil such dependent ceases to be so confined, except in the case of a newborn child who remains hospital confined . , following birth because of disease or congenital abnormality. � A dependent for the purposes of this agreement shall mean an ' ' employee's (a) spouse, and unmarried children to age nineteen (19) " ' or to twenty-three (23) years of age if regularly attending school • � ' at an accredited institution and dependent upon the employee for more ' - ' than one-half (1/2) of their support as defined by the Internal Revenue Code of the United.States and who qualify in the current year for dependency tax stat�s or have been reported as a dependent on the • . member's most �recent Federal Inaome Tax return. • � ' 6. Termination of IndividuaZ Benefits: The benefits of any member , ' shall cease on whichever of the following shall first occur: , a) the�date of termination of this agreement; or � , � b) the last day of the month for which premium has been � ' - - , ' paid coincident with or following the date of employment ' - � . ' ' • termination, except that a member on leave of absence � � � '� • � • approved by the City, or layoff, shall remain eligible � - ' - � , . ' for benefits hereunder 'for a period not to exceed six (6) • ' � , . � � � . consecutive months during such leave of absence or layoff, � , , : • . by making the required premium payment directly to the ' , "� ' � ' administrative agency; or . , • • ° �. c) the last day of the month for which premium has been • � , - � ', paid coincident with or following the date on which . � , such viember retires from active work, except when such '_ ; . _ ' , . ' • member is eligible for continuation of benefits as a . _ , '.' • � � retiree heretmder; or • d) in the case of any member who fails to make his premium . ' contribution, if any, when due, as required by. the City, , � benefits shall cease on the date of the expiration of the last monthly period for which such contribution was made�,. • A dependent's benefits hereunder shall cease �on whichever of the � . following events shall first occur: • • � � . a) the, date on which such person's dependency ceases; or . • i b) the date on which the member's benefits terminate. � . • • 7. Conversion PriviZeqe: Any employee whose eligibility for benefits - . hereunder terminates, shall be entitled to have issued to him without • , evidence of insurability, an individual plan providing up to seventy _ (70) days of hospital benefits, and comprehensive prepaid medical- �". � : � ; . � , . , • . . - .; �' � � . . �, '. � , ' `, , . , . `� � ' .: .' - � . . �,• ' . . , . • ° ' P a g e 4 . � . � - City of Saint Paul Health Benefits Agreement • � . . . surgical benefits as customarily issued to individual members, � � ' _ provided written application therefor and payment of the first � premium thereon is made to the Plan within thirtyrone (31) days • _" , _ • after the date such employee's benefits hereunder terminate. . � 8. Riqhts ShaZZ Not Vest: No provision of this Agreement or the - � • benefits provided for heretmder shall vest in any employee rights . � - ' which would prevent modification or change of this Agreement or - ' - � � the benefits thereby provided by mutual agreement of the parties ' , • " _ - hereto. "" ' . 9. Bene its: The benefits to be provided hereunder shall be as set . , forth in the Certificate .of Membership, a copy of which is attached hereto and made a part hereof. ' . 10. Inconsistent Provisions: This agreement is made pursuant to the City Health and Welfare specifications, the advertisement for bids, • • Formal Bid ��2528, and the award of contract, and this agreement shall be interpreted in accordance there�vith. It is mutually agreed that if there is any ambiguity or omission herein, the specifications, • advertisement for bids and award of contract shall control. � Executed at � this day of , Z96 . . � , - . GROUP HEALTH PLAN, INC. , ' � � - � � By . General Manager Accepted at ' this d.ay o f , Z96 . • , CITY OF SAINT PAUL , By . • , • • COUNTERSIGNED . .' • • ' . � � ' Mayor �' ay � - : . � Comptroller City Clerk ' � � . ' . � ' � ' � , � . � INDEPENDENT SCHOOL DISTRICT #625 � , . _ . . ; By . , . , .. . ' . .. .. � . ' . '. , • � Chairman , - • � � . . . : � � � ,�By � ' �. � , . • Clerk � .' .� �. � � By , APPROVED AS TO FORM AND EXECUTION: . Treasurer , CITY OF SAINT PAUL ., � � �• � , � � � � •Assistant Corporation Counsel �� , _ , • • ' � ' INDEPENDENT SCHOOL DISTRICT #625 . . • � , ' � ' . . Attorney for School District • , ,� � ' � � ' ,' � _ • � .� . . � � ' � �