The URL can be used to link to this page

218392 `P_ ! w 3 � ORIGINAL TO GITY CLERK M � . �� , ` - ` CITY OF ST. PAUL FOENCIL NO. _ ' OFFICE OF THE CITY CLERK COUNCIL RESOLUTION—GENERAL FORM PRESENTED BY ' - ' COM M I551 O N E DAT RESOLVID, That the proper City offieers of the City _ of Saint Paul are hereby authorized and dir�oted� on behalf of said City� to exeaute Amendment� between the City and The , Minnesota Mutual Life Insuran.ce Compa.ny, to the City= s life insurance group poliay, Group Poliay No. 2881-G� said proposed Amendment to agreement being marked "F.xhibit A" and ineorporat.ed , l�erein by referenee; and RESOLVED FfJRT�ER, That t�ie proper City officers of t e City of Saint Paul are hereby authorized and direeted� on beha�lf - of said City� to egecute 9mendment, between the City and the S�. Panl Fire & Marine Insurance Cc�mpany, to the Cityts group Aecident and S�.ckness Policy� Policy No. CEO 9�8, said proposed Amendment 'being marked "Fzhibit B" and ineorporatec�. herein by referenae. � � Council File No. 218392—By Severin A. ` Mortinson— ' Resolved, Ttiat the proper C i t y officers of the City of Saint Paul a;e hereby authorized and directed, on be- half of the said City, to execute Amendment, between the City and the ' Minnesota Mutual Life Insurance Com- pany, to the City's life insurance group policy, Group Pollcy No. 2881-G, said proposed amendment to agreement � being marked "Exhibit A" and incor- porated herein by reference; and Resolved F�rther, That the p r o p e r _ City officers of the City of Saint Paul are hereby authorized and directed, on behalf of �said City, �to execute ' `� Amendment, between the City and the " St.Paul FYre&Marine Insurance Com- pany,;to the City's group Accident and Sickness Policy, Po}icy No. CEO 920, s a i d proposed amendment being marked Exhibit B" and incorporated � herein by reference. Adopted by the Council,May 28,1964. Approved May 28, 1964. (May 29, 1984) � FO APPROV D � �� sst. Cor�oration C un�el - �� a � COUNCILMEN Adopted by the Council ' 19— Yeas DAI:GLI�I� Nayg e�o rc� ��i� �$ '� Holland � pproved 19.— ,�, � In Favor y��Z,'�� — Mortinson ` / "r�• , a � Peterson '`� ��i��, yor A gainst " •, C�, '�osen " - r Mr. President, �is– �r– : . � � � SM �j.(j] � .a• � ��p� DUPLICATE TO PRINTER ' . • ��„�'ta�� CIN OF ST. PAUL couNCi� � " OFFICE OF THE CITY CLERK FILE NO. � _ COUNCIL RESOLUTION—GENERAL FORM PRESENTED BY COMMISSIONER DATF __ f RESOLVED, Tha-t the. proper City ofPicers of the Cit� of S�int Paul are hereby authorized and directed� on behalf of � said City� to egea�te Amendment� between the City and The I Minnesota Mutual Life Insurance Company, to the City�� life insurance group policy� Group Policy No. 2881-G� sai� proposld Amendment to agreement bein� marked "E�hibit A" attd invorporate8 �erein by reference; and I RESOLYED FURTHER� That the proper City offi�ers of �the City of Saint Paul are hereby authorized and directed� on be �alf of said City� to exeeute Amendment� between the City and the� St. Paul Fire & �Marine Insurance Compeny, to the Citqes groupr �c,cid�nt and Sickness Policy� Poliey No. CEO �0, said propos�ed Amendment being marked "Eghibit B" and incorporated herein by� , r�fe�ence. � . .��, � :�:;:, � ,u-�. COUNCILMEN Adopted by the Council 19— Yeas DAY..GLISH Nays � �Co,_u�-� .,.:a� �F': ��-'�- Fiolland Approved 19— �oss� In Favor Mortinson Peterson � • , 11�ayor �� A gainst Mr. President, V�� S M (j-(j 1 �. � �`. ..✓ _ - '- - — `+' - '_�xao�` a 7 �— ._...._»..�.�..��:..�� } � .,._�_..._....�.. - - ---�--__ � - t . ;oaax,l, . +o�3x� � �.. , �� %�`�: ._Z:ti 7e�. ' 3; :.:t �::. ;!�'? tl_ '-Y.i..l",,�.1.'i7 r ..�,u.. sJ a� "g ' • t t;'' �'tf�- �w' ' .�:�,.i!'x''�•;n v 7 V'�� ' . + , ��= (�,� � � �r.� Z,. �e� l'•. ..u.:j��'��:� �, �[,�rJ � 'C+t�- �r �N j� ��i.�.. '�l � �u'_i:�,�i•� �(W .ii'% ° '�r�ar �(?'^�J. t 9•.,Js?:��, r� i• h�� . , �, °• s7 y..J!s<�.i.." 1 t��.;��•1-. � .�4}`lrx aaA•.�T^t1' �*, :r ;} 'iS-,�� ',.•-Y:��_.. .�~iJroin�^ {l P • �'yl� w';v i�'LNAhV��i4{� .c."��1;,�,:11��c ,i �'� , _✓�r '1�� r�:� �aLi•�t �r _+1, ; �% .^1. �r ' .. � �� . F. .,�� ,, � ' f �.�`,,,1 " � •�, ,��, `�� , � F' ��,i'� �y�,e� r�f`..'� ; _ r �":` � /�rL/'V . • , 1 iy�4•' ' �i}.�i�t ��r�U��•( • �F• !�i�) ' � - �r; '�;:� :�.� �� '°� `i �� ,t:. � �� .� �.� � � �� -..;� , u; "��l�. . . �''j:. ,.'i ��,, ^��'; • • � � '� ,Vr�' t7 ❑ " � � � ''L's ��E:: �•�1E '� t..l �.!�,i,� i ! ir `£'� IF`Y��S'' '�,F� 11 ik�:��; (O�GAPdiZED �aso) , �.,�- �;; • ,i; 'r,�i.' , •;��, ,; � ; ,,- ��< . , . , • AidEIV*Di•�..�3�I' , �3;�' ') . I'-��J'�'`� �'�� `' ' • i �} � "o be �tt�.cl�ed to aac] �ade part of Grouv Policy No�., 2881-G issued by T� MIPIP?�'SCT�s'�� i� � i t'��' ,� 't. �:% =:'v'3'uAL LIP'E II�TSUF,i,idC� CO?�AI3Y to CI'I'Y OF S�. PALTI,. ��'�" ,` , �l> ?��s•; �r;�� i�� .:_%`� l.. On p�e 1 oi' the tiolicy, the second paxagr�ph bas been a*ner.ded �o read as ri��•._ 'f ' ,' ? � ��`.�� folZows, effective Jsnuary 1, 1g54: ``'� �� t !, i,�:.-, � ��''� -�i I.• Tt,, �;r;, � ' I; 1.� �� '``�" "This Policy �t�?ces effect on �h� �irst day of �larch, 1�58, w�ich is the datc �;;t.�.;' . a,,. �� • of issae hereo�. Policy anniversaries are dcemed to occs.0 on t;h� first day �,�,��'';�� !��`°4�� ot N�ch oi ee�h e�r du±'1 the ears �g59 throu � �953 inclusive cnd on <"{`;'� " � ,�,,..;; Y � � Y g- s �;�'•,='.� - . '' a;:• i.he fir�t day o_° J2nu�r;/, be�inn.ing in 19b�. Tnis policy m�� be rzne�•red sE. ,.; , . �: ;,-. ��,�,_ �� :;��;s for successi*�e �erms of on� ;/ear each, sub,ject to the provis�ons, conditior:s, ��;:;.'• i+ ' -:,��•- � s�t�' ;• �, ��'� linitat�ons and e�:clus3ons con�ained in tais Policy and t�e ti.s,�ely ps�m�ent ,. I::n. 'S�%�''.�i ; ifr• �;`: o� t::e montY!ly pre�i�ms." . ,:.�.,i , Il ;,ic,? `f�'1,��;I ;v h4,�,; 4. On•nage 5 of tne �licy, the sec�ion entitled, "Gr2ce Period--Ter�in2tion of �;;';;;:�� r• �-?�=�� Policy" bas bzen ��nded to re¢d as follows, effectil7e Jar.uary �1, 1p6�: sf:' � '! "j�'?V' �'i; ;`' . IE �;.jl;� „C�.4C� PP�IOD--T��PfL.dP.TIOIvT OF POLICY � '�;:F',;'j ' I" ,:�t•t . �'�t=�.� i �,, r:,... • E..,.:i;. I: "f:{,; A grace peY'iOt'. of thi_t�-one e�ys, withou� interest ch�r;�, �,i11 b� allcwed sz,.%•� �� c��.• �:+. "; . �r ,`j;'� for th2 payW�nt of each Are�iva� except the first. If any gremiu� is not }„�.,,�� . ,� a�;: psid ,rithin t::e da.ys of orace, the policy shall terr�ia�t:: at t�z end o� such ��t"�'? ��, �::?�:'•: �race period, °fcept t:�at the policy may be termin�ted on a� �olicy anai- y�',;,.`�.,� ,�i ��ers�.ry i� ts�e E�pZoyer �zkes writter. reqnest for termir_rz�ion on or bePore `��'� '�!� *. �� '� the D2cember 1 i�r:��diately preceding such policy anniversary. If the polic;� y;;�• �, ��' �:.A:.. ��: ;�i;��, t,2?'mlriat',.^s �durin or at �he en3 of the race , '�^�p 3*= �� °'"�� , g g period the ,1,., lo r sba.7.1 be �;•-•;�.; ;:,��:.c5 li�ble to the Ceyp�.r�,r for t;�e pa��men� of a pro rata premii:m, for t�e tine t�e c?;_;•�-:I , ir.- .<,►_,; " ,.�.,• I:� '_�� • policy �,��s in fcrce duri�g suc?� a ace period." �.'- ,��• c. -.;,;; t�:.�, :F i�• ,' '" sii -,:,r. �[,• ;��s�° �. On pa�e 3 oY tre Sup�lemental A�rce�ent w8ich was issued to Policy I�'o. 2881-G,'�'ti;-.,';j I� �'�� -?;,� under the section �nti�led "�,ffective Date of Insurance", the �irst par�.�r�n:� 7;i�. I�4-r'"'•• has been �aended to rea� as �ollatas, ef�ective P;;zrcb l, Z�62: �:�=; �� y;. � . . �� a ' '� �j�.' �� ;;i�_`,{ ;� ��,ti:,, 5ub�ect tio the fur�her nrovisions o� tY:is section, fr� , !I I�: ;�•:.: �='� _ ' . .�•, ,` �a''' ``i�' ' �� :;: 1. The iLSZruac� under this Supplerrentrsl Agreement �or e4ch dependent of �r.., ;� �� ';.}�4-; �n insi:red e�plo�es �rho m�kes application wit�in 30 d�.ys s�ter becoming 1.�._� ..,� , �C :T�;-; elioible s�all become e�fective on the later of tne �ollowing� �;,�r.'..�y ;�• �r. ;t,ti-`. .��f ;, � '� � �•,,,,:I '� '�s ':' . • 'i�yi ' '� '` �. �r i� . .GS:.:1,�•',°r.,-; ' �I , ' ,��Y?r.ylxv�NW/'rNN^�`:;�'::Y:�K'rfl4��/� f+M �•1v ��M ay��V�.Ml�nnti�nM'WMLN.kUU;��1v• , , VI� c +m�J+.�N ��W'y"�Y�.� :�:S`�^l.!:��...`._ w .wf,� ^' �I: ' �L r_w... � ..'..�`.*.�-�,�-�;T ��= ._ ±v^Y ...... -«�:.�:;:'�� !, ;r�ti . � r.2_4�7tll�2.�••.,;r�+� .�1•'��-��."�.'rf't.y,��v,'a;EFff�✓��7�::4�`�`'r� '1��.��;rrL 'Jr-'t�•+�:°'��f�r'''i�r� _"7 t ' �';•':t'�(+•�:�'��'~' f , , '�i,,,`�.�t.�u:(�:�:�^s':,•.�,i:_ G°, l. •�l`v °�`u.� , v, �-�:.. �'tc;`": C:3�c�--::.�,�,�r` � .�•• .� :i .l' .r' \ �r... ��i:t�k:F,✓�V��s3�ar�:��.:.T;-/:i_��..... 7,.y'<��..�� ., a: �;:��/':.U.`�."��'__. �, • . . ' , �-.--�- ---_—'_-- - =_•la'—°------"�'--__._._, . . ...' "' - " " .. �N�7 CO�Y��rc-.�+,�1— - . �C�X��I XERO� - ��Etqy N.'r � �• - 'J� �T' . e .`�i. COPY(�f � (�d f�pF�� , I'J F+ ( � � � � ,�� EXHIBIT A f� ' � ,, . ' ' , _ �,! �� [())'`��.,.i :�.�: �.,u �r�s � ✓ .' .: ,� , ___ �.��ArJOJ� t' j AdO��. .r��..w....+....,...�.�•.Y.....� � � , - • . �Olf3Y.� . iOH'rJY ��' t � • . � • -�. . .. • ' _ . • • . . � ' ' �' .'`hl -'�1��.'� _r--t�� = �a f��Cy,n L: �,.?'��(i� �_ '� ''r.� :.'f �stc�:zjCr<r=' fi =.�1. �'�,�� :T '�u-��'��F�?l� '^t, t. ��"• -��-�a`:��'i.�ti�°'cM`4'1r.+_F.,�l-�i: `�1i.t�; .� .°!Y^,:� 5�� r ��s�..'4, c4'� .,`5., 4��'`'.�`�;.L,-_9i'�:�, i�"'t�^�tj 1�•�`�C . !• �A,f ".-�._._.. ' qf:°. .;:, . ':'J�.Y.-�.ra: _ ._��.y.�+��•J � ' . �' 1 t�I� �:;:- �n .!',�+,w+ F•" � n, ,�rI„"_;'P'f ' �, '�: '.c;atn,i.�ti.hw�f`u',iw�:r'J?"r��i,t�ivu�,�ww��w�n"w1c.+n��v�iNwwv�f�'n;wv�Lw�'��w'��,�v�,�,�v,�n;�,vt��,n,w"'i+�'��.."ti.��r'+'��''�� :;� . `. ;'a1. �y;,'�. ,, �`, .;t;: :/� . _2_ � ��;y.: =:s�� (; . , •; . ,t ��r' y �4-�:. .i .t` ;!ti � � • � °l:'.j � �1' ,';:1'= �a+- � o � �:�^'�r- �. a. tne d4�e tre employee h�s m,.de written request on ,� form approveC �� • ��``�.�'�� by the Compa�y for the coverage provided by this Supple*eental �:?:�'� �. '•, � ;.:�;, ,��=a�:, P.gre�ent; . �#.�, - ;�� 'ts � . `�: .C� 'a, �! '�� b. the d�te 75� of the insured employees With dependent� i� t�e �h;;��;; � �`� =�°'' e��alotiee s p;x,j-^oll unit eques`t t..e coverane nro�_a�d by tn_s `, ,_;.�, , T � ,, ,. �, n ; t �' ;� ,`! ; `�`�� Q ��e��nt or � of a?1 ins��ed em i o ees wit�+ �e �nc?er_ts re uest �� ;;,,"�;; • �"" 75� P- Y P� q� '`�r�� cover,: ovided b this A ree�ent. f '=�• • f. 5•'•: �1 TG l• � ;�;: �- F- Y b �� :;' ; •` �� ►'.��ti� ,;t:; ,�. �';� 2. Tl�e insurance uncer th:s Supnlen�ntal Agrecanent for each de�endent of `_ �' � � , :j��;, an inS1LT'ECZ era�loyee shall be sub,ject to evidence o� i�surability, �, ; �,� • •��:'�'.`�� inclu3i�g �ood health, satisfactory to tbe Campany �t no extens� to {�; .' � ,� ::��.; .� � �� ?j�:; it in t�e �ollot�rino c�rcumstances: �, 1;i ��F ' �t� ,�i., �d�� . _. ;; �;;, a. tY:� empleyee nc.�_es writ�en application on a form �pgroved by �he `;; '� � ,.;. �•; ', i .,;�t�:: Comp�ny��ore tban 30 d4ys �,fter h� becor�es elig�ble for th� cover- ;:�i � � ', ,,�:. # :: _ ; a:;;?:; a�e provided by �his Supplenental Agreenent; or, �,�'- ; . . � . '; '?":. ' fs; ' - �' y'•''' b. less tha.i: 75�� of the insured employees wi�:� dependen�s in the �:i' �r:•,, , ;,. ,t, ,��, ,��'t';; e��loyee's pa;�oll unit request tbs covera�e provided by tY:is �•;�;,�•. �i' ��`�' Agr�e�ent or less thr.n 75�� of a1Z insu.red e�plofees wi�h de- ��,,,' .�• ��' pen��n•ts raquest coverage provided by this,A�reemeat.° f:� ' +' � ..,�•. . <:�{,; '' ,r ±;;•,' �:;, . +� ^' °reed to by The bfinnesota Vutual Life Insurance Company t'�is 30th day o� �,�, ' ':` r;i,• ..vice�ber, lgb3. , � �a � .. ;�. �!'�' . . � � / � `4�k �: : i� ':�-: �%"./�%� .�r�%'_� �;�; '! :(, �;�� . Assis�ant Secretwry*�;�,. �� Y.' ' . ;, q w �,►. . 'i .,ir'. • $j;: � , ' j,,��:�. P:�reed to by City of St. Paul tbis day of , �96 . �;�,;r,_ � �. c• _" ,* , , !i� ,,�{; 1.° _ t r. ;i; �' `�„ i%J, 1�:�:� � , � <�! , ii "E' . " . , , . ,. T��/Ol' ��Q,.t;,:, : '-• . f�+t`;'• ' ,�, ,�q]j~� • . ' � ��' ;-�;• �� ";% �'a»atersigned: • ComptroZler ��'. ��•�; - ; f'��. �;.';��•. . ;f ��:,,' . . . . �}F�:r., ir��+,;: • � , � Ci�y Clerk �:i;:;`'I` , ' •� :``� . � . ' • ' �'��;:''� � . ,i. :';�, !:�proved as -to �orm �hic � " � day o� , 196 ��,� ; �Yy�r"' � {�:1 ��. j`' •�•�Y'r`,.. � � 7��G ?a' i � :, � , . . ' ::z1K:�S';. i4�-�;�: ' . � • - . . �� . �� ` Special flssis�aat ;:� ;;�;' ;E,a.'�:'` ' • . ' • Corporation Counse� . �=;��'`;:�� . , . f'�'�� . �� .+� . ! ,��} �, o fay i. '� :i': �� 2W��`r/�. �fZ'�1=, ,. { - ,IS �= ,i l i �� %� . �� . 1'� ;� ' :Tti� ,N :Vl1 Ml�M'IMf6'IV1:�Vl^:11Vl�"C�,J•'Ll^�^ 1:" l,-ri('�>,`-,� • " vuv��v 1^-'L"w,M/y.I'Yti� i AM!Lv�fnnr��"1M 'ri'�'1�'VYfrt1't 1�.'Yri /� �.,'.� _` ..,'�.'✓wi"l�.r3y+v�y,�,•?,"f,'�!:`L:9.. ?.'�`1.'...5,�«.r�r�.rf..+.-`�_•'.'L+'._..�� ...��`�«.�f...�'_.�''1.7'�J�."��:.r.w...... _ f'_..1%.�+`. ��+,� ` � . ' �F:, �^,_":'�rt:��'�:R;` ':?;'r''r;%c�ir�a�'LT:".:'�^.:'a: �i-��'��z.��'�(yr�� " ,:ur.:,=T'�'��/r�� ' .�:':��f%`\'••�`.,^:l}�.._��.-'�i��e,�` , ��_.��;a'v rfn''.\i :it:`'.�L'--�:.v- ��'��;is��I 0 7i ++rr^''i.c•`' .A,..9 j'_��'�. (\��1..rt,,,,�+�ti�=�bJ) ��'-,-�e`;��f'l.s-,�[��}�r 1,, � ,. . .....�....� �L... ..�� .�...� At 1 f/ii+_ �LC.�.wL��'LL.i�...�,�U:..:�..2. .1��a� .lY ,.:4].C�...'J� �:T�.::....� ..�r . „�,Y . . . .. ..v ... �o i - - - � !x�o: ,_ ,� ,',., .. �, ..--.._� , ' N--, . . COPY� � .I., . �� ._..� �; ��,.�.,f:.., �� f� L�� ' . .. � o • . $J :,• �% fr ; , +r'1 � �} t[�J , ��'j M� �� %�J (, � � .+� _....... � 4J AdOD --�.�.�_. �F��.1 Act00�•w•--.�.__... - _ _ — _ ��_ _ :�, , -� . '��t�� 0�3X' .�]r ' AMEPIDMENT ' �roup Accident �r_d Siclmess Policy CEO 920, issued to t.�e Ci�y of St. Paul, eff�c , - �j ve March l, 1958, is hereby altered a.nd a�ended as folloVrs: l. 73'ae first para;raph describing covered medical e_-coenses and t;lie sections " en�itlea, "�ductible Amount, " "Limitations" and "i�clusiens" appearing , under Part V en�itled, "hiajor Surgical-N!edical �r.per_se Eene�i�s for �a- ployee and Jepen4�nt �ccent on Account oi Pregr_ency" �.re hereby deleted and there is substituted in lieu �hereof the fo7lowing: 4he Co�pany rri11 pay indemnity in the amount o= 80� of covered r�edical expe�ses, as hereinafter defined, whicn are incurred by �n employee or ' _ ' @ependent because oi' such injuries or such siclmess durin� any calen- • clar year,�nrovided such covered �nedica,i ex�ienses exceed tn.e deductible � amount applicable"for that cale�dar year; but the a�grebate of the bene- • fits �ayable under this �ro;rision *.•rith respect to a.r! e�loyee or dependent • during such persor_'s er_�ixe li�etine sha11 not exceed the n�:.cimum benefi� hereinafter s��ted, �anethe'r or not there has been any interruption in the � continuity oF the employee's or de�enden��s insurance heretznder. Zne deductible shall be equal to the sun of: ' • (1) Ziae amount o� benefits pa,yable for covered PQedical �roerises under � any and aL otr�r covera�es vrovided under �his volicy i.-1C1udiTlg any futuxe ar,iendment or revision thereof, and . ' (2) P. czsh deductible of fifty dollars (�50) anplicable to eac� insured - person, excent (a) a r•saximum of three deductibles t•rill be a.nplicable to a.n emnioye� and his dependents rrho are insured under the sarae Certifica.te • of Insurance a.nd wY!o incur covered medical expenses �ri�hin the s�ne cal- • endar yea_r, and (b) the deductible araount wi7.]. not �.pnly to covered sur- . gical charges. , �e deductible z�ri L apply each calend2x year pro•ri�ed, ho;•te•rer, tha.t any � covered med�ca,7. expenses (for which benefits were not pai�) incurred during t�ae last three mor_ths o� any calendar year �aay be anplied �o*.•ra.s�d the cash. deductible �ount for the next calendar year. �e I�a.r.i�um Eenefit payable to an e�mloyee or dependent insured un�er this benefiL sn�.L be �n �ousand Dollars� (;�7.0,000), except tnat if such en�loyee ha� previously been covered as a dependent or such o.ependent has roreviously been covered as an en�nloyee under this policy, the IYiaa;imum • � Benefit payable to such ernnloyee or dependent sha?1. be the a.moun�� if any, by which the Naximum Bene�it e:tceeds the anount of a11 benefits nai.d or payable witn respect to him under said em�loyee's or dene�dent's coverage, . ' provided, hoti:ever, (1) when a,n. �,�loyee has received brzymer_ts under this � benefit ar•�oun�in� to One Zrnousand Dollars (�l,000) or more he ttay have his r��a:r.imur,i Eenefit r�stored by (a) fur�ishiag at his o;m ea�ense to the " Comnany, se�isfa,c�ory evidence o= insurability, or (b) co�pleta.ng a con- . tinuous sir. months period of full-time active yrork for �he employer, a.nd (2) k*nen a �eper_aent has received payn:ents under this benezit amounting ' ' to One �iousand Dol].ars (,`�pl.,000) or m.ore, such dependent may have his i�laxinun Ber.e_i� reatored by (a) furnishin� at the emnloyee's e_mense, . . �...�� EXHIBIT B � ` x�.R�t .. �.... . .,. ,_ „� EX RO�i.. :,�•..Y. a.-,..>.r.e—v-...�-c-•-�.-s —,:..,....'....-..w �e�'XERp�'., �, n-l+:n� . .��.�� • . , - <<t�� i.��Ray —._'_ . COPY ; COPYt . -' . _ . y�' . ,.p.�,.. ,, {�'� �plR. �F � � r' ,-�1• ��`.y' :� ��'- ` _`3 �',� � � . ` �;..� ;�•;� - �, :�.; � . . , _ �y , . . �`,. � ,' �� r ., i.� ,.._s. �.. AaOD .�r ...i AtlOD - — ° �--' � '' . _ y�Ya..,�.,X� • IO`a,,..3X7 . `��' � i to the Co�pany, satisfactory evidence of insur�bility, or (b) .comnleting - � a period o� si.ti consecuti�e months during which such dependezlt has not � • received medical care or treatment and has t�zlly enga�ed in the activities � , of a normal person of like age and sex. _ • Hospita]. charges or charges normally ma.de by a hospi�al for ca,xe and txeat- ' . ment �,;hile con.L°ined as a registered bed patient are not considered Covered Medical �xpenses. Covered I�iedical �oenses sha.11 includ.e tre customary chaxges for �he follot�ri.ng necessary medical treatment, surgcry, services , and supplies t•rhich are recopunended or prescribed by a leg'ally quali.fied doctor otner �hzn the insured person: (1) the services' of lega]1y qualified doctors and physiotherapists ' (including Kenny treatments); (2) �he services o� registered gradua.te nurse(s) other thar_ a nurse z•rro ordin�.rily resides in the employee's home or is �, nie:nber of �he e�mloyee's immediate family; � � (3) �'u�s and medicines requiring a doctor's prescription; � � , (4) laboratory service, blood transfusions, X-ray examina.t�ons (excerot � X-rays of teeth) and X-ray treatments, including rwdium and radio- active isoiope therauy; , - _ (5) rental �'• �,n. iron lung and other mechanical equipment; (6) oxy�en and rentaZ of equipment for the administratioa of oxygen; (7) rertal of a rrheel chair and hostiital-type bed; ' , ($) anes�he�ics and the administration thereof: � (9) �rtificial lirabs a.nd eyes; (10) casts, spl�nts, trusses, braces an.d crutches; a.nd ` (11) transAOrt�tion by a professio�al ambulance service to or fro�. �. hospi� .. � EXTENDED COVERAGE Should the insurance Yrith respect -Eo the ermloyee, or a depender_� of the ersp o;,r�e, termir_ate #'or �ny reason except y�hen termin2.tion occuxs beca,use i:he h�fa.x_im� Amount beca�e pay�ble s•ri�h respect to such insured nerson or b�cause the e�-� , ployee failed �o m�.�ce �he requixed premiu*n contributions �inen dae, cover2�e �o� such person ;�rhose insura,nce terminated will. be extended in the event such pe ��e:� is totally disabled, (as tnat tera is defined in the Policy), ard under tre �a��:z � of a doctor, ior reasons other than nregr_ar_cy, (excent as Arovided under �r.� u- sion "e", P,�rt V of the Policy) at the �irne of �uch termi�ation bu� such en- tension of coverare for such per�on will c31�DlY solely to �n.e acciaent or sic - ness t•rhicn caused the total disability and �Ehen only during the period of su•Iz �otal dis4bilit�f �.nd *.�rni.le sucn nerson is under the c�re of a doc�or, but r_o beyond the end os" 1$ months fo11.o?•�ing t�e date such termin�,�ion occurs. ( . �t r.rao E - -._ _..._ � . ti xEao}'�,.. _ .,,_;,,,__ .c,:_:,�.......,, ._ x°Ro� ... _a_. ,,.,,� _ ' ' C�, ni�y� __.�t_.��__.._..-,.._.,-.—_..--�COPY _r � . ••r. ^ f.f,':n COPYf� v� � f� 7 �t�� ;�y�`� jV �y .� . . . . «..�+rwY.�+v�,�nr�w...::�N_-rrt..,>r�.na.v�wr�+tti.�w " �..w.��r.-w� - Hr+.fn.4�.�.a- ..h..un�:r�wr. Y�I�HMYar ., .w . t . t �,.i Jj1 ::i i,.�=� 4 .. � u! _��_ ^ ��AHOJ�. _'Y �'_ "j AdO��—�.,. .. _�.._ . i.i�� . ' � :O,'�,�t Ioa,aX r'�tJ ExGZUSIOIdS • � � Anything 3n the group policy and the Certificate to the contr�.zy notwi.th- stand=ng, the insurance under Part V o� the�group po'!icy sha3.1 not cover: (a.) acciden'-�a�. bodily in�ur3es axising ont of or in the coi;rse of em- � ployment or sickness for which tirne employee or dependen:t is entitled , to benefit under any �,Torlflnen's Compensation, E�ployers' Liab3lity, Occupation�l Disease or similax I,sw or Act; n�r . (b)�ex_pens�s i.ncurred for trea�nent or while confined (1) in a state hospital as a non-pay3.ng patient or in a federal or '�eterans Adm3.n- . istra�tion hospital., or (2) at the direction of the Vetera�s Admin- istra�ion; nor (c) accidental bodi?y ii�juries susta,_ned or siclmess contra,cted. by the � employee or dependent while on active m3litQSy or navei. @uty or w�ich resil.ts from an act o� r�rar (declared or unaecl�red); nor {d) intentiena.11y self-in.fllicted in,jur3.es; nor (e) pre°ancy, childbirth, abortion, miscarriage, or co�olications s3xis- 3.nr� ther�from except (a) an operation �'or extr2.-uterine pregnancy, , (b) intre,-�,bdomi.nal su�gery, (c} pernicious vomi�3.ng o� pregnancy . (hyperemesis gravidasi.un), or (d) ta�temia wi�h convulsions (ecl.aa��s3.a af pre�nancy), resulting from a pregnancy which h�s :ts inception While th3.s coverage is i.n force with respect to the employee or @e- pendent wife vri_L1 be covered hereunder; nor (f) svsgery pez�'ormed or visit(s) for treat�ent(s) made by a doctor as tQ result of an. in,jury or�sickness t�rhich disabled t,he employee �,n3, c�use hira t� be on sick leave on the effective date o� nis 3.nsuxance vnless such enmloyee, before the surgery 3s performed or such visit(s) �or trea�ent(s) begin, �sha11 ha.ve returned �o active yrork on fu71-time ° for a� least t�ro weeks; nor (g) expenses i.ncurred for visit(s) �or treatment(s) durin� any period of � hospital coa�inement beginning before the effec�ive date of the in- surance with respect to the person confined; nor � (h) dentat sur�ery or dental work or dental treatmen� o� a�y natare or ey ' exer,�ination or the �itting o� glasses; nor � (i) routine physical examinations, he2ring aids, eye refs�a.etions or exsmi , � na�ions, or the fitting o� eye gla.sses or heaxir.g ei.ds; nor (�) expenses �incurred �or cosmetic surgery except to the extent necessa�ry to repair dis�i,urement due to a.n accident occtiring while insured; no � (k) expensea incti:rxed for treatment o� alcohol3sm or nzrcotic habits; nor (1) expenses incurred �or services and supplies for z,ti�ich the employee or dependent sha17. not be required to make paynent. 2. The second p�ra�raph appeasi�g under Pa.rt I entitZ�ed� "�'or Sur�ical Pro- � cedure F�cept on Account o� Pregna.ncy" is hereby deleted a.nd there is � Xl.-RU� . �"' ' ' '" �>m-r �XERO .--.,�,.....�v� ;r-^,v-•.. —r-�---�•.�<.i �... ..,-..,�x"��E�R�O�..---•-,..�.. .�..�„_._...�.�. t` _� , �'i; �I�Y�""^-.--T^^^^r^^^.' COPY �� ,� . .. _. COPY� _ � f��r,� �, � � %'� '�'b. 'i� 't'�1 `''' ,p�. E a� . .... .. .. w.,�....� ., .a,.-_........�..-..,..� ..,..�»..._._.�.�,.....��.....�...w..�,..�...�.._....,......._...»......,ry. ., ,�. , r • j 'r �G.1:1J, �rll ir:i .. ; ��A; }}}[,,, 4tt ° H ' .�.r ,- • L7 AdOJ��. . _�:� ��s.. •�AdOJ C.J_ � _' .. a l.�� --I �� • OLf3X� ' IOtl3X U�� . � ... .. -� _ , '+--r-' ' substituted in lieu thereo� the following: - ' , For any surgical procedure not specified in the Schedule oi Surgical Pro � � cedures and performed by a doctor upon the employee, or dependent o£ the , e.mployee when covered thereunder, because of such inj�ries or sucls sick- ' ness except when performed on account o� pregna,n.cy or for extraction of , teeth or for other dentistry, the Company wi11 determine the indemnity payable based on a surgicEl procedure oY equivalent gravi�y and severity' ' 3. Part II entitled, "For Administer3ng of Anesthetic by a ProPessional Anes- � thesiolo�ist" is hereby deleted and there is substituted in lieu thereof t e folloj•r.tn,�;: . Tae Company will pay indemnity in the amount o� the expenses 3ncurred by the employee for administering of anesthetic by a professional anesthesi �ogi:.�; - not a salaried employee of a hospital to the e�nmloyee, or de�oendent of t e " esployee �;hen covered �hereunder, w3sen requ3sed in connection with a sur icai or obstetrical procedure �or which inde.�nity is pay2,ble under the �roup policy, not exceeding Ztlenty (20�i) Per Cent of the m.z:�imum amount speci� e� '. for the appl3.cable surgical or obs�etric�l procedure perforned as shown - . the Schedul.e of Surgical or Obstetrica.l Procedures contained in this po1 cy. _ ' • 4. Pa.rt III entitl.ed, "In-Hospifial. Medica.l E�pense Benefit" is hereby deleted and there is substituted 3n lieu thereo� the follow�.ng: Tae Ccmp�,ny wL1,1, pay 3ndemnity in the amount of the expenses incurred by ' the e�loyee for visit(s) for treatmen��(s) made by a doctor *.•rhile the employee, or dependent o� the e�nmloyee when covered thereunder, is conf eu as a re�is�ered bed patient in a law.E'uLty operated hospital beca�e of s c� . in�uries or sLCh sickness, except pre�aancy, not exceed7l'lg Four (�4.00) Dolla.rs for each day such visit(s) �or trea�nent(s) axe u,zd.e during such hospizal con£inement, but for not more than one hundred t;zen�y (120) days on account o� any one accident or siclmess. ^ � Provided always that no indemni�ty sha11 be paya,bZe under this Part III = r ' e:spenses in.curred on �.nd after the day a surgical procedure is perforned ' unless tne amount payable for such vi.sit(s)� for trea-t�e�t(s) by doctor made on and after the day surgical procedure(s) is per?ormed would excee the 2�ount pay�ble for surgica.l procedure(s). 5• Items (1) and (2) a.ppearing under the section entit3.ed, "�efinitions" are hereby deleted �d 'there is substituted in lieu tlzereof the �ollowing: (1) "dependent" shall mean only the employee's (a) suouse, and (b) nnm�...rri d children, (3ncluding step-children, lega]�y adopted children and fost r children) under 19 years of age if not a student, or to a.ge 23 if a s�u- �.dent or to the time of marriage, whichever is earliest; aud � (2) (a) "tot�.7. disability" w3th. respect to a.n e.�oloyee sha11 mean inabili to perform every duty o�' occupation because of such injuries or such sic2mess, and (b) "-total d3.sability" wi�th respect to a dependent sha,.�.l. mean confine en� in any hospital or inability to perform all the activita.es o� a no pe_,�- son oi like age a.nd sex because of such in�uxies or such siclmess. 6. '2he anniversary date of this policy is changed from P�.:rch 1 0� each yeer to' Januzzy 1 of each yeax. ' �t-RU� -„ , , .,-,�r,. w �.'" -. :XERO ..r ., ,, .�,. «��;-._ , ,.r r.rt•. .a . ..�^X-c3��' �-._.- �.c_,.. . -. , � . .. ` . <';� �If�y� .-..�,._...--•�-�r--+--�----�-•+- COPY , y l f.r� pT � COPY � ,�� t � � +tir1 ��'� :;� �.� '`� � s: 1 . + .. ' ,._al .._ �' , G:I�AdOJ L. a <i:4� , L:� ;J:��Ad07,� . �. �c, , 0213X� r 'O`3-7f r•I� , � • .k 7. Ziie second paragraph appearing under the heading "�rmination oi'.Policy" � is hereby dsleted and there is substituted in ,Iieu thereof the follot,d.ng: � �.e Policyholder ma,y terminate this policy as of a�y policy a.nniversary by ° . giving written notice to the Conpa.r.�y on or be�'ore December 1 of ar�y yea�. ' ., � � �CTIVE DATE OF INDI�TIDiJAL INSUFt�NG`� � � Eac� employee �•rno is eli�ible for city-pay coverage wi.11 be eligible for �_e , , revised be:�efi�s set forth in this. anend�ent on Ja.nuary 1, 1964. _' Ea.ch employee �rho is not eligible for city-pay cov�erage b�zt iaho is wor?tin� •- tos�raxd such el�gibility ano. i�rho has been emuloyed continuously by the pol�cy- holder �or or_e month t�ril.l. be eligible to become i_nsured for tlze revised bene- � fits se� forth in this amendment lrf authorizing the 7olicyhoZder to deduct�` the required nremium thereior xxo�i his salary or ,•ragea. �e effective dat�e c� � such emnloyee's insurance hereunder t•ril7. be the effective da.te of this a.� na- - ment, or the date of apnlication, whichever date is later. , 4�hen an e:aplofee is �bsent from ��ork on the effective date of this amendm nt . because of tentporary lay off or leave of ab$ence, aot includin� sabba�ical leave, sick leave or compensa-Eory disability leave, the insurance hereund r , snall r_o� take effect until the e�oloyee returns to fu]1-t�e active �rork ' rrith civil �ervice or er.enmt status. � ' • EFFECTIVE DA� OF INSUt�ANC� LIITH RESP�CT TO DEPEPIDIIVTS �e effective date of an erupZoyee's insurance hereund�r 4ri�h respect to his u^- pendents sha71 be the d�.te of the employee's eligibility for insurance he�e�u:fic��• ' or the date th� emnloyee applies for such insurance by authorizin� the polzc��- holder to deauct the required pxemium �herefor from his salary or wages, �hich.- eyer date is later. , T_nsuran�e under �nis amendment �•r1.th respect to a denendent wno is disable� on � the date such insurance would otherwise become effective shail not beccrae�ef- fective until the disability of such dependent has terminated. Disabili�y o° � a dependent sha_]1 mean confinement in a.ny hospital because of bodily in,j ' or siclmess or inability to perform all the activities of a nor�a.1 person of�like age and sex. In no event sha_L1 insura.nce with respect to dependents beco• e effective before the insurance with respect to the emnloyee becones effec ive. EVIDENCE OF INSTJft�1BILITY Ea.ch erm�loyee, not eli;ible for city-pay coverage who a�nlies for the rev scd bene�its set forta in this amendment more than 30 deys af�er becoming eli ib?c therefor wi71 be required to furnish satisfactory evid.ence of insurabilit� �vitl:. respect to himsel� witnout expense to the company. ' Each e�!ployee *auo ap�lies for insurance under this amendment S•tith resuect to his dependents more tha.n 30 da,ys after the effective da�e of this a*nendme�� oi more than 30 d�ys after beconin� eligible for such insurance hereunder ��i.11 be required to furnish satisfactory evidence of insurability ,rith respect to sucl dependents s�r thout expense to the company. ' ; xr'RO� _•r•c�____�._�-•,-,.dXERO- -• -� •,-.,.YF.r�.;r..,,:ti..,n"n — , ''"^"�'' . ��tl�� -- �COPY .- � � .��CUP�Y~ — •c,• +y {�' , ; r � �'1 �' i,.t] �h:J �� r(v;t, ��• T � r � � � This Amendment sha11, take effect on January 1, 19b1� in cons deration of the paymen-t by the policyholder of the following month7�y premivms: - � 3.40 per month for each emnloyee without dependen�s � $,$0 per morrth for each emplopee with dener.dents 2dothing herein contained shaLt be held to vary, al.ter� wai.ce or extend an,p of tY:e -�erms, conditicns, nrovisions, exclusions or ]�mi.tations of group .policy numbe ' �� 9�0� other tiian as above stated. This f�nendmerrt is subject to a?�. the ter �s, coraditions, provis�ons, exclusions and limi�ations of said groun insurance po 'cy no� inconsistent wi�h its provisions and is effective January l, 19b4, ' ST. PAUL FIRE & .•L�RINE ITdSURANCE COi�A:�f i , Secretary \ ACCEFTF,D: CITY OF SA3NT °AUI, ' , , J � Nlayor , • � � � Countersigned: � � . � � ��1.- ./�� . Com?�tro]1er� � � �•.;- . '�;.J , _ , � Ci:� C:_ent; . -,,..;� , _y . ., e.i �.� , ., ,;..,1 ,;_f �:;,� • ��ay -._..._......,..,___.__._....__....__..�,,.......,.. , , ,,. , ., t��.s day of �3'c:{t&:Ye,� 1964 ' Special Asst, Corpora��on Counsel . � � • c .r-._. ' � s,.-.a.., x v(l:O. _.._ XERO I XERO' �1" �� i• nY('�� - �COPY :�.�- .,�, j _ f:..�..r J: COPY[� - ""_ ,( r' � � � 1 � v.�t ��' ' ''' �! � � '{ ..i�s... .v:Cp�., . �r„;u�;°` '.—.—_. COP�y I I COP�Y —.—�-•-• _ _. p� n-i., �7 � 0. ." � � Y .� ..k{�: -�v� 'I�_'.� ..-�-� L.;