Standard Insurance Company
AGREEMENT
BETWEEN
STANDARD INSURANCE COMPANY
AND
CITY OF MIAMI BEACH, FLORIDA
FOR GROUP EMPLOYEE LIFE PLAN
FROM OCTOBER 1, 2004 TO SEPTEMBER 30, 2007
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It is hereby understood and agreed by the undersigned parties this S day of
,rJ 0" (/~ be R.. , 2004 that Standard Insurance Company, a Oregon Corporation
having its principal offices at 920 SW Sixth Avenue, Portland, OR (The Standard) and
the City of Miami Beach, Florida (City), shall enter into a mutual agreement to provide
group life insurance plans to eligible employees of the City of Miami Beach.
It is agreed that The Standard, as the successful proposer pursuant to the City of Miami
Beach Request for Proposals for Life, AD&D and Additional Life Insurance, the terms of
which are incorporated by reference hereto, will provide the City with the following:
1. The Standard will issue group life insurance policies that provide: a) Basic
Life Insurance to active and retired employees of the City of Miami Beach
except police; b) Accidental Death and Dismemberment Insurance to all
active employees, except the police; and c) Additional Life Insurance
coverage offered to all active employees, retirees and police.
2. The following are the monthly rates for 2004-2007 that are herein guaranteed
by The Standard for the plan years October 1, 2004 through September 30,
2007. With an option to renew for a fourth and fifth year with a contingent
rate guarantee upon an incurred loss ratio of 81 % or better:
Basic Life Rates: 0.285 per $1,000
Basic AD&D: 0.015 per $1,000
Additional Life: Actives .27 per $1,000
Additional Life: Retirees 3.25 per $1,000
3. Brochures and all marketing materials for enrollment.
4. Employee Certificate of Insurance to be mailed to the employer.
5. Ample supplies of applications and marketing materials for all new full-time
City employees.
6, Coordination with management during on-site enrollment when possible by
The Standard Insurance Company.
7. Terminated employees will have the right to convert to an individual Life
Plan,
Performance Standards
Our Performance Guarantee Program assures you that we will make every effort to meet
your overall expectations for service. If ever we don't meet those expectations, we will
refund five percent of the previous quarter's expenses, excluding commissions and
premium tax.
a. The City of Miami Beach will participate in an annual survey conducted by The
Standard, to rate your satisfaction with our service.
b. Our expectations for return calls are within 4 business hours.
c. Accuracy on claim payment is an average of98.7%.
Termination of A!!:reement by the City:
The City has the right to terminate this Agreement without cause and/for its convenience
by providing one hundred and eighty (180) days prior written notice to The Standard
Insurance Company. Said termination will be effective as of the date specified by the
City in such written termination notice or the date the notice is received, whichever is
later.
Termination by Standard Insurance Company:
If a premium is not paid on or before its Premium Due Date, it may be paid during the
following Grace period. The length of the Grace Period is 90 days. The Group Policy will
remain in force during the grace period. If the premium is not paid during the Grace
Period, the Group Policy will terminate automatically at the end of the Grace Period.
On any Premium Due Date if we determine that the Policy owner has failed to promptly
furnish any necessary information requested by us, or has failed to perform any other
obligations relating to the Group Policy.
Application
The City's execution ofthis Memorandum of Understanding shall constitute its signature
and agreement to the terms and conditions contained in The Standard's Application for
Group Insurance (a copy of which is attached to and expressly made a part of this
memorandum of Understanding).
Notices
All communications relating to the day-to-day activities shall be exchanged between the
Account Manager, Benefits Representative and Billing Specialist appointed by The
Standard and the Project Manager designated by the City. The Standard's Account
Manager and the City's Project Manager shall be designated no later than the
commencement date of the Agreement or October 1,2004.
All other notices and communications in writing required or permitted hereunder may be
delivered personally to the representatives of The Standard and the City listed below or
may be mailed by registered mail, postage prepaid (or airmailed if addressed to an
address outside of the city of dispatch).
Until changed by notice in writing, all such notices and communications shall be
addressed as follows:
TO PROVIDER: Standard Insurance Company
Kevin Falcone, Employee Benefits Manager
550 W. Cypress Creek Road
Fort Lauderdale, FL 33309
954-771-6828 ext. 701
954-771-7086 fax
E-mail: KfalconelaJstandard.com
TO CITY:
City of Miami Beach, Fl.
Mayra D. Buttacavoli, Director of Human Resources & Risk Management
1700 Convention Center Drive, 3rd Floor
Miami Beach, FL 33139
305-673-7000 ext. 6469
305-673-7529
E-mail: mavrabuttacavoli@miamibeachfl.gov
Notices hereunder shall be effective if delivered personally, on delivery: if mailed to an
address in the city of dispatch, on the day following the date mailed: and if mailed to an
address outside the city of dispatch on the seventh day following the date mailed.
LITIGATION JURlDICTIONNENUE
This Agreement shall be governed by and construed according to the laws of the State of
Florida. This Agreement shall be enforceable in Miami-Dade County, Florida, and if
legal action is necessary by either party with respect to the enforcement of any or all of
the terms or conditions herein, exclusive venue for the enforcement of same shall lie in
Miami-Dade County, Florida. This provision shall only apply to dispute between
Standard and the City and shall not apply to legal actions arising from The Standard's
administration of claims under the group life insurance policies issued to the City.
BY ENTERING INTO THE AGREEMENT, CITY AND THE STANDARD
INSURANCE COMPANY EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY
MAY HAVE TO A TRIAL BY JURY OF ANY CIVIL LITIGATION RELATED TO,
OR RISING OUT OF, THIS AGREEMENT.
Signed and agreed this
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day of
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,2004.
The Standard Insurance Company
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ami Beach, Florida
Attest:
Attest:
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Print Name
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City Clerk
JANE E. HILDEBRAN
Notary Public, Maine
My Commission Expires July 20, 2007
F:\HL'MA'Sllll\Jknefits\LIFE INSURANCE\AgJeement-Standard~ 1 0-04-.doc
APPROVED AS TO
FORM & LANGUAGE'
& FOR EXECUTION
IIIV1;/;&!
Date
STANDARD INSURANCE COMPANY
Employee Benefits - Regional Accounts
900 SW Fifth Ave. Portland, OR 97204-1282
Please type or print REQUESTED EFFECTIVE DATE ! C
APPLICANT
Full Legal Name of Group (Exactly as it is to be shown in the policy.)
Application for Group Insurance
For Use in Florida
Street Address
City
Phone Number (_)
Group Contact
Contact's Phone No. if different (_)
Nature of Business
State Zip Code
FAX Number (_)
Contact's Title
Contact's FAX No. if different (_)
INSURANCE COVERAGE REQUESTED
o Life Only 0 Supplemental Life 0 Dental/Employees
o Life & AD&D 0 Additional/Optional Life 0 Dental/Employees and Dep(s)
o Dependent Life 0 Stand Alone AD&D 0 Dental/Orthodontia
OTHER INSURANCE
A, Does this insurance supplement other insurance? 0 Yes 0 No
If yes, specify for each line of coverage and Insurance Carrier:
B. Does this insurance replace existing insurance? 0 Yes 0 No
If yes, specify for each existing line of coverage:
. Please submit a copy of each inforce policy, certificate or plan document.
Effective date of Prior Plan: Termination date of Prior Plan:
ACTIVE WORK REQUIREMENT: A person must meet an Active Work requirement to become insured. Members who have not met an
Active Work requirement are not insured until returning to work for one full day and meeting all other contractual requirements.
Initial: Note: Some members who do not meet an Active Work requirement may be eligible for Waiver of Premium with a
prior carrier. The Active Work requirement does not apply to Dental coverage.
APPLICANT AGREES THAT: I hereby apply for Group Insurance as provided in the attached proposal.
The above information is true and correct to the best of the Applicant's knowledge and belief. It forms the basis for this request for group insurance.
If the requested insurance is acceptable to Standard Insurance Company under its current ruies and practices and is legally permissible,
a Group Policy will be issued in the language customarily used by Standard. It will be effective on the date determined by Standard. No
producer has the authority to guarantee the acceptability of the requested insurance.
Standard may issue separate Group Policies if more than one coverage is requested in this Application. The insurance, if approved, will
be subject to Standard Insurance Company's usual underwriting requirements, including the exclusions and limitations in the Group Policy
and, if applicable, Evidence Of Insurability. The effective date of insurance for which a person is required to submit satisfactory Evidence Of
Insurability will be determined in accordance with the terms of the Group Policy, subject to the Active Work requirement. No premiums will
be collected or paid by the Applicant for such insurance until notification of approval.
No material describing coverage under the Group Policy will be distributed by the Applicant to any person to be insured without the prior
written consent of Standard Insurance Company.
Premium rate quotations were based on data submitted to Standard. Final premium rates will be determined by the actual composition of
the group.
The consideration for any Group Policy which may be issued is this Application and the payment of premiums. Payment of premium after
receipt of the Group Policy is acceptance of the terms of the Group Policy.
This Application, including the attached proposal, is made a part of the Group Policy.
Applicant authorizes the producer, broker of record, or consultant to receive information regarding the applicant's claims status and experience
that the applicant has a right to receive and which is reasonably necessary to assist the applicant in conducting a review of the information.
Fraud Notice: Any person who knowingly and with intent to injure, defraud, or deceive an insurance company, files a statement
of claim or an application containing false, incomplete or misleading information is guilty of a felony of the third degree.
o
DSTD 0
o LTD with Transitional Duty Agreement
o LTD
Signature and Title of Applicant's Authorized Representative
Signature of Witness
Signature of Licensed Producer (where required by law) (Print)
Date License #
(Must be signed prior to the requested effective date.)
Initial Deposit $
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STANDARD INSURANCE COMPANY
Employee Benefits - Regional Accounts
900 SW Fifth Ave. Portland, OR 97204-1282
Receipt for Initial Deposit
Received from
$
, an initial deposit of
, in connection with the Application for Group Insurance bearing the same date as this conditional receipt.
Date
This receipt is subject to the terms and conditions below.
Received By
Name
Title
'All premium checks must be made payable to Standard Insurance Company.
Do not make check payable to the producer or leave payee blank.
Terms of Receipt (Please read careful/y.)
If the requested insurance is acceptable to Standard Insurance Company under its current rules and practices and is legally permissible,
a Group Policy will be issued in the language customarily used by Standard. It will be effective on the date determined by Standard. No
producer has the authority to guarantee the acceptability of the requested insurance.
Standard may issue separate Group Policies if more than one coverage is requested in this Application. The insurance, if approved, will
be subject to Standard Insurance Company's usual underwriting requirements, including the exclusions and limitations in the Group Policy
and, if applicable, Evidence Of Insurability. The effective date of insurance for which a person is required to submit satisfactory Evidence Of
Insurability will be determined in accordance with the terms of the Group Policy, subject to the Active Work requirement. No premiums will
be collected or paid by the Applicant for such insurance until notification of approval.
No material describing coverage under the Group Policy will be distributed by the Applicant to any person to be insured without the prior
written consent of Standard insurance Company.
Premium rate quotations were based on data submitted to Standard. Final premium rates will be determined by the actual composition
of the group.
The consideration for any Group Policy which may be issued is this Application and the payment of premiums. Payment of premium
after receipt of the Group Policy is acceptance of the terms of the Group Policy.
This Application, including the attached proposal, is made a part of The Group Policy.
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