Item F45
Revised 2/95
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting
Date:_11/21/00
Bulk Item: Yes [8] No 0
Division: Manaaement Services
Department: Administrative Services
Section: Employee Benefits
Office: Group Insurance
AGENDA ITEM WORDING:
Approval of the 2000-2001 Renewal Amendment for our Specific and Aaareaate
Excess loss Insurance Policy with John Alden Life Insurance Company (Policy
Amendment NO.1 0).
ITEM BACKGROUND:
Contract oriainally approved throuah RFP in 1999. This is the first one-year renewal of
the contract.
PREVIOUS RELEVANT BOCC ACTION:
Approved at the September 20.2000 BOCC meetina.
STAFF RECOMMENDATION: Approval.
TOTAL COST: $635,000 (approx.)
BUDGETED: Yes [8] No 0
COST TO COUNTY: Same as above.
REVENUE PRODUCING: Yes 0 No [8]
AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY ATTY 0 OMB/PURCHASING D RISK MANAGEMENT D
DIVISION D1RECTORAPPROVA~ J
James L. Ro erts
DOCUMENTATION: INCLUDED rgJ
TO FOllOW 0
NOT REQUIRED 0
DISPOSITION:
AGENDA ITEM #:
\.ftl5
'O;;A~
~;::~~'U'RANCE COMP:NY
Amendment No.:
Effective Date:
Policy No.:
Policyholder:
John Alden Life Insurance Company
Home office: St. Louis Park, MN
Executive office: P.O. Box 020270, Miami, FL 33102-0270
A Stock Company
POLICY AMENDMENT
10
1 % 1/2000
EL 0000646
MONROE COUNTY BOARD OF COMMISSIONERS
As of the Effective Datel and in spite of anything in the Policy to the contrary, the Amendment
changes the Policy as fo lows:
This Policy is renewed with the revised terms and conditions hereby shown on the attached
Schedule of Coverage.
The expiration date on the Face Page is changed to 09/30/2001.
The Policy is changed only as stated in this Amendment. All provisions not changed by this
Amendment shall apply.
AGREED:
By:
Title:
Date:
(Policyholder)
J-1133-AM
JOHN ALDEN LIFE INSURANCE COMPANY
Chief Executive Officer
SCHEDULE OF COVERAGE
(Herein called Schedule)
Policyholder:
Monroe County Board of Commissioners
Address:
5825 Junior College Road; Public Service Building, Rm. 217
Key West, FL 33040
Administrator or Plan Supervisor: Acorida National
Address: 2665 So. Bayshore Drive, Suite 900, Coconut Grove, FL 33133
ALL AMOUNTS AND NUMBERS SHOWN IN THIS SCHEDULE APPLIES ONLY TO THE POLICY PERIOD IN
EFFECT. A NEW SCHEDULE WILL BE ISSUED FOR EACH NEW POLICY PERIOD.
[xl SPECIFIC EXCESS LOSS (Provided if marked.)
1. Benefits Covered: MEDICAL EXPENSES ONLY
2. Benefit Period:
ELIGIBLE EXPENSES PAID FROM 10/01/2000 THROUGH 09/30/2001.
If this Policy terminates prior to the Expiration Date, the Benefit period will
not extend past the date or termination.
3. Specific Deductible: $100,000
4. JALIC's percentage payable (Excess of the Specific Deductible): 100%
5. Maximum Specific Benefit payable by JALIC
per lifetime per Covered Person, while this Policy is in force: $900,000
6. Specific Monthly Premium Rate:
$25.47 PER SINGLE EMPLOYEE PER MONTH
$51.12 PER FAMILY EMPLOYEE PER MONTH
[Xl AGGREGATE EXCESS LOSS (Provided if marked.)
1. Benefits Covered: Medical/Prescription Drugs/Dental/Vision
2. Benefit Period:
ELIGIBLE EXPENSES PAID FROM 10/01/2000 THROUGH 09/30/2001.
If this Policy terminates prior to the Expiration Date, no Aggregate Excess
Loss Benefits will be payable.
J-1133
[xl AGGREGATE EXCESS LOSS
(continued)
3. Aggregate Monthly Factor(s) :
Medical/RX - $545.40 Composite
Dental/Vision - $ 37.61 Composite
4. Aggregate Deductible (all Covered Persons). This amount is determined at the
end of the Policy Period. The Aggregate Deductible is the greater of the:
a. Product of the Aggregate Monthly
Covered units for the Policy Period;
Factor(s)
or
times
the
actual
number
of
b. Minimum Aggregate Deductible. This amount is 85% of the product of the
number of Covered Units for the first month times the Monthly Factor (s)
times 12 months.
5. JALIC's percentage payable (Excess of the Aggregate Deductible): 100%
6. Maximum Aggregate Benefit payable by JALIC: $1,000,000
7. Aggregate Monthly Premium Rate:
$2.40 Per Employee Per Month
8. Payment Mode:
MONTHLY
OPTIONAL ENDORSEMENTS ELECTED
J-1133