Loading...
HomeMy Public PortalAbout069-Madison National LifeNATIONAL INSURANCE SERVICES OF WISCONSIN INSURANCE TRUST JOINDER AGREEMENT FOR LONG-TERM DISABILITY INSURANCE The undersigned Group and the Administrator of the National Insurance Services of Wisconsin Insurance Trust (the "Trust") agree that the following choice of Plan and Options shall constitute its Program as an Employer. The Plan is as follows: 1. Employer 2. Carrier Number (Employer's Group Number) 3. Eligible Class 4. Effective Date 5. Initial Premium Rate (Monthly) 6. Plan Renewal Date 7. Maximum Annual Covered Salary 8. Maximum Monthly Benefit Rate Change Notification Subrogation Probationary Period Effective Date of Insurance - Employees Termination of Employee's Insurance Employer Contribution Minimum Hour Requirement for Active Service Continuity of Coverage Elimination Period Definition of Disability Maximum Benefit Period Benefit Percent Minimum Monthly Benefit Minimum Participation Non -Consecutive Elimination Periods Calculation Basis Coordination With Other Benefits Recurrent Disability Rehabilitation Survivor Benefit Residual Disability Maternity Coverage Pre -Existing Condition Exclusion Mental & Emotional/Substance Abuse Right of Recovery Section I City of Richmond 1168 01-All Active, Full -Time Employees excluding Police and Fire July 1, 2004 .490 % of covered payroll July 1, 2005 $75,000.00 $3,750.00 60 Days (Standard) Applies per Endorsement No. 3 Date of Hire Per Policy Per Policy 100% Employer Paid 600 hours per year Per Policy 90 Consecutive Calendar Days Two year regular occupation (per policy) See Section II 60% of insurable Basic monthly earnings $100 100% Applies per item G. of the Policy Option B (Monthly)/Per Policy (Base Wage Only) Full Family/General Freeze (See Section II) Per Policy Per Policy Per Policy See Section 11 Option B Applies Applies per item B. of the policy See Section 1I Applies CONTRACT 69-2004 Section II Maximum Benefit Period Age at Disablement Duration of Benefits* 61 or younger To Age 65 62 3 '/z years 63 3 years 64 2 'h years 65 2 years 66 1 % years 67 1 '/2 years 68 1 '/a years 69 and over 1 year * To the later of (1) the specified length of time as stated above; or (2) the day before attaining the Social Security Normal Retirement Age as stated in the 1983 revision or any later revision of the United States Social Security Act. Coordination With Other Income Benefits • In the Policy, under `SECTION III - BENEFITS', under section `C. OTHER INCOME BENEFITS', `Social Security Primary Integration Only' does not apply. • In the Policy, under `SECTION III - BENEFITS', under section `C. OTHER INCOME BENEFITS', the following sentence is hereby deleted: `After the first deduction for Social Security benefits, the monthly benefit will not be further reduced due to any cost of living increase payable under Social Security.' And replaced with: `We will not count as other specified income any automatic other general cost of living increases in the amounts of benefits payable by any of the sources described within the section entitled "Other Income Benefits" which occur after monthly benefits begin.' • Indiana Code: `Pursuant to Indiana Code 22-9-1-10, Trust, any sub -contractor, or any person acting on behalf of Trust or any sub -contractor shall not discriminate against any employee or applicant for employment to be employed in the performance of this Agreement, with respect to hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment because of race, religion, color, sex, disability, national origin, or ancestry.' Mental Illness Limitation Option A (Standard) applies. Furthermore, the definition of "Mental or emotional illness" found in the Policy is hereby deleted in its entirety and replaced with: "`Mental or emotional illness" means any neurosis, psychoneurosis, psychopathy, psychosis and all other mental or emotional illness of any type including, but not limited to, substance abuse or addiction and the use of any hallucinogen. "Substance abuse" includes alcoholism and the taking of a prescription or controlled drug in a manner not prescribed or recommended by a physician.' a= , Residual Loss of Income Benefit. Endorsement No. 7 of the Policy applies with the following exception: Under the definition of "Indexed Pre -disability Earnings", the statement: "The amount of each adjustment will be the 7%" is hereby deleted and replaced with: "The amount of each adjustment will be the lesser of 10% or the current annual percentage increase in the Consumer Price Index. The Consumer Price Index (CPI- W) is published by the United States Department of Labor. We reserve the right to use some similar measurement if the Department of Labor changes or stops publishing the CPI-W." ©--- -"Vro% Joinder Agreement The undersigned Group adopts and agrees to be bound by the terms and conditions of the National Insurance Services of Wisconsin Insurance Trust Agreement, as amended from time to time (the "Trust Agreement"), and the insurance agreements covering its employees. The Group understands that the Trust is a vehicle for obtaining insurance to provide benefits under one or more of the Group's employee benefit programs. In this regard, the Group joins together with other groups under the Trust as a single policyholder in the purchase and maintenance of group insurance policies. The Trust's Administrator shall provide the Group with the information involving the insurance policies which is necessary for the Group to comply with applicable state and federal reporting requirements which relate to this group insurance. The Group agrees to be bound by actions taken pursuant to the powers granted under the Trust Agreement or the affected insurance policy. This agreement can be terminated by either party upon 60 days written notice or for non- payment of required premium. The signature by the Administrator of the Trust constitutes acceptance of the undersigned Group as an Employer under the Trust. Dated this Ig day of gliq"2004 . g, /, j �L— City of Richmond 50 N 5th St Richmond, Indiana 47374 By. �AUWA. Y" nit Jo P. Kenny, Preside t Board of Public Works & Safety National Insurance Services of Wisconsin Insurance Trust Administrator - National Insurance Services of Wisconsin, Inc. Approved B Mayor Sarah "Sally" Hutton 7 ,o Date This Program is underwritten by Madison National Life Insurance Company.